Runaway Train

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.

32 Weeks

Seven months. 32 weeks. I won’t bother with trying to figure out how many days or minutes are in that time span. At 32 weeks a baby is taking its first practice breaths in the womb, its skin transforming from translucency to look like actual flesh. An ideal pregnancy has roughly 8 more weeks in its timeline during which babies get nice and fat in preparation for the work of outside life.

32 weeks is by no means an ideal point at which a baby enters the world, yet it happens to so many people. And it happened to me.

Let me preface this by saying that I had a textbook healthy pregnancy. Yes, the nausea and the heartburn were bad throughout, but that was to be expected. My blood work, vitals, and nonexistent medical history were all mundane in their normalcy. After the fact, I found out that preeclampsia is completely unavoidable. There is no special tea to drink, no extra amount of times to measure blood pressure to somehow catch and stop it in the act.

Once it starts, its like you’re on a runaway train and the only way to get off is to give birth.

A word on preeclampsia. No one really knows where it comes from (Herndon, 2018). It happens in about 5% of all pregnancies. The syndrome is characterized by high blood pressure and a high urine protein after week 20 of pregnancy. Ladies also get ridiculously swollen (but really, who isn’t swollen when they’re pregnant?), get vision changes and headaches. If left untreated, it can progress to eclampsia, which means all of the aforementioned symptoms plus seizures. Ultimately, it can result in long term organ damage as well as maternal and fetal death. It’s pretty bleak to think about.

I knew about preeclampsia from nursing school, of course. The symptoms to watch for were engrained in my brain long before I was ever actually pregnant. But as that particular individual with a nonexistent medical history and textbook pregnancy, I felt I had nothing to worry about.

The day before I realized I was on the runaway train was a great one. Vlad and I spent the morning putting the house in order. I remember bending down to pick a bag off the floor only to notice my ankles. Or should I say, where my ankles used to be. That area had gotten so swollen that it was as if my calf grew directly into my foot. I laughed about it and sent a photo to some friends. In the afternoon we finally made it out to Buy Buy Baby to make some returns and spend our store credit on baby necessities (a.k.a. pink pig ottoman). Vlad’s friend, Eugene, was in town from Colorado, and the three of us went to Mindy’s Hot Chocolate for an indulgent treat paired with excellent conversation. We ended up getting home around midnight and I fell directly into bed because I had a shift the next morning.

I awoke with back pain, which was a typical occurrence for me in those days. It was so common that I had a routine worked out that would pep me up before I started my shift at 11 – I would get in as hot a shower as I felt was appropriate for a pregnant woman, take two acetaminophen and sit on the couch eating my breakfast with a heating pad. It tended to work like a charm and that day was no exception. With the pain subsiding, I used the remainder of my morning free time to check my baby app. It was a fun little ritual that happened every Sunday as the weeks flew by. This Sunday I was 32 weeks and wanted to know everything going on with Baby Girl, who was supposedly the size of a squash. After a satisfactory scroll through the app, I squeezed into my non maternity scrub pants and made sure my work bag was packed before setting off for my 12 hour shift.

I felt delightfully peppy as I walked into the Emergency Room. It was November 4th. The weather outside was frosty, meaning a lot of patients would not venture out unless absolutely necessary, keeping the waiting room nice and empty. My favorite day shift charge nurse was working. I had been assigned to the fast track along with some of my bestie coworkers. The goal of fast track was to weed out the minor complaint patients so that the nurses and doctors working the main side for the day could focus on the critical cases. It was a nice mental break that my 32 week pregnant self did not mind at all.

The first four hours flew by uneventfully. Then, the backache came back with a vengeance. I stiffly walked around from room to room, a fake smile plastered on my face for the patients’ sake. The pain was a relentless, tight ache radiating from my waist to my shoulder blades. Additional acetaminophen was doing nothing for me. I toyed around with the idea of asking to go home early but brushed the thought aside. I needed to save my PTO for maternity leave and didn’t want my coworkers to think of me as less capable simply due to being pregnant. At the urging of my fast track teammates, I conceded to a 15 minute lie down in one of the patient rooms.

As I lay on the stiff ED cart, one hand on my belly, I remember wondering how much more it could stretch in the next 8 weeks. I remember hoping that this baby would come a few days early. I made a mental checklist of all the things I still needed to get done before she arrived – finish decorating the nursery, pre-wash all the clothes, pack a hospital bag.

Fifteen minutes and I felt like I hit a second wind. I came out with full resolve to finish out the mere 6 hours I had left in my shift. The department felt mine for the conquering.

That lasted only about an hour or so.

