Hey Jude – Medical Records

STILL…QUESTIONS

Over a year ago, I paid roughly $140 to get my medical records from Providence Hospital in Mobile. I was—at the time—evaluating a theory that low blood pressure was instrumental in losing Jude. We were approaching finding out the gender of our rainbow, Eilie, who would be a girl, and I’d come across some research that implied that hypotension could be as health-hazardous to a fetus in pregnancy as hypertension.

Fast forward to two days ago. Sean and I do natural family planning (Creighton method). Not to over-share, but two cycles within the past five months have been indicative of low progesterone and / or infertility. **Spoiler, we’re not trying right now, so I can’t say if infertility is an issue**. The first month was while I was weaning Eilie, so I attributed the incident to her changes in nursing. This month, I have no excuses.

As I started to look at the indicators of low progesterone, I realized that me during Jude’s pregnancy matched well with those indicators. These things were abnornmal for me but included:

  • Extreme, frequent headaches
  • Low **nudge, nudge, wink wink** drive (seriously, any nudging had better mean that I get to go to sleep early)
  • Extreme fatigue
  • Weight gain
  • Irritability / depression

Oh, and a few other things. Anyway, for anyone who’s ever been pregnant, thinking of being pregnant, or is pregnant, you know that being fat, achy, and fatigued are all pretty darn normal. Sean and I were in the roughest patch martially we’d been in. We’d just renovated a house together (so stupid). We were recovering from the growing pains of our first child’s first year in which I felt completely neglected (in that, I had no personal time to so much as shave an armpit…I did, in case you were wondering). I was working passionately to mount a new career as a freelance writer so that when we had Jude, I could start working from home. Because I was visiting Lillianne at Mom’s store during my lunch hour at USA, I’d lost my hour to exercise.

Of course I was fat, cranky, and tired. Who’d want to have a squelch after that? And honestly, I have NO idea how Sean felt. He was probably as unhappy as I was; however, when one is unhappy, they have limited time to actually assess how unhappy the other person is.

 

GROWING PAINS

We were at the precipice of a slippery slope. Throughout Jude’s pregnancy, Sean had commented he’d barely felt the baby kick because he we never spent enough time together for him to feel Jude’s baby bump. I, on the other hand, felt Jude kick all of the time. He was such an active baby. I knew he’d give Lillianne a run for her money. I mean, if we thought Lillianne was a climbing monkey, Jude was going to be a cirque du toddler. We’d need helmets…and padded mats.

Then, as you know, on December 24, we went in for a 9:00 a.m. check-up. Sean, Lillianne, and I looked at Jude’s heartbeat on Dr. T’s handheld device.

“He’s going to be a chunker,” she said. I felt the same way. I knew that like my brother was to my mom, my second baby—my boy, was going to be a meatball. I couldn’t wait.

Without any intelligible reason, I candidly asked Dr. T as she left the room, “Do you think there’s any chance he’ll come early?”

She tilted her head and scrunched her face thoughtfully. “No, I don’t see any reason,” she said.

Why did I ask that? What a stupid question. I had no reason to ask that; however, it was prophetic and my second indicator thus for of things to come; though, I didn’t realize it at the time.

 

RECAP

On December 26, after noticing decreased fetal movement, I called and went in. On the way to the hospital from west Mississippi, I had reassuring movements. It’s a false alarm. I’m still going in, I thought.

We checked in…Jude had a heartbeat. There were some indicators on his BPP—like the lack of lung activity and my slight excess of amniotic fluid (polyhydraminos) that were causes of concern.

The doctor on call told us that our baby was actually small…lower 5th percentile. This was when I started to cry. My parents had come to take Lillianne with them, and we bravely blinked back tears in face of the news. How was my doctor so wrong about his size?

The setting sun was visible through the windows at Providence Hospital. Sean and I were hand-clasped as we followed a nurse toward the hospital where I’d be checked in for monitoring. Meanwhile, Lillianne…a little over 18th months, held hands between Mom and Dad and walked in the other direction. I looked back to see my golden-haired daughter walk away from me. I had no idea that it would be the last time she’d be in the same room as her brother while he was still alive. If I had, I’d have let her hug him goodbye.

