Sunday, October 25, 2015

HELLP Me (On Riley's Birth and Allergic Reaction)

Below are two stories- one written after my daughter Riley was born, and the other written a week after she had a severe reaction to something.  I combined them a few weeks ago, when I thought I'd be using this as part of my thesis for my Master's degree.  Instead, I'm posting them here.  Both remind me of how much I love her, and how absolutely lucky I am that I'm here with my daughter, celebrating her 5th birthday tomorrow.  



            I had plotted out what I wanted with my babies from the start.  Life is funny that way, especially for those of us type-A women who have that “go go go” do everything mentality.  Riley’s birth was to be a serene event, all calmness and essential oils, my doula by my side while I held my husband’s hand and delivered our perfect daughter.  I didn’t want any drugs, I wanted to be able to walk the halls of the hospital, use their birthing tubs and shower, and have a holistic, transcendent experience.
            The best laid plans and all that.  
            At my 39 week appointment, I remember that the office was cool, and the thin white gown didn’t cover much of my nine-months-pregnant body.  I lay back as the blue gel squirted onto me with a squelch, and I was simultaneously repulsed and comforted by its warmth.  He ran the white plastic heart monitor over my stomach, as the baby kicked in protest, its heart rate audible through the little speaker system.  After, he gently prodded my stomach, the skin so tight I could see the tiny mound where I knew my child was trying to moon Dr. Weidman.
            When the exam was over, he removed his gloves, cheerfully saying “Well, it looks like you’re going full term. No effacement, fingertip dilation.”
            Damn, I thought.  I wanted her here NOW.  For once in my life, I wasn’t able to will something to happen.
            I groaned, looking up at the wallpaper where it met the ceiling. “Really?  Because I’ve felt so nauseous.  I was really hoping-”
            There was an almost imperceptible flicker on his face, his eyebrow twitching just a bit.  “Nauseous?”
            “Yea, can you believe it?  Not a hint of morning sickness until now, and all of a sudden, I feel dizzy and sick.”  I shook my head, which made the dizziness slightly worse.  He looked at me, nodded, and glanced at my chart.
            “You know what?  Let me just have the nurse run a blood test.  You don’t have any of the major physical signs- your protein is +1, your blood pressure is a little high for you, but pretty normal for other people- but I think we should do this, just in case.”  He opened the door and called out.  “Barbara?”
            I saw the nurse with the curly greying hair and big glasses walk down the hall, and they conversed briefly.  I got off the table, and waddled towards her, while Dr. Weidman tapped my back, and said he’d call me with the results.
            “Do you want me to order it stat?” Barbara said, looking at my puffy hands and wrists as we turned into the blood drawing room.
            He nodded, and wrinkled his brow.  “Yes. I think that’s a good idea.”
*          *          *
            Come on,” I said, bending and grunting, willing the shoe to expand just a little more, the fluid in my foot to shift enough so that it would fit into the sneaker.  I could hear ringing coming from my bedroom, and, fed up, I dropped the shoe, and ambled over in search of the noise, while simultaneously casting glances around for my flip flops.
            GYNO flashed across the top of the screen in bold letters, as I sat down on the bed, which creaked under my oppressive weight, and I flipped open the phone.  “Hello?”
            “Hi, Kristen.  It’s Dr. Weidman.”  His voice had just a hint of nasal to it, and was almost monotone in its calmness, rather reassuring.
            “Hi there.”  I leaned on my back like an upside down turtle, and tried to use gravity to get my flop flops onto my feet
            “I just got your test results back, and they’re a little abnormal.  Your levels seem to be a little off, so I want you to go to Valley to get retested.  It might be something called HELLP syndrome, a bit of pre-eclampsia, but we want to be sure.”  I detected a hint of urgency in his voice, but wasn’t sure if I was imagining it.
       The flip flop slipped on, and I did a little wriggle victory dance.  
       I didn’t know until much later that HELLP was ridiculously rare, affecting only 1.2% of pregnancies in the US, and was an acronym standing for H (hemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count).  I didn’t realize that it can cause a woman to bleed out, her liver to quite literally rupture, or cause a stroke.  In my mind, it had a cute title, something you ask for politely: “Excuse me, but I have a case of HELLP- can you please help me?”  Liver levels over 200 are considered high.  The test revealed mine were over 1000.  Dr. Weidman told me later he thought there was a clerical error and that the person added an extra 0 to the end.
