I rolled my eyes in my husband‘s direction and thought, Good thing you were paying attention, Ed.
A few more minutes of waiting and I was ready to be rolled down to the OR. Dr. Miller came into the room again, this time accompanied by Dr. Cooper who wanted to check on me before the procedure.
Dr. Miller asked us whether we had decided what to do if they determined they could only save one of the babies. Ed and I had discussed this the night before. The ethical and practical dilemmas posed by this question were immense. Dr. Miller had explained that, if one of the twins had already died in utero or was in a chronic condition, the other twin would almost surely follow unless drastic steps were taken. Basically, the surviving twin would panic and die if she realized her sister was gone. The only way to stop this from happening was to block the supply of blood and nutrients to the twin that had passed (or would soon pass).
In the little time we had the night before, Ed had consulted our priest, Fr. Matthews, who had met with us several times before we were married as part of our Catholic wedding preparations. The twin to twin diagnosis was terrifying. And I wondered how I could be the one to decide the fate of one of my babies, knowing that it might lead to the death of both babies. Catholic doctrine is not perfectly clear on the subject. Generally, Catholicism opposes any intentional action on an unborn baby that would kill it (even in the case of ectopic pregnancies). But how did those teachings, or any ethical rules, apply in a situation where neither would survive if “nature ran its course” while killing one might save the other? How could someone weigh the survival of one‘s child against the moral opprobrium of killing one‘s other child? It was the worst paradox that a parent could imagine.
Even though there was a slim chance it would come to this, it was a horrifying dilemma. I understood that for some families this may be their best option, which is why Dr. Miller presented it. But for us, we decided that Dr. Miller and his team should try to save both, even if this reduced the likelihood of the healthier twin surviving. But, we said, if there was no chance of Katie surviving, we authorized them to do whatever they needed to save Lauren. Either way it was a nightmare, and I prayed it wouldn’t come to that. These unthinkable Sophie‘s Choice scenarios weren’t what I wanted to discuss before the operation, so I cleared my mind of the possibilities and returned my focus to the positive news we’d heard: both girls were alive and doing better.
Another thought came to mind. They were taking me to the same operating room where I delivered Abby two years earlier. Dr. Cooper scheduled a C-section when Abby was breech and I started having contractions. I was awash with very different emotions this time around. Because Abby was my first baby, everything had been new and I balanced a mix of feelings—mainly excitement, but a tad bit of nervousness too. Throughout my pregnancy with her, I had felt calm, safe and reassured. Of course, I had my worries, as with any pregnancy, but I mainly focused on my pregnancy winnings. I had managed to escape prolonged nausea, stretch marks and hemorrhoids. I was slightly worried about Abby‘s size in relation to my petite frame and how we would get her out safely. It was something we had talked about since the very beginning. I recalled those early appointments with Dr. Cooper in which Abby was measuring unusually big.
“I’m not sure your body is going to be able to labor naturally with this girl, kiddo,” Dr. Cooper said.
I had the vision of doing everything naturally—I had contemplated a home birth to re-enact what my grandmother Ita did seven times—but it wasn’t in the cards for me. I was thankful to have been born in a time of medical advances which saved my and my baby‘s life. Abby had been in downward position almost the entire time and then decided to flip in my third trimester. I knew trying to get babies to flip back around could be a tricky proposition, so when I woke up that stifling hot July morning with labor pains, I knew we needed to take the quick, safe route and have the C-section. Turns out I made the best decision for us.
“We made the right call, kiddo,” Dr. Cooper told me later. “You could have labored for two days and then we still would have had to do an emergency C-section.”
Even with the urgent C-section, I knew that my baby would be robust, that I’d be able to hold her right away and that she’d be going home with us within a few days.
This pregnancy was the polar opposite. It had been a struggle from day one and hadn’t let up since. Every day brought new challenges. I had no idea what to expect. The positive readings earlier that morning gave me hope that the fear and difficulties had crested, but I knew that wasn’t the case. It felt strange to be wheeled to OR #2 where my pregnancy with Abby had ended. Definitively. Safely. Positively. Joyfully. This time around it wasn’t the final destination, but merely one stop along a very long and uncertain road.
Another difference: when they had delivered Abby, I was fully conscious; they just used a local anesthetic. This time, I’d be knocked out and completely unaware of my unfurling fate. Will the surgery have worked? Will they have had to sacrifice one baby for another? Or will they have saved both baby girls? I agonized over the decision Ed and I had made, but tried to stay focused on the little bit of good news we’d received and remembered the incredibly positive outcome the last time I had been in this operating room. I wanted to believe that magic was present, as it had been two years earlier. I remembered Abby‘s first cries—her grand entrance into the world—and our first days with her in the hospital. My last thought before the anesthesia set in was, Things are in God‘s hands and in the hands of Dr. Miller and his team.
Chapter 5
What Do We Do Now?
I slowly emerged from an anesthesia-induced slumber to the incessant beeping of the heart and oxygen monitors. There was a dull pressure from the IV in my arm. The elastic, adhesive tape had been wrapped around tight and was digging into my skin. And of course, there was the nausea that never seemed to fully dissipate. Ed was at my bedside, holding my hand. He asked me how I was doing.
“To be honest, I feel much less like a blowfish,” I croaked, my throat a bit raw from the anesthesia.
Ed laughed. “You look less like one.”
I would’ve slapped him if I didn’t have an IV stuck in my arm.
He told me that the surgery had gone really well. Dr. Miller said both girls looked okay; he had been able to get a good separation of the placenta, meaning that the fluid imbalance and the blood flow problems should improve. After the laser ablation was done and the blood vessels had been blocked, which apparently only took fifteen minutes, Dr. Miller drained the excess fluid from the recipient‘s side of the sac. This apparently relieved a lot of the pressure that I had been feeling—the reason I knew something was wrong in the first place.
“But, Houston, we do have another problem,” Ed said.
“Are you serious? What now?”
“So, the doc nicked a hole inside ya.”
He‘s joking, right? Not cool, I’m still all drugged up.
“Ed,” I said as I rolled my eyes, “what the heck are you talking about?”
“When Dr. Miller inserted the needle into the umbilical sac, it caused a small hole in the inter-twin membrane.”
“Oh, crap!” I said. “Is that something they can patch up?” I asked.
“No, and it‘s actually not as bad as it sounds, but it is something they’ll need to monitor,” he said, reassuring me.
“Katie and Lauren are safe—and so are you.” He reached for my non-IV hand and gently kissed the top. “And that‘s all that matters.”
For the first time since I had learned of the diagnosis, I let thoughts about the long path ahead sink in. The ablation surgery had just been one step along the journey, the most daunting step, perhaps, but still the first of many. We had weeks to go before the babies had even a remote chance of survival in the outside