What followed for me from my experience has been documented; however, the medical records…the data story tells of a different narrative and one in which I feel says the opposite of what I’ve been told, which was, “We don’t know what happened.” If I read this accurately, and mind, I’m not a medical doctor, I think it’s clear what happened. Jude died of hypoxia. It’s not apparent WHY this all happened (I’m inclined to think hypotension and possibly low progesterone were factors, but there’s literally no way to know); however, I think what happened might be easier to discern.

 

A DATA STORY*

*A use of ***indicates I’ve skipped perfunctory detail

5:49 p.m. : Patient admitted to ‘Provid:0703’

***

6:33: Fetal Monitor: UA REF (So, the baby is on the monitor, too, I guess?)

***I received an IV. My BP was higher than normal (123/63 and my BPM was 90).

7:00: Decreased variability

7:00: Average contraction duration: 40 seconds in the last 30 minutes; intensity, mild

7:00: Accelerations: 2 in the last 30 minutes

7:00: Decelerations: 1

7:00: Baseline: 150 bmp in last 30 minutes

7:00: Variability: Minimal – detectable <= 5 bpm

7:00: Contractions: 6 in last 30 minutes

7:00: Contraction frequency: 2/ 10 min in last 30 minutes

7:05: Dr. F notified of poor variability; IV orders changed from heplock to LR at 125ml/hr

7:05: Fetal tachycardia noted, reported to Dr. F (Dr. F. is the doc on call who I met with previously who indicated Jude was small.)

7:24: FHR1: TACHYCARDIA (tachycardia detected)

***

7:30: Contractions: 4 in the last 30 minutes; 1/10 in last 30 minuets; 0 accelerations in last 30 minutes (FHR 1)

7:30: Dr. F called to check on patient; informed that FHTs has improved; however, variability is still minimal, *** and she denies feeling any contractions or abdominal pain.

7:33: PT sitting up, eating; family brought dinner and visiting.

7:53: FHR1: SIGNAL LOSS; Please adjust FHR sensor

8:00: Contractions: 6 in last 30 minutes; accelerations 1 in last 30 minutes; baseline 155 bpm in last 30 minutes. Av. Contraction duration: 70 seconds in last 30 minutes

8:07: BRADYCARDIA: Severe Bradycardia detected

8:12: TACHYCARDIA: Tachycardia detected

8:16: RN Nurse remarks: I went to the phone to update Dr. F about decelerations and variably. Dr. F called to inform of another pt on the way and I updated her. I was told that we would continue to watch her and more lab work would be done in the morning. I expressed concern about the decelerations and minimal variability.

8:30: Accelerations: 0 in last 30 mins, 155 BPM in last 30 mins, contraction duration 108 seconds in last 30 mins,

8:57: FHR1: No Transducer

9:00: Contractions 4 in last 30 minutes…

***

9:00: Up to bathroom (me, the patient)

(I was put back on the monitor. This was the longest 50 minutes of my life. If I were to swear to it in court, I’d way it was 10 minutes).

9:06: SIGNAL LOSS. Please adjust FHR sensor

9:06: BRADYCARDIA; Severe bradycardia detected

9:12: O2 applied via face mask at 8L per (nurse) (What they haven’t noted is that at least half an hour to an hour earlier, I requested to be moved to USA Women’s & Children’s. I was advised when I stabilized, that would happen. It. Never. Happened.)

9:14: O2 applied via face mask at 10l/min

9:15: BRADYCARDIA: Severe bradycardia detected

9:19: FHTS audible; fetal movement audible

9:20: SIGNAL LOSS; Bad FHR signal; please adjust FHR sensor

9:22: PT discussing how much baby is moving and states that she things it is because she has just eaten for the first time today; fetal heart tones audible 140s; fetal movement audible

9:22: Doppler at bedside; FHTS audible; fetal movement audible; begin using Doppler to aide in placement of efm so that it will trace

9:23: SIGNAL LOSS; Please check patient and FHR sensor

9:23: FHR1 measurement method: No transducer

***

9:24: Nurse (RN) remarks: Pt states that it is hard to believe she went to the doctors office for decreased fetal movement this afternoon when he is moving so much since she has eaten while attempting to audit monitors fetal movement is visible and audible. (In hindsight, I believe Jude was in fetal distress, which is why I felt his movements. My poor baby. I wish so much that I’d have done so much so differently.)

9:29: FHR1: SINGAL LOSS

9:33: Dr F notified of patient status and requested for her to come assess fetal monitoring strip. She stated she was on the way and to have ultrasound ready in pts. Room. Dr. F informed that FHTS were audible and fetal movement was audible and visible per RNs as well as the pt and significant other; however, we were uncomfortable not being have be to have the monitor tracing the heart tones.

