HELLP, Part Deux

Ok - where was I? Oh yeah, broken fingers and happiness. Well, Little Dubya made his entrance into this world rather abruptly and with a very loud, ear-piercing scream -- a very good sign. I told him that's the last one and from now on he'll have to communicate like an adult. They took him over to the warmer where he got a quick spa treatment - he wasn't fond of the seaweed wrap but he did enjoy the warm bath and rubdown. He weighed in at a respectable 4lbs., 7oz. and 17.75" and continued to let out his blood-curdling screams - I told him we'll talk later about ignoring Daddy.

Meanwhile, Mrs. Big Dubya was tolerating having her insides on the outside as they examined her liver for any damage. Let me say right now that at this point, we were still fairly ignorant of what had transpired over the past 5-6 hours. Yes, we understood how imperative it was to have a C-section, yes, Mrs. Big Dubya was certainly having some issues, but to what extent, we did not know.

So, I went back over to Little Dubya who was busy being wrapped up in a couple of warm, pink blankets - surely another reason for wailing - "I'm a boy, dammit!" And then he was handed to me. To hell with George and his "My boys can swim" - I wanted to hold Little Dubya over my head and proclaim as loudly as humanly possible "We have created life", but I had already done enough tempting of the gods for one day. Best to wait until they were distracted elsewhere. The nurse asked for his name and I replied "Little Dubya, of course. Does no one here read my blog??"

Finally, Mrs. Big Dubya was back together again and wheeled to the recovery room, where they continued to monitor her blood pressure and keep tabs on everything else. However, something was awry with Little Dubya and the nurses took him from me. This is the point I wish it were physically possible for a person to divide himself to allow for being in two places at once. Mrs. Big Dubya might not have been knocking at Death's Door, but she was pretty much on the same street looking at the house numbers. Little Dubya was having difficulty breathing and was taken to the nursery and an incubator.

We would learn in the next day or two what happened to Mrs. Big Dubya, but I will clarify those things now for the five of you reading. Toxemia is one thing and caught early on can be managed well - it certainly isn't good though. However, rapid onset toxemia, coupled with HELLP (read here, here and here) can make for a very bad day. Consider:

HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity. The pathogenesis of HELLP syndrome remains unclear. Early diagnosis is critical because the morbidity and mortality rates associated with the syndrome have been reported to be as high as 25 percent. Platelet count appears to be the most reliable indicator of the presence of HELLP syndrome. The D-dimer test may be a useful tool for the early identification of patients with preeclampsia who may develop severe HELLP syndrome. The mainstay of therapy is supportive management, including seizure prophylaxis and blood pressure control in patients with hypertension. Women remote from term should be considered for conservative management, whereas those at term should be delivered. Some patients require transfusion of blood products, and most benefit from corticosteroid therapy. Rarely, patients with refractory HELLP syndrome require plasmapheresis. (Am Fam Physician 1999;60:829-39.)

So - this was where I was at. A wife with HELLP and a baby who's grunting. So - I spent time looking in on Little Dubya who, as I mentioned last Friday morning, was having difficulty keeping his lungs inflated due to a lack of surfactant. So, at around 1:00 am, it was determined that he would go to UConn Health Center where they could better monitor the breathing.

This is the point I believe that time begins its funny way of moving because things become blurs and some events become hazy. I went back to Mrs. Big Dubya and she was in her room now with leads and IVs - more than enough to make her look like a marionette. Her blood pressure had dipped from where it was at arrival, but no where near an acceptable neighborhood. Here's where Mr. Big Dubya just reaches his helpless state. Rather than sleep in the ridiculous torture device they called a bed, Mr. Big Dubya opted to go back up the hill and sleep for an hour or so and come back. I came back just before 5am to learn that Little Dubya had already been transferred to UConn. Mrs. Big Dubya, in her infinite wisdom (I told you all that she was smarter than me) chose to let me sleep knowing full well that a lack of sleep on this scale would certainly result in a catastrophic migraine for me later. I was disappointed, but grateful for her sensitivity (and the two Excedrin I took as well). She was exhausted and dozing off while I was there, so I went back up the hill to make all the necessary phone calls. Did I mention the 1:20am phone calls we made to parents -- it's really not a nice thing to scare the elderly, but they needed to be informed of their new grandson. Needless to say, conversations at that hour needed to be repeated the following morning.

Thus begins the saga. Mr. Big Dubya would do double duty for the next few days -- visit Mrs. Big Dubya in the morning, head to UConn to see Little Dubya, head back and see Mrs. Big Dubya, go home and eat something, see Mrs. Big Dubya, head back to UConn, go home and sleep. Thankfully Mrs. Big Dubya was discharged from the hospital on Monday, still with high blood pressure but with enough medication to manage it.

And she finally got to hold Little Dubya as well - which was as it should be.