When it became clear that the pain was not backing down easy, I finally waved the white flag. If I felt better after laying down for 15 minutes, then clearly I needed to continue doing so…but in the comfort of my bed. I waddled over to the charge nurse desk and conceded my need to go home. Before I knew it, I was punching out on the time clock and heading towards my car in the parking lot.

On the drive home, I actually began to feel better. I called my mom and we had a nice chat about the goings on of the past few days. As I got off the highway on the exit towards home, I chided myself for wimping out on the rest of my shift. No matter, it was too late to turn back now. I was going to make the most out of my night off.

Vlad met me at the front door of the house. We had a nice long hug and I made a beeline upstairs to our room. There was nothing I wanted more than to put on my comfiest, softest pajamas and snuggle under the covers. Netflix and early bedtime were waiting.

I’m not certain exactly when the change in pain happened. Maybe it had steadily been building throughout the day and I wasn’t paying attention. Or perhaps it hit me like that runaway train. All I knew was that suddenly the pain had shifted from my back to my head.
When I say this was the absolute worst headache of my life, I am not exaggerating. It felt like someone was playing whack-a-mole in my temples. Tension headaches from stress were not unusual for me and I tried to tell myself this is all it was.

I tried my best to ignore the gnawing tension of an internal alarm telling me something about this was not right.

Vlad, in his sweet and supportive husband mode, brought me a bowl of cut up fruit and Tylenol. The headache was making me nauseous. I took a few bites of fruit and collapsed back onto a pillow, praying the Tylenol would work quickly. It wasn’t long until I was urgently walking to the bathroom as my body rejected the food I just ate. Throwing up at all times of the day from random meals was nothing new to me; I had gotten extremely good at knowing just how long I had from the time I felt the vomit coming to make my way to the nearest toilet in an orderly fashion. Typically, one such episode would make me feel instantly better and I could continue about my day. As I watched my stomach contents get flushed down the toilet bowl, I was elated in thinking the worst of my day was behind me.

Nothing got better. The headache seemed to be only worsening in its intensity. I threw up twice more. I could not think or speak coherently any more. Even laying in bed was getting difficult – there was no position of comfort. My internal alarm grew more intense. At some point I had the idea that Vlad, who was sitting helplessly beside me, should take my blood pressure. Since headaches were a sign of high pressure, the nurse in me reasoned, I needed to prove to myself that my pressure was normal. That would mean that this is just a silly headache and nothing to worry over. All we had to measure with was an old manual cuff I had left over from my nursing school days. Vlad had never taken a manual blood pressure before that moment. Talk about a high pressure first experience (pun intended). I tried my very best to walk him through how to use the cuff. He followed the directions as I laid there, tying to relax through the pain.

“It’s high. Like 190, I think.” He said as the cuff was deflating from around my arm. Cue internal alarm. If true, that was extremely high. Like getting close to having a stroke high. I brushed it off and told him that he was probably doing it wrong. Next, I had him hold the dial as I pumped up the cuff and listened in the stethoscope myself. My result was only slightly better – 160 systolic. Still I refused to believe what I was seeing. Obviously I couldn’t be trusted to take an accurate pressure in my current condition, I thought. Vlad was asking what should we do.

I imagined all of the pregnant patients with headaches I took care of in the ED. Usually, they got re-hydrated with a bag of IV saline and a cocktail of pregnancy safe medications for their pain. Within a few hours, they were feeling much better and on their way home. I so badly did not want to be one of those pregnant women who rush to the hospital over nothing and subsequently become the subject of eye-rolling discussion in the unit break room. On the other hand, the prospect of getting some kind of relief from this pain was very enticing. Vlad and I came to the consensus that we would call my doctor’s office and see what they had to say.

Within minutes I was talking to the ob-gyn on call for the practice I belonged to. I explained my symptoms without trying to sound as if I was actively dying over the phone. The response came without any hesitation – I should report to labor & delivery in the hospital as soon as possible for an evaluation. As soon as I got off the phone, Vlad and I jumped out of bed and got dressed. Ok, he jumped and got dressed. I barely rolled out and could not even think of wasting time putting on clothes. Now that I knew we were going to the hospital, I suddenly could not wait to get it over with. My super soft comfy pajamas (which were that way from years of washing and stretching) were very appropriate. I threw up a fourth time (one for the road) and tried not to dwell on the internal alarm, now loudly shrieking, inside me.

We drove silently, hand in hand, through the dark streets to the hospital. It was already dark and the roads were mostly empty. The chill of winter approaching was thick in the air.

“I guess I’m probably not going to show up to work tomorrow either.” I tried to joke as we turned into the hospital parking lot. My first day of being 32 weeks pregnant was coming to a close.