The hospital I belonged to was divided up into two parts – the main building and the Women’s Hospital. In order to get to Labor & Delivery late on a Sunday night, one had to park in the main garage and enter through the Emergency Room since the main lobby doors were locked. One then had to make a five minute walk down a seriously long hallway to another lobby set specifically for the Women’s Hospital. There was no way to park at the Women’s Hospital and walk directly in. I guess maybe they thought it was good for all those laboring women to get their steps in.
Once Vlad and I made it to the second lobby, large double doors ushured us in to the Labor and Delivery unit. Several staff greeted us from behind a giant desk. A clipboard with privacy forms appeared for me to read over. At this point I was more than ready to stop feeling the headache, still cracking at my temples. All I could think about was following the nurse who appeared from around the corner and was beckoning me into a room. I managed to scribble my signature at the bottom, pushing the clipboard at Vlad to finish filling out.
In the room, the nurse helped me change into an ever-fashionable hospital gown as I told her the story of my day. We joked about the grumpy cat socks I was sporting. I waddled to the bathroom for a urine sample. After that was taken care of, I settled into the hospital bed for a vitals check. The blood pressure cuff was inflating, cutting off the circulation in my left arm. The alarm was creeping up inside of me again. I tried to be nonchalant as I stared at the clock on the opposite side of the room from the monitor. Vlad finished with the paperwork and appeared beside me. I took a deep breath and kept looking at the clock. The cuff suddenly let go and a high pitched sound rang out from the monitor. It was too ugly to be good news. Still refusing to look back at the screen, I asked the nurse how high my pressure was.
“Let’s just re-do it on the other arm!” She said brightly. Obviously it was bad enough that it warranted a second try. I tried to tell myself that this was ok. Blood pressure can falsely elevate in tense situations and this was definitely one of them. The repeat measure would be more normal, I was certain. Again the cuff inflated, this time on my right, and again the ugly sound rang from the monitor. I could not bring myself to look. I knew if I looked I would not be able to remain calm.
“How bad is it?” I asked again with an anxious laugh. The nurse continued to smile but I could see the concern in her eyes. She said she would page the doctor. This was the kind of answer nurses used if things were not good but they were waiting for the person with MD behind their name to deliver the news. The nurse then began preparing to start an IV, which told me this was a serious enough situation that she could not wait for the doctor to evaluate me and actually place order for one. I pointed out a spot in my forearm where a juicy vein could typically be found. To me, it seemed like a no-brainer placement for anyone with a few weeks worth of experience. How very wrong I was. Try as she might, the nurse could not seem to find the vein. I’ve never been a huge fan of needles (ironic, isn’t it?) and the very large one the nurse was using to dig around in my arm caused me to be covered in a thin layer of cold sweat. Vlad tried to distract me by telling the nurse that I too, am a nurse. I’m sure this helped her feel totally pressure free. After a few minutes, she gave up on my forearm and moved on to my antecubital area (the crook of my arm). There, too, she struck out. She ended up having to call the unit IV whisperer, who finally placed a line in my left antecubital area. The whole time, I was glaring and rolling my eyes at Vlad out of frustration at what I thought to be the nurse’s incompetence. Later, I would find out my initial blood pressure readings were showing 220/110, which was much more than just a little concerning for anyone, much more so for a pregnant woman. Such a high pressure was causing my kidneys to stop functioning properly. As a result, I was retaining fluid, leading to massive swelling over my entire body. The swelling masked my veins as well as exerted pressure, squishing them down and making them impossible to find.
As the vein search wore on, the on-call physician for my ob-gyn group, Dr. T., stepped into the room. Her tone was calm but serious. She explained that based on my symptoms and blood pressure readings, what was happening could be pregnancy-induced hypertension or preeclampsia. If it was pregnancy induced hypertension and I would respond to treatment, it was possible that I could go home, be placed on bed rest and continue taking blood pressure medication until delivery at 34 weeks. If it was preeclampsia, then there would be no choice but to deliver me as soon as possible for fear of life-threatening complications. Confirmation of one versus the other would come by way of blood work, which was currently being run in some windowless, halogen lit lab somewhere in the hospital.
