The First Day of My Hospitalization for PPROM

Wednesday, February 20th 2019

WAKING UP IN A HORROR FILM

*Note even though the imagery described below is factual, it might be too graphic for some readers, proceed with caution*

I woke up at 1am feeling like I was surrounded in moisturize, I remember feeling my pants and asking myself, "Seriously Heidi, did you pee your pants?". I didn't feel any severe pain beyond the normal pregnancy aches and pains that I had started to become accustomed to. I went straight for our master bath and turned on the lights. What was behind me was an image from a horror film. Our bed, the floor, even when I looked down at my pants, everything was completely soaked in what looked to me like gallons of blood. I screamed out once to my husband who was still laying in bed but the first time no words came out because I was so horrified, my lungs could not bolster the volume needed to make a sound. After a deep breath, I screamed my husband's name and told him I was bleeding. He jolted up, still asleep and uttered incoherent words loudly. Finally when he took in what was beside him I was already changing my clothes and putting on socks and shoes. At first I told him to get dressed and we'd drive to the hospital but then thought of our 2 year old sleeping soundly in her room and demanded that he stay home because she most likely wouldn't be allowed in a hospital room anyways and I didn't want to disturb her. My husband Joel asked if I felt the baby, I stopped suddenly trying to feel anything and nothing, my stomach felt limp and lifeless. He didn't put up a fight with my decision because I think he was in too much shock. Adrenaline was surging through my body as I drove myself to the hospital, the roads were empty. I kept trying to stay within the speed limits and then blowing through them thinking if I got pulled over I wouldn't even be able to talk through the tears. I sobbed for the first 15 minutes of the car ride when I finally noticed no music was even playing inside the car and I was driving in silence. I decided to call my Mom. I didn't think she would answer at 1:20 in the morning but she picked up on the last ring before the answering machine kicked on and all I could do was sob, no words forming in my mouth. She asked "What's wrong"... I could only cry ."Is it the baby?" and I said "Yes". She asked "Did you lose the baby?" and I said "I think so". I told her I was going to the hospital and I would call her back when I knew more.

