Triage

When you buzz in to Labor and Delivery, you're typically treated like a VIP.  When you come bearing the label of preeclampsic, you're a rock star.

I am settled in Triage Room 1 as the endless parade of nurses and residents begins.  They don't mess around when they get a case like me.  Garfinkel is in his first section of the night so I won't see him until after that baby is born.  Vicki, a large-boned woman reminiscent of a blonde Madame Maxime from Harry Potter, is my assigned nurse.  She's got that no-nonsense Mother Abbess with the mouth of a sailor vibe.  I like her immediately.  She'll be seeing me through until shift change at 7:00 PM.  We share a love of "Law and Order: SVU," which her husband won't watch because of it's tawdry plot lines, and Gone Girl.  I highly recommend the author's other novels and she seems thrilled that there's more where that came from.  BP cuff and fetal monitors on, I wait until the doctors can visit me to make a decision.  It's barely 4:45 PM and we're off and running. 

Soon, I am visited by Dr. Garfinkel who is honestly the most down-to-earth doctor I've ever met.  You can imagine grabbing drinks with him some day after a regular gyno appointment.  It's also kind of cool that he was pals with Brian Slomovitz, my surgeon from last September, which brings everything full-circle in a Shakespearean resolution to this medical journey.  Garfinkel is a great foil to Convery's med-student precision and between the two of them, I know I've received the best possible care and will always be grateful that they truly listened and took me seriously.  When he opens with "what's your favorite vacation spot?" I know where this is headed.  You want me to relax?  Really?  We're talking emergency c-section here and you're asking me about whales on my Hawaiian honeymoon?

"When did you last eat?"

"Noon."

"What did you have?"

"Uhhh, eggs and french toast sticks."  (Oh, so classy.  Thanks, Aunt Jemimah.)

He orders IV Tylenol for my headache - ok, an IV?  We'll be here at least overnight, I'm guessing.

"You're what, 36 weeks today?  That's good.  The baby looks healthy.  It's just a question of whether there's anything to gain by waiting a few days will or do we go ahead and deliver tonight.   I'm leaning towards tonight, but I want Dr. Lashley from MFM to talk with you.  She's reviewing your ultrasound from Wednesday right now.  I just looked at it and there's still some vascularity that concerns us.  Talk me through your prior surgeries."

So I do.  I explain "the mess in there" according to Slomovitz.

Garfinkel laughs.  "Don't worry.  I'm better than him."

"Well, I always tell mothers at this point, you'll have at least a five-pounder in there and that's what we look for with late-pretermers.  Sound good?  Any other questions?  I'll be back in a bit."

Next Dr. Lashley comes in, asks about all of my aches and pains and seems amazed that I'm not in serious distress.  I tell her I'm used to pain.   She confirms that my upper right quardrant pain is probably not the baby's head as I had previously assumed and rather is symptomatic of my condition.  She is very compassionate and says that I am full-on symptomatic preeclampsic and all roads lead to let's have this baby tonight.  She leaves to consult with Garfinkel.   

Suddenly Rhett appears at the same time as my poor mother with whom I've communicated only via text ("We may be having a baby tonight!")  She makes it to the hospital in under 30 minutes direct from the middle school.  Rhett shockingly also has an easy commute up 287, despite the ritualized face-palming retardation of registering Oscar at Pet Pals.  He straight-up told them "I have to go" and walked out before the paperwork was finished.  Ha!  I would have paid to see that.  Love that man.

Vicki comes back in to start my IV and without actually shooing my parents out of the tiny room, suggests the comfortable waiting room down the hall and yes, I'll be able to see them before I go into surgery.   I feel for them but promise that Rhett and I will text updates and he'll get them before anything big happens.  Things are quickly simmering to a boil.  I tell Rhett to poke his head out into the hallway to let Garfinkel know he's here.

There's handshaking and a cards-on-the-table, "OK, I spoke to Dr. Lashley and she and I are in agreement.  We're going to have this baby tonight, probably around...let's see, I have one more c-section ahead of you but let's say 8:00 PM.  Could be a little later as there's another woman currently in labor.  Sound good?  Everyone on board?"

Rhett and I look at each other.  I see the panicked uncertainty in his eyes melt away and express nothing but relief, quickly followed by the realization of dear lord, this is happening.

"Ok, sounds good," I say.  Yes.  Yes, let's do this, please.  I just want her to be healthy.  

"Great.  Sit tight, Vicki will get you all set up here.  Just relax.  Think of Hawaii.  See you later."