       “Okay.  I can do that.”  I looked out the window, noting that PSEG was blocking my driveway with a forklift while they worked on the road outside.
       “Do you have someone who can drive you?”  He stressed this, as though it were an important point.  I glossed through it.
       “Sure.  Sure.”  I struggled to get to a sitting position.  “Should I bring my bag with me?”
       “That’s probably a good idea.”  I could picture him nodding.  “If the results are the same, we’ll probably induce you tonight. “  I was almost giddy, thinking about the possibility of meeting Riley.  Finally.  
*          *          *
            “This is Dr. Weidman’s patient- I need you to get her a room.”  The nurse’s skin was dark against the shiny white countertop.  Another woman walking by guided me into the room, swiftly handing me a gown.
            “Fasten the ties in the front.”  She turned to input my information on the computer, and hooked me up to a baby monitor and a pic line.  I marveled at the efficiency of the nursing staff.   Jeff arrived, bag with a sandwich I insisted he grab in hand  (seriously, it’s fine. If anything, they’re going to induce, so stop off and grab yourself something for dinner, in case it’s a long night, I’d said while whizzing through the streets of Ridgewood, phone on speaker and my foot tapping the pedal).  He gave me a quick kiss, and went to have a short tete a tete with the female doctor on call in the hallway.
            “My wife was hoping for a natural birth- our doula is on the way.  Is there any way we could at least induce her?” he nodded towards me.
            She looked at him, her face serious and solemn.  “She has HELLP syndrome.  It’s a severe form of pre-eclampsia, and the baby needed to come out.  Dr. Weidman is on his way, and I’m scrubbing in just in case.”  She put a hand on his arm, and Jeff noticed she was shaking.  “I’m sorry, but we have to do this, and we have to do it now.”
            The anesthesiologist came in next, and started talking about low platelet counts and potential clotting issues. My husband looked nervous, and I squeezed his hand.  Our doula arrived, all smiles and reassuring back pats.  I only saw the baby coming, the daughter I’d been dreaming about since I toted around dolls as a child, naming them and giving them personalities and backstories. Now I had a real baby, one I could feel stirring in my body, her tiny arms and legs pushing against my taut skin.
            The C-section itself was surreal.  I’ll be honest- I felt like a failure in my first effort at motherhood, lying on a gurney, blue sheet separating me from my daughter.  There was no pushing, no lavender oil, no walking around (my body was numb thanks to the epidural).  I felt very biblical with my arms splayed out and strapped down.  There was an unreal amount of pressure as the doctor pushed down on my stomach, and a huge release as he began the incision, saying “it’s time if you want to look!”
            I made a note to myself that with any future children, I would not look.  Seeing your internal organs is not something I want to make a habit of and there was a lot of blood as they reached in and pulled out my daughter’s purplish-red body.  The nurse used an aspirator to clear her nose and mouth, and the doctor held her above the curtain, her tiny face contorted in a cry while I blubbered and shook, the oxygen tube in my nose blowing cool air.  They took a second to place her next to my head, and I was able to just touch her cheek with my finger (they freed my arm for this moment before subtly retying it), and then she was paraded out of the room by men and women in scrubs, their mouths covered by masks.  
I could feel my skin being tugged as they sewed me up, and heard my doula ask for Zofran for me when I whispered how nauseated I was.  The gurney shimmy shook around the corner while they wheeled me to recovery.  The clock’s hand ticked past, heading towards the next hour with vigor while I chit chatted with the nurse on duty, asking for my daughter’s Apgar score (which was a 9 out of 10- her first test, which determines how well the baby tolerated the birthing process, was a rousing success.  “Already overachieving,” I mentioned to the nurse), and wondering when I would next see her.
            Jeff walked in, pale and shaky.
            “Where is she?” I asked, smiling through the drug induced fog.  “She’s okay, right?”
            He nodded, and then the tears started coming.  “Her temperature started to drop and she had trouble breathing.  She swallowed fluid on her way out.  She’s okay now.”  He sucked in a breath and I exhaled. “They had to bring her to the NICU and tubed her twice. I couldn’t do anything.  I just stood there.  She’d hooked up to monitors, and has a little breathing tube in her nose…”
            “But she’s okay?” I was confused.  This was triumphant birth day, the culmination of over 15 years together, of all the love we had and the effort put in to have this perfect little girl.  I had done everything right- eaten healthy, taken my vitamins, stopped working when the doctor said to.  I never drank, hadn’t been around smoke, and had exercised and walked right up to the last day.  And the C-section had been flawless.  Her Apgar was a 9, for goodness sake.  He looked at me, then at the clock.
