The Days After the Day After

 Jonah sidles up close to me.  His face is pink, and so angelic.  His eyes sparkle with little flecks of gold and sky blue, and there is a comical spray of chocolate freckles across his nose and cheek from a stolen "hi-bar" (granola bar) that he somehow managed to sneak.  I smile at him and he tells me he loves me, and all feels well with the world. 

After we were released from  "the procedure that never happened" Friday, Guy took me upstairs in a wheelchair to visit my sweet nurses and tell them the good news.  They were overjoyed.  They hugged me and smiled and hugged me again.  Nurses nearby who didn't even know what was going on had smiles on their faces.  We hugged goodbye and said we would see each other in a few months when I gave birth. 

We spent the rest of that day glowing with smiles and sharing the good news.  Hours of phone calls and emails occupied our day, and that night that Guy helped me into bed and we gratefully fell asleep in each other's arms.

The next morning before my eyes were even open, a crushing feeling settled on my heart.  I was disoriented and confused, and couldn't understand what we had been through the day before.  My heart was racing, my blood sugars soaring.  I spent the day mostly immobilized on the couch.  Threads of doubt wove their way into my thoughts.  Could there have been a mistake?  Could they have been looking at the wrong vein?  Of course not, I reasoned, there is only one vein that large in my leg.  What if they had scanned the artery rather than the vein?  No, the contrast dye would have headed down, not up, if they had been in an artery. The same doctor that diagnosed me gave me the scan.  There was no mistake: my vein was proclaimed clear.  I felt like an Israelite lagging behind at the side of the Red Sea, already questioning if I had really come across it.  Am I a doubting Thomas even after having seen the evidence for myself?

As evening drew to a close, my thoughts began to clear.  I realized that the Prednisone had been playing with my mind throughout most of the day, as well as my heart rate and blood sugar.  I settled into a peaceful place somewhere in my heart, and calmed down.  Not much later I began to realize that my leg was beginning to swell and hurt.  They had warned me that a clot could return, that we weren't out of the woods entirely.  I began to panic.  If you doubt in the miracle, does it go away?

It dawned on me then, that I had been sitting motionless for hours and that the weight of the baby was pressing on my vein, causing it to be even more restricted than it already is.  I went to bed and stayed there all day yesterday.  As the swelling went down, I began to understand what a very long process this is going to be.  I will need to be careful how I even sit so that I don't make things worse or cause a new blood clot.  Today I woke up feeling even better, knowing that I have the support of my family and the comfort of loving friends. We can do this.

Today the high risk OB called...

Without skipping a beat he unfurled a laundry list of all of the things that could possibly go wrong with this pregnancy over the next three months.  At any point in time the placenta could detach from the uterus, necessitating an emergency delivery to save our baby's life.  "10% chance, very high," he said.  I may have inherited this disorder from my mother who had a history of blood clots.  My aunt had blood clots in pregnancy too, lending more evidence supporting his genetic theory.  Because I am on blood thinners they won't be able to test me to see if I am lacking that clotting factor genetically until after the baby is born.  If it is genetic, my body may be trying to create blood clots that will cling to the back of the placenta and inhibit the baby's growth.  I will need to receive ultrasounds every four weeks to check to see if the baby is growing, checking its kidneys and liver and heart to make sure that they are still developing.  If baby is not growing right, it will be safer outside of my body than in, and I will have to have a very early delivery.  The goal is to make it to 35 weeks, the doctor said. My goal is still to make it to 40 weeks, I thought. The doctor is still very concerned about a pulmonary embolism and reviewed with me all the symptoms.  We realized I have had symptoms of small fragments of blood clots entering my lungs over the past week.  If the symptoms persist for more than 10 minutes next time he wants me to go to the hospital. 

Like a cherry on top, the doctor ended the phone call with one last word of caution;  if I get a uterine infection during labor, a "balloon of bacteria" could enter my bloodstream as the placenta detaches and infect the blood clot in my pelvis, putting me at risk for a massive blood infection.  You know, just in case I didn't have enough on my mind.

A few minutes after hanging up the phone with the OB, Mary, a sweet nurse I have only met over the phone, called me.  I started to cry when I heard her voice and told her everything that I had just learned.  She had called to tell me that the midwife was not comfortable seeing me as a patient because of all of my risks.  We talked for over an hour.  By the end of it I was in better spirits and Mary was excited to help me.  She would talk to the midwife about following my care.  I need someone who sees me as a pregnant woman, not a woman ready to give birth to a blood clot, I told her.  I am being followed by every other doctor on the planet for my leg, for the blood clot, and for the high risk nature of this pregnancy.  But I need someone who will still tend to my mama heart.  I need someone who will still listen to the little details that are important to a woman who is getting ready to welcome a baby into the world.  Mary said she would do whatever she could to help me find that safe place in all this chaos.

