Mother of all battles … actor Mary Coustas had been ambivalent about marriage, but always knew she wanted to have children. Photo: Tim Bauer. Hair and make-up by Wayne Chick.
In September 2003 my biggest love arrived. An hour into our first date I knew without a doubt that the advertising executive I was looking at was the man I would be with forever. There was an ease that came with spending time with George, a level of comfort that I had never experienced before in a man I was attracted to.
Six weeks after George and I were married, I found out that I could not have children. A laparoscopy revealed that I had blocked fallopian tubes. Our honeymoon was brought to a swift end by an unanticipated and massive blow. I was told my only option was IVF. I was completely winded emotionally.
The shock of hearing I could not have children ricocheted in me for months.
The shock of hearing the news that I could not have children naturally ricocheted in me for months. My future as a mother was now at the mercy of laboratory long shots.
For richer, for poorer … Coustas with her husband, George Betsis. Photo: Tim Bauer. Hair and make-up by Wayne Chick
During each IVF cycle we did, on the morning of the pregnancy blood test I would arrive as early as possible, under the assumption I would get the result sooner. Wrong. It's going to be the longest day. Everything is in slow motion. And your heart beats at a volume so deafening that's all you can hear. That and how heavily you're breathing. And you wait. And then you wait some more. And you look at the phone, willing it to ring with good news. Finally it does ring and you listen so intently to the nurse, trying to gauge her tone and guess the words that will follow. And then the answer arrives. And then pain.
In 2009 I was 45 and my egg quality was diminishing due to the ageing process. Adoption was not a possibility. In Australia, you cannot adopt if there is more than 40 years age difference between you and the child. And you are not permitted to adopt while trying to conceive using IVF.
Everyone has a theory about why you're not falling pregnant. Some lean heavily on the "letting go" one. It's not as offensive as the old "Just relax and it will happen" one, which is often said as well. It's mostly coupled with the well-intentioned "Why don't you go away and have a holiday? Maybe that will help." A friend of mine, also an IVF patient, was with me when a mutual friend said blithely, "Just relax. You just need to relax and you'll get pregnant." Without skipping a beat, my friend jumped in: "That's like telling a cancer patient to drink carrot juice and the cancer will go away!"
Together … the couple with Tom, George's son from a prior relationship. Photo: courtesy of Mary Coustas & George Betsis.
I put my work, which has always been my spiritual saviour, on indefinite pause while I took the scientific road to motherhood. The IVF world required of me a commitment to a schedule that is not predictable. Indeed, to be available for appointments, retrievals and implantings, they monitor you according to how your body has responded to the drugs on each attempt, so knowing what's happening next is always uncertain. Not being able to commit to work that is long-term or interstate, I was left with no choice but to temporarily let go of my career.
On the day of my pregnancy blood test in December 2010, the only time I wasn't within earshot of my phone was when it rang. I was in the bathroom - on the toilet, to be exact - when I heard Nathalie, my close friend since childhood, yell out as she was running towards me, "It's your doctor!"
I froze. I couldn't get up. I couldn't move.
Signature role … Coustas as her most famous character, Effie, circa 2001.
I managed to open the door slightly just as Nathalie passed me my phone. I sat there with my trousers around my ankles and with my heart skipping beats, trying to listen with my fertility tone-honed ears for clues. The confirmation came - third sentence - I was pregnant! The exact words were, "We have great news, Mary. I'm pleased to say, it's a positive result. You're pregnant."
And then, in the smallest voice ever to come out of my mouth, squeezed in order to keep the levee of tears from bursting, I humbly replied, "Thank you, thank you for everything."
At last there was a stillness and a promise of a future that had been six years in waiting. A new era had begun as I found myself floating through the hours and the days, which prior to that felt endless.
Bittersweet … Coustas holding the tiny feet of Stevie. Photo: courtesy of Mary Coustas & George Betsis
By my week-seven ultrasound, nausea had really taken hold. George, Nathalie and I sat waiting in Dr Joel Bernstein's office for the first visual confirmation of our joy. I undressed from the waist down, covered myself discreetly with a sheet and waited for the others to join me. In that tiny room, the screen lit up and the four of us saw two beating hearts. Twins! Fraternal twins, two individuals, each with their own independent "utilities", as one doctor termed it. And here I was, after all these years of trying, finally pregnant with child and with sibling to child. An instant family.
George and I were soon back in Dr Bernstein's offices for our week-nine scan. He asked the usual questions. I knew the drill and what to do next: into the scanning suite, get undressed, call in the doctor. George came in. We were so excited to see our babies again. Smiles hadn't been part of the drill before. As Dr Bernstein studied the screen an expression of concern came across his face. George and I could see two hearts beating but the doctor was pausing.