What was being said to me sunk in very slowly. As the nurse pounded me with medication to bring my blood pressure to a safe level, I was starting to realize that I was on a runaway train with no means of exit. Being totally devoid of control petrified me. Vlad was also stunned. We held hands, praying and clinging onto the hope for the best possible lab results. I tried my best to find a positive, lighthearted aspect of the situation. Two weeks of bed rest, endless books, shows and snacks being brought to my bedside wasn’t the worst possible outcome. In two weeks Baby Girl would be a whole 14 days closer to being ready to live in the outside world. Whatever it took in those days for her to get stronger, I would do. I could not bring myself to consider the alternative.
In the late hours of that Sunday night, I was thrust out of my hopeful existence into reality. The labs were back and they were bad. By bad, I mean so ridiculously horrible that some of the staff on duty that night had never seen values so out of normal range. I was so sick from the preeclampsia that my kidneys not just malfunctioning, but were about halfway to being entirely shut down. Dr. T explained all this to me standing at the foot of my bed. Although she was hoping for a different outcome, based on the severity of the findings, she and the rest of the medical team on the unit that night concluded that there was no time to lose. The only way to definitively stop the preeclampsia from progressing was for me to give birth.
The next events were like a horrifying, yet perfectly orchestrated game play carried out by a team of professionals who knew exactly what they were doing. The news of my imminent delivery came right during the nursing change of shift at 11 pm. My new nurse charged into the room with the confidence of someone who regularly managed other people’s crises for a living. Her name was Morgan, she had strawberry blonde curls tucked into a bouncy ponytail and she seemed around my age. She listened to the outgoing nurse’s report on my situation and plan of care as I cowered in bed next to the both of them.
“Right, this is what we are going to do.” She said. Word that I was also an RN had spread throughout the unit quickly. She spoke to me as an equal, as someone who was preparing to fight my battle right by my side. “Your blood pressure needs to get under control. We are going to give you meds for preeclampsia, steroids to help mature your baby’s lungs and then as soon as you are stable the doctor will start the induction process. I am going to be here with you every step of the way.”
I was and am still so thankful to God for having Morgan take care of me that night. She was like the relentlessly positive, capable and compassionate warrior Vlad and I needed in the room with us as the night spun on.
Treatment started with more medication to keep bringing my pressure down and an IV antibiotic for group B stretoccocus, which is routinely ruled out in all pregnancies at the 32 week ob-gyn visit. My 32 week visit was scheduled for that Tuesday but I would never make it. I was given the first of two steroid injections to speed up Baby Girl’s lung development in preparation for her entrance to the world. As if being poked by multiple needles for IVs and injections was not enough, I needed repeat blood work every 4 hours to keep checking on the status of my poor kidneys. Megan showed nursing excellence here as she advocated for the best phlebotomist in the hospital to come and stick me for blood since no one on the floor could find a good vein. An ultrasound machine was rolled into the room to check on how Baby Girl was doing as all this drama was unfolding. To our relief, none of the symptoms I was experiencing affected her in the least. Her heart rate was in perfect range and good movement was seen during the scan. She was head down, poised for optimal vaginal delivery. Women’s bodies are designed to protect a baby at all costs in pregnancy, a truth I was never more grateful for.
One more large puzzle piece in the treatment of preeclampsia that I needed to undergo: magnesium. As a result of an IV infusion of magnesium, the body’s nervous system is tricked into dilating blood vessels in the brain as well as relaxing skeletal muscles. It acts to prevent the likelihood of seizures and protect the mother’s and baby’s brains if one does occur. The unpleasant side effect that goes along with this life-saving treatment is the feeling of heat and tingling from within. I knew this as a fact because I had also regularly given it in the ER to relax the spasming lungs of patients suffering asthma attacks. The usual ER dose was 2 grams and just that caused perfectly rational patients to turn into anxious wrecks who would jump out of beds and pull IVs because they couldn’t handle the heat (literally). The dose that I was set to receive, said Megan, was 6 grams over 20 minutes followed by a continuous infusion of 2 grams per hour…indefinitely. I steeled myself for what was going to be a certainly unforgettable experience.
