Adventures in making and raising our test-tube babies

Wednesday, May 6, 2009

In Bad Taste

I've been meaning to write this post for a long time, so while I'm on a roll and have my second wind of the night (or is it first wind of the morning?) I'll go ahead.

Several days after I was discharged from the hospital after my C-section, I noticed my tongue with horror. It had lots of jagged growths on it that seemed like they were filled with puss or some other disgusting substance. I ran to the doctor, who said, "Neat" and took a picture. He said that this was just inflamed taste buds. Why were they inflamed? I said I'd had dry mouth for months during the pregnancy. That might be it, or it might be something else. It might be related to the pregnancy or not. Maybe my salivary glands had stopped working. If it didn't go away in a few months, that might be it. Or it might be a reaction to other things going on in my body.

I suspected the latter. There were lots of things going on in my body. This is the story of how I gave birth.

I went to the doctor on January 13 for a weekly check-up. They said, "Go to the labor and delivery unit right now." Apparently my liver enzymes were high and platelet count was low. I walked over there, in the same building. When those people finally figured out why I was there and who I was, they put me in a room with one monitor on my belly. "The other baby is about right here," I offered. Oh, there was another baby? Well then, they slapped on another monitor. They hooked me up to an IV for reasons unknown to them, and I decided to text James. "Everybody ok but I have preeclampsia. In hospital. Could u come now pls." The return text said, "On my way."

Pre-eclampsia is one of those syndromes that happens a lot in multiple pregnancies. It involves the shutting down of organs -- liver, kidneys, etc. I had HELLP syndrome, a particularly nasty version of pre-eclampsia that involves low blood platelets. When the hospital finally got my chart from the doctor, they put me on IV magnesium, which helps keep the pre-eclampsia in check, but brings on nausea. I immediately threw up. That was nothing new. I had been throwing up for months. I kept throwing up. Every time I did that, I peed in bed. Peeing while vomiting was nothing new either. They gave me anti-nausea medication in the IV. Every few hours they took blood to test the platelet and liver enzyme count. They put saline in the IV to keep me hydrated.

In the meantime, they needed to know how much urine I was producing. They put a urinary catheter in so they could suck the urine straight out of my bladder into the measuring bag. You know how that feels? Sucky. And you know how it feels if they do it wrong? Like a urinary tract infection. You know how that feels? Remember the UTI medicine commercial where you see the door of a bathroom stall and hear a woman screaming? That's how. After hours of that, a nurse mercifully took it out, let me pee into my bed like a normal person, and reinserted it the right way. Then they changed the sheets.

More blood tests. They gave me a steroid shot in the hip to bolster the babies' lungs. Ideally, I would get four shots over 48 hours, and the babies would be more ready to breathe when they came out. They were at 33 weeks of gestation at that point. Normal is 40.

More blood tests. The question was: was my pre-eclampsia getting worse? The cure for pre-eclampsia is giving birth. How long could they wait to get the babies out before my organs started shutting down? Could they wait 48 hours, long enough for the steroids to kick in in the babies' lungs?

More blood tests. The nurses and doctors kept looking with concern at the urine bag, not filling up. I wasn't making urine. I should say, my kidneys weren't working. The blood tests showed the liver was spewing enzymes left and right. That's what a liver does when it is in distress. I didn't really get that at the time. My platelet count was dropping lower.

James was there. So was Mom. The endeavor had started about 3 p.m. and by 3 a.m. James was asleep on the fold-out chair, Mom was back home, and the doctors said, "We've got to get these babies out now." We called the appropriate people and James got his paper outfit on. We were going to have a C-section.

I started to get a little nervous in the operating room. The anaesthesiologist tried to put an epidural in my back twice, and a spinal once, but my back was so twisted with scoliosis that after the three tries he didn't want to waste any more time. I had held on to my doctor, a wonderful woman who had twins herself via C-section several years before. I said, "I'm scared." She comforted me.

The anaesthesia was making me throw up. Or maybe that was the magnesium still. Lying on my back on the operating table, I threw up huge amounts of liquid -- all the liquid that wasn't making its way through my kidneys -- into little tiny vomit pans that the nurses held at the side of my face. They had a fireman line of vomit pans coming to my cheek and back to some receptacle to dump them out. "Is there a better way to do this?" I asked, wondering if the pans were designed to fit my cheek at a better angle. I certainly didn't want to make a mess. "No, you're doing fine." Vwaaaaaaahhhh. Vwaaaaaaahhhh. Vwaaaaaaahhhh. Later the doctor told me that everyone in the operating room was impressed by how nice I was being. "It must be what happens when she gets stressed," she said. What, me? I'm always nice!

