Fetal Surgery Week

There were a lot of conversations the night before surgery. I was admitted the day before since the team was anxious about my Diabetes management and wanted to go over everything in detail. I met with several anesthesiologists. Some made me feel comfortable, some made me feel more anxious.

“What if my body is paralyzed but my mind stays awake and I can feel and hear everything throughout the surgery?” I asked the question mostly joking but I had some irrational fears. Expecting to be laughed at, the resident anesthesiologist responded.

“Yes that does occasionally happen where people report that they remember their entire surgery. Anyway, let’s talk about tomorrow.”

“No, I’d like to revisit what you just mentioned…”

I don’t think you can ever feel fully prepared going in to a surgery like this. One where you have been repeatedly told that the recovery is extraordinarily painful and your child may not survive, or you may not survive. One where you are only their 40^th case in the last 6 years because it’s such a rare procedure. Where you are the first insulin dependent diabetic in the world to be getting the surgery so they are going to do things differently than usual. No matter how brave I felt, I didn’t sleep the night before surgery.  

My surgery was delayed a couple hours in the morning because of another neurosurgery. Bryce and my mom were with me and the room seemed quiet and tense. Bryce came over to me and I started crying. I felt like no one was encouraging me or really acknowledging me. He got the picture and painted my nails bright pink. There was a lot of laughter seeing him attempt a manicure. During my manicure, a huge group of people came in to prep me. Bryce and mom had to leave the room so my epidural could be placed. The goal is to insert the epidural catheter before surgery. Toward the end of the surgery, they inject the medicine so when you wake up you feel no pain for the next 48 hours. The doctors kept reminding me that if I feel anything at all when I wake up then there is a problem.

As the doctor was stringing the catheter into my spine, I passed out. I’ve never done that before. Thank goodness a nurse was in front of me to catch me and lay me on the bed. I kept apologizing as I woke up and they assured me it’s pretty common because people have a drop in blood pressure during procedures. It was more of an exciting start than I had hoped for. Everyone was brought back into the room and it seemed like there were 100 people in there. I was given something to relax me and my memories got foggy as I was wheeled down to the OR. I do suddenly have vivid memories of being in the OR as they asked me to move over to an operating table. I lost count of how many people were in the room at that point but I already knew that over 25 people would be there for my surgery. The doctor put a gas mask on me and said I would be asleep soon. I felt very alert. I was looking around the room at taking everything in. It seemed like a minute passed and I grabbed the doctor’s arm. She removed my mask. “Why am I still awake?” I asked. “You will be asleep soon,” she assured me. That’s the last thing I remember.

During fetal surgery, I am placed in a very very deep level of general anesthesia. Not only do they need to put the baby to sleep but my uterus needs to be completely relaxed. My surgery was about 2.5 hours and went well. Caleb’s portion of the surgery was about 25 minutes while most of the time is spent cutting me open, removing my uterus and positioning it, cutting it open to expose Caleb (first he needed to be flipped from his back to his tummy), and eventually piecing my body back together. Caleb was measuring 1 pound 11 ounces the day of the surgery. The team updated Bryce through the ordeal and also text him pictures of the surgery throughout. My blood sugar stayed perfect the entire time.

I woke up in the recovery room in excruciating pain. I don’t remember saying much other than, “Pain, pain.” I remember people running around and the anesthesiologist team coming in to redo my epidural. I have no concept of how long that took but once it was working, I was a happy woman. We weren’t sure why my epidural didn’t work initially. I was told maybe the catheter migrated. I was given high doses of magnesium sulfate to prevent labor. All fetal surgery moms talk about this drug. It makes you feel incredibly hot, nauseous and terrible. It is very similar to having the flu. We kept the room at 55 degrees and it was intolerable to everyone but me.

Here is where the story gets interesting.