And with that the decision has been made: we're having a baby tonight.  In about two hours.  My heart is racing, despite the pounding headache, and I am the most mobile woman in triage since I'm a) not in labor and b) queen of the nervous pee.  Cannot wait for that catheter!   

Vicki reappears to ask the million-and-one intake questions, urges me to accept the morphine - "trust me: you'll need it" - even though my chart says I'm allergic (not technically true but I don't tolerate it well at all.)  I explain how nauseous I get and she reminds me of what my cousin also helpfully told me: make them give you anti-nausea meds before the pain meds.  (Thanks to Becky for that tip - seriously.  More on that later...) So many questions and then the onslaught of forms: social security, birth certificate worksheet -- which I neglected to fill out ahead of time because, well, I thought I had more time -- and so on.  It's surreal filling in her legal name before her birth.  We didn't have to write it in but I want to.  Somehow, it makes it more tangible that our daughter is coming imminently.   

Rhett is a huge help as I begin to leak the news: we're having a baby tonight!  Our closest family members and friends receive texts.  We summon my parents back to give them the update and I say my goodbyes.  It's the last time I'll see them before they become grandparents.  I can tell they are anxious for me but so excited to meet their granddaughter.  Rhett promises to update them after he accompanies the baby to the nursery (we hope - and not the NICU.)  They won't see me again until I'm out of recovery and installed in the high-risk postpartum suite.  I am going to be spending the first night in the Hall of Complications which also doubles as overflow from the regular postpartum suites.  I will need 24 hours of Magnesium Sulfate via IV or as I like to call it, Mr. Freeze because holy God, I thought the veins in my arms had frozen but more on that later...

Kisses and hugs all around and then Vicki returns with an electric razor.  OK, party time.  I'm shorn like Aslan about to be sacrificed on the Stone Table.  (Kidding.)  So this is what happens when you don't have a chance to book a wax.  The goal is to use the same incision as the laparotomy so it's an easy job.  Still, bless the labor and delivery nurses. 

A petite female resident who looks to be about 15 comes in wheeling an ultrasound machine.  She is quite thorough and goes over all of my previous surgeries (the 4th time I've been through the litany tonight) and explains that she partners up on most c-sections with Dr. Garfinkel and she'll be assisting during delivery.  She takes one final look at the baby who yes, is frank breech.  Her head is on my right side and her bum covers my cervix.  The little legs are folded in lotus pose somewhere on the lower left.  I can't imagine the shock baby girl is going to experience when they haul her bum first out of my womb.  The resident has a soothing manner and says the anesthesiologist will be in shortly to discuss the surgery. 

I'm not sure if a scheduled c-section unfurls this quickly but I sure was impressed with the tight ship they run in triage.  From the time I arrived at the hospital to the time I was having the spinal explained to me, only two hours had passed.  It was staggering but I think the point is that they don't give you an opportunity to whip yourself into a panic.  It's like mental parcourt.

Dr. Lawson, who I will spend the rest of the evening calling Stieg Larsson, introduces himself.  We talk medication options and allergies.  I practically beg the man for the behind the ear sea sickness patches but he says he'll do me one better via IV.  Ok, fine, whatever just please, please, please don't let me puke on the table.  (I will remind him approximately 15 times in the OR that I NEED MY ANTI NAUSEA MEDS -- politely -- and describe in vivid detail how I projectile vomited after morphine during my surgery last June.  ha!  Bet they loved me.)  I'm oddly looking forward to the spinal.  I've been a little obsessed with the mind-body connection of not being able to feel your legs so hey, bring on that giant needle and threading tube.

Stieg leaves and Rhett and I have approximately one hour to ourselves which we fill by semi-watching the John Stamos episode of SVU where he plays a ritual procreator predator who pokes holes in condoms and consequently has fathered 22 children.  Classy stuff.  Vicki takes me off the monitors, says goodbye and good luck, and with that, we are introduced to our delivery room and recovery nurse who also appears to be 15 years old.  She's very good about complimenting my glasses and nail polish (which is a sensitive subject, as I was planning on the full mani/spa pedi experience the day before my planned c-seciton...such is life) and generally maintaining a calming level of rapport.  She will be back just before 9:00 PM as the woman in labor isn't progressing and will be getting a c-section right before me.  Dang, Garfinkel is busy.  There's one after me, as well.

Bring on more SVU!  I am so thirsty that I am actually looking forward to the post-surgical ice nuggets.  I send Rhett out to get a snack because he's going to need it for what lies ahead.  Poor guy, I think.  He has no idea what's in store through the doors of the OR.  The guts!  The gore!  The miracle of birth!  

To be continued...