Before I knew what was happening, they had the sheet hung vertically to shield my abdomen from my eyes. They let James in to see me. I felt them poking my lower belly. "Do you feel that?" Yes. "Do you feel that?" Yes. Here? Yes. Here? Yes! Here? Yes!! I had this feeling that the operation was about to proceed without the anesthesia.

And then I got confused. What really happened was that they gave me general anaesthesia to put me to sleep, now desperate to get the babies out of me. What I felt was confusion as to whether I was inside or outside. I didn't know where I was. I yelled as much to James. I saw white buildings like a theater set coming in at me. I thought they should all know that I didn't know where I was. James found this unnerving.

James had to tell me later what happened during the operation. They pulled Amanda out and showed her to James briefly. She weighed in at 4 lbs. 13 oz. at that point. Elisa came out immediately afterwards, a small 3 lbs. 13 oz. James didn't even see her. As the neonatologist ran the babies to the Neonatal Intensive Care Unit, James watched the receptacles on the floor fill up with blood. I was hemorrhaging; that's what happens when you have no platelets to help clot your blood. Fortunately they got that under control. And eventually they woke me up and told me I had two babies.

The rest of the night and the next day, my IV was delivering magnesium, anti-nausea meds, saline hydration, and morphine. Though James kept slipping away to go look at the babies, I lay in bed thinking, "I would have thought I would want to see them, but I'm too tired to bother." That was the morphine, I'd venture.

I had a monitor on my finger measuring the amount of oxygen in my blood. Whenever it got too low, the alarm would go off and a nurse would come running. Whenever I went to sleep, which was always, my breathing would become shallower and the alarm would go off. It's not a very restful situation. Morphine -> sleep -> shallow breathing -> too little oxygen -> alarm -> wake up -> sleepy -> sleep -> shallow breathing ... times 24 hours.

The nurses tried to get me to cough and do other things to get my abdominal muscles and lungs going. Coughing after a C-section hurts. Like hell.

A day later, I had still not been able to see my babies, though everyone else had. We begged and begged, and finally they let me go down to the NICU. I still had the IV in, but my liver enzymes were now low enough to let me go off the magnesium. They pushed me in the stroller (did I write that? I meant wheelchair) to see my destiny.

I got to hold Amanda. I cried and kissed her. I caressed her head. James videotaped it for Amanda's enjoyment later. I don't think we'll be posting it online. I didn't get to hold Elisa, and from my rickety perspective in the wheel chair, not able to move my body on my own, I couldn't see her very well in her incubator. But I did see her teeny body a little. I wished I could hold her.

When I came back to my room, they gave me a transfusion of two units of blood. I want to thank the person who donated for me to use. I needed it, and I appreciate it. I think it might have saved my life.

The next few days were a blur of blood tests, pain meds, IVs, and not being able to roll over in bed from so much pain. James, and occasionally the nurses, nursed me back to health. Every hour or so I would ask James to hand me my glass of water and my chapstick. Now we realize that it was the dry mouth that made me need both of these things; James just thought I was addicted to chapstick. It was the bane of his existence as it went rolling around under the hospital bed and other inconvenient locations.

For several days they kept me on a liquid diet, not because I needed it, but because of some error in reporting my medical status to the cafeteria. The first time I cried in the whole process was when the cafeteria refused me real food. Was this post-partum depression, I wondered. No, I concluded. It was the fact that I had just been sliced open, bled dry, stabbed repeatedly, and jostled, and now they wouldn't give me a sandwich!

With James's loving care and unsqueamish walking me to the bathroom, and bathing me while I sat on a seat in the shower, I finally got better. He wheeled me to the NICU several times a day to feed the babies. After a few days we finally got to hold Elisa, who had been cloistered while she still had an IV in her umbilical cord stump. We have James on video feeding her for the first time. What a sweet little, little girl.

We went home without the babies. I had a prescription for percoset and ibuprofen, but that wasn't really enough. I don't know what I would have done if I had to care for newborns in that state. Though I hated to leave the little girls at the NICU, I was grateful for the rest at home. My platelets were closer to normal; my liver enzymes now a mere three times the normal amount, not ten times. My exercise regime was going to see the babies several times a day, and occasionally standing up straight.

And then I looked at my tongue in the mirror and was horrified. Was it that my salivary glands had stopped working? Or was it that something else in my body had thrown my system off kilter? Was there anything else going on in my body that would have disturbed my equilibrium?

Oh, I don't know.

Anyway, yeah, my tongue went back to normal within a few days. It just had to register its disgust first.


Lisa Clarke said...

Whoa! What an ordeal! Thank goodness everything worked out in the end. How's your tongue now?

DAVs said...

Holy crap. You had HELLP syndrome? Geez Kay. That is some very serious serious stuff.

I'm glad you wrote it all down, all the details.

Be well, my friend.

Kay Bailey said...

My tongue is perfect now!