Around 1 am, I woke up in a panic. I could feel my epidural rapidly wearing off and all my feeling came back instantly. I began sobbing and Bryce woke up. I can only describe the next 3 hours as a scene out of The Exorcist. Since it was the middle of the night, the fetal team was gone and they suddenly had a fetal surgery patient with no painkillers on board and no working epidural and no orders written. Bryce, my mom and my nurse spent the next few hours trying to get the on call anesthesiologist to redo my epidural but he didn’t seem to believe it wasn’t working. The nurse kept pushing Morphine in my IV which did almost nothing. I could not wish pain like that on anyone. Every single minute felt like an hour. Bryce called a fetal surgeon on his cell phone in the middle of the night which the surgeon did not like, but he asked to speak with me. The second he heard my sobbing, he was giving the anesthesiologist a piece of his mind. I remember begging and pleading, sometimes to Jesus, sometimes to the doctor. I asked them to put me under. After two attempts at redoing the epidural, I was numb again. It was the longest 3 hours of our lives. There is nothing I couldn’t endure after that. Bryce was scheduled to fly home the next morning to be with our boys.

“Please don’t leave me,” I begged him. “I already moved my flight to Friday.”

We all fell asleep and exactly 2 hours later, I woke up to my feeling coming back again. No, this can’t be happening. I called for the nurse and more anesthesiologists came in, continually bolusing my epidural. “You should be paralyzed,” they would say. “Do you need proof?” I would cry hysterically. I’ll stand up and run around this room if you need proof!”

This time, they knew something wasn’t working right and they put me on a drip of Dilauded. I had never heard of this drug before but now I kindly refer to it as “my day on heroine.” It is essentially medical grade heroine and only used in extreme situations for pain. It wasn’t ideal for Caleb, but we had no choice and of course I would accept any relief. I barely remember the next 24 hours and I was hallucinating and could not hold a conversation.

My remaining couple days in the hospital consisted of more pain as I came off the drip, starvation, vomiting, enemas, and attempting to get up for the first time on day 4. My blood pressure ran dangerously low the whole week, around 55/30. It’s from the combination of drugs being given. Trying standing up after 4 days with blood pressure that low is…eventful. I was also not allowed to eat food or drink water for 4 days since the Dialuded was making me sick. If you wanted to see a hangry person, you should have visited room 544. The second they said I could eat, I went straight to a BLT. Also not a smart idea. Broth would have been a better choice.

My amniotic fluid levels were at a 3 (normal is above 10), but this is expected after surgery. I could feel every movement that Caleb made, tenfold. I also could tell he was in pain. He thrashed around like I had never felt before. It was heartbreaking because there was nothing I could do. Doctors seemed happy with our recovery and discharged me on day 5. They don’t want you sitting in the hospital waiting for a blood clot but it did seem early to go home. As I was being wheeled away from my room I pointed out if I were to ever be in this much pain for any other reason, I would be heading TO the hospital not AWAY!

Last pregnancy pic pre surgery

Right before surgery

Waiting to get checked in

Dr. Papanna

Diabetes Talk

Dr. Moise and Dr. Snowise

Final walk through the halls

Netflix and Chill

Next to Miles, I'm the hardest IV stick

Card reading and nail painting

Dr. Fletcher, Neurosurgeon

Dr. Tsao, our favorite

Being sent into the Operating Room

Waiting for a new epidural after surgery

We couldn't get me sats above 80- oxygen time

Painkillers make you smile

We stood up, then immediately back down

First shower, heaven

He hadn't slept in a week

Christina had the same surgery the week before

Jess flew in just to be there

Fetal Surgery- It’s Only A Day Away

Dinner with Mom at Cyclone Ayana

It’s my last day of true freedom. It’s all hitting me. I started dry heaving as I walked around Houston with my mom today. It’s funny what nerves will do to you.

Here’s the plan friends. I spent three days last week in the hospital at Memorial Hermann Children’s for my steroid shots. No one was with me so I was bored and basically just ate too much gross hospital food and had heart to hearts with the nurses and doctors. The highlight was I got to meet the mom who had fetal surgery for Spina Bifida on her daughter last Tuesday. We had been speaking online and her room was right down the hall from me. I went to see her every day and she tried to smile and grit through some serious pain for my sake. I’m seeing so much bravery in the women that go through this. It was fascinating to see someone experiencing this just one week ahead of me. Please pray for Christina and her daughter, Haven. She has been a big support to me.

