Thursday, March 06, 2008

Wow, It's A Good Thing We Were So Worried About My Cervix (Part 2)

Up until now we've been following me. What, you might ask, was happening to H during all of this?

He had a fairly boring morning. Up at dawn (he's NOT a morning person), off to the hospital without any coffee, and then sitting around waiting to get into the room. We get into the room, and more sitting around. Sit, sit, sit. Off to lunch. Back from lunch to discover the epidural is in and Dr. Favorite is about to rupture the membranes. Cool- now things will get moving!

Um, dear? You're feeling funky? What's that? Wait, who are all these people? We're going to the OR? Um, okay, I'll follow you... I guess she needs a C-section. Well, that happens a lot, I guess that's okay... I'll just stand here... Doh-dee-doh...

I think the part where he gets taken into the OR and handed the baby to hold up for me to see goes in here. I was conscious, so he wasn't too worried and didn't ask WHY I'd been rushed off. He assumed it was the normal reason people get rushed off for C-sections-- a compressed cord or something. He was then sent off to the NICU with the baby.

Experienced Polish Nurse followed him from the OR and said something along the lines of, "I hope you realize how lucky you are." This was where he was informed of just what had happened, but he was left with the impression that all was now fine with me and headed off to the NICU where he spent some time getting the baby settled in. I'm not sure why they sent the baby to the NICU instead of the nursery. I was told later that the NICU was nearly empty and so they put him in the step down unit where he had three nurses to himself for the next few days, but again I'm not really sure.

Back to me. I know it was about 2:30 PM when they delivered the baby. I know I didn't get to the SICU until about 6 PM. What happened in between is a bit of a mystery. I was conscious, they tell me, but I have no memories from that time. I don't remember ever being told I was going to the SICU, nor do I remember being wheeled over there (it was in the hospital next door, but they're part of the same network and are connected by a corridor). I don't remember meeting my nurse, though I met her again later and she reminded me we'd met that first night. I don't remember meeting my pulmonologist, though we actually became buddies over the next 2 weeks. Anyway, at some point late that evening (maybe 8:30?) my memory switches back on and I remember talking to H.

H, by this point, was no longer in blissful ignorance. Upon arriving in the SICU, he also met my pulmonologist (let's call him Dr. LikesMacsToo) who informed him that I was "in for a rough night" but that I "had a good chance." H went white and was pulled into a conference room by Dr. Favorite, who was there as well. She explained everything to him more gently and told him that the scariest part was behind us, but that there were certainly a number of challenges to be faced in the coming days.

Anyway, my memory picks up here with H coming in and sitting with me for a bit before going home to update my mother (she had arrived the day before to stay with us and take care of D) and get some sleep. I did the following in some order that I do not precisely recall: I wondered where I was and why I was there. I asked my nurse to order me a breast pump and bring in a lactation consultant. I noticed for the first time that there were blood products going into me. I wondered what the thick line disappearing under the blanket was (the aforementioned central line into my groin). I noted I still had the urinary catheter in. Dr. Favorite and Dr. LikesMacsToo explained to me what happened. Dr. Favorite told Dr. LikesMacsToo and my nurse that she was going to sleep in the on call room tonight in case anything changed with me. I dozed. Time passed.

I was in the SICU for, I think, three days. At the beginning there was discussion of me being transferred out of there and back to my original hospital so H and the baby could room in with me, plus I'd have easier access to the lactation consultants, and indeed to a staff more familiar with pregnancy and babies (the ICU hospital doesn't see much of that). This talk died down over the next couple of days as more and more lines and drugs were removed and discontinued, but the pee-bag hooked up to my catheter remained stubbornly close to empty. They brought in an ultrasound machine and a technician to take a peek at my kidneys and bladder to see if there was any noticeable damage from the surgery, but there was nothing. The kidneys just weren't working. I had fluid going in but none coming out. This fluid started to accumulate in various tissues of my body, most spectacularly in my lower legs, and more dangerously, in my lungs (did you know they can do chest x-rays on you without you ever needing to leave your bed?). The hospital next door sent over a lactation consultant once my nurse returned the leg pump (yes, a pump for one's leg- I have no idea why) which came after she ordered me a breast pump, and demanded that thay find me an actual breast pump. Everyone warned me not to expect too much in the breast milk department but I think denial was still running pretty rampant for me.

