Donna Hoke is a writer, crossword puzzle constructor, and playwright (THE COUPLE NEXT DOOR). Her work has been produced across the country, as well as in Seoul and Manchester. She is also the author of Neko and the Twiggets, a children’s book about mice living in a double bass.

Brief Lives, Enduring Love

“Two sets of twins?!” The words are always accompanied by shock, and I cringe even before the inevitable follow-up begins: “Do twins run in your family? What are the odds? How do you do it?” I hate the attention, I hate the prying, but mostly I hate that the truth isn’t obvious.

There are three sets of twins.

I’d always wanted children. When I was young, my friends and I wish-listed how many we wanted, their order, their sexes, their names. It all seemed inevitable until the day I lay in recovery following a three-hour surgical attempt to clear my scarred Fallopian tubes. Barely awake, I heard my ob-gyn deliver the crushing verdict with all the finesse of a lumberjack performing ballet: “It’s either IVF or adopt.”

It sounds so simple when you reduce it to three letters—IVF—but unless you’ve gone through it, you can’t appreciate its insidious nature. Every morning up at five, driving, waiting, hoping to get a phlebotomist who can navigate invisible veins with just one stick, bracing for the vaginal ultrasound, driving home, waiting for the daily instructional phone call, injecting until butt cheeks are black and blue, surgical egg harvesting, waiting to see if actual IVF—in vitro fertilization—takes place, transferring the fertilized embryos back to the uterus, crossing fingers, and waiting again, this time for the most important phone call of all. For years, this was my life.

The first time, it worked. At 35 weeks, after ovarian hyperstimulation that bloated me to the size of a small tank, hypertension, and 52 days of bed rest, I welcomed two beautiful daughters.

When I tried again two years later, I got pregnant immediately. IVF seemed pretty simple after all—until I miscarried. I got pregnant again, and miscarried. And again. And again. In retrospect, I laugh about rushing out of the Crayola Factory with my daughters before I left a trail of blood through the Model Magic room, or my then-husband being stopped by the police as he raced to get miscarriage contents to the clinic for examination. But back then, I couldn’t understand why my body kept failing me.

For the infertile women, sex and pregnancy have as much connection as a soothing bubble bath and the war in Iraq. When fertile friends fret in the aftermath of careless, condomless fits of passion, I can’t muster even a shred of empathic fear. What I do understand is how desperate desire can obscure reason to the point of no return.

My own irresistible seduction took place in the pre-transfer room and came in the form of a question: Would you like to put back three embryos or four? That was the critical moment, the time for caution. Doctors shouldn’t allow couples this decision, and ethical ones no longer do. Why? Because by cycle six, weakened by a string of heartbreaking results, my mind was on just one thing, and in the heat of the moment, I went for it.

A month later, defying one in 100 odds, a quartet of tiny heartbeats pulsed from the ultrasound screen. My doctor cursed audibly.

When you’re pregnant with quadruplets, what you want more than anything is support.

What you get—more than anything—is opinions.

“You know, there’s an 85 percent likelihood of quads being born with lasting problems.”

“You’ll get so many donations that you’ll never have to worry about money.”

“God doesn’t give you more than you can handle.”

“God did not get you into this, man did, and man needs to solve the problem.”

“I don’t know how you could not have them all.”

”Women are not meant to have litters.”

“You have to think of the babies.”

“You have to think of yourself.”

“I could never do it.”

“If it were me, I would reduce to twins. There would be no question.”

The last came from a doctor at Mount Sinai Medical Center. She was kind, professional, and sympathetic, but dealt in harsh reality. Nearly always the result of assisted reproductive technology, higher-order multiples are not the modern-day miracles the media likes to suggest, she said, but serious health risks to both mother and children. Unfortunately, selective fetal reduction carries its own risk—up to a 15 percent chance of premature birth.

Difficult decisions are difficult because we can’t predict the outcome of either choice. I could not be assured that I would deliver four healthy babies; I could not be assured that I wouldn’t. So I asked myself: Which was the worst of the two worst case scenarios—taking home four severely handicapped babies, or none at all? After a month of painstaking, heart-wrenching, soul-searching consideration of all factors, I had my answer, and I returned to Mount Sinai. Selective fetal reduction is every bit as horrible as the name implies, in every possible way; I could only hope that this time, the odds were on my side.

