Ready for Air
A Journey Through Premature Motherhood
By Kate Hopper
University of Minnesota Press Copyright © 2013 Kate Hopper
All rights reserved.
It's midmorning, but already the air is thick and the streets are gummy. Heat rises in rippling waves from the asphalt, inflating me beyond what pregnancy seems to mandate. At seven months pregnant, the only shoes that still fit are plastic flip-flops, and as I make my way slowly into the heart of downtown, they slap against the concrete. I should have splurged on the parking ramp next to my obstetrician's office, but it's a luxury I can't afford.
I didn't expect pregnancy to be so unpleasant. My mother claims that she never felt better, that she was "full of energy," that she "glowed." She looks perplexed when I tell her how much I hate it. But it's not just the swelling and heaviness I dislike, or even having to eliminate alcohol, caffeine, and decongestant from my diet; it's the worrying and waiting that bother me most. Pregnancy has brought my neuroses bubbling to the surface, and I worry about everything: the six (or ten?) glasses of wine I downed in the days before I knew I was pregnant; the antidepressants I weaned myself from during those first weeks; the level of mercury in the fish I ate last month. I also worry about things like cell division, meiosis and mitosis, those hazy terms from high school biology that now have an immediate bearing on my life, on my child's life.
My mom says she didn't worry about any of those things when she was pregnant. "We didn't know enough to be worried," she says. I raise my eyebrows, skeptical. I'm convinced that her memory has rewritten the worry just as it has rewritten the discomfort of pregnancy: the swollen ankles, the bloating, the sluggishness.
To make matters worse, I've developed a horrible cough. It's a dry, hacking cough, and by the time I get to the center of downtown, my chest feels raw and heavy. I'm determined to get my doctor to prescribe something to quell it.
I'm drenched by the time I check in with the receptionist and make my way into the bathroom to leave a urine sample. I drink liters of water every day, but in the last few weeks, I haven't been peeing much at all. Today, as I twist the lid onto the container, I notice that I've captured less than two ounces. But I'm sweating so much in this heat, it's no wonder.
The nurse weighs me, and I cringe when the scale settles at 173 pounds. "Oh, my God," I say. "I've gained almost fifty pounds!" The nurse's only response is a tight smile, and I'm immediately embarrassed by my outrage. We are supposed to gain weight, after all. But fifty pounds seems excessive considering I still have two months until my due date. And a few weeks ago I even gave up my nightly bowl of chocolate ice cream, a sacrifice that apparently hasn't made a difference.
The nurse checks my blood pressure, then leaves me in the small exam room, where I lie on the table, coughing. Each time I cough, my belly tightens, and I wonder if it's possible to cough myself into early labor.
"What are you doing in there, sweetie?" I whisper. We know the baby is a girl. I had an ultrasound a few weeks ago to rule out placenta previa, a condition in which the placenta attaches to the uterine wall on or near the cervix. An earlier ultrasound had indicated this might be a problem, but in the follow-up my placenta looked fine. Donny wasn't able to make the appointment because he had just started his first teaching job, and although we were desperate to know the baby's gender, I didn't want to discover it without him. As the doctor wiped the cool gel from my belly, I asked her to write the baby's gender on a piece of paper and seal it in an envelope.
I carried it in my purse all day, periodically removing it to hold it in my hands, as if the weight of it alone would reveal the answer. The moment Donny walked through the door that afternoon, we tore it open. We both started to cry when we saw the doctor's writing: "It's a girl!"
I was relieved to be having a girl because I felt I understood girls. Clearly I was a girl, and I grew up with two sisters and no brothers. A boy represented challenges I didn't feel ready to meet. I worried about teaching him to respect women. What if he wasn't as kind and gentle as Donny?
There is a knock on the door, and Dr. Bradford steps into the room. "How are you feeling?" she asks, closing the door behind her. She's a no-nonsense doctor, and I like her.
"Awful," I say, pulling myself up to a sitting position. "I have a terrible cough." I'm convinced that if she sees how miserable I am, she'll give me a prescription for something strong — safe for the baby, of course, but strong enough to allow me to sleep at night.
Dr. Bradford looks down at my chart. Her dark hair is cut short around her face, and her glasses are stylish in a midfifties kind of way.
I begin to cough again, and Dr. Bradford furrows her brow.
"It feels even worse than it sounds," I manage. "And the semester just started." I teach creative writing at the University of Minnesota, where I'm also a graduate student, and yesterday I hacked my way through the first meeting of my intermediate nonfiction course. My students were, quite appropriately, disgusted.
Dr. Bradford looks down at my feet, dangling over the edge of the examination table. "Colds," she says slowly, "take time to pass through your system when you're pregnant."
That's it? You're not going to give me anything for this?
She points at my plastic flip-flops on the floor. "Is that what you're wearing?"