While all this was progressing I had a healthy stream of visitors from my original hospital. Various people seemed to be making it a top priority to see me well and healthy. Experienced American Nurse and Experienced Polish Nurse came by and helped me stagger around the ICU in my first expedition on my feet. Another one of my OBs, who would deliver her daughter in less than a week, came by near tears and said she was just so glad I was alive. Several nurses that I am friends with from my stay in the hospital in the summer of 2005 for preterm labor came by. I also met Doogie Nephrologist, M.D., who was brought in to deal with the kidney issue. Dr. Favorite later confided in me that she's had him checked out and heard he was the best.

Blood work showed my clotting factors were still less than ideal and my creatinine level was rising to soaring new heights. (Creatinine is a by-product of protein metabolism, and here is used as an indicator of how well my kidneys were cleaning waste products out of my blood.) So, my kidneys were really not doing anything for me and my body was filling with fluid. The diagnosis: acute tubular necrosis (meaning all the cells in my kidneys that usually function to clean my blood had died from lack of oxygen). The solution after a few days of watch-and-wait: dialysis. We would hook me up to a machine that could (1) remove waste products from my blood and (2) remove some of the excess fluid building up in my body (another thing my kidneys were slacking on).

A couple of problems first, however. I still had the epidural in. When the pain relief I'd gotten for the delivery wore off (it takes about 24 hours), Dr. O'Wonderful kindly gave me a repeat dose through the epidural. When that wore off, I graduated to an interesting cocktail of various derivatives of morphine. Dr. O'Wonderful told me she'd take the catheter out once my platelets got above 100. Three days and two transfused units of platelets later, they still weren't even close. Also, the dialysis required a procedure to insert a catheter through my chest and into the large vein that returns blood back to your heart, which is something you don't necessarily want to go and do on a patient who is at risk for bleeding, nor do you want to pull a catheter out of said patient's spinal cord, for bleeding there could potentially lead to paralysis from the waist down.

So, they scheduled insertion of the catheter for Friday, and Thursday evening Dr. O'Wonderful sauntered in and said she was going to remove the epidural catheter, despite my straggling platelet level. There was a risk of bleeding and paralysis (in the event of bleeding they would first try an emergency surgery to prevent the bleeding from causing paralysis), but she'd consulted with the other eight anesthesiologists in the hospital, and they all agreed with her that the risk of infection from leaving it in was greater. She made it clear that this was entirely a judgment call; there were no statistics or previous cases to go by. Fabulous. Here we go then. She counseled me on exactly what order my feet, toes and legs would go numb if we had a problem, and out came the catheter. She then nonchalantly strolled to a computer just outside my door and hung out for an hour.

It was a long hour. I wiggled my toes and stared off into space.

Fortunately, the puncture site clotted just fine, as did the site where they inserted the catheter the next day (I think it was the next day; my sense of timing is pretty fuzzy here). The catheter insertion marked my third experiece with an operating table in pursuit of building my family, and while they didn't give me a general anasthetic, whatever they gave me instead caused the whole procedure to take about four seconds by my mental clock. I don't remember much from that day. I was still in a tremendous amount of pain, and couldn't do anything much beyond rolling a little ways onto my side. I pumped and pumped and got a couple of drops of colostrum. I was transferred out of the SICU to a telemetry wing upstairs to continue my recovery and get to know the nephrologists and dialysis nurses a whole lot better.

The baby was discharged that day, too, and went home with my husband. I'd seen him twice-- they brought him over from next door in an incubator on wheels with his own nurse. It hurt to hold him, and I was pretty unsteady, but I did get to hold him for a little while. H took the first photos.

Next up: fun with dialysis! Also, a related topic: how to lose 56 pounds in eight days. And a bonus for faithful readers: how it feels to take a partial shower after ten days without (one of which involved giving birth)!


Lori said...

This is a fascinating story, and you're telling it so well.

But I still wish it hadn't happened to you.

Geohde said...

'That doesn't sound like much fun' is really a heck of an understatement, but it's the best I can come up with other than I'm very glad that I know the ending is good...


KMW said...

I am totally a faithful reader. I can't believe all of this. I can't wait for the next installment. And I am so glad you are okay and sorry that you have to be telling this story at all:)

Alice said...

This is just incredible. How scary for everyone. I found your blog through a friend of mine (KMW) and have been checking in for awhile.
So glad everything turned out ok!

MrsSpock said...

Ah, reminds me of work....and I'm so glad your story has a happy ending.

Jen said...

Came over here because of the very helpful note you left on my blog (thanks!) what an adventure. I'm so glad you and the baby are okay.

dharmesh said...

Normally I wouldn’t comment on posts but I felt that I had to as your writing style is really good. You have broken down a difficult area so that it easy to understand.