When I arrived at the ER and walked in, two younger receptionists were chatting and laughing and I felt embarrassed to break up their conversation when their expressions went flat and they saw the tears running down my face. At first I couldn't speak, I just rummaged in my bag handing them my ID and Insurance card with a shaking hand. I then finally mustered up enough air to tell them, "I am 24 weeks pregnant and I woke up in a pool of blood", they pointed at a wheelchair and told me to sit down. They made a phone call and asked, "Do you feel the baby moving?" and I paused again waiting to feel something and said "No." They wheeled me up to the same room where I was admitted when I was pregnant with my daughter and had come in when my contractions started. They had me undress and fill out paperwork and sent in a nurse and a nurse practitioner to do an exam. A sweet nurse laid me back to get a heart monitor on my belly. She applied the cold gel and pressed the monitor down and around my belly, I remember looking her in her eyes looking for a reaction to what she saw and finally shaking my head when she couldn't find anything after a minute of searching and watching her expression. She instantly told me to stop, she said it was still small, so harder to find. Suddenly she stopped and turned up the volume of the machine. She pointed at the monitor, it looks like a normal heartbeat to me, 155. I was in disbelief, this whole time I thought I had already lost the baby, now my stress levels were on alarm thinking about what could be done next. In the next hours they did test after test. Drawing blood, doing a swab of the fluid to look at it under the microscope to see if they could see what is called "ferning", a sign that amniotic fluid was present in the blood meaning my water broke, hooking me up for heart rate monitoring and contractions. They ordered an ultrasound and refused to let me get out of the bed. They took urine with a catheter for a clean sample. The sweet nurse named "Dana" kept getting swabs but told me there wasn't a very accurate test to take because the mixture of blood would give the amniotic fluid test a false positive. A quiet man came in to do my ultrasound and didn't say a word the entire time. Again, I tried to study his face instead of the monitor to look for some kind of reaction to what he was looking at. He left and I asked the nurse for an update. She said after the bloodwork, labs and ultrasound were reviewed by the Dr on call they would be able to tell me more, that she was just a nurse and couldn't give me a diagnoses and that one of the Doctors from my practice would be in at 7am so I would most likely have to wait until then. She said if the bleeding stopped maybe they would discharge me once the Dr signed off. In the mean time my back pain increased more and more as the hours went by and they continued to monitor the fluid I was losing. When the Dr arrived she said she remembered me even though she was the only Dr I had not met from the practice. She shock my hand and looked at my labs. Everything looked normal. She did an exam and looked completely perplexed, simply saying...well the blood is coming from somewhere, stating my cervix was intact. She finally looked at me and said the hospital was not equipped to take care of a baby under 30 weeks old and she would be calling the High Risk Ward at Northshore for their recommendation, that they were able to care for babies as small as 22 weeks. I remember thinking, am I having a baby today, how could it even survive? While she was gone I did exactly what you are NOT supposed to do, which is google statistics for survival of an infant born at 24 weeks. She came back a couple minutes later and said they approved the transfer and that a rescue squad would be up to transfer me. The nurse reassured me that it sounded intense but that it was necessary to transfer me to a place that could care for me in my condition and for the baby if I went into labor. She came back with a steroid shot which she said would be necessary if the baby came early. She warned me that many people thought it was very painful and to prepare myself. I told her afterwards it wasn't as bad as all that. She told me everyone's pain tolerance was different. Two young men who looked like they could be my high school students arrived. The nurse said I should try and pee in a bedpan before I left but I wasn't allowed to get up. I had been holding it all this time, dreading the thought of it. Afterwards they wheeled me through the hospital into the critical care wing. As I looked through the first critical care room I saw an unconscious woman, wound in bandages and a young woman holding her hand with her other hand covering her eyes. Wheeling past another room I saw a family crowded around a man in bed with mournful faces and wheeling past a final room I saw a priest talking to an elderly man while his wife watched on. They got me in the ambulance and I tried to make light of the situation by telling one of the boys that it was my first ambulance trip. I asked how long the transfer would take and he said 25 minutes. I fixated on the clock in the ambulance as the ambulance jostled me around and my pain increased and warm tears started to pour out of my eyes again. I started breathing deeply, we kept hitting traffic. The young man sitting behind me told the driver to put the lights on as my breathing must have seemed more intense. It took over 45 minutes to arrive even with the sirens on. I was wheeled into a high risk room and the lab work and exams started all over again. The nurses hooked me up to a hundred machines and inserted an IV, it was then I realized my lips were cracked and bleeding because moisture started to return back to them. They asked me questions like who my emergency contact was, if I had a living will and who would be in charge of medical advanced decisions if I was unable to do so for myself. I begged the nurse for Tylenol or anything that would help with the pain. She said a Dr was on their way to evaluate me. A resident who explained she was not one of the high risk Drs (who was in surgery) asked if they did an amniotic fluid test on me. I stated they kept doing the slide tests to look for ferning but they thought the fluid test would be a false positive because of the presence of blood. She said she wanted to do the test anyways. As she swirled it around it turned bright blue, a positive for amniotic fluid. She asked if anyone told me what to expect. At this point I had no clue what the hell was going on, just that I was bleeding, my pain increased and that somehow the baby was still alive. She sat on a chair and scooted up close next to me so our faces were close together. She said because there is now evidence that my water broke I would not be leaving until the delivery of the baby. She said I could deliver that night or even up to 10 weeks from now if things were stabilized. I tried not to shed a tear and listen completely but it was almost as if a ringing bell was going off inside my head making it hard to concentrate on what she was saying. She said that the NICU Drs and high risk Dr would be down to talk to me as soon as they could find time in their schedule, she told me to make phone calls and arrangements to prepare my family and work about the situation. I quickly texted my coworkers and told them I would not be returning to work for along time and that I would be a permanent resident at the hospital. I didn't know