            “Go back to her.  I’m fine.  Just let me know she’s okay.”
            I passed out soon after, the effect of a number of calming drugs, and woke up shortly after midnight, when Jeff wheeled a plastic bassinet into my recovery room.  I struggled to sit up, and realized the epidural had worn off, leaving in its wake a tugging, aching sensation in my abdomen.                  
           “You ready to meet your daughter?” he asked, gently lifting her from the plastic tray, like a waiter revealing the night’s wine selection.  
            Her eyes were open, and her mouth formed a tiny heart.  I reached out while he laid her on my chest, and her little hands curled around my fingers.  Her dark brown hair was soft as I brushed my lips against it, and she looked up at me sleepily, her eyes big and round with wonder.  She yawned.
            “Hi Riley. I’m your mommy," I whispered, tracing her tiny eyebrows with my fingertip.  Her skin was soft, covered in a thin layer of downy hair, and her skinny legs kicked against her swaddle.
            I promised myself in that moment that I’d always keep her safe.  It’s an impossible promise made millions of times a day by parents around the world.  But we try.  And we fail and try again.
            When she was a week shy of her third birthday, I was completely exhausted, and trying to find some way to spend time with her, play with Ella, and still get all the stuff done related to work.  Sleep was an afterthought more and more, and on one afternoon, I finally found a quick moment to sneak into the back room. 
            I fidgeted, burrowing under the Lightning McQueen comforter snatched from the family room, and buried my face in the pillow.  The bed creaked under my weight, and that of the small creature who climbed over the edge of the bed, and onto my back. 
            I hadn’t slept in ages, and the “to do” list in my head danced by, as though each activity were a sheep I needed to count.  1. Grade papers on Allegory of the Cave.  2. Wash dishes.3. Fold laundry (note: did I switch the laundry?).  4. Answer business emails.  5. Organize Riley’s clothes and move things that are too small to Ella’s room.
            "Mommy," Riley whispered.  
            Children never understand the importance of naps, I thought.  
            I sighed into the pillow, trying to hold onto the sleep that was steadily drifting through the dark recesses behind my eyes. 
            "Mommy, my eyes hurt.  Blow on them."
            This is my own fault. 
            Any boo boo, any scratch on her arm, or soreness from bumping into something, mommy blows on it and everything is okay.  More often than not, one of my children asking for me to blow on something is a push for attention in this crazy hectic world.            
            And a push for me to not sleep.
             Riley knew how to make an entrance, knew how to interrupt.  My stubborn streak and ambition were somewhat legendary in our family.  If I wanted something, I went after it, and got it.  She was the same way, both modeled after me, and something I’d wanted forever.  I wondered if her impatience was a direct result of my own when I’d been pregnant with her.
            In the darkened room, I remembered the dizziness as a wave lapped over me as I  rolled to face my older daughter. Her father was in the other room, relaxing with our one-year-old, Ella. Opening my eyes, I intended to blow into Riley's, so that I could go back to pursuing sleep.  But in the haze of my contacts sticking to my eyelids, and the soft light coming in from between the shade slats and the hallway, her eyelids looked like puffer fish. 
            Normally bright blue, the whites and irises were black slits.  Her cheeks were smooth and round like steamed dumplings, and even in the shadows, I could tell her skin was pinker than usual.  The blanket tangled my legs as I kicked free, grabbed her, and swung out of bed, literally running as I hit the floor.  My dogs lifted their head, in case I had food on me, and my husband looked up from his computer screen as I, with all the calmness of Peyton Manning in a two minute offense, said "She's having an allergic reaction.  We need help.  I’m going to Valley."
            I grabbed my purse and keys from the pile of papers and mail on the counter, and swung myself towards the door as Jeff called out, "Wait- I'll get Ella and we'll-"
            Thundering down the stairs to the side door, he was cut off by my voice.  "There's no time. If this is what I think this is, I need her in the ER NOW."  I left them in the living room, him reaching under the sofa to find shoes for Ella’s tiny feet.
            Buckling Riley into her car seat was done on autopilot, my hands shaking as I snapped the metal buckle into its plastic holder.  She was whimpering.  Thrusting the keys in the ignition, I cursed as a plastic water bottle rolled beneath my foot.  It was promptly kicked into a strawberry-banana bar wrapper, and rolled to a stop next to a small rubber ducky with a mohawk. 
