Monday, October 22, 2012

Surviving Severe Morning Sickness: A Life and Death Issue

          Welcome back, or welcome! Grab a cup of coffee or tea to join me today. This post will be longer than usual, but I promise it’ll be entertaining and educational! And read all the way to the end. I have some hard-learned advice for any of you suffering unnecessarily during your pregnancy, or those of you who have suffered and are willing, able and ready to try again.  

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“When Jesus heard that, He said, “This sickness is not unto death…”
John 11:4a NKJV
(Oh, but it certainly felt like it to me!)
            My euphoria evaporated when my morning sickness rapidly developed into a severe, twenty-four-hour-a-day blight. (Can any of you relate to this?) Often, I lay curled on my bathroom floor, crying out to God to end the affliction, or take me home. Either scenario was totally okay with me!
            Yet the nausea worsened. One day, in a fit of frustration and tears, I called Chris at work, asking him to first pick up our son Parker from preschool and then to meet me at the urgent care clinic. When Chris arrived there, I lay outstretched on a table. The doctor was just beginning a glucose IV to rehydrate me. The official diagnosis was severe dehydration. Medical term: hyperemesis. Within minutes, the cool fluid rapidly coursed through my circulatory system, making me feel plumped up and relatively recovered. Oh, the relief and joy!
            Momentary joy.
            Unfortunately, the medical staff was overzealous in the amount and rapidity of fluid administration, and I ended up relieving myself of their efforts in the restroom immediately following my treatment. One of the nurses terrified me when she jovially reminisced about her pregnancy experience: she had suffered bouts of nausea all the way into the delivery room! I blinked and gaped at her, wondering why anyone would ever have any children under those circumstances. She quickly added that she’d never again subject her body to that insult. Was I destined to be sick-to-the-bitter-end too? The thought made me shudder.
            The next afternoon I was back in the doctor’s office waiting to be seen by someone about the persistent nausea. The effects of the previous night’s IV were only temporary, and I was in serious need of additional medical intervention. The anti-nausea medications weren’t helping, and I was becoming increasingly dehydrated and severely weakened. I wondered just how long my body would sustain itself under this unforgiving assault.
            After waiting half-sprawled in a chair for three hours, I insisted that I be allowed to lie down in a room, away from the oppressive, glaring lights of the waiting room.  Chris was uncharacteristically outraged. He kept saying he didn’t know how much longer he could take this. As much as he suffered physically (fatigue) and emotionally, he could never understand my agony. Too weak and shocked to respond, I simply stared at him, and fought to pound my flickering feelings of guilt and defensiveness into submission.
            The medical director – the one I argued with on the phone for my ultrasound – finally arrived and decided that I needed prolonged IV rehydration at home. However, she emphasized, it would be difficult to receive authorization for treatment so late in the evening – six o’clock – on a Friday night. My insurance company only used one facility for that kind of treatment, and their office was in another county. I silently wondered why the hospital wasn’t an option; the obstetrician had told me about a patient he kept admitting to the hospital for just such treatment.
            Didn’t my insurance company pay for that, or was the director trying to save money again? And what would happen if something went wrong during the day while I was home alone?
            Why did this sound like a bad dream turning into an inescapable nightmare?
            She promised to remain in her office until authorization arrived. Until then, she’d give me a shot of anti-nausea medication and send me home to await the arrival of a home health nurse. The medication made me drowsy, but not so drowsy that I didn’t need to once again lock myself in the bathroom. (Now that I think about it, I might have made my point better if I had just gotten sick right there in the middle of the waiting room. That might have gotten everyone’s attention, and I might have received the in-patient treatment I needed!)
            A nurse and my husband repeatedly knocked on the door to check my status. At that moment I would have been content to lie on the cool bathroom floor indefinitely, but my years of competitive athlete discipline and “work through the pain” attitude kicked in. With steely resignation, I leaned on the icy porcelain sink, slopped cold water on my face and vacated the cubicle. Sympathetic comments, murmurs and looks shot my direction upon my dramatic exit. I walked stoically from the medical office.
            “I’m fine!” I flippantly tossed my hand at the onlookers and managed to eek out a convincing smile. (My theater and performance training had also kicked in.) “I’ll be just fine.”  
            Three hours later, the doctor called to confirm the authorization, and soon after a home health nurse contacted me for directions to my house. She lived an hour away in San Diego and was unfamiliar with our rural area. Since the fog was thick and our road dark, her arrival took much longer than any of us expected. 
            She finally arrived just before midnight and unloaded her arsenal of IV bags, shots, machines and always-insurmountable insurance paperwork.
            The only redeeming factor in this midnight affair was that this woman was one of the kindest, gentlest people I’ve ever met. She spoke lovingly, soothingly, and carefully explained the procedures. While she worked with me upstairs, her husband fell comfortably asleep downstairs on our living room couch.
            Chris received a crash course in hanging IV bags and machine adjustment, and administering intramuscular shots. In record time, he perfected the necessary wrist flick for pain-free insertion. He’d get to practice his new skills every eight hours, and the IV machine would awaken us when IV bags needed changing.
            Then the moment arrived for introduction of the IV into my hand.
            The nurse spread her sterile paper towels, gloves and equipment on the bed next to me. While turning our king size bed into a medical-surgical table, she cautioned us that there would appear to be a lot of blood lost onto the towels, so I might not want to watch. She handed Chris several items to hold for her, then checked my veins. Another problem. Due to my severe dehydration, my veins kept collapsing, making it impossible for her to keep the needle inserted.
            Again she tried, with more blood spurting onto the towels. It hurt, and the word pincushion flashed across my mind. The vein collapsed again, and the needle sprang from its location. Simultaneously, the color rapidly drained from my husband’s face as he quickly dropped the items he held for the nurse onto the bed, hastily excused himself to retreat through the bedroom door and quickly assumed a prostate position on the floor outside our bedroom. So much for moral support, I thought.
            Throughout this futile exercise, this wonderful woman repeatedly apologized and patted my arm tenderly. I could hardly blame her for my body’s lack of responsiveness to her efforts. She said she’d try a third time, and if she couldn’t get the line started, another nurse would have to come in the morning. If that attempt proved unsuccessful, an eight-inch flexible catheter-like tube would be threaded through a vein in the elbow area.
            The third attempt wasn’t the proverbial charm. With profound disappointment, we had to settle for another nurse later that morning. At 2:30 AM, Chris managed to gather enough strength to stand, wobble downstairs and awaken the nurse’s husband for the long ride home. More apologies and expressions of regret passed between us. Chris helped them pack and stood waving goodbye in a swirl of fog.
            My teeth were being eroded from stomach acid. My throat and mouth burned from vomiting. I was 10-12 pounds below my pre-pregnancy weight. My skin was ash gray; my eyes were sunken. My skin looked and felt like tissue paper.
            Another twenty-four hours had passed without water, fluid or food, for my unborn baby or me. Wasn’t this getting more than a little ridiculous – and dangerous. For both of us?

