The Green Light
This piece explains a surgical procedure, so if you’re sensitive to those types of stories, please read with caution.
After a mid-afternoon appointment at the Maternal Fetal Medicine doctor in Dallas for a second opinion four days after we received the fetalis hydrops diagnosis of our fourth baby, we were hugged and prayed off by our new doctor to Houston, Texas, to get potentially life-saving surgery for our 20 week gestation baby.
Our three older kids were with my mother, and we quickly made plans with my sister in-law to being the kids to her house for an impromptu sleepover so we could begin the trek to Houston.
We had just returned home from a short, family trip in Broken Bow, Oklahoma that morning, trying our best to enjoy the time away after we’d received the worst news in our married lives of our sweet baby’s illness.
I was starving, as I misunderstood our intake instructions thinking I had to immediately stop eating, while I actually had until midnight to stuff myself silly until I was put on a clear liquids diet until our surgery.
I broke down and decided to eat, when I took a second look at the email from the labor and delivery ER and realized I could have one last meal.
Taco Casa- it’s now our celebratory spot when we leave the city. I’d never had it, but at 10pm on a Monday night it was all that was open that didn’t sound downright poisonous (we are not a fast-food family) and I tried the super-tacos.
Holy cow, Taco Casa is so good- who knew?
That’s when my trend of city-trekking knock-out naps began. I fell straight to sleep and didn’t wake up for three hours until we entered the Houston metroplex.
The Hermann Memorial Hospital is ginormous, but bleary-eyed, we traded out the clothes in our trunk leftover from the Broken Bow trip and packed a quick overnight bag for our hospital stay.
We checked in at about 1am on Tuesday November 12th, our third child’s third birthday.
In triage, we met the first physician on the perinatal team. She took another sonogram, confirming the hydrops diagnosis, and also confirming heart rate variability that was getting shakey.
Our baby’s completely compressed heart was weakening quickly, and we would soon learn our baby had mere hours to save their life.
After about two hours in triage, where the nurses were so kind to let my husband- who’d now driven a combined seven hours from Broken Bow to Dallas to Houston- a nap on the other stretcher, we were put in our room where we’d catch up on sleep until it was our time for surgery.
Over the day, we met our perinatal team, the doctor who took on our case via the new MFM we met in Dallas the day before, and the other doctors who all worked together to save the lives of the unborn. Seriously, the most intelligent people I’ve had the pleasure of meeting so far in my life, and also the kindest. They didn’t make us feel silly for our lack of knowledge, they didn’t fear monger, they didn’t pressure us. They took a lot of their valuable time to educate us and answer any question that came to our minds.
They showed us the shunt they’d be using in the procedure, called a pigtail shunt. It was a 3cm, white, flexible, super-skinny tube with two twisted ends, like a pig’s tail that would be inserted in our baby’s chest to let the fluid come out of their swollen body, into my amniotic sack, but not flow back in.
Technically, the shunt was invented for bladders, and doctors learned to use it for baby’s in utero for cases such as this. They actually then shared about another type of shunt, typically used for pancreas’s that was less pliable and likely to fall out, and with our permission, we could be the first couple to have ever in the world to have used on their baby for hydrops.
We signed off our consent, and the science nerds in us (if you didn’t know, we both have kinesiology degrees, my focus on health science and my husband’s focus occupational therapy) were geeking out at the opportunity, and left hopeful for the experienced hands who were over our case.
The doctors, we learned were working through a fairly complicated case ahead of us ( I could be mixing up stories, but I’m pretty sure they were separating a cord for monochorionic twins sharing a placenta to save those two babies, and it took them something like 7 hours plus a lunch break) before it was our turn on the tar-mat, as they explained OR scheduling to us.
At about 7pm is when the came in and prepped me for the OR. I was so hungry, and the nurses were so sweet to sympathize with me, knowing it wasn’t intended for me to wait so long between meals.
I met the anesthesiologists who were on call that night, a young Asian guy and an older Indian woman, and I was given a mild sedation to help calm my body.
Haha, that was a fun surprise-I’d be awake for the procedure. Yeah, I didn’t know that part, but for this surgery, baby and I needed to be awake.
The medicine was sour, and went down easy, but my body really doesn’t like anesthesia, and not long after we parted ways with my husband at the elevator and I was wheeled into the bright white operating room, I was feeling a little sleepy and a lot nauseous.
