The Uninvited Lesson of Preeclampsia
I found this essay yesterday while searching for something else. Since today is the fourth anniversary of Rachael’s stroke, it seemed apropos to share it here this morning.
In therapy, so much time is spent focusing inward that the return to the outside world can be jarring. Somehow, week after week, I remain surprised that the rest of the world keeps spinning during the hour I spend on the couch.
One morning in October of 2014 – newly pregnant with my second child – I was riding the post-therapy high that comes from a session where things seem to move along effortlessly. We spent our short time discussing my excitement and fear of this new unknown.
As I crossed from the courtyard outside my therapist’s office to my car, I glanced down at my phone and saw that I had a message from my friend Charis.
Smiling, I swiped the screen to view the message.
“Rachael is in a coma and is in critical condition.”
Rachael, Charis’s best friend, was 26 weeks pregnant. I read the rest of the message, learning that she had gone to the emergency department where she had suffered seizures that had led to a stroke.
“Eclampsia?” I replied, though it really wasn’t a question so much as a statement. Seizures are the hallmark of preeclampsia turned eclampsia.
I glanced back at the glass door separating this reality from my therapist’s waiting room. I briefly considered running back into her office and refusing to leave its safety for the next seven or eight months.
Shaken, I drove back to work and fell down the Dr. Google rabbit hole, looking for reassurance that the dreaded “it” would not happen to me. I had already done this routine a million times before with every imaginable pregnancy ailment because, for me, reassurance seeking is an insidious part of my obsessive compulsive disorder. Still, I prefer to call it “research” — with emphasis on air quotes.
I tamed the hormonal panic by noting that I had none of the most likely risk factors. I was not overweight, I was under 40 years old, and I was in my second pregnancy. There was no personal or family history of preeclampsia, and my blood pressure had always been perfect.
Worry for my friend washed over any concern for my own health.
In late February, after four months of small steps forward and back, a message came in that Rachael had passed away, having never regained consciousness. She never met her daughter.
Rachael and I had not been close friends; but as I scrolled back through the message threads between us, I was struck by the way they bookended her life. In the first, she asked for suggestions on what to take on a picnic date with her new boyfriend. Later, married to that boyfriend and expecting a daughter, she asked my opinions on baby carriers, cloth diapers, and car seats. In both, there was an implied expectation of the future.
After her funeral, as I stress-ate my second or third brownie, one of the few familiar faces in the room came over exclaiming, “Rhiannon, I did not realize you were expecting! Congratulations!”
With my eyes and abdomen both swollen, I felt like an elephant in the room. I wished I could hide my expanding belly, but it had stretched beyond that possibility.
Wiping the crumbs from my lips, I said, “Yes, thank you;” and because these conversations are predictable, I added, “I’m due in late June.”
I could almost see the mental gears turning before she said, “Oh. So you must be about as pregnant as she was when it all happened.”
Oh, indeed.
Another facet of my personal flavor of OCD is an overwhelming pull towards symmetry, coincidences, and the full circles of anniversaries. Sometimes, that universal search for connection leads my brain astray, away from noticing interesting bonds with others. Instead, it builds bridges out of anxiety.
I soothed myself as I ran through my mental litany of preeclampsia risk factors.
It was ok. It would not happen to me.
I wonder if I led the universe straight into temptation.
One April evening after my daughter’s fifth birthday party, I went to the bathroom. In a holdover habit from the early days of miscarriage fear, I glanced at the toilet paper. Blood. Without processing what I was seeing, I stood up and looked into the bright red water.
I kissed my daughter and said we’d see her in the morning before heading to the hospital.
During the brief wheelchair ride to labor and delivery, I felt two more gushes. The bleeding could not be definitively explained; but after testing an uncomfortable variety of bodily fluids, they decided the likely cause was mild preeclampsia that led to a partial placental abruption.
A quick email to my therapist ended with, “Yeah. Not joking.” It certainly seemed unbelievable.
Worried that my son would be born that night, I was sent via ambulance to the same hospital where Rachael had been. The last thing the doctor said to me after ordering the transfer was, “Your mascara is running.”
Four days later, I was sent home with the promise that I would take it easy and show up for twice-weekly testing.
The next day after a reassuring session of fetal monitoring, the nurse slapped a blood pressure cuff on my arm to get a quick reading before I headed out to lunch.
The machine let out an alarm.
“Why don’t you lie down for a minute, and we will retake it,” she said with a concerned smile.
Within the hour, I was once again lying in a hospital bed as doctors and nurses rushed around the room, speaking to each other with their serious faces.
Occasionally, they paused to ask me questions.
“Have you had any facial swelling? Headaches? Shoulder pain?”
“Any upper right quadrant pain?”
“Has your vision changed at all, Mrs. Giles?”
I thought about that morning when my eyes had been puffy from what I had attributed to too much salt the night before.
A nurse standing at my bedside began opening IV supplies “We are going to give you an IV of Magnesium Sulfate to prevent seizures.”
I imagined never seeing my daughter again. Never meeting my son.
One awkward resident stood at the foot of the bed and stared at me, clearly unsure what to do about the crying pregnant lady in his midst. I imagine he had spent most of his OBGYN rotation wishing he were anywhere else.
Eventually, he said, “You seem upset.”
I cocked my head at Captain Obvious and nodded.
He had no idea.
The next two weeks were a blur of near misses. I had headaches that resolved at the last minute, blood pressure readings that teetered on the threshold, and a lot of boredom.
At 31 weeks, the scales finally tipped; and my son, Rowan, was delivered via cesarean section. Five days later, I walked out of the hospital, leaving my three-pound baby behind in the care of those better equipped to keep him alive.
The trauma and sleep deprivation of his weeks in the hospital mixed with what passed as my “normal” anxiety to create a nearly constant feeling of panic. Every time I closed my eyes, I dreamed of babies dying. During the day, I was haunted by intrusive thoughts that if I did sleep, I would never wake up.
Preeclampsia stole so much from me and from Rowan.
And yet it asks us to be grateful. Because it could have been so much worse. It stole everything from Rachael and her family. There is no rhyme or reason. There’s no explanation why it was her and wasn’t me.
The search for gratefulness is an ongoing battle. Rowan and I are here, on this Earth, but that does not mean we can’t mourn his difficult start in life. Thankfulness, sadness, and even anger don’t exist in a vacuum — fear and pain and hope mingle together to create a sometimes messy collage. That this lesson was forced on me unwillingly does not negate the importance of its message.
