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After the doctors left, I sat on the edge of Kim's bed and we cried. It had all come to this. All the back-and-forth about whether to have children; all the thinking and talking about what we'd need; all the books and the articles and the prenatal classes; all the morning sickness Kim had endured; and all the excitement about the twins. And now here we were, 100 miles from home in a hospital room in Charlottesville, Virginia, sixteen weeks before term and waiting for Kim to get sick--very sick--so the doctors ...
After the doctors left, I sat on the edge of Kim's bed and we cried. It had all come to this. All the back-and-forth about whether to have children; all the thinking and talking about what we'd need; all the books and the articles and the prenatal classes; all the morning sickness Kim had endured; and all the excitement about the twins. And now here we were, 100 miles from home in a hospital room in Charlottesville, Virginia, sixteen weeks before term and waiting for Kim to get sick--very sick--so the doctors could cut her open and bring our babies into the world too early. Our twins."
In the course of a routine prenatal check-up Kim Woodwell learned that she had a severe condition that would require doctors to deliver her twin girls in a matter of days. She was barely halfway through the pregnancy. The twins still had four months to go before they were officially due.
The birth of the twins later that week--each weighing less than a pound and a half--marked the start of a months-long roller coaster ride that reminded the parents and everyone around them how fragile and how precious life can be.
This is a gripping account of the day-to-day struggles facing the thousands of families every year whose pregnancies end far too soon and whose babies have to fight to survive. It offers a firsthand view of the anger, the grief, the hope, and the joy that can follow in the wake of a too-early birth.
"And it proves," the author says, "that the smallest human beings can teach us the biggest lessons we will ever learn."
William H. Woodwell, Jr., is an independent writer and editor. He is the author of Choosing the President: The Citizen's Guide to the 2000 Election. His work has appeared in the Washington Post.
Kim's visit to her doctor on the morning of May 27, 1997 wassupposed to be no big deal, just a regular checkup to seehow everything was going. At the time, Kim was twenty-fourweeks pregnant with twin girls. She had just started on aschedule of seeing the doctor every three weeks, with ultrasoundappointments scheduled for every six.
I was working in my home office that morning when Kimcalled from the doctor's. "They're sending me to the hospital,"she said matter-of-factly. She said her blood pressurewas high and that she had protein in her urine, two signs ofsomething called preeclampsia. Kim said it probably meantshe'd have to spend the summer on bed rest. She said they'dhave to do more tests. When I asked how she was feeling,Kim said she was fine.
"I feel perfectly fine," she said. "I don't understand it. Ifeel fine."
I told Kim I'd meet her at the hospital as soon as I could,and I rounded up our three dogs to bring them inside. I thenset out on the thirty-five-minute drive north to Winchester,Virginia, the nearest city to the Shenandoah Valley farmhouseKim and I had moved to from Washington, D.C., just twoyears before.
The idea of Kim in bed all summer long was disturbing; Iwondered how she could possibly stand it. But if that was theprice we had to pay, then so be it. We already expected Kimwould be on bed rest in the final month or two because of thetwins, or at least on "limited activity," as Kim's doctor hadcalled it. This was happening a lot sooner than we expected—wewere sixteen weeks shyof the girls' mid-Septemberdue date—but I figured we would somehow deal with it.We would somehow cope.
I met Kim in the recovery room on the hospital's laborand delivery floor. She was alone, dressed in a hospital gown,and lying atop the sheets in one of the four or five beds linedup like parked cars against the wall opposite the recoveryroom door.
Kim was in an OK mood, it seemed, forcing a smile nowand then, but obviously perplexed at how this could happenwhen things seemed to be going so well. Throughout thepreceding five months, she had been extremely conscientiousabout her health. She walked every day, avoided alcohol andcaffeine, and followed all the basic diet guidelines in the pregnancybooks without getting fanatical about it.
Besides, high blood pressure bad never been a problem forKim before. Why was it a problem now? She had been ahealthy person all her life, and I imagined her wondering ifshe was in a dream, wondering if she wasn't really in a hospitalbed but in her own bed at home, still pregnant without aproblem but with her subconscious making a show of theinevitable anxieties lodged deep in an expectant mother'smind.
I perched myself uncomfortably on the low, rolling stoolbeside her bed. Kim told me the nurses had taken a secondurine sample, this one through a catheter. They also had takenblood for various tests to find out more. The results weren'tback yet.
Kim then handed me a brochure that one of the nurses hadgiven her on preeclampsia. She said she'd been too agitatedto read it herself. She said she'd read it later.
Leafing through the piece while we waited for the testresults, I learned that preeclampsia affects as many as one inten pregnancies in the United States. The primary signs arehigh blood pressure, protein in the urine, and swelling, oredema. The most severe cases can lead to convulsions—eclampsia—andeven death. Although bed rest and othermeasures can help prevent preeclampsia from advancing to amore critical stage, the only known "cure" for the conditionis to end the pregnancy. Often, doctors will have to deliverthe baby early to save the mother's life. As a result, preeclampsiaaccounts for an astounding one-third of all prematurebirths.
