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“Are any of them twins?”

And there it is again.  It’s not an unreasonable question with so many children so closely spaced together, but every time it comes up I have to pause and loosen the lump in my throat, smile and say that no, none of the children standing with me are twins.  One of them, my littlest girl with the pigtails and impish grey eyes, should have been a twin though.  And she was a twin until fall of 2009 when I caught H1N1 influenza.

We hadn’t even been trying to get pregnant, so when those two pink lines showed up we felt pretty stunned.  However, my husband and I quickly wrapped our hearts around the fact that we would be welcoming our 5th child and were so excited to see him or her on ultrasound.  In the darkness of the ultrasound room at first I didn’t know what I was looking at and wondered why there was something else in my uterus next to “the baby” until the tech pointed out very clearly “so, there is baby A and there is baby B.”  I asked if she was sure.  I had to stop driving a few times on the way home to collect myself, muttering under my breath “one baby… and another baby.  Two babies?!?!!”  I hadn’t expected to be pregnant at all and here I was, extra pregnant with a couple of stowaway twins.  I called my husband who quickly started calculating how we were going to afford a full size van.  I called my midwife, and a nurse friend who had two-year-old twins and started figuring out how to try to have the healthiest multiple pregnancy that I could have.  I wasn’t sure how all of the logistics were going to work out, but we are a Catholic family and decided to place our trust in God and to walk by faith.  

For weeks I took belly photos, counted grams of protein, devoured any book on multiple pregnancies that I could and consulted with my doctor and my midwife about how to plan for pregnancy, birth and life with twins.  I felt amazing and was so excited about my babies. I cherished listening to baby A and baby B’s heart beats, so distinct from each other, one much faster than the other.  Living in a house that would barely have accommodated one more baby, we started looking at finding a bigger home in our area and price checked on eBay to see what kind of car that would fit our family we could afford with our tax return that year.  

When the first cases of H1N1 started popping up in Mexico I barely noticed.  I thought the idea of “pandemic flu” sounded so overblown.  When my friend told me that natural immunity was better than the vaccine and there were miscarriages associated with the flu vaccine, I took what she said seriously the same way I trusted her about what size shirts I was going to be in by the end of my pregnancy.  I was afraid to get the vaccine.  Ultimately I wasn’t sure whether I was more scared of the disease or of the terrible things my friend told me could happen if I got the vaccine, but I decided to trust my health care providers and signed up for the very first vaccine clinic for pregnant women in my county.  Beyond that I went about my daily life and just waited for the vaccine to become available in my area since there was such a severe shortage in our area.  I never thought that anything bad could or would happen to me.  I was in my mid 20s, ate a healthy diet with lots of vitamins, tried to lead a more natural lifestyle and I worked too hard to have a healthy pregnancy for anything to possibly go wrong.  I worried about how I might get pneumonia if I caught H1N1, but beyond that it never occurred to me that my babies could be at risk.

I was the first in my family to show symptoms.  At first I felt slightly off and then I spiked a fever that evening. Through the night I slept fitfully, slipping in and out of hallucinations and for the first time in my life truly afraid that something worse could happen to me from a virus than just being miserable for a few days or weeks.  My doctor saw me first thing in the morning while my husband and then our kids started showing symptoms, and immediately prescribed Tamiflu.  I realized how serious my condition was when my doctor gave me the “if you start turning blue, don’t try to get to the hospital.  Call 911 immediately” discussion.  Within even a few hours of getting the Tamiflu on board I started feeling not exactly better but like I wasn’t getting worse.  I was still weak and took time to recover fully, but I was certain that the worst of it was over.

But what bothered me in the weeks that followed was that I only heard one range of heart tones.  Before there had been two, even as recently as the day before I was sick.  They were still in two different places and I measured ahead enough that my midwife had no concerns, but I couldn’t shake the feeling that something was off.  I put it down to being the normal jitters of a mother who had had previous pregnancy losses and trusted that everything was ok even if it didn’t feel ok.  After all, the worst was over, so I waited for my 18-week ultrasound to find out whether my babies were boys, girls or one of each.  We brought all of our kids with us to see the babies on ultrasound, the day after Thanksgiving that year.  It was clear as soon as the tech’s face changed from excitement to concern that something was very wrong.  She kept looking but finally had to tell us “right now I’m only seeing one baby.”   With those words my heart sank through the floor.  I had children in the waiting room waiting excitedly to find out whether they were having brothers or sisters.  I had no idea how I was going to tell them what had happened.  The radiologist came immediately and confirmed what the technician had found. Life would never be the same again.

Through so many phone calls to be made, emails, Facebook updates I felt numb and wondered what I had done wrong.   I took all of my vitamins, I was healthy and working so hard for a healthy pregnancy.  As much as I looked for things I should have done differently or better, I kept coming to the bewildering conclusion that there was nothing.  I had done everything right and my baby, my daughter’s twin, still died anyways.  There was no rhyme or reason.  There was no missing piece of the puzzle that if I had just done that one missing thing, everything would have been ok.   The only thing that may have made a difference was the vaccine, and no amount of wishing was going to change the fact that there was a shortage and that I got exposed during that delay.  I am so thankful to still have my daughter, that she was able to survive, but loving her doesn’t change the knowledge there is someone who isn’t here who should have been.  

No one looks at my family and sees that empty space where the lost child we named Nicholas should be.  No outside observer sees the missing fingerpaintings, hears the missing voice in the crowd, or notices the muddy footprints that aren’t left alongside his brothers and sisters.  But I see them.  I see them in my daughter’s eyes and wonder whether Nicholas’ would have been blue, brown or grey like hers are.  I see them at Thanksgiving when my beautiful little girl sits so proudly at the table and I know exactly how old Nicholas should be this year.  These are the invisible losses, these are the hidden pains that I will always carry because of what H1N1 did in my life.  And I will spend the rest of my life wondering what would have happened if I had been able to get the flu vaccine.

The question still comes up every so often even now that we have our sixth child:  are of my children twins?  No, and yet yes.  My daughter will never know her twin and I will never have that baby, that precious child in my arms.  But I carry him in my heart and in my life just the same.  I remember him with every vaccine that my children get as soon as they are eligible to receive it.  I remember him with every stranger or friend I help to research vaccines so that they can feel comfortable in the safety of immunizing their children.  I remember him with every step of immunization advocacy that I take, every time I share his brief life with others.  This is his legacy.  This is his life, and how I honor it by remaining Nicholas’ mom.

Johanna Holmes is a Catholic work-at-home mom who lives in the Northeast with her husband and their six children.  

Editor’s Note: We cannot know for certain that Nicholas’s Mom’s miscarriage was caused by the influenza infection. The causes of miscarriage can be uncertain.   However, the CDC recommends flu shots for all pregnant women as influenza increases the risk of miscarriage.  




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