37 Seconds

by Stephanie Arnold

  In the weeks leading up to Jacob’s birth, I kept writing those letters. Now, on May 30, I was driving to the hospital to probably give birth a week before my scheduled C-section and wondering who was going to say Kaddish for me.

  I called my father in the most tranquil voice I could muster to tell him I was going into labor. My father had a weak heart, and I knew I needed to speak calmly to him so he wouldn’t panic. He said he would let my sister and the rest of the family know, and he asked me to call him after Jacob was delivered to let him know everything was okay. He then added, “Good luck, sweetheart, we are excited to meet our grandson.”

  Tears filled my eyes. I said, “Good-bye, Papi, I love you.” Five words filled with intense love and now anguish.

  At the hospital labor and delivery entrance, I was admitted quickly. A nurse hooked me up to the monitoring equipment and told me to relax. Right. Adina was with me in the room. So was Tessie. My friend Jodi met me at the hospital and told me she would be there as long as I needed her. She always makes me laugh, and I needed her stupid sense of humor to take my mind off of things. At one point I walked to the bathroom and passed a clot on the floor. Jodi, with her quick wit, said, “I think you dropped something.” She made me laugh so hard. Tessie assured me she wouldn’t leave Adina’s side.

  At that same moment, hundreds of miles away in New York, Jonathan was at the New York State Bar Association antitrust meeting. The host had just called the meeting to order when Jonathan’s phone started to vibrate. He walked out to the hallway, answered, and heard my panicked voice. “I am on my way to the hospital. We are going to have this baby today. Get here as fast as you can.” After expressing how much we loved one another, totally, completely, and forever, we hung up.

  Jonathan hopped into a cab, made a flight reservation en route, and stepped on board just as the door closed. He would remember that trip vividly as he recounted it months later.

  “The moment we hit 10,000 feet, I logged onto the Internet and started Skype-chatting with Steph,” he said later. “I felt horrible that I was not with her and she was scared and alone. She was updating me constantly on her condition. She told me she was being watched closely, and while I was upset that I wasn’t there to hold my wife’s hand or console her, I didn’t think we faced danger. Steph, on the other hand, felt great danger. She kept reiterating her fears and begging me to get to the hospital without delay. Steph was happy that she was able to persuade the doctors to delay the C-section until 1:30 P.M., so I would have time to get there.”

  Then there was a reality check. Julie changed the plan. Everything was quiet in the operating room, so she thought it was best to start the procedure even though Jonathan was still en route. I continued typing as frantically as I could, like a high school student racing against a clock while taking a timed test. Where could I start? How should I start? What could I say knowing these were the last communications I would ever have with the most important person in my life?

  I wrote, “You are the best husband and the greatest father and your children will always know it.” I continued: “I love you with all of my heart. And no matter what happens, you have made me the happiest woman in the world.” Still focused on the logistical questions, he asked where he should meet me, and I said, “The 8TH floor, Recovery . . . hopefully.” That was it. Our conversation was over. I had to shut down my computer before I could see his reply.

  “Somewhere over Ohio, the plan suddenly changed,” Jonathan said later. “Steph IM’d me that they were prepping her for the C-section. Why the sudden change? All she did was repeat over and over how much she loved me, that she thought our marriage was wonderful and . . . nothing. The line went dead. The IM connection went dead. My heart sank.”

  My fear was palpable now. I looked at Adina, wanting her to remember me as a happy woman who was desperately in love with her. I kissed her a few times. My friends assured her I would be back, and my doctor gave her a hug and said, “We will be back with your brother soon.” As I was being wheeled out of the room, looking back at my daughter’s face, I held back the tears as I realized this was the last time I was going to see her.

  Chapter 5

  THE FEAR WAS EXCRUCIATING. I desperately needed to hold Jonathan’s hand, to hear his voice. I knew that if he was there, he wouldn’t let anything happen to me. As I was being wheeled down the corridor by my doctor, I tried again. “Julie, there is something wrong with me, put me under general anesthesia, the baby is fine, but I need to be under general anesthesia.” She told me to calm down and reminded me that all the tests were negative for any problems. “I’m sure you are just nervous because Jonathan isn’t here, but it will be fine. I will take care of you.”

  D-day was here, and under the bright lights of the operating room, surrounded by strangers who would hold my life in their hands, I finally let go. I put myself in my doctors’ and G-d’s hands. I was being wheeled into the room where my son’s life would start and mine would end. I was sure of it. Attached to IVs and strapped to a gurney, I felt like I was being held hostage and there was no way out.

  I remember a lot of people in the room, preparing for the surgery, and I also remember someone putting soap on my belly where the place for the incision would be marked. They had to wait three minutes exactly for the soap to dry before they could begin the procedure, and during the entire 180 seconds everyone was silent. Everyone but me. It was so tense that I tried to make light of the situation by asking everyone, anyone, to tell me a joke. They weren’t laughing. They were ready to begin.

