Surgery and Back Home

At just before 7 a.m., some members of Dr. Quintero’s team came in to my room to go over paperwork, do a last-minute ultrasound to get another look at the babies and the presentation of the placenta, and prepare me mentally for surgery.  They started to move me to surgery (on another floor, in another part of the hospital) around 8 a.m., and my husband was not allowed to come with me.  We knew this ahead of time, but it was still tough to face those hallways alone.

The operating room was one of the largest I’ve ever seen.  It was at least four times the size of the operating rooms at the local hospital where I had my c-sections.  There were people coming in continuously, and I venture to guess there were at least 25 people in the room.  Only a few of these folks introduced themselves to me; it was very unnerving.  I was given a sedative to relax me, but not put me to sleep, right before I was transferred to the operating table.  The anesthesiologist also gave me some Benadryl to combat itching, which I had experienced in the past while receiving anesthesia.  There were two Labor and Delivery nurses at the end of the table and incubators at the ready in case the doctor needed to deliver the babies via c-section.  I was 26 weeks and 2 days at that point.

The nurse inserted my catheter, and the team began to prep for surgery.  Dr. Quintero came in with additional staff, and by that point, I was pretty tired and so grateful for the sedative.  I felt a bit of a sting when the local anesthetic was injected into my belly, but that was pretty much it.  I kept dozing off, but the anesthesiology assistant shook my shoulder to keep me awake, because when you sleep, you breathe deeply, which moves the placenta too much.  For such a delicate surgery, every little movement was critical.

I remember Dr. Quintero saying that he was severing the last of the vessels before he began removing fluid from Baby A.  I could breathe easier immediately when he removed the first batch of fluid.  He ended up removing FOUR (4!) liters of fluid from Baby A (imagine 2 2-liter bottles IN YOUR BELLY).  The doctor could have removed more, but he did not want to risk placental abruption by removing too much fluid.

I had the opportunity then to see my beautiful girls through the camera on the fetoscope, but I was so drowsy that I just couldn’t focus.  I vaguely recall seeing some limb-shapes projected on the screen.

Dr. Quintero said that one of the vessels the girls shared had become so huge it essentially became a fast track for the blood to flow from Baby B to Baby A.  Once the blood starts flowing in one direction, it no longer goes back and forth between the babies.  He realized before he removed the fetoscope that there was one tiny vessel that he almost missed.  He cauterized the vessel and left to speak with my husband.  I was basically passed out, but I remember being wheeled through the halls and up the elevator to the recovery room.  I had a nice, warm blanket, and I could finally breathe.  My back pain almost immediately subsided.  I took a nap and woke up to text and e-mail my friends and family to tell them that the surgery, according to Dr. Quintero, was a success!  We just needed to get through the day and have an ultrasound the following morning to see if the babies were responding to the surgery.

I spent all day in recovery, and I mean all day.  The recovery nurse kept waiting for me to be transferred, and we contacted nurse B with the FTC to see if I would be able to be moved to a nice room up there.  My husband and I were both looking forward to getting some sleep, and the suites promised a couch where he could sleep, too.

On the other side of the curtain, a woman waited.  And waited.  And waited.  She had been waiting to be brought back for her c-section since well before I got back to recovery.  This meant that she had not eaten all day.  I felt really bad for her, because she just could not get a straight answer about when she would be taken back for surgery.  The doctor on call finally came back and spoke with her, telling her that there were some emergencies that had to be fit in, but if she wanted, she could come back first thing in the morning and be put on the list then.  She waited and finally was taken back at about 8 p.m.

My catheter was finally taken out in the early evening, and still we waited to be sent to the floor.  We were basically told that they were understaffed, and we needed someone to come down to get us and bring us up to the room.

Finally, someone from the Labor and Delivery floor came to get us and bring us to one of the nice suites in the FTC section of the floor.  I was the only patient in that wing, but a nurse from Labor and Delivery was assigned to take care of me.  She was very kind and made sure I had drinks, towels, and a clean nightgown to put on.  Even though it was around 9 p.m., fairly early for two adults, we just turned on Shark Tank for a few minutes and went to sleep.  I slept well enough (as well as any pregnant woman does), and was awakened at 5 a.m. when the nurse came in to draw blood for my post-operative labs.

My husband and I both showered and got our things all ready to go while we waited for the ultrasound tech to come and get us.  We thought it would be around 8 a.m., but it was more like 10 a.m. when she got there.  Luckily, my husband was able to go and get some breakfast from Au Bon Pain, because I they forgot to bring me breakfast (since I was the only patient on that part of the floor).

We went back for the ultrasound and were pleased to see that the babies were still alive and looked pretty good, considering the circumstances.  Baby B’s bladder was still not visible, but she had a bit more fluid, so we had hopes that she would continue to improve.  Baby A was happy with the lessened fluid, and, although her bladder had thickened as a result of the fluid she was trying to process, it looked smaller and a little better already.  Dr. Quintero came in and expressed confidence that the surgery went really well.  He believed we would have two healthy babies when they were born.

We were discharged from the hospital to go home.  I was told to remain on bed rest for at least a week and see Dr. MFM for an ultrasound on Tuesday.  After that week, Dr. OB and Dr. MFM would decide whether I needed to remain on bed rest or not.

During the long drive, all my emotions and anxiety overwhelmed me, and I started to get very depressed.  I cried most of the way home, while my husband spoke to his mother and sisters to tell them about the surgery.

I was so happy to see my toddler, but I couldn’t hold him, which was very difficult for both of us.

“Where are my baby sisters?” He asked.

“They aren’t ready to be born yet.  Mommy has to lay down to try to keep them safe in her tummy as long as possible.”  He understood as much as an almost-3 year old could.

My parents had come up to clean our house before we arrived home.  It was a relief to come home and not have to worry about laundry or bathrooms.  I went to lay down in my own bed for the first time in three days, but I was having difficulty breathing.  My mom wanted me to go to the hospital, but I worried that they wouldn’t understand what I had just been through.  I called Dr. OB’s on-call number, and he called back fairly quickly.  He said that it was probably just from the shifting around during the surgery, but he wanted to see me the next day to check my lungs and make sure everything was ok.  My mom kept insisting that she should speak to him, as she always thinks I’m still 8 years old and need her to speak to medical professionals for me.

We also left a message with Dr. Quintero, and he too was not worried about my breathing problems.  I was finally able to get to sleep and begin the long process of keeping my babies safe until the latest possible date — ideally, they would be born the first week of December, and it was only September 20.  I had a long road ahead, but at least we seemed to have climbed this hurdle successfully.

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

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