            There were too many cars on the road for one in the afternoon.  The minivan sped around them, a curving red bull racing over straight double yellow lines, maneuvering past the brick townhouses with bright white trim and the antique Victorian homes with turrets and grand front porches.  A woman in an SUV was driving slowly, inching along while chatting on her phone and fixing her hair in the rearview mirror.  I waved my arms and leaned on the horn, swerving around her and screaming out “I’m sorry!  Hospital!” as she gave me the finger and went back to her hair.  
            I was  panting, and Riley was weaving in the rearview mirror.  "Riley, sing 'The Wheels on the Bus,'" I encouraged, trying to gauge if she was having any problems breathing or speaking.
            "No mommy, ABC's."  In the middle of utter terror, I laughed at my daughter's obstinance, noting that one, she seemed to be breathing, and two, that even in the most dire of circumstances, it's nice to know she is little miss bossy pants.  A red light loomed, and I said a quick prayer as I slowed, made sure no one was speeding through, and turned right. Careening into Valley, I saw the men in their valet jackets, and left the keys for them, grabbed Riley out of the car seat, and ran through the doors that opened with a whoosh.
            The front desk was a wall of glass with a podium in front, an off duty guard listlessly leaning on his fat forearm.  The hospital, for all its bright lights, was markedly dimmer than the blue skies outside.  There was someone ahead of me, giving his name and information, but the nurse off to the side took one look at my daughter, and said "Allergic reaction?"
            "I think so," I said, grateful that she, in one motion, opened the door, and ushered us through to the pediatric ward on the right.  The fluorescent lights hummed above, and the floors were slick and hard beneath our feet.  It looked so much like the labor and delivery floor- all side rooms, curtains, and people walking quickly and not really looking around. 
            "I need a room," she stated, not so much a question, but a "don't mess with me" statement.  Her tight blond bun bobbed on her head ever so slightly, and her face was stern and sturdy. 
            "Well, this one is available now, but w-" the male nurse shrank as he spoke, all thin limbs and gesturing hands.
            "Get me a doctor- allergic reaction," she said as I followed her past a curtain and into the small room, smoothing my daughter's hair the whole time, and kissing the top of her head.  Her brown hair was falling on her forehead, and her skin felt hot to the touch.  She whimpered a little, and clung to my neck, burying her little face in my hair. 
            I was amazed at the number of people who appeared within seconds.  There was a nurse with a dark, loose ponytail, holding a syringe in her hand, and a small bottle.  There was another woman, with a fairer complexion, hooking my daughter up to the blood pressure machine, and placing a little gripper on Riley's tiny finger to check her oxygen intake.  The third woman, who I am assuming was a doctor, made a game out of checking Riley's other vitals.  Her smile was cool and reassuring, a practiced facsimile of the real thing.  She bent down over Riley on the white table, one hand on the metal handle. "Can you open you mouth big?"
            I finished with a silly rhyme I knew Riley would recognize "...and wide.  Where's your tongue?  It hides inside!"
            On cue, she stuck out her tongue, opening her mouth wide enough that the doctor could see her perfectly shaped little uvula.
            "Good news- her airway is clear," the doctor nodded to me, smiling.  Then, she turned to the nurse holding the syringe.  "No Epipen, but give her 10 mL of prednisone, and 6mL of Benadryl, and let's see if that works.  Let's try it orally- I don't think we need an IV."
            I breathed for the first time since I'd seen Riley's swollen face.  The professionals continued to check her out, noting the blotchy, raised hives taking over he belly, legs, and arms, swarming like dragon scales, while I answered questions at length about our family history of allergies, our health insurance, and Riley's food intake that day. 
            There are moments in your life when you realize there are more important things than sleep.  That no matter how strong willed you are, your world can be turned upside down, and no matter how prepared you are, how well you’ve plotted everything out, it doesn’t matter.  A random disease, ingesting something new.  On a random Tuesday, the world can fall apart, or come together like a jigsaw puzzle.  Peering down at my daughter, I ran my hand over her hives, which had begun to go down. The miracle of modern science.  Around the half hour mark, Riley's light blue eyes were once again visible.  She was curled against me, her breathing slowed and steady from the Benadryl.  She closed her eyes and began to softly snore.  I knew sleep for me wasn’t going to come.  And that was okay.  Watching her sleep, feeling her moving next to me, that was more important than the most glorious afternoon nap.  The machines around us hummed and whirred, and I curled around her on the child sized stretcher, curving my fingers around her tiny hands.


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