Genetics called, and we struck out. Goose eggs all around. But we did discover something during the phone call; apparently the "it's most likely a autosomal recessive disorder (but could be infection, but really probably not, because infections leave traces and do specific things and none of this is evident, but just to cover our butts)" line was not so much a unified front between our two point doctors, but a disagreement. Apparently this whole time they've been playing "naynahnaynah" with each other, as pathology reports and assorted tests failed to prove either of them correct. "You can't prove your caus-a-tion" (sung, annoyingly sing-songy, with tongue out, natch).
Turns out the one actually does think it was an infection. Just not one medical science is currently aware of. From what I gather, this doctor is putting all his grim-reaper eggs in one basket: Maddy had an echogenic bowel at 28w that was gone by 32w. The most common cause of these feared bright spots on the ultrasound is infection, but usually of the garden variety TORCH Infections, and so they tested me for all of that (a lot of it for the second time), and we came up with nothing. (And for clarification, Maddy and I were both again tested for these same infections and more within a day after her birth with the same negative result.) (Should you go read what causes echogenic bowels: we scratched Down's, CF, and the Torch Infections off the list with a few blood tests, and assumed it was ingested blood from my long-term subchorionic bleed, or nothing. And "nothing" is a totally feasible explanation for echogenic bowels in the thrid trimester, from what I gather.) So what the fuck "Infection" is this guy talking about? could be one of those crazy situations where the baby's antibodies attack mom. Or something. It is totally possible that Maddy had a genetic disorder which made her susceptible to some bizzaro infection, in which case they both win, and they split the bedroom set down the middle and come back next week for the playoff. The doctor trying to argue infection also has some tough explaining to do; Maddy's problems were clearly long term, evolving from a problem extremely early on in gestation. So why the sudden infectious marker at 28w and not earlier? (And remember, by 28w I had undergone 10 or so of my 12-14 ultrasounds.) There is no way to disprove his side, but no way to prove it either. The infectious side is made on a house of assumptions and the basic fact that the other side can't prove their case.
Sadly, there's no way to prove or disprove the genetic side, either. Maddy's genetics have been combed through by the genome experts at Ba.y.lor; in one case, she was only the second human trial. They found nothing. The doctor arguing in favor of the killer genetics relies heavily on the multi-system crash, severity of multiple crashes, and uniqueness of problems to assume it's autosomal recessive. Again, assumption, assumption, conclusive assumption based on facts and non-proof of other side. Both doctors apparently presented Maddy's case to outside doctors at two conferences, and even there, the ringer "Guess that Cause of BabyDeath!" doctors disagreed on whether her case presented more infection or genetic. "I'll take enlarged heart muscle and depleted mitochondria for $500!"
In short, we have no idea why she died. We have a 1-25% of having a dead baby, with no possible way of knowing the baby will die prenatally. They would like us, should we want to partake in this life-affirming expansion of our family, to use an egg or sperm donor, just in case. Not that someone else's reproductive material will make a whit of difference should I happen to harbor some never-before-seen infectious catastrophe. We will know if the baby is viable when he or she is born, presuming we make it that far. Which, should I choose to go through this exercise, will (if I continue to follow their wish list) happen at Children's or right next door with them present in the room.
No, that won't be awkward at all to have the doctors who told me Maddy would die watching me deliver another baby, not at all. I'll probably be used to it by that point, what with the recurring nightmare and all.
This is exactly what I'd expected, the strike out in the genetic lottery and the shrugged shoulders, and I had no hope of them delivering the magic bullet. That scenario never once played through my head. So I'm trying to be level about this, and didn't realize how upset I was until I ruined dinner by dropped the blender full of marinade on the floor and erupting into a screaming, cursing, sobbing pile of frustration. It's especially rough when the late Friday afternoon phone call ends, "Is there anything I can do for you other than tell you I'm sorry we have no answers?"