My mom flew into Houston yesterday night so we got to have a girl’s day. We grabbed some Tex Mex for dinner and have relaxed in the comfort of our hotel room. I called one of the surgeons on his cell phone today with a few more questions because as we draw near to the surgery, more fears are arising. There are a few things they are doing differently with me because of my Diabetes and it always makes me nervous to have to go outside the box. For instance, they want to do quick blood draws on me to test my blood sugar during surgery so they are doing an Arterial IV line. They said these are painful and if someone accidentally puts IV drugs into an A Line, there is tissue damage and can even lead to amputation. Please don’t make that mistake medical staff! I’m putting so much trust into strangers.

Bryce flies into town tomorrow morning and I am getting admitted to the hospital around 11 am tomorrow. There are still more meetings and conferences to have with the doctors. The team has still not agreed on whether to cut my incision horizontally or vertically. There is some big debate on this. They are also deciding if they want to learn how to use my insulin pump during surgery or to move me to an IV drip of dextrose and insulin. Everyone is very nervous about my Diabetes control during the surgery and days to follow, including me.

Tuesday morning, I will be prepped and heading for surgery by 7 am. My mom or Bryce will keep you all updated on the status. The surgery is generally 3 hours but Caleb’s defect is more involved so they said it could be longer. I’m really hoping to wake up to good news. All I want to hear is, “Everything went to plan.” Words like that have become music to my ears the last couple years. The following few days after surgery will be very difficult.

I talk to moms all the time that have experienced this surgery and there is one common theme they discuss: pain. There is no denying this is one of the most painful things to go through. Unless someone has done a lot of research on fetal surgery, they have no idea the magnitude of it. Most doctors don’t fully understand. What makes it unique, is they do such an invasive procedure, cut your uterus in a very unsafe spot, and once sewn back up, your baby is in a rapid stage of growth. Most women deliver between 30-34 weeks because something emergent happens in their pregnancy. The luckiest ones make it to 37 weeks. My C-Section is scheduled for December 18.

I told the doctors that people keep comparing this to the pain of their C-Section or hysterectomy. They all look at each other and laugh and say they would compare this to going through open heart surgery, though probably more painful. Not to mention the intent of the surgery. My baby is having neurosurgery and he has to heal in my womb. They told me a C-Section will be the easiest thing I go through after fetal surgery. Ok I get it guys…this will hurt!

There are 25-30 doctors in the room to perform the surgery so in that sense I feel incredibly taken care of. With that many smart people in a room to keep Caleb and me alive, I know they will do a great job. Once surgery is over, there is a long road ahead. The goal from then on out is to stay pregnant as long as possible. Mothers say each day they get closer to their due date they feel so relieved. Most start celebrating when they make it 30 weeks! I will spend about a week in the hospital and then I’m moving into an apartment next to the medical center. I’m hoping after a few weeks there I can return to Phoenix, but it all depends on my recovery. My mom and mother in law will trade off caring for me. Bryce is going home the day after surgery to be with our boys and return to work. I wish he could stay with me longer.

Fetal surgery is so rare that it’s hard for most people to relate to. I’m so grateful to the moms I have met that have had it and the candid advice they have given me. It makes me feel less alone is this crazy experience. The love and support we received during my pregnancy with Miles ran wide. But I would say the support for Caleb has run deep. Friends, family and total strangers have invested their whole hearts into this experience. There must have been dozens of people involved in arranging care for my boys while I’m gone. This has undoubtedly been a community effort. Oh Caleb, how you have been loved before anyone could ever meet you!

If you are interested in learning about fetal surgery, there is a PBS documentary on Netflix called, “Twice Born- Stories From The Special Delivery Unit.” It has several parts and follows a few stories, so to save time I would recommend following the mother, Shelley. Her daughter is having fetal surgery for Spina Bifida.