"What's wrong? Is there a problem?" I asked.
"Well ... there are ... three heartbeats. There is a third embryo there. I must have missed it on the scan two weeks ago because it was too small. These two sharing the one placenta. They are identical twins and the triplet is in its own sac, independent of those."
"Wait. There are three? How? I'm pregnant with triplets?"
"Yes, Mary," he answered.
From Dr Bernstein's tone this didn't sound like good news. I struggled to get pregnant for all those years and now I am over-abundantly pregnant? What just happened? Minutes ago we thought and knew one thing, and now? George and I looked at each other, not knowing what had hit us. Dumbfounded, astonished, stupefied, stunned, scared, floored. All of those things and yet, I'm loath to admit, somewhat oddly excited.
When we can't process an event or information, we animate it or deny it or have a child-like reaction to it. Among all those other feelings was my Rocky Balboa moment. I pictured myself in a grey hoodie bounding up those same 72 steps leading to the Philadelphia Museum of Art. Each step represented a month out of the last six years trying to get pregnant. Suddenly I felt there was nothing that my body couldn't do.
But then came the reality check. George and I sat there frozen, with our jaws on the floor, listening while Dr Bernstein explained the sudden serious conundrum we now faced. There are often complications with identical twins sharing the same placenta and health risks involved in twin-to-twin transfusion, which is when blood moves from one twin to the other. The highest risk factor, however, is that of a triplet pregnancy. The uterus responds to the mass effect of accommodating the three babies and stretches to the point of initiating a premature labour. "A uterus doesn't know quantity, it only knows weight," Dr Bernstein explained.
The consequences of giving birth to three very premature babies include the risk of cerebral palsy, and loss of sight and hearing. There was also the possibility of personal risk to me at my age, and with triplets, of pre-eclampsia, which could lead to me developing cardiovascular issues as well as liver or renal failure.
Our brains went from baby names and tandem strollers to percentages and probabilities. We could roll the dice and take a very risky chance on a triplet pregnancy fraught with high chances of permanent physical repercussions for our babies and/or me. What other choices did we have?
"A reduction," answered Dr Bernstein.
Fog descended, the cogs in my brain slowly ground to a halt. I was trying to comprehend something so unbearable that I had to shut down to prevent what surely would be irreparable. A lifeless zombie took my seat so that lunacy didn't engulf me. At every turn there were risks, odds to consider and unthinkable decisions to be made.
Let's take stock here. Okay, we've gone from none, to two, to three. They've been our numbers. The roulette ball bounced out of the "2" slot into "3". But what number will come up next? Pressure grew because we really didn't have much time to decide. In that next week, we needed to choose a course of action with a precarious outcome. Because the longer we waited, the greater the likelihood of further complications.
Over the next few days we consulted with five separate doctors. Each specialist came to the same clinical conclusion: "Reduce the twins." The consensus was that the twins were the highest risk. Our best chance and lowest risk was preserving the singleton pregnancy. Until then, my story had been like so many I'd heard before. Years of trying, a miscarriage, more years of trying - but this had now become a whole other expedition.
Could we live with the possibility that one decision could result in three unhealthy children? There was no avoiding the catch-22 dilemma we were facing. Just to make matters worse, a 3D ultrasound was scheduled for that week. It was agony watching our three babies doing exactly what you would hope for - moving and breathing, their hearts beating, but for how much longer?
The day after the 3D ultrasound, George and I made the excruciating decision to reduce the twins. Wanting only a healthy life for our babies motivated the hardest decision we've ever made.
Two days later, we headed across town for the procedure. The "selective reduction" happens in a normal ultrasound room and is performed by two doctors. We were told that there was a 10 per cent chance of a miscarriage after the procedure had been done.
The method of essentially aborting the twin foetuses was to inject potassium chloride into one of the hearts, the science being that because of the shared placenta this would also terminate the second foetus. There I was, lying down on that examination bed just like I had on other occasions to look at my babies. Except that the screen was respectfully turned away to shield me from witnessing what my imagination had already replayed over and over in the days leading up to this nightmare.
The cruelty of those circumstances was beyond anything I had experienced before. A sense of foreboding brought about an utter collapse in my composure. The doctor held my hand and said gently, "Mary, I'm sorry you have to go through this. But I need you to stop crying. You must stay completely still."
I took a deep breath and with every bit of my will power I did not move. George held my hand and squeezed it. I couldn't look at him. The thought of seeing George's face with the hurt that I know he was trying so hard to hide would have been my complete undoing.