The cause of preeclampsia, the brochure told me, is notknown. More often than not, it affects woman who are pregnantfor the first time and women who are either undertwenty-five or over thirty-five years of age. Kim was thirty-threeat the time; this was her first pregnancy. Other riskfactors include chronic high blood pressure, kidney disease,and diabetes, none of which was a problem for Kim. One riskfactor that might have been a problem, however, was the factthat Kim was carrying twins. I later found out that preeclampsiaoccurs in as many as three in ten twin pregnancies.
Kim and I waited in the recovery room for what seemedlike hours. After two other women were admitted to theroom, I pulled a curtain around Kira's bed for privacy. Oneof the other women was pregnant with twins, too. From herconversations with the doctors and nurses, I made out thatshe was farther along in her pregnancy than Kim, hut it wasstill early. One of the twins, apparently, was much smallerthan the other and they were going to have to deliver thatafternoon. The woman disappeared as quickly as they broughther in.
I remember thinking that Kim and I were lucky. Our problem,it seemed at the time, was manageable. And our babiesappeared to be doing all right.
But soon we got a sense that our problem had become lessmanageable than we thought. There suddenly seemed to be alot of activity and a lot of talk in the nurses' station outsideour room. Through the door, we could hear a male voicesaying something about needing transportation—-either anambulance or a helicopter—and needing it fast Kim told methe voice belonged to the doctor on call, the one who hadseen her when she first arrived.
One of the nurses finally came in and told us the bloodtests had turned up some "more concerning news." "Moreconcerning than preeclampsia?" we asked. She nodded yesand said to sit tight until the doctor could come to explain.He was busy with a delivery, she told us. We figured it wasthe other woman with twins.
Within minutes, the nurses had Kim hooked up to an IVof magnesium sulfate. They told us this was standard procedurefor preeclampsia, that it would help stabilize her bloodpressure and keep her from going into seizures. The nursesalso gave Kim a shot of steroids—betamethasone—-into herbehind. When we asked what the steroids were for, one ofthe nurses explained that they would help the babies' lungsdevelop if we had to deliver early.
I remember Kim's eyes when the nurse mentioned the possibilityof early delivery. And I remember an unblinking lookof fear and helplessness, like she'd been caught in the headlightsof an oncoming truck. We were only twenty-four weeksalong. Kim had just recently started to show. How early adelivery were they talking about?
We were alone in the recovery room for another ten minutesor so before one of the nurses came in to explain thatKim was going to have to be transferred to the University ofVirginia Medical Center in Charlottesville that afternoon byambulance. It would be a two-hour ride. When we askedwhy, the nurse explained that the Winchester hospitalcouldn't take care of babies born before twenty-eight weeksgestation.
The doctor was through with his delivery and returned tosee us at about two o'clock. We had been sitting together inthe recovery room since noon. He explained that they wantedKim in Charlottesville as soon as possible, "in case you haveto deliver the babies," he said. When we asked what the problemwas, the doctor explained that it appeared to be a severeform of preeclampsia called HELLP syndrome. The doctorsaid they'd be able to do testing in Charlottesville to find outmore. It was clear from his all-business demeanor that hewanted us out of there fast—uncomfortable, I'm sure, aboutthe thought of having to deliver extremely premature twinshimself.
Kim began to cry after the doctor left us alone. "I don'teven believe this is happening. I feel fine. I'm doing fine." AllI could do was hold her hand and say, "I know."
Soon one of the nurses was back with some paperwork wehad to sign. She said she'd be going along for the ride in theambulance with Kim. She asked if I wanted to follow in ourcar.
I said no. While we were waiting for the doctor, Kim andI had agreed that I would stop at home before leaving forCharlottesville so I could water the plants and take the dogsup the road to the woman who boards them when we're away.Then I'd pack some clothes for both of us—two or threedays' worth, maybe. It was hard to think much farther ahead.
When the ambulance drivers finally arrived, they helpedKim shimmy from her recovery room bed onto a transportgurney, careful to move her IV equipment with her, alongwith the catheter that was now collecting Kim's urine in aplastic, see-through bag.
During the ride down in the elevator, the others were talkingcasually about the weather and work. At one point, thenurse told the ambulance drivers she was on until eleveno'clock that night and was "glad to get away for awhile."
Outside, I gave Kim a kiss on the forehead before theyloaded her into the ambulance. "I'll see you in Charlottesville,"I said. She barely responded, still stunned by the eventsof the last several hours. I could see she was trying hard tohold back more tears.
Excerpted from Coming to Term by William H. Woodwell Jr.. Copyright © 2001 by William H. Woodwell Jr.. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.