9:40: Ultrasound brought to pt room, plugged in and turned on

9:42: Nurse: Explained to pt that the ultrasound was brought in because Dr. F is coming in to ultrasound her and assess the fetal monitor strip. RNs alternating assessing FHTs with EFM and doppler—pt states that she feels baby kicking, fetal heart tones audible 150s fetal movement audible, significant other has been at bedside.

9:46: FHR1 SIGNAL LOSS

9:50: Dr. F at besides. Ultrasound reveals no fetal movement and no heart rate per Dr. F. Pt requests stat c-section and states, “Please do all you can do.”

 

AFTERMATH

After that, I was rushed in for an emergency Cesearean delivery with the hopes…the hopes that a miracle could happen and knowing it probably wouldn’t.

I was in shock and convulsed in panic as I was wheeled in to L&D. I rhythmically changed, “Oh God, oh God, oh God,” on the way in. I looked into a light that was a facsimile of the Kingdom of Heaven—a big beautiful bright light—as I took what could’ve been my last gulps of air in the hopes of saving my son. In those moments, I also prayed to be spared so my daughter, Lillianne, wouldn’t grow up without a mother.

Lillianne’s mother survived. I pulled out of the sandbag of medicated sleep and asked Sean, “How’s our baby?”

Sean clasped my hand. “He didn’t make it. I named him Jude. Jude David. Is that okay?”

I started to sing, “Hey Jude.” And Sean started to sing with me. And then appeared a man of God whose name is also David, Father David, our Priest, and he prayed for and with us in our darkest hour.

 

REFLECTION

I keep thinking I’m finished looking for answers, but then something happens, and I’m on the hunt again. I know this is the writer in me. The bloodhound that sees mystery, intrigue, and questions to be answered at every turn. I m insatiably curious about the what-ifs of life. Respectfully, in the case of my son, I am curious not for causes of morbid fascination but to (1) get closure; (2) to help others; and (3) to know what to look for if we get pregnant again.

I have increasingly become of the opinion that hypotension is undermonitored and undervalued as a complication of pregnancy; however, as one who suffers from this sleeping giant, I know for a fact that Eilie, our rainbow baby would have died had it not been for increased monitoring and the solid instincts of my regular OB, Dr. T.

I miss Jude so much…every day. He would be such a precious age now. I loved seeing Lillianne at two. I imagine my boy at this age…just two months away from two and a half. He’d have been so cuddly and beautiful; however, he’s among the angels, and he blesses me every day. I know God took Jude for a reason. I no longer believe Jude’s death was a miraculous ascension into heaven (I never thought that per say, but I also had no idea “what happened). Now I know that there were variables that might have influenced our outcomes. What if a different doctor was on call? What if we went straight to the high risk facility, USA Women’s & Children’s? What if I just ripped that darn IV out and drove myself to Women’s & Children’s? Would Jude have lived? But then, would he have died in minutes? Would he have suffered greatly? Would he have lived but with traumatic brain defects due to lack of oxygen?

To every question, all I can say is, maybe. That’s the bitter-sweetness of hindsight and begging the “what-ifs”. I could go for days. At the end, this is my life. This is my world. We lost Jude. He’s in heaven, but he’s such a beautiful addition, and he’s such a real part of my family and my life…it’s as if he was still right here every day.

Jude has given me drive and strength. I’m going to continue exploring my research about hypotension in pregnancy. I’m going to raise money for women and prenatal support particularly in the area of raising awareness for women who fall into this category. Jude will not have gone in vain; he gives me strength to do something good for all of woman and their unborn children’s kind.

 

Dear Jude,

Goodness, how much we’ve grown in these past two (and almost a half!) years. You’ve taught me so much. You’ve made me everything I hoped you would and more. You’re so amazing my darling. Please keep inspiring me and moving and motivating your father and me. Help us to be our best selves for Lillianne, Eilie, and you…and that last baby if it’s meant to be. Jude, help us learn and use your story to help others. What’s more, help me find real and accurate information and researchers who can prove my theories or lead me to better ones so that you and I can be instruments for raising support and awareness to help other mommies keep their angels on Earth so long as that’s where God intends them to be. 

I love you, sweetheart.

Until we meet in heaven.

Mommy

 

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