A couple of tearful and sleepless nights later we returned to the same place, to the same room for a check up. Again, the doctor respectfully turned the screen away from us. He stared at the screen expressionless. He then took a deep breath and said, "I'm so sorry to have to say this, Mary, but we're going to have to do it again. Unfortunately the second twin is still alive." We were dumbstruck. This was the most brutal déjà vu.
How do you find yourself in the same traumatising scene twice in two days? How do you process something as harrowing as this? Let alone the shattering disbelief that we have to live through it yet again. So there I lay with endless tears, gasping and squeezing George's hand, replaying dialogue from a scene that actually happened only days earlier. "Mary, I'm sorry but I need you to keep completely still." And as the needle punctured my stomach, the silent wailing screamed vehemently in my head. Those moments are beyond a vocabulary of words. Instead, primal sounds take their place. Your soul is lacerated by that level of torment and you become incapacitated by the relentless grief.
Week 22 of my pregnancy and I was now in the second week since my waters broke and I hadn't yet gone into labour. The hospital was quickly becoming my new home. The idea of an early labour was something I tried very hard not to think about, but even a simple twitch would send me reeling into darkness again.
On May 10, I felt a clenching sensation down low. My contractions had started. I asked George to time them. They came regularly. He called the midwife and she gave me some pain relief and left to call my obstetrician, Dr Vijay Roach. Within minutes I was being wheeled into the birthing suite in the labour ward. Fifteen minutes later, Vijay arrived.
I now had my legs up, feet in stirrups. After looking closely he said, "I can see her coming down. Mary, I have got to tell you that the chances of her coming out alive are very slim. She will most probably die coming through the birth canal."
The only thing I could say was a defiant "No!" It was my most heartbreaking moment and, as the reality of what was next hit me, I couldn't help but ask myself, "Doesn't God love me?" People say he tests the ones he loves the most. Maybe, on that day, he loved me too much.
I wanted to collapse, to scream, to wail uncontrollably, but I couldn't.
I had a job to do. I had to deliver my baby. And as difficult and unimaginable as it was, I had waited for this moment my whole life. The cruelty of our circumstances was not going to ruin that.
In that room with my favourite midwife, my incredible doctor, and my beautiful heartbroken husband by my side, I pushed with everything I had. And I pushed. And pushed and pushed until I felt her feet coming out of me and Vijay said, "Mary, one last big push and you'll see your daughter." And I pushed harder than I've ever pushed before. And there she was: tiny and perfect and so incredibly pretty. The minute I saw her staggering beauty I knew I was looking at an angel. She was placed on my chest and I know I could not have loved her more than I did in that moment. It was the crush of a lifetime. My wounded, aching heart was suddenly full.
George stood silently beside me, watching, unable to speak, unable to touch, just crying quietly and helplessly. I cried too for the many reasons that are obvious but also for the miracle that is love. For its ability to strike in ways that leave you breathless, for its breadth and for its blindness to the abrupt nature of death. But my love affair with my baby was cut short by the need to get the placenta out.
I was wheeled down to the operating theatre. The placenta had attached itself with such force that it was unwilling to release. I was losing a lot of blood. When I awoke, oblivious to the blood transfusion that had taken place in the operation theatre, I was taken to my room where George and my mother were waiting for me.
Before I went down for the operation I told my wonderful social worker Deb that I would like my mother to hold Stevie. George was a little tentative about whether she should or not. He himself had struggled with it. I respected that it was far too confronting for him. But I felt that for my mother, who was not at the birth, it would be an important experience.
My mother began to tell me how grateful she was for the opportunity to hold Stevie. To see what I too had seen in her. To stand in awe of what a beautiful baby she was. The wonder of which she would carry for the rest of her life. That was so important for me, to share with her. She who had been such an incredible mother to me.
It was 3am. It felt a lifetime had been lived in those hours. The aftershocks kept pummelling me in a fierce and confounding way. For the first time in hours and months there was silence. Silence from praying. There was no delaying any longer. The unthinkable had happened. Too much had happened.
In six months I had gone from none to two to three to one to none. How do you fathom something like that? How do you survive the reality of it?
You rest, you grieve, you reach out, you recover, you trust, you remember, you hope and you accept. You gravitate to kindness, to help and you relinquish control over the things you can't govern. You assume that life is not out there to get you - it's there to teach you and to introduce you to yourself. You love because it's sweeter than bitterness. And you realise that people are incredible, resilient, willing and capable, and that you are one of them.
All I Know: A Memoir of Love, Loss and Life by Mary Coustas is published by Allen & Unwin this week.
This is an edited version of an extract which appeared in the Good Weekend.