  And that’s where my story ends. Or ended. Or could have ended. I gave birth to a beautiful baby boy named Jacob, and seconds later I died.

  “I WAS GETTING ANXIOUS to see Steph,” Jonathan recalled. “The plane couldn’t get there fast enough. I couldn’t wait to meet Jacob and kiss my wife. As soon as the plane landed, I texted Julie, asking her how everything went. She answered, ‘Jacob is fine. Stephanie is . . . stable.’ That wasn’t what I expected.

  “I arrived at the doors to the delivery room just as Julie was walking out. She had her scrubs on, covered in blood. My wife’s blood. I went into ‘emergency action’ mode. This was my natural inclination, and my Air Force pilot training reinforced it. Whatever emotions I possessed were tabled and replaced with cold analytical thinking and evaluation.

  “Before I could ask a question, Julie told me that Steph suffered an extremely rare pregnancy complication and that she was in recovery and stable. She said it was an amniotic fluid embolism, or AFE. Extremely rare. So rare the doctors, who were all very seasoned, had never seen one in person, only read about them in medical books. Julie handed me a bag of Steph’s jewelry, including her wedding bands, and told me to wait for the anesthesiologist. They ushered me into a conference room and Dr. Nicole Higgins arrived.

  “Nicole explained it’s a condition where material from the baby gets into the mother’s bloodstream. It could be a drop of amniotic fluid, a hair, or even as small as a cell. It somehow enters the mother’s bloodstream, and if you happen to be allergic to it, it sets off a chain reaction, breaking down the structure of the blood and in turn causing cardiac arrest, shutting down the organs, and destroying everything in its path.

  “I started peppering her with questions. ‘What is Steph’s current state? What are the current threats she faces in the next hour? Two hours? Twelve and twenty-four hours? What treatment is she receiving? What judgments are being applied? What is the alternative?’ Nicole exhibited no emotion when answering the questions. This was her comfort zone too. We communicated just fine. Later, she told me how much she appreciated the absence of emotional drama with me as well as the cold analytical assessment we undertook.

  “Nicole continued. Amniotic fluid embolisms have two phases. The first is that the body goes into anaphylactic shock and it flatlines. Some studies show as many as 50 percent of AFE victims don’t make it past that point. But if you happen to be lucky and get to phase two, you could bleed out because the clo
tting capability of your blood stops working.

  “She said that both Jacob and the placenta were delivered perfectly, but after that it all went downhill. Steph had a seizure and flatlined. She was clinically dead for 37 seconds before they resuscitated her. Nicole explained that her platelets went from 236,000 to 12,000 in less than 12 minutes. Steph’s blood could no longer clot, and she was bleeding out. She would be given 60 units of blood and blood product (platelets, red blood cells, etc.) over the next several hours.”

  Anesthesiologists will tell you that their worst nightmare is something called DIC, which stands for disseminated intravascular coagulation—the inability to clot. If your blood cannot clot, you will hemorrhage to death. Doctors sometimes refer to it as “Death Is Coming.” I was on the edge.

  They wouldn’t know for days if I would survive and if I did, whether there would be any neurological damage or other consequences of the initial attack. All Jonathan could do was educate himself on what had happened in order to make the best health decisions on my behalf, and then wait.

  To start trying to make sense of what he was hearing, Jonathan got online and Googled “AFE” to find out more about it. He read that it’s completely unpredictable, unpreventable, and in most cases fatal. He saw that it was rare. Only 1 in 40,000 births. There weren’t many stories of survival. Almost everything he found talked about support for widowers. He kept thinking it just wasn’t possible. He was not going to lose me.

  “As I waited for word on Steph’s condition, I knew I needed to see Jacob. It felt very lonely taking the elevator up to the nursery. My wife was in dire straits. I had never even seen Jacob, much less held him, and I was going to see him, alone.

  “Jacob was a beautiful sight to behold. When I walked up to the secure door to the nursery, I saw the nurse putting him into his cradle. She had just fed him, and he was already asleep again. She buzzed me in. While I sterilized my hands, she told me what a wonderful little boy Jacob was and wheeled him into an adjacent room for us to have some private time.

  “As soon as I picked him up, the suppressed emotion came flooding out. I rocked him back and forth and wept. I assured him that I was going to make sure his mommy would be fine, all while not knowing what could possibly be done to alter the trajectory my wife was on. In retrospect, I was lying to him and, more importantly, to myself.

  “I spent over two hours with him, holding him close. I took off my shirt so he could have skin-to-skin contact. I knew that to be important. And it should really be mother and child. I would have to do, under the circumstances. We bonded immediately, and he looked up to me with his beautiful little eyes and snuggled up into my neck and shoulder. He slept easily and soundly, and it felt perfect. Almost.

  “That feeling of perfection gave way to my desperate concern for Steph. The docs told me to meet them over in the surgical intensive care unit in a few hours. I left the nursery and started the 15-minute trek to the ICU.