 

There is literally nothing I can do. 

 I can't eat better, I can't exercise, and I can't take more vitamins. 

This is completely in God's hands. 

At some point in time over the past two weeks, a nurse said to me,

 "God hasn't gotten you this far to leave you alone now". 

 I cling to those words every day.

 

 

A Thousand times a bunch...

Jonah is snuggled at my hip.

 

"Miss you, mama.  Dove you, mama."

 

"I love you too, sweetie."

 

He says this a lot now.  Every day since I came home from the hospital.  That first day he said "miss you" about 25 times.  I missed him, too.

 

*****

If you are beginning this story today, go down to read the previous post first.  You definitely need to get caught up.

 

I was given a shot.  It was to stop my blood from clotting and to keep the clot from growing.  Donna said I would learn to give myself this shot and would do so every 12 hours from now on (later told it would be for 10 months,  but by the time we were clear on details, we learned it would be only till the baby comes, then I will go on pills.).

 

We were taken to Postpartum, where we were settled in a room right out in front of the nurse's station.  Over the next several hours many doctors came in.  The first, we call him Dr. Roto-Rooter, came in like a whirlwind.  He stood at the doorway and told us that the clot was very dangerous.  It could break off and go to my lung, causing a pulmonary embolism, which could be fatal.  The treatment for a PE was very dangerous for baby.  He said a surgery could be done, right away if we wanted it, where they would use an ex ray for 2-3 hours to insert a catheter up into the length of the blood clot while I lay on my belly.  They would then place me in ICU over night while they sprayed a chemical called TPA into the clot for 10 hours.  Next morning they would remove the cath and suction out the blood clot.  If I didn't do it, the damage to my leg would be permanent.  The blood clot, we were told, was not affected by the blood thinner, and may or may not go away on its own, but not for months and not in time to save me from damage.  If we wanted to do the procedure, it would only be effective if done in the first 14 days. 

 

 Oh, and by the way the clot extends from mid calf all the way up to the area in the pelvis behind the baby.

"What about the risk to the baby?" I asked.

 

Yes, he stated rather nonchalantly, the risks of ex ray include cancer and tissue damage, and the risk of the medicine to the baby and to me was internal bleeding.  I told him that all sounded out of the question.  I pictured the baby, it's tiny brain happily developing, with a sudden uncontrolled bleed, damaging it forever.  And cancer?  In our little child, all so that my leg wouldn't be damaged?  We asked questions that the doctor kept deferring, "This isn't really my area of specialty.  You'll have to ask the Radiologist"

 

He left.  I told Guy that I felt like he had just come in and dumped a wheelbarrow full of barn-droppings at the foot of the bed and left.

 

15 minutes later, Dr. P reappeared to explain that I needed a filter put into the vein below my heart to keep chunks of the blood clot from going to my heart and lungs.  There were risks, 10 minutes or so of direct radiation to the baby.  We had questions, he said he would find out the answers from the radiologist.

 

Our nurses came and went, tending to us carefully and sweetly.  Lori, who stayed and listened to what the docs were saying, tried to comfort us.  They had seen blood clots before, "but like this," Nurse Kim said, holding up her fingers like she was holding a bean.  "None of us can even remember hearing about one this big back in nursing school."

 

A while, a century later, a new doctor came in.  He was the Interventional Radiologist.  He let us know he had trained at Stanford under the "Guru of this field of medicine".  He re-explained both the filter and clot procedures, and fielded our very concerned questions.  He understood that I wouldn't expose the baby to such extreme risks.  He said that, looking at my leg, he felt like there was a good chance my leg could fair pretty well if we just left the clot and hoped for the best.  But if the leg didn't respond to the blood thinner he said I could loose it, and the surgery would save it.  "Are you a praying man?" I teased.  "If you two are, then I don't have to be."  He said.

"Oh, even more so!" I smiled

 

He stayed a while and answered more questions.  The filter, he felt, was redundant with the blood thinners now started.  He said it was old school to do both.  It was a comfort to know that he heard my concerns and was not pushing the procedures.

 

That day is a blur.  Sweet angel nurses focused heavily on my lungs, making sure I didn't have a pulmonary embolism.  They each brought some new comfort and kindness that was needed at each moment.   Guy had to leave to tend to the kids who had been alone all day.  I cried as I watched him step behind the curtain, allowing myself to think for just a moment about what could happen while he was gone.   Kathy came with flowers and listening ears.  Calls came.  I learned to deal with mother nature's calls without moving my leg. 

