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This story is from the Anamnesis episode called Empathy and starts at 02:57 on the podcast. It's from , a pediatric critical care fellow at the Lurie Children's Hospital in Chicago.
Following is a transcript of her remarks:
'No Way This Could Be Right'
So, I was in my third trimester of pregnancy. And at that point in time, my feet started to get a little bit swollen, my legs a little bit swollen, my face a little bit swollen. And it got to the point where I would text my recently pregnant friends and ask them to know, what part is normal? Like, is this a normal thing? How swollen is normal during your third trimester of pregnancy?
And one of my friends said, "Oh, my gosh, I had so much difficulty with breathing at nighttime, I had to get a new chair for myself so I could sleep upright." And another friend of mine said, "Oh, yeah, third-trimester swelling, that is a real problem. It just happens."
And I would go to bed at night, and I'd look over at my husband, and I'd say, you know, I feel pretty awful. And people are normalizing it, and I'm normalizing it. But at what point does this become abnormal? I didn't really want to believe that something was wrong. As a fellow, we get 2 weeks of maternity leave at Northwestern, plus 4 weeks of vacation if we didn't take any weeks prior to the time we were planning to take our maternity leave. So I was nervous that I wouldn't be able to take time off to go to the doctor, that I wouldn't be able to find coverage.
So it was a Friday night. And I had just worked on my feet in the ICU for the full day. And I had my feet up in front of me and I recognized indentations in my legs pretty much up to my knee.
That was consistent with pitting edema -- meaning if you put your finger into the ... into my skin, it would leave a mark. And I looked over at my husband and I said, "You know what? I think I might have this thing that I learned about in med school. It's called preeclampsia. Would you mind just getting this blood pressure cuff under the bed?"
And this is a blood pressure cuff that I hadn't used since medical school so many years ago. And he literally handed it to me as he was dusting it off. And I put my stethoscope to band part of your elbow. It's called the antecubital fossa.
And I put my stethoscope there and I listened. And he said, "No way; this can't be right." And my systolic blood pressure was 170. And I normally through most of pregnancy ran nowhere above 110.
So I looked at him. And I say, "You know what? I think I really do have it. I called a triage line. I said the same thing." I said, "Listen, I haven't learned about this diagnosis or really thought about this diagnosis for almost 9 years. I think this is what I have." And the person on the other end of the triage line said, "OK, I'll meet you in triage."
So, I took a shower because I kind of thought that they would deliver me that night and I'd wanted to be clean for myself and for everybody who was about to witness everything.
And I got there. And on my way there I had already started texting some of my co-fellows who I knew were on call that night, just saying, "Listen, it's Friday, I'm on call on Sunday. I'm planning on being there. But if something happens, I won't be able to be there. And I'm gonna need you to find coverage for me."
I sat down in the triage vital sign chair. And at that point in time, my systolic had increased even higher to a systolic of 190. And I ... I couldn't really believe it.
I think I was frustrated and felt guilty that I hadn't sought care earlier, and also frustrated at the system. As a trainee and as a provider, we're really trained to take care of everyone else other than ourselves.
So blood tests were starting to be drawn. I got an echocardiogram because, again, I'd had shortness of breath when laying flat for a while now.
We were weighing the risks and benefits to delivering a baby who is premature.
Go With the Flow?
From the beginning, my husband and I said that we would go with the flow, like this is even before we developed preeclampsia. But people kept asking us, what's your birth plan? What song do you want playing? How do you envision your birth and delivery? And my husband and I from the beginning would always answer health first, safety first. So I think that helped us a little bit in terms of framing what was about to happen in the next few days.
In the triage center, I was given multiple medications and then admitted to labor and delivery.
They started magnesium on me. And my blood pressure started to normalize. And again, everybody was weighing risks and benefits to delivering early rather than later. And the biggest risk to the baby for delivering earlier is that her lungs were not mature yet. And the steroids that they give for lung maturity wouldn't have worked at this point in time.
And then the risks also for myself is that preeclampsia can develop into eclampsia, which leads to which basically is seizure activity.
So ultimately, with all the information gathered, the team and my husband and I, decided to wait. It lasted a couple of days, everybody was saying, hopefully, you'll get to 34 weeks. And I kept saying I hope I get to 34 weeks. And at this point in time, we were 32 and 1.
And so a couple nights into our hospital stay, I was 32 and 4, the time that I started to develop high blood pressure again and pain in my abdomen that I initially attributed to reflux because it's something that I've never had before. And I assumed this is what reflux felt like.
And I soon realized that it actually wasn't reflux -- it was liver pain. And it was the most significant pain I've ever had in my life.
So the team gave me some blood pressure medications, and decided to induce me. And so the goal was to have a natural labor.
The medications they gave me for pain made my pain go away for a short amount of time. And then within about 10 minutes, the pain came back with a vengeance. And the team decided to take me for an emergency cesarean section.
They took me to the operating room. And at that point in time, I don't remember much of what was going on.
What I do recall is that I didn't hear my daughter cry when she was born. She wasn't placed on my chest. And I don't really ... I don't remember meeting her at all.
They sort of showed me what she looked like as they wheeled her into the room. And then they rushed her to the NICU.
I remember encouraging my husband to go to the NICU and meet her. But he didn't want to leave my bedside.
So this was just after midnight, and she was in the NICU at that point. And about 6 hours later, about maybe 6½, I had a whole new team of people rush into where they had put me, which is in the postpartum section of labor and delivery. And they walked in, and they said, we're sending you to the ICU.
