Thursday 3/15/12
Tucker Henry was born at 4pm…uneventful, joyous,
routine. He was healthy, quiet, perfect. I even made the comment to Erin “I can’t
believe we have had 4 healthy boys without any pregnancy or labor
problems.” We felt very fortunate because Tucker's umbilical cord was tied in a complete knot, yet was long enough that it was never pulled tight enough to cut off blood flow. The midwife said this is extremely rare.
Friday 3/16/12
On Friday Erin looked and felt great. She entertained guests, bounced around the
room and toyed with the thought of going home that day. However, at 8pm she began having abdominal
pain while breast feeding Tucker. The
nurses and midwife attributed it to uterine contractions typical with a
multiparous female. But, the pains never
went away…all night long. She took a
Vicodin and tried to stay comfortable. I
had gone home to sleep that night and Erin called me at 6am saying that she had
an awful night of “gas pains.”
Saturday 3/17/12
When I arrived to the hospital that morning I found Erin in bed
complaining of abdominal pains, and her abdomen was distended. She hadn’t had a BM since before the baby was
born but wasn’t nauseated or vomiting. I was concerned about her am labs and vital signs as they were all slightly off. The midwife, her attending and the OB resident evaluated her and all said the findings were explainable by the typical post partum period. Her pain was from her bowels trying to
move and so the plan was…aggressive bowel
regimen. Later that day she had
increased pain and I asked for a CT scan.
Interestingly it didn’t show much, just a colon full of stool and an
ileus. The uterus looked like a normal
post partum uterus…difficult to assess on CT scan. At this point I was spinning my wheels, a general surgery resident being forced to trust an OB resident, a midwife, and her backup OB doctor. I began reading OB textbooks online and had
created my own differential diagnosis with endometritis at the top of the list. But…she didn’t have a fever, the hallmark of
postpartum infection. Erin did complain
of subjective fevers and chills but nothing documented over 37 C (99 F). I knew something was not right...and the words of one of my surgery mentors kept resounding in my head, "If it ain't right, it's wrong." Why would a perfectly healthy woman who had a normal vaginal delivery get constipated postpartum? I didn't know who to call for a second
opinion so I decided to call a colleague's wife. I ran everything by her and fortunately she
was on call for her group and said she would see Erin on rounds the next
morning. From what I told her she agreed
with the treatment plan since the CT didn’t show much and she didn’t have a
fever. So, Saturday continued with pain,
trying to walk, and no luck with the bowel regimen. That day was a lesson in trust and patience and stress management. I knew what it felt like to be an airline pilot taking a transatlantic flight riding coach.
Sunday 3/18/12
I slept in the hospital call room that night because I was
nervous about Erin’s abdominal pain. I
went up to her room about 7:30am and the midwife’s OB backup had already rounded
on her. Erin said he pressed on her
belly and said “Once you poop, you can go home.” My colleague's wife came in for rounds and I asked her a bunch of questions about endometritis,
ovarian vein thrombosis, ovarian torsion etc.
Erin’s WBC came down from 18 to 11, (normal is 5-10, higher than 10 is bad, less than 4 is worse) and she continued to have the same
pains. The doctor said that since Erin
doesn’t have any fevers and her WBC was near normal that it is difficult to
make the decision to start antibiotics for endometritis. The plan was to continue watching her and I
asked for a repeat WBC later that day (to make sure her WBC wasn’t going to go
down below 4). Sunday was one of the
worse days of my life…if not THE worst.
Erin writhed in pain all day and I was at the mercy of the doctors. I called the midwife and told her that
Erin wasn’t looking all that good and she came in to see her about 3pm. She also was concerned and made some phone
calls trying to mobilize some troops.
She made a mention of wanting a surgery consult so I decided to call one of my favorite mentors Dr.
Kemmeter. Besides being a great surgeon, I knew he wasn't on call but I knew he would care and that he was the type of guy that gets stuff done. To my amazement he answered
the phone with “Hey Eric, how is she doing?”
I was shocked that he already knew the story so I just told him that
Erin looked sick and needed evaluated. He
said “What could be going on with a healthy 33 y/o uncomplicated vaginal
delivery? I’ve been working out in the
yard so let me wash my hands and I’ll be in as soon as I can.”
At 5pm all the chips fell into place at once. Her repeat WBC came back at 1.9 and her heart rate jumped up to 140, evidence that she was not only sick, but septic. Whatever infection she had was bad news. Dr. Kemmeter came to evaluate her and the OB doctor was there too. At that point the decision was easy. She needed surgery ASAP. The running diagnosis at this point was a Group A Strep infection and that meant that we were in for a long night. Before transferring her to the ICU Dr. Kemmeter sat with us and told Erin what he thought was going on. He also took the time to pray with us, which meant a lot. Erin asked him if she was going to die, and he said "I've known Eric for a while now and about the faith you both possess. I also know about your plans to serve the Lord in missions. God has big plans for you and therefore He will take care of you." (A few days later Erin recalls this answer and didn't like that he didn't say a firm NO! The truth was that he couldn't guarantee anything at the time.)
No comments:
Post a Comment