Pregnant with twins, I grieved for the two children I would never meet, tried to ignore the veiled—and not-so-veiled—judgments about my decision, and focused on the babies to come. My daughters were told to expect siblings in May. But on January 20, after three weeks in the hospital, I delivered my son and daughter via crash C-section at 25 weeks and 2 days old, 12 inches long, and averaging less than a pound and a half each. I wasn’t even allowed to touch them.

Twenty-four weeks is the limit of viability, the age at which a fetus becomes a legal human being, and is named, given a social security number, and provided with medical care to encourage survival. That Cameron and Gracelyn were twenty-five weeks-plus was good, my doctor said. But it wasn’t good enough.

It didn’t happen all at once, but in painful waves that kept me relocating hope like a houseplant in need of sun, trying to find the one place where it might actually thrive. First, Gracelyn developed a Grade 4 intraventricular hemorrhage, a brain bleed that would likely result in severe long-term disability—if she survived it. On January 22, Cameron, who’d been doing well, suffered a pulmonary hemorrhage. Rushing to the NICU, I was held up by a ward nurse who insisted on drawing blood. By the time I held my son for the first time, he was gone. I looked at his sister, wondering what lay ahead for her, for us. In the morning, the NICU called again. I made it in time, held my daughter as she took her last breaths, and wept and wept and wept.

The graveside funeral was private; there was nobody to grieve with, nobody capable of caring at a level deeper than sympathy for these brief, unrecognized lives. And yet, these two babies were with us in ways I didn’t realize until months later, when I offered my girls a wishbone. As one stood triumphantly holding the larger piece, the other burst into tears. “I wished that Cameron and Gracelyn would come back,” she sobbed. Her innocence broke my heart, but affirmed what I’d felt: My son and daughter would never be gone, and could never be replaced.

Knowing that, I went back to the infertility clinic, feeling strongly that another baby—one who would not have existed if its siblings had lived—would give those brief lives the meaning they deserved. After three more failed cycles (including two more miscarriages), I was back in the pre-transfer room listening to the embryologist say that three embryos had thawed beautifully; did I want to transfer all of them? My body ached with familiar desire, but I would not make the same mistake twice.

Nine days later, I sat in my bathroom, pregnancy test in hand. Through nine procedures, I’d never taken a test. Instead, on the fateful day, I’d kept busy, willed the phone to ring, ceded my emotions to clinic nurses. I’d been superstitious, thinking that if I waited for the official call, the result would be better. Now I knew there were no jinxes, just a will to know. Taking the test would not—and did not—change the result: Two lines such a deep shade of hormonally-induced blue that I knew it was twins.

Physically, the pregnancy was perfect; mentally, I was a wreck, insisting on a cerclage to tie my cervix shut, convinced that cold cuts I’d eaten had made the babies stop moving, obsessively counting each day until week 24 and beyond, reciting the mantra: “Thinking positive thoughts does not make bad things happen.” When my sons were born at 38 weeks, all I could think was “I made it.”

In my family room, a box holds mementos of my son and daughter—their tiny footprints, photos, birth certificates, sympathy cards, hats, blankets, and the tiny dolls we gave the girls for their fourth birthday to help them understand. In my heart, I hold their memories. In my arms, I hold the sons they made possible.

My boys are nine now, old enough to understand. All four kids used to fantasize about what our Brady Bunch family would have been like with three girls and three boys, the boys imagining an older brother to play with. I would always very gently tell them, “It wouldn’t be like that; if they were here, you would not be.” Until recently, it was a message they just couldn’t grasp, the idea that their very existence is predicated on a brother and sister they will never meet. But not too long ago, we had this conversation again, and comprehension dawned. “Oh,” my son said. “You wouldn’t have had any more babies, because you would have had four already.”

My sons are now aware—far beyond the garden stones we made in Cameron and Gracelyn’s memory, far beyond the blurry instant camera photos they’ve seen, far beyond their middle names honoring the two people most significant to their lives—that they are forever linked to a brother and sister who do not live with us. They realize that there were two babies who never had a chance to be loved the way they are loved, but who are loved every bit as much. They know that those two babies made an impact on all of us in a way that even living people can’t.

And my daughters and I, every time we hug those boys, or see them smile, we know it too. So if you see us at the store or the movies or the zoo, please just say, “Two sets of twins!? You’re so lucky!” It’s much more appropriate. And so very true.

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