Emergency care, American style.

[Author's note: This entry was originally written in January 2012. It was originally sent to a smaller circle of family and friends on Facebook as a way of explaining in one go what happened at the end of my pregnancy. However I have decided to publish the original draft on my journal since Facebook is not the best way to present, locate, or archive long postings.]

Since Facebook updates are best for bite-sized portions of information, I have decided to explain why I've been scarce lately. I include a tiny disclaimer- everything that happened in this story is true, however I might have a few things out of order due to circumstances beyond my control. Memory is funny that way.

For 37 weeks, I had what most people would describe as a normal, uneventful pregnancy. I'd been taking my vitamins regularly, eating as varied a diet one could manage in Ashgabat, and keeping busy. Everything was fine, and nothing was out of the ordinary. I'd picked out my OBGYN back home to deliver the baby, selected the hospital, had a list of items I'd researched for review and purchase, etc. The only real topic of concern had been coming up with a name for our daughter, which is no so much a concern. It's more of a back and forth waffling tug o war over the names we were looking at.

I (with Nara in tow) came back to the US at the beginning of December, on a crowded 18 hour flight. My first visit with the OBGYN was a few days after my arrival. That visit went well, even if I had to explain to each person I spoke with a) where i'd come from, b) what it's like in Ashgabat, and c) where Ashgabat is (geographically speaking). Oh and my doctor asking how I found and decided on this particular OBGYN. The answer to that was the OBGYN's internet website, and my insurance provider (who confirmed that this particular OBGYN was a in-network provider). That he worked in conjunction with the hospital I planned on going to was a bonus. He was pretty amused with that answer. I think it helped that I was probably the most mellow pregnant patient he'd dealt with up to that point. That first appointment, and every subsequent appointment I had at his office was as uneventful as every appointment I had since the beginning.

So, December passed uneventfully. I contacted MED in DC to let them know I had arrived safely in the states, and that they could send me the packet of information and forms (passport, medical clearance, etc.) I would need to fill out once our baby arrived. I bought baby-related things we needed, celebrated the holidays with family, arranged for temporary furnished housing, registered with the hospital, and counted down the days till Mike's arrival and the subsequent arrival of our little monster. I broke down and bought a baby name book, figuring that it might help us finally pick a name (fat chance).  Mike (along with Elizabeth) eventually did arrive earlier than expected- which was a very happy surprise. He started his classes, I kept shopping around for baby-related stuff, and things were going well. We went to dinner with my mom and my brother Ray on the 20th for his birthday, followed by a movie. We came home after the movie, and went to sleep. Everything was normal.

I woke up at 2:40 in the morning with heart palpitations. I got up, went into the living room and sat down on the sofa to see if it would go away, and my heart would go back to normal. It didn't. I waited until 4:00 A.M., and when it was still racing at 4 I woke Mike up and told him we needed to head to the hospital because my heart was racing. He was suitably freaked out when he checked for himself and saw that my heart was racing. So, after getting hastily dressed and leaving the apartment, we drove to the hospital for the very first time because hey, up until now we thought we had plenty of time to drive there and see it, and you know, do everything you should be doing together as a couple when you are preparing to have a kid.

SURPRISE SURPRISE!

So, after having to detour thanks to a police roadblock (the cops were more than happy to direct us along an alternate route to the hospital), we get to the hospital, and locate the emergency room entrance. I have never seen an ER receptionist move so fast to get two people into the ER as I did that night. I can only imagine that I must have looked as horrible as I felt at that point.
After telling them about my racing heart, giving them the name of my doctor, and being sent to the bathroom to pee in a cup, the doctor on call in the ER had me lie down so they could take my pulse, blood pressure, put me on a iv to lower my heart rate (it was 190 when they checked), put me on a second IV for blood thinner, brought in a tech for an ultrasound of my baby, brought in a labor & delivery nurse to set up a baby monitor, took blood, performed an EKG, and an ultrasound on my legs to look for blood clots.

That's when my OBGYN arrived, and proceeded to tell me that a) my heart rate was still fast (190), and b) it was irregular.

In order to aggressively treat my Atrial Fibrillation, they would have to perform an emergency c-section, and that I might have to be unconscious during the procedure . But before the c-section, they would have to put in a filter, because the concern was that if I had blood clots anywhere, they could travel to my heart or brain and kill me once the baby was delivered (and all the extra pressure from baby was released). Oh, and that they were taking me to get a cat scan of my chest to check for blood clots. It was probably the most horrible and terrifying moment I have ever experienced. That was about the point when we decided on Olivia Nicole for our daughter's name.

I went for the cat scan, and came back to the ER afterwards to find a succession of specialists stopping by to talk to me and have me sign consent forms. I was told that my lungs were clear of blood clots, but I had blood clots in both legs. My OBGYN had called in yet another specialist who would be inserting the filter before I went in for the c-section. I asked if I would be conscious while they were putting the filter in. The answer to that was that yes, I would be awake for the entire procedure. Fun Times! The trip from the ER to get the filter inserted was very surreal. They let Mike follow me to the doors of the operating room where we were greeted by the specialist who would be putting in the filter- and much like a game show presenter he was gleefully showing us the 3 ft box containing the filter. I was later to discover that this specialist does not typically work on Saturdays, but came in as a favor to my doctor.

After being wheeled into the room, they basically drugged me enough so I could not feel pain, but i'd still be conscious and be able to feel this weird pressure (from the micro tool being fished through my veins) until they could place the filter below my kidneys. Which they were able to do. After they finished, they moved me from that room to the room where I would deliver Olivia via c-section. At the very start, they had told me I might not be awake for the c-section (depending on what drugs were still in my system during the surgery). By the time they were ready for the c-section, I found out that I would be able to stay awake for the procedure. So with Mike as the only other family member with me in the delivery room, they delivered Olivia at 2:21 pm, on January 21st, 2012. Everything else about that Saturday is pretty much a blur. I did get to see her after she was cleaned up (Mike has a photo after they cleaned her up where Olivia is posed just like the figure in Edvard Munch's "The Scream") before the whisked me away to the ICU, but beyond that the rest of my Saturday was lying in a bed, drugged up, checked out for all intents and purposes. Sunday was pretty much the same, except with less of a drug-haze, and food. Monday, they performed a cardioversion to return my heart to normal.

That, thankfully, I was knocked out for.

I can say that immediately after that procedure I felt much, much better than I had previously. You could say the difference in my appearance and general well being was like night and day. Which is a very good thing. But I was still stuck in the Coronary care ICU, getting blood thinner shots to the gut daily, blood draws, IVs of iron, and stuck in a bed. On Tuesday, late in the day, they eventually moved me down to the maternity ward, and I was finally able to be in the same room for longer than ten minutes with my daughter. I still had to get injections to the gut, but I was able to get out of the bed and move around the room freely- a big improvement over only being able to walk a foot or two away from your bed at any point in time.

They did eventually release me on Thursday (the 26th), and my time since then has been filled with baby, sleeping, eating, taking medicine, going to doctor's appointments, and generally trying to feel better than the previous day. I have been told by my hematologist that I will need to be on blood thinners for the next six months, and that there is a possibility that I can be switched to a blood thinner that does not require monitoring. The filter they placed below my kidneys is scheduled to be removed in four weeks. My cardiologist is going to put a harness monitor on me this week to check on my heart.

So that's where I am right now, getting better but not back to normal yet if that is even possible. When all of the appointments are over, and my doctor's submit their recommendations to med, we will find out if I can be cleared to return to Ashgabat. Until then I get to spend time with my daughter, husband, and family which isn't such a bad place to be.

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