And I felt no different than I had before. I didn't really have any abdominal pain at that point.
And I said, "Can you explain why you're sending me to the ICU?" And one of the physicians -- again, who I'm meeting for the first time -- said, your labs are at the extremes of abnormal, your clotting factors are low, your hemoglobin dropped seven points from admission, your liver function tests are through the roof. So we're gonna start transfusing you now.
And then they wheeled me through the tunnels at Northwestern.
I had an ultrasound technologist waiting for me, there are multiple clinicians, ranging from nurses to ICU doctors, to the ob/gyn team and surgeons. And as I shifted from the bed they wheeled me in onto my ICU bed I felt blood empty from my uterus onto the sheets. It was a feeling that I've never experienced before. And then it happened again. It was a total of just over two liters.
The ultrasound technologist checked my liver with ultrasound to make sure the capsule, the area that surrounded the liver, hadn't ruptured yet.
And then a stranger, one of the residents, introduced herself and apologetically said she was about to be shoving a balloon into my uterus to try to tamp down on some of the bleeding that was going on.
Somebody who used to rotate through our pediatric ICU prepped to place a line into my neck, that was called an IJ -- it goes from your internal jugular externally, towards your heart. I was awake, and he talked me through the procedure.
The worst of it was I felt like I couldn't breathe during the procedure, I had this blue, sterile drape over my face. And my bedside nurse helped to lift it a little bit so I could breathe easier.
The pain started up again.
I felt the abdominal pain actually in my shoulders, and I feel like I couldn't take a deep breath because of it. It was, it was so painful.
Throughout the day, my blood pressure changed from running very high to low. And throughout the day, my mental status, my level of consciousness, deteriorated.
I don't recall this next bit of time, but my husband, for better or for worse, remembers it all.
At the third blood pressure drop, he called my primary ob/gyn, who wasn't in-house and was not on call. And he said, "Lauren's getting worse. And people are just continuing to pour in products but aren't looking into this." And she came in and she ordered imaging of my abdomen that showed I had an ongoing arterial bleed.
And she took me directly to the operating room. So at this point, I had been bleeding internally for about 14 hours. And she said that when she opened up my abdomen, about four and a half liters of blood fell onto the operating room floor.
'Wow, You've Been Through a Lot'
The next day was a little bit fuzzy. I don't remember too much of it, but I've heard stories with my ob/gyn team and from my husband.
Sometime after they'd put in the breathing tube in preparation for the operating room, they confirmed placement on a chest x-ray. And I made the bedside nurse in the ICU show me my own chest x-ray to make sure that I agreed that the breathing tube was in the correct place.
The breathing tube was uncomfortable -- they put in a breathing tube that was slightly, I think, too big for my size.
The next thing I remember was my bedside nurse telling me that if I didn't start to breathe on my own, I wouldn't get the breathing tube out.
We tend to say it in the ICU, that if you don't start to breathe on your own, then such and such isn't gonna happen. And I'm thinking about it now as if I'm ... it's an unfair judgment from our providers and sort of a casual phrase that we say, as if patients are actively trying not to breathe.
My breathing tube came out eventually. And I was transferred from the ICU to the postpartum floor after another night of making sure that I could breathe on my own without any issues.
We got to the postpartum floor, and all I wanted to do was shower.
I still smelled of blood and the prep that they use to clean the body -- it's pungent.
My husband walked me from the wheelchair into a chair in the shower. And he guarded himself -- or sorry, he guarded me -- from the mirror, so that I couldn't see how dysmorphic my figure had become with fluid overload and bruises from my neck to my abdomen. He combed out my hair because my arms were too weak to lift them above my head.
And afterwards, he helped dry me off and then he put me back in the wheelchair, and he wheeled me down to the NICU.
My heart was racing. I was about to meet my daughter.
The nurses nodded their heads at me as I was wheeled down the long hallway. And then Juniper's nurse took a look at me and said, "Wow, you've been through a lot."
I said that I had been through a lot and I was thankful to be here.
Juniper's room was a little square with a window on this side. And she was in the center of it in a clear plastic box and neon numbers were above her head.
And I put my hands against her box. And there she was.
I just stared at her for a little bit thinking how tiny she was. And then the bedside nurse asked if I wanted to hold her.
And at first, I was thinking like she's talking to me like I'm supposed to hold my daughter now. Is it okay, if I hold her? Am I gonna break her?
And I said yes. But it didn't feel natural to hold her. She was connected to wires and respiratory tubing and she was tiny. She's so skinny and her skin felt damp against my chest. It felt really like I was holding a salamander. Completely unsure of where to put my hands or support her head but also stay out of the way of the medical devices.
There's a blanket on top of her and a little hat to make sure she didn't lose more heat from her head.
I didn't feel that immediate love. You know, when you talk to moms, they talk about wow, you know, there's that rush of love that happens as soon as you meet your child, and I didn't feel it, I felt like I was holding a stranger. And then I had this almost reflexive need to introduce myself to her.
And, on one hand, I felt this external pressure to feel it, to feel the love, and also an internal pressure to allow myself to feel compassion for our horrible introduction.
And I sat there, and I introduced myself and I said the word mother for the first time, and was overtaken with a stream of thoughts. It was overwhelming, and beautiful and sad.
But the word mother means something. And it means more than I'd ever imagined.
Check out other stories from the Empathy episode, including "It Isn't the Dead Child Who Haunts Me" and "Treating Cancer Patients 'Like Cattle About to Be Slaughtered'"
Want to share your story? Read the Anamnesis Storyteller Tip Sheet and when you're ready, apply here!