Megan, being ever experienced, came armed with a basin of cool water and towels in addition to the bag of IV magnesium. She started the drip at the prescribed rate. The first few minutes were not so bad. Slowly, I began to feel the sensation of burning. It crept and tingled from somewhere within, soon taking over my entire body. I felt like I was having a thousand hot flashes all rolling from one to the next and piling on top of each other. It was itchy and sweaty and really did make me want to jump out of bed. Under Megan’s direction, she and Vlad began soaking towels in water from the basin and placing them over my body in attempt to alleviate the sensation. We started a countdown to when the drip could be turned down and tried to carry conversation as a distraction mechanism. After 20 long minutes, the fire was over. I was able to breathe a sigh of relief as Megan changed the settings on the infusion pump to 2 grams per hour.
Shortly thereafter, I attempted to go to the bathroom. This seemingly simple ritual made me discover that magnesium does not only make you boil from the inside, but also causes your body to be weak and your mind foggy as a result of inciting all that relaxation. Add to that extreme exhaustion from stress and lack of sleep. I had the strength and wits of a newborn kitten. There were about ten different wires and tubes connected to me from all angles. I stared in a stupor as Megan whizzed around, untangling and organizing all my accessories in attempt to make me mobile. Walking was a whole other thing. I swayed like a drunk, dragging two IV poles, as I tried to make the ten feet from my bed to the bathroom. Megan had to help me through the entire process, speaking encouraging words as I clung on to her for dear life.
What seemed like an endless stream of professionals funneled through the room. Social workers, ob-gyns specializing in high risk pregnancies, the neonatology and pediatrics teams, a respiratory therapist, lactation consultants – it seemed as though the whole hospital was mobilized to ensure the best possible outcome to a frightening situation. Vlad and I contacted our family and close friends to brief them on what was going on. Vlad’s parents were in New York on vacation and my dad was in Russia taking care of family business. The only one actually close by was my mom, who immediately started driving to the hospital. The text message alerts on our phones went off every few minutes as people sent prayers and expressed their support. It was comforting to know that there was such a literal army standing behind us. Somehow it was also very overwhelming. Giving updates made the whole situation even more real. I was afraid to waste the precious energy I had left on explaining and reassuring worried loved ones. Even holding and looking at my phone seemed debilitating. The faces of all the hospital personnel introducing themselves was reduced to a blur. I mechanically thanked each one and repeatedly stated that no, I did not have any questions at this time. In reality, I was barely processing information to be able to think of anything to ask.
Dr. H., the ob-gyn who I had been seeing for my pregnancy (plus the past seven years) drove in to see me. She arrived all dressed up, straight from the bedside of her daughter-in-law, who had just given birth to the family’s first grandchild. I was shocked that Dr. H. had left her house in the middle of the night after such a pivotal day in order to see me. We had always had a very warm doctor-patient relationship but this act of care truly brought tears to my eyes.
“You were supposed to be my easy patient! What happened?” she asked.
I tried to picture what she was seeing. My body, swollen to the point of disfigurement. The multiple bags of IV medication hanging on either side of me. Megan glued permanently to my bedside. My mom, who had promptly arrived at the hospital and now sat in the corner with a decidedly terrified look. Vlad’s grim smile and my blank stare. All three of us were trying to process and failing miserably. I had made a total transition from taking care of patients to becoming one in less than 24 hours. A 32 week baby was about to make an appearance in the world and she was mine. My once healthy body slapped me in the face in an act of ugly betrayal. I felt like I should possibly be crying, or screaming from fear or indignation or the injustice of it all. I knew that I needed to pray. Yet I could not muster any words. All these thoughts and emotions were blunted. All I could do was lay back and hold Vlad’s hand. To me he was maintaining supernatural calm. In reality, he was also barely holding on. We were at the mercy of God’s grace. It was just the beginning of the most humbling experience of my life.
As Sunday night wore into Monday morning, the medications kicked in and my blood pressure began to look more like that of a healthy person. Megan paged the on call resident physician. It was time to induce labor and meet the tiny human still in the process of being knit within me.