The Night Before Surgery

We drove through the hospital’s campus, the largest hospital I’ve ever seen, and attempted to navigate which entrance we needed to find.  My husband dropped me off so I could start to check in while he parked the car.  I found my way to Labor and Delivery through an office area and down hallways that were covered with construction materials.  Apparently the Labor and Delivery portion of the hospital was undergoing a much-needed renovation.

I went to the desk to check in and was sent to the triage area, where I filled out some forms and had my blood pressure and temperature taken before giving a urine sample.  There was a woman in there (pregnant, obviously), who had a small child with her and was coughing and hacking into a paper towel like she had tuberculosis.  My husband sent me a text message saying that the guard would not let him back to be with me, since I hadn’t been admitted yet.  I also got a call from Dr. Quintero’s nurse, B, asking where I was.  Apparently, the Labor and Delivery section is together but separate from the Fetal Therapy Center (“FTC”), although the FTC is on the same floor.  They have a separate staff for the FTC, and their suites are much nicer than the typical hospital rooms.  That made me feel better, as I was put in a triage room that was straight out of the 1970’s, and may have had original 1970’s dirt in it.  I’ve never been in a dirtier hospital room, and it (along with everything else going on) made me so uncomfortable.  However, the doctor wanted me to be hooked up to the monitors to make sure I wasn’t going into labor, so I waited on this thin stretcher while the triage nurse attempted to get both babies’ hearts on the monitor.  I hadn’t really slept at the local hospital the night before, and the exhaustion (and the pain) was really wearing on me.

Finally, I was brought back to the ultrasound room in the FTC.  It was clean, nice, and the ultrasound tech was so sweet and kind.  She warned us that this would be a 2-3 hour ultrasound, and I would likely be very uncomfortable.  Allan went to get some food for us for dinner, and we got to work with the ultrasound.  The tech needed to get accurate measurements, as well as dopplers for the babies’ hearts, umbilical cords, and brains.  If there were signs of brain damage, we would not be able to move forward with surgery.  If I went into labor, we would not be able to move forward with surgery.  We were just waiting and counting the hours until the surgery so that we could give our babies the chance to survive and hopefully thrive in the womb for at least a few more weeks.  Dr. OB called to wish us luck and remind us to get the second steroid injection (I had one the night before at the local hospital), which would help the babies’ lungs mature so they could breathe if they had to be born the next day.

Three hours after the ultrasound started, around 10 p.m., Dr. Quintero came in to speak with us and take some additional ultrasound images.  He measured my uterus, and it was measuring 51.  This was just two days after it measured 43.

I wish I had taken pictures of my huge belly, but I had other things on my mind.  The difference was all attributed to the crazy increase of fluid.  Baby A, the recipient, now had a MVP of 21+, and Baby B, our donor, had no fluid.  Baby B also had no visible bladder.  Dr. Quintero said that he had never seen anyone with so much fluid.  The ultrasound tech corrected him, and he said that he had never seen anyone with so much fluid who hadn’t gone into labor and lost the babies.  A lot of the time, TTTS comes on slowly, but in my case, and in the case of many other unlucky families, it comes on very rapidly.

Dr. Quintero classified our case of TTTS as a modified Stage III due to the severity of the fluid imbalance.  Typically, a Stage III case shows signs of abnormal blood flow in the umbilical cords of the babies.  He again went over the probabilities: 80% chance that we would have one live, healthy baby, and 50% chance of both surviving.  He also explained that there are multiple complications that can arise, and multiple health issues that can arise as a result of the TTTS and the laser surgery, including, but not limited to, brain damage, kidney damage, heart problems, death of one or both babies, or death of the mother.  He went over the surgery, which was scheduled for 7:30 a.m. the following morning.  During the selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome, the mother is awake, but drowsy, during the procedure, and with a local anesthetic is provided at the site of the fetoscope (like an endoscope).  The doctor goes into the uterus with the fetoscope and severs the blood vessels that the babies share.  Fluid is also removed from the recipient’s amniotic sac.  Following the surgery, the babies will each have their own separate sources of blood flow, so each baby’s fluid should balance out, and the donor baby’s bladder should return.  For more information about TTTS and the surgery, look here: http://www.jacksonhealth.org/fetal-therapy-ttts.asp

Dr. Quintero scheduled the surgery for 7:30 a.m. the following morning.  By the time we were through with the ultrasound, it was 11:30 p.m., and I still needed an I.V. and blood drawn, the steroid injection, and I needed to be hooked up to the monitors to make sure I didn’t go into labor.  If I went into labor, he would have to deliver the babies, who, if they survived, would have the difficulties and obstacles that extremely premature babies have.  There was definitely concern that I wouldn’t make it through the night without going into labor and would not be a candidate for the TTTS surgery.

Because the doctor wanted me to be monitored for contractions, I needed to go to the Labor and Delivery floor, rather than stay in one of the FTC suites.  However, there were no rooms immediately available, so I was placed back on the stretcher in the dirty triage room.  My husband had only a hard plastic chair to try to nap on, and I was again on an uncomfortable stretcher.  The nurse came in and I asked when she thought I would have a bed, because I was so tired and was having surgery in the morning.  She was a real bitch and snapped at me that she didn’t know and they were very busy so I would just have to wait.  She expressed no sympathy or empathy at all.  Typically, at the local hospital, if you’re pregnant and in Labor and Delivery for any reason, everyone is really kind and caring.  They always ask if they can make you more comfortable.  Here I was, measuring way past full term, with babies in distress, hoping to make it through the night, and this woman was such a bitch.  I will never forget how nasty she was.  Luckily, she seemed to be the exception at this hospital, as most of the other staff members were very kind and caring.

This bitchy nurse needed to start my I.V., and she started it in my left hand.  My hand was shaking, but I had nothing to rest my arm on because I was on a stretcher.  She snapped at me to keep my hand still or she would have to start another I.V.  I was in tears.  She had to take literally 14 vials of blood, because my medical records were not sent in their entirety, so the doctor needed to do many tests that I already had done.  She gave me the second steroid injection and still had not one kind word for me.  I couldn’t believe how awful this woman was being, but I hoped they would transfer me to a bed soon.

My husband and I both nodded off periodically in our uncomfortable positions, and we finally were moved to a Labor and Delivery room just after 2 a.m.  Someone came in for the THIRD time to change my hospital bracelet and put my maiden name as my last name.  I already had them correct the bracelet after initially coming in, and for whatever reason, they thought it needed to be changed again.  The nurse in Labor and Delivery asked me the same 100 questions that the bitchy nurse and the earlier triage nurse asked.  Apparently they all just wrote the responses on paper and then promptly got rid of it.  This nurse finally put the answers in the computer — answers to questions like “what date exactly did you have a bronchoscopy when you were 14.”  It was about 3 a.m. before my husband and I could attempt to get some sleep.  It was obviously a very restless evening, but at least I had a bed to lay in while I tried to rest up and hoped and prayed that my babies would be safe.

To read about the rest of our TTTS journey, click here.

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