"Yeah," I say, sheepishly. "None of my other shoes fit anymore."
Dr. Bradford kneels and presses her fingers into the mottled skin of my ankles, leaving imprints of her thumbs in my flesh. When she stands up, she says, "I'm worried about a couple of things."
Ha! I knew the rattling in my chest was serious.
"You're leaking a little protein in your urine," she says, glancing at her clipboard.
"Oh," I say, not knowing what that means.
"You've also gained nine pounds in the last two weeks," she says.
"I know," I say, grimacing. "But I've been cutting back."
Dr. Bradford shakes her head. "It's not from eating. You're retaining water."
I cough hard and look down at my feet, which have begun to throb. Tonight they will be so swollen and itchy that I'll have to sit on the edge of the bathtub and soak them in freezing water before bed or I won't be able to fall asleep. But it's not just my feet that are swollen; my collarbone has been enveloped by flesh, and when I look in the mirror I hardly recognize the chubby face staring back at me.
"Water retention is common during pregnancy," Dr. Bradford says, "but I'm concerned because you're also leaking protein." Her brown eyes are earnest. "Both of these are signs of pregnancy-induced hypertension."
There is something like a hiccup in my chest, and the room suddenly feels too cold. I shift on the exam table, and the paper sticks to my thighs and tears loudly. Dr. Bradford doesn't seem to notice.
"Have you heard of it?" she asks.
I cough into my shoulder and nod, searching my mind for the paragraph I read when I was looking for an explanation — other than the weather — for my swollen feet. I remember that one book said extreme swelling could be a sign of pregnancy-induced hypertension, or preeclampsia, but I didn't think I was extremely swollen. Was I? I mean, how do you know?
"The good thing," Dr. Bradford goes on, "is that your blood pressure is beautiful."
I never would have put "beautiful" and "blood pressure" together, and this suddenly seems very funny to me. I smile, spreading my hands over my huge belly.
Dr. Bradford tilts her head, looking perplexed, and I realize I'm not responding the way she expected. But how does one respond? I wish Donny were here. He would know what to say. Or he would help me know what to say, his light eyes somehow slicing through clutter to help me think more clearly. Finally, I ask whether pregnancy-induced hypertension is the same thing as preeclampsia.
"Yes," she says, "but we don't call it preeclampsia anymore."
"Oh," I say, wondering if that's a good thing.
"You don't have it yet, but you have signs of it, so I want to keep an eye on you." Dr. Bradford looks at me over the rims of her glasses. "I'm going to have you come back next week rather than waiting two weeks. In the meantime, you need to take it easy."
"The semester just started," I say lamely, my to-do list suddenly lumbering awake in my mind, each bullet point clamoring for attention.
"You might need to rethink that."
"Oh," I say. I don't tell Dr. Bradford that I can't stop teaching. I don't tell her that I had to fight for this class — my dream class. I don't tell her about the countless hours I spent this summer walking from one University building to another, filling out forms, submitting them and resubmitting them in order to receive a paid six-week maternity leave in November. I don't tell her that I must teach if I want the University to continue paying for my graduate classes and my health insurance.
"Do you have a scale at home?" Dr. Bradford asks.
I shake my head.
"Well, you should get one. I want you to weigh yourself before bed and then first thing in the morning. If you gain more than one pound overnight, call me." Dr. Bradford takes off her glasses and rubs the bridge of her nose. When she puts them back on, she looks at me. "The other things to watch for are severe headaches, pain in your shoulder or upper abdomen, blurry vision, and vomiting."
"Oh," I say, suddenly sober, trying to memorize these symptoms. Headaches, pain in shoulder or abdomen, blurry vision, vomiting.
"I'll see you next week," she says, opening the door. "And remember to take it easy."
"Okay," I say again, but I'm not sure how I can do less than what I am doing. I raise my hand in a half-wave as Dr. Bradford shuts the door behind her.
When I walk out of the office a few minutes later, I'm clutching an appointment card with one hand and my belly with the other. I concentrate on the heat of my skin as I step into the bustle of downtown. I don't notice the cars or the blaring of horns. I don't notice the sweat running down the backs of my legs. I walk the eight blocks back to my car, holding tight to my belly and trying to convince myself that everything will be fine.
As I drive the ten minutes home to our small two-story house in South Minneapolis, I stare at my thick fingers on the steering wheel. A few weeks ago, I removed my engagement and wedding rings and tucked them into a corner of my jewelry box. This seemed a normal-enough ritual, something that many pregnant women do during their third trimester. But now that I know my swelling is not normal, I can't believe I ever thought it was. My wrists are as thick as ankles. And as I stare at my stretched skin, worry takes over. I have no idea what this means for the baby. What if something happens to her? But I remind myself what Dr. Bradford said — the swelling and protein are just signs, something to watch.
