My Caring Care Givers

The people here have really gone out of their way to ensure that I have been well cared for. All the doctors are amazing. Dr. S admitted me and has been keeping a close eye on everything. He has done most of my ultrasounds himself and has always taken the time to explain everything to me and made sure I understood what was going on, who was of what opinion and what the different opinions where. He has helped us to understand the benefits and the risks of everything and has been a calming and reassuring presence. Professor S and Professor G head the department. They have both been very caring and have made efforts to bring in all the specialists who are involved with my case and make sure that I am receiving top notch care.  Dr. Y saw me several times in the ER and has also been involved in my care now. Like Dr. S she has taken the time to explain many things and has really been an amazing doctor. Dr. T first did the ultrasound that diagnosed most of the problems. He also happens to work in the hospital and has made it a point to be involved in my care and follow up with the many parties involved. Dr. C is the resident in charge every day.  He has helped to explain when the doctors disagreed and has worked to try to keep me more comfortable on a day to day basis.

There are a few doctors in the ultrasound department who have really helped us also. Dr. R is the head of the department and Dr. M one of the staff doctors have both been very helpful.

There are many nurses who have been amazing. I’m afraid if I try to list them all I would forget someone. One of my favorite nurses in Nurse J. She has been a big help and a good friend. Dov always feels good when she is on shift because he says he knows I am in good hands.

There are a few national service girls, nurses’ assistants, and orderlies who have also been great. Among them are M and L who have both made it a point to come and talk to me and get to know me. R, a recent immigrant from France has especially become a friend. She stops by just to talk sometimes.  Z has fussed over me for a while now.

M and F are the two women who clean on our ward. They are both very nice. M always says good morning and talks to me a little. She has been telling me stories about her nephew who was a preemie 30 years ago and how he B”H (Thank G-d) survived and is doing well.

I have a lot of gratitude for all of these people and more who have thus far gone above and beyond to not only take care of me but to also make me feel taken care of.

I Found All The Crazy People

My roommate gave birth yesterday at 4:30am. B”H (Thank G-d) she is doing fine. Her baby was 1.5 kilo and is in the NICU but he seems to be doing well. The nurses decided I should move into her spot since it is more private and closer to the window.  However her bed was broken (it can go up but not down) so a few nurses came in and switched the bed. They helped me take down all the signs and decorations that the kids made for me and rehang them in the new space. We moved my hat collection (population 5) into its new home as well. I switched closets and once I was all settled the nurses left me to acclimate.

I had the room all to myself for about 12 hours before getting a new roommate. The nurses were so nice and tried to fill that bed last. After another 12 hours with my new roommate I am joining in her fervent hopes that she be discharged today or tomorrow.

I had another interesting experience yesterday. I have been in quite a lot of pain since Shabbos (Saturday). The doctors were afraid that my hernia may have reoccurred and wanted a surgeon to check me. After a day and a half of trying to get a surgeon to come up they decided to send me down to the surgical ER. Here, I discovered why they were not coming up – it was PACKED!! I haven’t been around that many people or seen that much activity in at least the month that I have been here. It looked like the shuk only with more urgency.

This would never have fazed me before but I guess the past month in the relative quiet of the high risk ward has made me a little more sensitive (don’t worry, that will be gone about 5 minutes after I get home).

There were a lot of “interesting” characters in the ER.  The most eccentric was a crazy lady that they were trying to get committed. She needed some kind of surgery and didn’t want it, but was clearly not all there.  She would randomly break into song (see Mom, it is NOT normal), and alternate between singing and screaming at people. At one point she tried to seduce the doctor while protesting the government (OK, pretesting the government was probably the most sane thing she did). She kept yelling to the doctor not to call a psychologist because she said, it wouldn't do any good. Little by little she snuck her catheter out by herself and then threw it at the nurse. She seemed to be particularly proud of this achievement and happily treated us all to a detailed explanation of how she pulled it off. (Just in case you are in suspense, in the end she was committed.) 

This would have been interesting enough, but there was a lonely old man waiting for surgery who decided to talk to her. The two kept debating back and forth (between her other antics) about appropriate behavior in the ER, the state of medical care in Israel, whether or not doctors should spend more time in school and a host of other things. Then there was the guy who kept emptying his catheter bag on the floor, the people who wanted to dance in the middle of the ER and well, you get the point. I guess really, none of this is unusual for a big, busy hospital in the middle of a large city. The nurse said it was just a little unusual that there were that many at one time.  As I reflect on my amazing ability to attract crazy people I can't help but think it was all in my honor.

A few weeks ago some random lady walked into my room and made herself at home. She sat down and started to talk to me. Well, I’m pretty friendly so I talked to her for a little bit.  However, after 20 minutes she was still there and asking some very personal questions. I decided to tell her I was tired and needed to sleep. She agreed but didn’t get up, so I got into bed and pretended to go to sleep. She just sat there and watched me! I was starting to get a little nervous but didn’t really know what to do. Thankfully, my roommate realized what was going on and asked the nurses to relocate the lady.  Of all the people on all the floors in the hospital, she chose me. This is pretty typical of my life. I guess I should take comfort in knowing that one aspect of life hasn’t been completely interrupted.