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            I have some additional thoughts on this horror.
            Severe morning sickness, or hyperemesis gravidarum, is a serious, potentially life-threatening condition that is often dismissed or downplayed by doctors. Pregnant women have died of it. It is thought that Charlotte Bronte may have died of it in 1855. One woman in the United Kingdom elected to have an abortion because of it. (Google “The all-day hell of extreme morning sickness” in The Guardian newspaper.)
            For my situation – and no, I was not able to keep ANY food or water down for days – Chris and I believe the care I received was irresponsible, reckless, and bordered on malpractice. After one hour of waiting for the medical director to arrive, Chris should have driven me to the hospital emergency room. They would have contacted my obstetrician directly, and he probably would have ordered admission and in-hospital treatment. I should not have tolerated the treatment I received from the medical director.
            Now that I’m older, wiser, and can evaluate these events with a critical, more realistic eye, I want to leave you with some tips.
            1. KNOW your insurance policy, especially what it has to say about pregnancy care. Some policies don’t pay for it. Some offer extra benefits for it. If you are even thinking about getting pregnant, make sure you have a good policy that will provide all of the care you MIGHT need. Please DON”T assume you won’t have problems.
            2. Have a strong advocate with you when you visit your doctor. I think you should take them with you EVERY visit. Pregnant women are in a vulnerable position, with hormones all over the map. You don’t need the added stress of having to combat condescending medical staff. Find a strong family member or friend who’s willing and able to ask questions.
            3. Bury your fear and ask questions – LOTS of them. Be firm. Do your homework. (Some doctors won’t like informed patients; they want to have total control. Find another doctor if yours is like that.) Demand and expect the best treatment you can get. You and your baby deserve it!
            4. If necessary, get a second opinion! I can’t stress this enough. If you have even the tiniest shred of doubt about how you are being treated, find another doctor or midwife and get their opinion.
            5. Call your insurance company to complain. I actually learned from my insurance company – way after the “final” devastating event – that my medical group and the director had a habit of repeatedly denying treatment and payment. That was their typical operating procedure with patients. I learned that information from someone at my insurance company. If I had known this ahead of time, my demands and insistence upon proper care would have been much different. I assumed too much and deferred too often.
            6. Much later I learned from a doctor that the best way to locate a good obstetrician is by asking the OB nurses in the hospital. Find someone who knows these nurses and ask them who they recommend. It could mean the difference between life and death – for you and your baby!

            Until next week!