I pull up in front of our pale-green house, which we moved into three months ago. Donny and I have been married for almost four years, but this is our first house, and it's still difficult for me to believe that it's really ours. When I push open the door, I drop my purse on the sofa and pause, taking in the slant of sun across the maple floor. Even in the heat, the house feels light, airy, and this reassures me. The baby will be fine. Everything will be fine.
Still, I need to understand what I'm up against. I need facts to ground me before I tell anyone, even Donny, about the appointment. Otherwise, as soon as I hear his voice I'll begin to cry. I walk upstairs to our bedroom, where, on the floor next to our bed, there is a small library of books cataloging each phase of fetal development. I toss them onto the bed and settle myself in a circle of words.
I read that pregnancy-induced hypertension (PIH), or preeclampsia, is characterized by high blood pressure, protein in the urine, and edema, just as Dr. Bradford said. Then I read this: PIH can impair kidney and liver function, cause bleeding, seizures, pulmonary edema, stroke, and in severe forms, death.
I stare at the word until it becomes blurry, its five letters running together on the page. Then I look away, gazing at the gold walls and the pale cream curtains that I spent hours making this summer. They hang limply on either side of the open window, not even the slightest breeze moving into the room.
I close the windows and flip on the air conditioner, which roars to life, and turn back to the books. I learn that PIH is simply the latest in a series of names for the disease. Its full name is preeclamptic toxemia, but it's regularly called preeclampsia or toxemia. Its Australian name is hypertensive disease of pregnancy, or HDP, and it's also known as gestosis. "All of these names," the author writes, "reflect the uncertainty as to its cause. A nineteenth-century doctor called it a 'disease of theories,' and this remains true today."
I take a deep breath. "A disease of theories" can't be good; there are too many unknowns in a theory, and thus too many unknowns in a disease that relies on theories. I want facts, something solid, unshifting.
I read that preeclampsia comes in two forms: mild and severe. Treatment for mild preeclampsia is bed rest and fetal monitoring. Treatment for severe preeclampsia is an IV of magnesium sulfate to prevent seizures, which is followed by delivery of the fetus, no matter how far from term the pregnancy is. If severe preeclampsia is not treated, it can progress quickly to eclampsia, which is "characterized by convulsions and coma." This book goes on to say that although it's unusual for women to die of preeclampsia in the United States, worldwide it is a leading cause of death — 76,000 women annually. Holy shit! But generally, the book goes on, preeclampsia is more dangerous for the unborn baby than the mother because it can cause growth retardation, placental failure, and premature birth.
Placental failure. Premature birth. I lean back against our pillows, feeling dazed. Dazed but not crying. Months later I'll wonder at my lack of tears. Why didn't I cry? I'll realize that even with the books spread before me spelling out our future, even as I contemplated eclampsia as a possibility, I didn't think my pregnancy would end that way — in seizures, growth retardation, premature birth.
Suddenly, I need to hear Donny's voice. I reach for the phone and dial his classroom. After four rings, he picks up. "Hello, Mr. Gramenz speaking."
I've never heard him answer the phone like this, and I'm quiet, letting his new teacher identity sink in.
"Hello," he says again, and I realize I haven't said anything.
"Hi, babe," I say slowly. "I might have preeclampsia."
"What?" he says. I'm not sure if he didn't hear me or if he's asking me to explain.
"Preeclampsia," I say, and as I explain the swelling and protein in my urine, I realize that I have adopted the outdated name for the disease. But really, pregnancy-induced hypertension doesn't seem to fit because I'm not hypertensive — I don't have high blood pressure — and I prefer preeclampsia for its prefix — it is "pre" eclampsia, "pre" seizures, "pre" coma. I like the way its name places me out ahead of these possibilities.
As I catalog my symptoms, the high-pitched chatter of Donny's students grows louder in the background. He says "Hold on" to me, then "Please be quiet" to his students. His voice sounds strained, and I picture him, hand covering the receiver, glaring the room into silence. I should have waited until the end of his school day to call, but the thought of him not knowing about the fact that I might be sick fills me with loneliness.
"Sorry," he says when he's back on the line. "I'll leave right after school." The timbre of his voice is still unfamiliar, and when he says, "Will you be okay?" I know he's scared.
"I'm sure everything will be fine," I say, suddenly reassuring, my confidence inflated by his fear. "We'll know more next week. I'm sure everything will be fine. Dr. Bradford is just being cautious."
When I hang up the phone, I still feel it, the certainty I've slipped on like a coat to counteract my husband's worry. This is the way we work. (Continues...)
Excerpted from Ready for Air by Kate Hopper. Copyright © 2013 Kate Hopper. Excerpted by permission of University of Minnesota Press.
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