 

Later that night, the Stake President (the person in charge of the group of eight local congregations of our church), his counselor and our bishop came to administer to me.  President Fisher uttered a sweet blessing on my behalf, calling on miracles, and blessing my doctors and nurses.  The room was filled with peace and beautiful warmth, and tears, of course.

 

We knew that something huge and potentially life threatening was happening, but something even bigger was happening in the four walls of that little room. 

There was a peace that said, "all is well".

 

Guy and I sat in the alone in the dark that night and spoke words of gratitude and held each other.  This is the biggest thing that has ever happened to us.  I am so glad God is the one in charge.  This is way too big for tiny mortals like us.

 

I went to sleep.

 

*****

 

We would learn a lot more about the risks of not addressing the clot in the next few days.  For that reason (as many of you already know) this story comes a little out of order here.  Tomorrow morning (March 1st at 7:30 AM)  I am going in for a procedure on my vein.  It is a "mini" version of the first one offered.  There will be no ex ray near the baby.  It will be 1 1/2 hours as opposed to 14 hours.  They will only do the thigh, and leave the clot in the pelvis till after baby is born.  They will use a teeny dose of the medication only in the clot, which does not cross the placenta, and then manually remove the clot.  If you pray, pray for us tomorrow.  If you don't pray, go ahead and send one up anyway, for me, please :)

One in a Thousand

It is with immense gratitude that I lay here in my bed at home writing on my blog once more. 

Last Tuesday I noticed while exercising that one of my legs was really tired.  I sat down several times to rest, got back up to continue, and finally teased Kathy that I would just watch her jump around and benefit vicariously.

Later that night I sat on the couch writing the last post.  I got up for dinner and felt a strange sensation.  My thigh, my whole leg even, felt like it was wrapped in a band or a cast.  It was like my muscles were seized up and it was hard to bend my knee.  I figured I had some how strained a muscle, or many of them, but strangely, there was no muscle pain.

A call to Guru Ellen, expert masseuse, for muscle advice led me to actually look at my leg.  It was swollen, a little purple and blotchy.  "Call" she said, so I did.  My midwife asked lots of questions about lumps, hot spots, pain, vericose veins - but I had none.  She said some women have cirulation problems in pregnancy, to gently stretch and elevate, and call if needed. 

I went online... there were references to blood clots, with a long list of symptoms, but I had none of them besides the swelling.  Anyway, the info said that the chances of a blood clot in pregnancy were one in a thousand.  One in a thousand.  Certainly not me.  I elevated my leg and wrote a post on my blog.  The theme of it now seems ironic in retrospect.  I went to bed.

At about 4AM I woke moaning.  My back was killing me.  I was feeling strong cervical pain, and then I had a contraction.  I headed to the bathroom, and upon standing a small but sharp twinge of pain shot through my leg.  I woke Guy, "You need to take me to the hospital.  Something is wrong"

We got in the car and he asked where to go.  Roseville was the newer, more modern hospital, but South was 10 minutes closer.  I figured closer was better, so I said South.  It would come to make all the difference.

When we arrived at the hospital I had Guy take me to Labor and Delivery (L&D).  "We can skip the ER," I said.  I knew that at 25 weeks I was finally to the point in my pregnancy where they would try to save my baby. 

In triage I was checked by nurses and then an OB, all with smiles and calm voices.  My pulses in both feet matched, and I turned to Guy and said, "Well, looks like we're going home".  The OB came back and said she was just going to send me over for an ultrasound of my leg "to be on the safe side". 

The radiologist, Jane, was sweet and careful.  Soon I was realizing that this scan was taking a long time.  After having had four miscarriages, one learns the body language of a radiolgist, and I could tell she was finding something.  She called in a woman in a white coat.  Jane asked her vague and carefully worded questions.  A finger point to the screen and a nod.  Back to the calf, back to the thigh, back to the groin, now to the lungs... something was clearly not right.

The specialist left.  "I know you can't tell me anything, but I think you found something." I said with the lilt of a question.  Jane smiled gently and said, "You're right, I can't.  Let's just say there is a reason you are here.  It was a good thing you came in tonight."

I was glad she said it.  I guess it echoed in my mama heart that somehow I had listened to a voice from somewhere deep within; one I had always wondered if I would hear in the time of a "real emergency".  But honestly, this didn't feel like one.

Back in L&D they tucked me into a bed.  One sure sign you ain't goin' anywhere is when they tuck you into clean sheets... if you are going home, you stay on paper. 

I don't really remember what happened next.  Guy says Dr. P came in and told us that I had an "extensive blood clot".  I remember trying to ask what that meant, but not getting a clear answer.  My nurse, Donna, was sweet and kind and smiled at me.  She retold me about the medication I would be given soon, but I don't know how much I understood at the moment.  It was confusing, and it was about to get worse.

(continued here)