As for a medical update, the doctors are still debating about the baby but the good news is that after the hours I spent with the surgeons they decided I do not have a hernia. Instead they think there is an infection under my surgical scar (apparently they can see that in the ultrasound, but have no idea how I would have gotten one there of all places). We are waiting for the results of the blood test and for an infectologist (I promise that, despite what spell check thinks, I didn’t make that word up) to come examine me. Then, if everything is positive, they will try to find an antibiotic that I am not allergic to (I'm deathly allergic to most of them) and that can be taken during pregnancy.  The fun continues…..

Anatomy of a Tough Decision

At the meeting yesterday the majority of doctors seemed to think the best idea was to try to wait another two weeks. This would give the baby the chance of going from a micro-preemie (under 3 pounds) to a preemie. Doing that would give the baby a much better prognosis. However, Professor G, the head of the department, is very concerned. Dr. S explained her concerns to me this morning. Previously the medical community has always believed that in a case of IUGR when the baby went into distress there would be a sequence of events that would happen that, if identified, would give doctors time to intervene and save the baby from fetal demise. However, recently there have been a few papers and studies coming out saying that this is not always the case, especially in babies who are suffering from severe IUGR. Our baby is in that category being in only the 3^rd percentile.

Professor G feels that our baby will most likely not go through the sequence if it goes into distress. Therefore today when I go for an ultrasound it will be done by a doctor and Dr S and Professor G will come in and observe the ultrasound. (Dr. S is the doctor who admitted me and also happens to be an expert at ultrasound. He has taken a special interest in our case and we have come to trust him very much.) Based on what they are seeing they will hopefully be able to decide one way or the other.

Another problem they are facing is that as the brain sparing effect stops there have been changes in the dopplers (ultrasound measurements of blood flow in the baby’s brain, umbilical cord, heart and the vein connecting the umbilical and heart.) This is something else that will have to be taken into consideration.

Additionally, just to complicate matters, I am having a lot of pain against the incision site from my hernia surgery and that along with a few other symptoms have the doctors concerned that my hernia may have returned. This is a very rare complication from hernia surgery, but since I have hit so many of the really rare conditions and complications with this pregnancy, nothing will surprise me at this point.(Maybe I should by a lottery ticket.)

So, I am waiting for the ultrasound with the doctors, the surgeon to asses my hernia and the surgical site in general, more monitoring, plenty of meds and all of this while we await the doctors to make what is a tough decision. While this is a stressful and somewhat scary time for us, our doctors are just as stressed and worried. This shows me just how good they are. They are really taking us into account and have made it a point to keep us informed. I can see that they are agonizing over the decisions as well, each one determined to do what is best for me and the baby. No one is taking this lightly. I feel that I am not just another patient, but someone that they care about. This has gone a long way towards keeping me healthy and in good spirits and has been more effective than any medicine. IY”H (With the will of G-d) they will be able to help us towards a favorable outcome for everyone.   

High Wire Balancing Act or Now Comes the Hard Part

I know, I know. NOW comes the hard part? What was everything until now, a walk in the park? Let me explain.

What got the doctors worried earlier this week was confirmed today on the ultrasound. The baby is looing it’s brain sparing effect. One of the problems in the pregnancy is IUGR (Intrauterine Growth Restriction). There are two type of IUGR, symmetrical and the far less common asymmetrical, which is what I have. In asymmetrical IUGR the baby redirects blood flow to save vital organs. In a fetus the only vital organ is the brain (as opposed to a person where it is the brain, heart and lungs). Therefore the head and brain will be proportionally larger than the rest of the body; this is called the brain sparing effect. 

The fact that the baby is starting to lose this effect means that we will have to deliver soon. Now here is the catch. We, and the doctors, are faced with a difficult decision. Having the baby early in my case presents more problems than a regular premature baby. Our baby will have the problems of prematurity and the problems of IUGR. This puts the baby at a much higher risk for many different complications. If we wait two weeks, the chance of many of those complications happening drops significantly (in some cases to as low as 1-4%). However, if we wait we run the real risk of fetal demise. Additionally, the longer that I am pregnant, the high the risk of my developing preeclampsia (a condition that puts both mother and baby at risk and is occasionally fatal to the mother).

So basically, we are stuck between a rock and a hard place. Until now, I have been a curiosity, and rare patient, a hot potato, a teaching case and a “once in a career opportunity.” Now, I will be the subject of a hospital interdisciplinary board meeting. The perinatology (high risk pregnancy) department will meet with the pediatric and neonatology (premature baby) departments and try to decide which choice is the lesser of two evils, which risk has the better chance of yielding a good outcome. Neither option is good and the risks of both are very real.

I am so thankful to be in a great hospital with doctors who really care about what is best for me and for our baby. Everyone has really taken the time to make sure I understand everything that is happening and to answer all of my questions. The entire staff has gone out of their way to make sure I am not only taken care of physically, but also emotionally and spiritually. I therefore feel confident in the doctors and know that they will make the right decision. Hashem (G-d) should bless them with clarity and let them be the right shaliach (messengers) for our yeshuah (salvation).