Two of the doctors on the team were scrubbed up waiting to receive me on the table, and a nurse practitioner I’d met earlier that day, as well as a few other OR nurses got me setup for surgery.
They lifted me to the OR table, laying my flat on my back with my arms out to my sides and strapped down.
Compression sleeves were put on my legs to make sure my blood kept from clotting, and a blue curtain was begun to get strung up just above my belly to keep me from seeing what was doing on below.
It was probably about then I got sick on the table, and the anesthesiologists heard my warning and stuck a tube in my mouth to catch my sickness (sorry TMI). So fun, so fun.
My belly was shaved and once again, wiped down with the yellow antiseptic cleaner.
This website shows a good example of the setup I was under for our fetal shunt procedure.
“Change the OR lights to green,” our lead physician called out.
I don’t know if there was a scientific reason for the green lights, or if it was just a vibe, but the OR went from bright white, to red, to green in a second, and the rest of my body was strapped down to the table to keep me still.
“Ready? You’re going to feel some pressure, we have to get baby into position, and then I’m going to give you some numbing cream for the needle.”
The nurses in the room pushed on my belly from the left, and I felt the doctor manipulating the baby inside me to shift their body sideways so the doctor could reach its chest.
Ouch.
Then they held baby there for the next hour, trying to keep them still- yes, from the outside.
Crazy, right?
Oh but it gets crazier!
There was indeed not a little pinch of the trochar needle with the metal cannula (tube) was inserted through my abdomen and uterus, under the guidance of an ultra sound to get to the baby’s thoracic cavity.
The day before I’d had an amniocentesis- an in-office procedure that extracts amniotic fluid for testing- and that was painful enough.
This shunt procedure felt like I was being impaled through the stomach, no pinching!
My eyes bulged at the insertion, I was not expecting that pain.
“Ow,” I called out to the anithesiologists.
They gave me a little more of the sedation to help with the pain, and held my hands, one on each side, encouraging me to squeeze them and try to take a nap.
“I can’t, but I’ll try,” I replied.
The male nurse told me he had a girlfriend, so he was used to holding hands, and I could be comfortable holding his.
I remember chuckling, but thinking, ‘yeah but do you know the death-squeeze of a laboring mother type of hand hold, because that’s what’s about to happen to yours.’ I tried not to squeeze too obnoxiously- they needed their dexterity for their profession.
The female nurse started to stroke my forehead, trying to encourage me to stay calm and get sleepy.
“I’m getting really hot,” I drowzily shared, “can I get a fan or something?”
To my surprise, a tube that looked like it belonged to a wet-vac showed up to the right of my head and began blowing life-saving cool air at my face. BLESS.
As comfortable as I could possibly get with my coherence starting to slip away, my abdomen being stabbed with a large needle, and my body strapped to the table as though I was clinically insane, my mind started drifting off.
“Jeremey, get down from there right now!” I quietly yelled to the wall,
My mind woke up, remembering there was no mischievous toddler climbing and jumping from the operating room apparatus to my left, and that I was just getting confused from the sedation.
“Why’s your brother yelling?” I asked to my imaginary elementary-aged kids who magically appeared in the operating room.
I was hearing my toddler’s familiar cry coming from my left, and I worried to myself about what he could possibly have gotten himself into now to warrant such a fuss. Of course, I was in an operating room, and my kid’s voices were a figment of my imagination.
For what was supposed to be about a 30 minute procedure, this felt like it was longer than that. It could be the medicine messing with my mind, though.
“Done!”
Phew, I was so ready. I felt everything during the procedure. It was 10x worse than getting an amniocentesis. Still slightly out of it, I was untangled, un-looped, un-raveled and unstrapped from the many IVs and wires and moved back to a wheeled hospital bed.
My core was sore, my brain woozy, but I was thankful to be off that table.
The nurses took me from the operating room back up the elevator, where I immediately was nauseous again and warned the nurses of my impending sickness coming up my throat again.
“Just hold it oneeeee second!”
Uhm. No. I definitely can't, haha! Definitely can’t.
That was a lot! Thank you for reading!
If you’d like another peek behind the veil of our pregnancy with a medically fragile baby, I made a YouTube short that takes you with my husband and I on a, “Dallas Day,” to see our maternal fetal medicine specialist and high-risk obstetrician!