what medical obstacles the new baby would face. I started to worry about how many sick days I had, what insurance would cover, insuring the new baby and how we were going to manage this financially, emotionally and physically in the weeks ahead. All this time I had been texting my husband telling him to hold off until I arrived at the new hospital and was given a diagnoses. I finally told my husband to drop our daughter off to day care and to come meet me to also speak with the Dr. My Mom and sister arranged to get my 2 year old, Sonja and stop at our house to pack her up and bring her to my Moms. We first met with the NICU doctors at 1:45. Mind you I still had no idea why I was bleeding or what was going on inside me physically. I had no idea about what the baby faced if born that day. They arranged chairs close around me next to Joel to start the conversation. The Dr had a piece of paper in her hand. She started by saying that she didn't want to give me the sheet if we wanted to wait for the gender to be revealed but they had more concrete statical data about the outcomes based on gender. I told her to tell us and show us the paper. She congratulated us, we were pregnant with a girl. She started to talk about why it was such good news as girls have an even higher success rate. Tears started pouring out my eyes again from hearing the gender and I tried to not to completely lose it while she was telling us what I had been waiting to hear about our little girl all day. She explained that at 24 weeks and 3 days we as parents had to make the decision if we would like the baby to be revived if necessary after the delivery. They said at 25 weeks they wouldn't even ask for our permission that they would intercede in any means possible because everyday the baby is still hanging on inside it is making huge developmental strides which will constantly alter the prediction for survival and neurodevelopmental impairment. Joel took a deep breath like he was relieved. He looked to me for my answer. I asked if he had an opinion and he said it was my choice. I said we are so close to 25 weeks in just days that they wouldn't even be asking me this question. I said I also feel like we wouldn't know till the situation presented itself what the baby faced, that I don't want the baby to suffer but of course I want to give her every fighting chance. I told them my answer was yes. They told us they would be back to visit us in the coming weeks as the baby developed and data changed. Joel was smiling after seeing the statistics. 70% chance of survival, 43% chance for profound neurodevelopmental impairment, 59% chance for moderate to severe neurodevelopmental impairment. An hour later we met with the High Risk Maternal and Fetal Medicine Specialist. She explained how they would treat a rupture vs how they would treat my water breaking which was just one extra thing. If it was just a rupture they would treat me with magnesium and steroids so that if the baby did come early the magnesium would prevent cerebral palsy and reduce the combined risk of fetal/infant death. The steroids help speed the development of the baby's lungs, effective in reducing the risk of potentially life-threatening complications, including respiratory distress syndrome. With the indication of my water breaking they also added liquid and then pill form antibiotics over the course of the week to avoid infection to myself and the baby now that the sac was open and vulnerable. While we were talking to the doctor she was continuously paged and asked for while she was explaining the difference between a rupture and my sac breaking early, she stepped out for a minute but a practicing Dr and my nurse still remained in the room. It was my first opportunity to ask the practicing doctor where the blood was coming from. I told him I was having a hard time visualizing where it was coming from and why so much was being lost. He explained using his hands how the placenta and uterus were connected and how it most likely separated/torn, that even just a 1 cm tear in the uterus to the placenta could cause the amount of blood being produced because my blood volume increased to the baby by about 75% during pregnancy. I asked if it would stop or clot, he said it would be ideal if it stopped altogether but they were hoping that it would simply decrease. He then explained that the baby is being supplied by the umbilical cord and every time it peed it was resupplying the amniotic fluid in the sac. When the Doctor came back in I asked her if there were statistics for when I would deliver or how long I could remain pregnant. She told me that there was a 70% chance I would deliver within the week and a 30% chance I could deliver up to 10 weeks from the day. But that at about 32-34 weeks the risk of infection is greater than the need for further development of the baby and they would induce. At that time she asked when the last time it was that I ate. I told her the previous night and she told me they would get the medications started and then I should order food. A little bit later my brother, Christopher showed up, which completely shocked me as I don't get to see him very often with his crazy social life. After visiting for a bit he went to the cafeteria for some dinner while Joel and I ate for the first time that day and we were alone together to talk about the days events. They started me on the antibiotics and magnesium. The nurse said that the magnesium would burn going through my IV and make me feel hot. As it first started, I felt the burning through the IV and thought to myself that it seemed bearable. I then started warming up throughout my body as if I was lying in the sun on the beach. It soon escalated after 20 minutes and it felt like I had just finished an 8k in the hottest muggiest day of July. The nurse had brought in towels soaked in ice water and placed them on my head and chest. My mom walked in as the nurse was helping me and my IV and monitor to the bathroom. I had been sitting for a period of time so when I stood up the nurse stopped me and told me to stand still. I had made a giant river of blood again on the way to the bathroom. I don't know if my Mom noticed but she decided to find a bathroom herself. The nurse then hooked me up with some mesh undies and an enormous amount of absorbent materials and of course new socks. I started to rehash everything to my Mom and Sister, Joel had went down stairs to watch Sonja while we talked. They told me anyone under 18 was not allowed to see patients unless they lifted the flu ban which was valid until April. They came to tell me that I would be transferred to a private room in the morning if I remained stable. I talked to my sister and Mom for a long time. My Mom said she needed to go, my sister and I still continued to talk till Joel came back up to tell Heather my Mom was waiting. I asked Joel about how Sonja was doing and how he felt and what he had been thinking about the entire time we were waiting. The rest of the evening and into the early hours is a blur to me. I think I told Joel to go home and sleep while I tried to rest. At 3 am they moved me to the second floor to a private room and dis-attached about 4 of the 6 machines. I continued to get antibiotics through the IV and they continued to leave the monitor on baby's heartbeat. I tried to sleep but they came to check on me every 30 minutes to an hour that night. We had made it through the day, another day pregnant and fluids started to minimize.