  “It was the first of many trips that would take me down the elevator, across the pedestrian bridge, through the parking structure, over a second pedestrian bridge, and up another elevator to the ICU. I would come to like the walk because it gave me time to think and review all the dozens of new facts flowing into my head each hour. It also gave me time to steady myself for the terrifying juxtaposition of the promise of new life, with all the wonders it brings, against the threat of death or permanent paralysis, degraded neurological function, and other side effects of the horrible AFE that struck my wife.

  “I arrived at the ICU at 3:15. Steph was not there. The chief resident told me that she had not even left the OR to start the move to the surgical ICU. I should come back in no less than an hour. I was back in 30 minutes. I was in no state of mind to spend more time elsewhere. The details of an AFE were making my mind spin. I needed to see my wife, and there was no way to do so.

  “I went and got some food. I wandered around the hospital aimlessly. I didn’t call anyone because there was nothing good to say and no reassurances I could give. All I would accomplish was scaring people needlessly. I sucked up the calamitous situation and kept it inside. She was dying on the operating table, and I was dying inside.

  “I returned to the ICU at 3:45. No Steph. Back again at 4:00 P.M. No Steph. Finally, I planted myself in the room assigned to her and waited. At 4:35 P.M., Steph was wheeled in through the back entrance to the ICU. She looked horrible. Scary. My heart sank as I scanned her from head to toe. She was pale, with all the color drained from her face. One doctor was using a device to pump air into her mouth to keep her oxygenated. She was hooked up to more than a dozen drips. Her wrists and ankles were strapped to the rails of the gurney, presumably to prevent her from shrugging off her IVs. Blood seeped through her gown and bandages.

  “Blood was being infused into her body. They had put my wife into a medically induced coma.”

  Jonathan later said that when he saw me, it almost brought him to his knees. Apparently, I was unrecognizable. Not just because of the bloody blankets, but because my body was unbelievably puffed up by all the fluids being pumped into me.

  “As they started preparing to transfer Steph from the transport to her ICU bed,” Jonathan said, “the [ICU] fellow, who seemed to be the person most in charge, started to manhandle Steph’s limp body. When he realized I was watching, he asked me to leave and come back in 45 minutes. It felt wrong to leave her, but the combination of his request and seeing my wife in pain during the transfer resulted in me walking to the waiting room for a few minutes. My mind was racing through all the permutations of what happened, what needed to be done, and what outcomes lay in my future.”

  Jonathan told me later that he was on autopilot, trying to figure out how to save me. He went from doctor to doctor, telling each one that if I needed a hysterectomy, Dr. Schink was our doctor. At that time I was stable, and the doctors told Jonathan that a hysterectomy was unlikely, but they took note of the referral and went back to check on me.

  I think he was worried he was being overly cautious, but he was happy and relieved that he spoke up when the doctors told him they thought it wasn’t going to be necessary. One less complication to worry about and at least one premonition he was happy wouldn’t come true. Or so he thought.

  “When I finally was allowed back into the ICU,” Jonathan said, “Steph was in the final stages of being transferred to her new bed. The doctors and nurses were checking all the hookups to Steph, and there were many. She had four poles, and each pole had three to four bags of drugs hanging off. The bags were slowly dripping into her. Some were antibiotics, others were blood pressure meds. An automated blood pressure cuff took her blood pressure every few minutes, with the most recent reading announcing itself on an overhead monitor. Her heart rate was updating even more frequently. In addition, she was hooked up to a breathing apparatus because she was in a coma and could not breathe by herself. And to top things off, a large bag of blood was hanging from the ceiling, slowly infusing into her. Outside the room, several spare bags of blood were sitting on a machine that was slowly rotating, presumably to keep the blood moving so it would not go bad.

  “It was an ugly sight. Every few minutes Steph would make some noise and move her arms and legs a bit, only to be constrained by her wrist and ankle restraints. The restraints probably made it feel like prison, but it was soon obvious that Steph would pull herself off of her many IVs in their absence.

  “I sat down in my chair and watched for many minutes, taking it all in. There was an immense amount of information flowing onto the screens, and it was updating rapidly. Doctors and nurses needed to be able to digest all this information in a flash and then make the correct decision on what to do or what to change, or to not do anything at all. My wife’s life depended on it. It reminded me a bit of my days as an Air Force pilot flying a military plane and getting an in-flight emergency. When such an event occurred, the instrument panel would light up with multiple systems failures, followed by the plane losing power, altitude, speed
, and more. All in a fraction of a second. We trained on what to do in these eventualities. When they actually occurred, we had to execute immediately, reflexively.

  “The doctors and nurses were executing. No doubt about it. Steph was under constant attention on the afternoon of Thursday, May 30, 2013. A dedicated ICU nurse, the chief resident and ICU fellow, along with additional staff, were devoting the vast majority of their time and attention to Steph in her first few hours in the ICU.

  “During that time I received many briefings and updates from various medical personnel. The news was guarded. Everyone emphasized that her incident was extremely traumatic. No one said, ‘Lucky to be alive,’ but that was quite evident. They said that Steph had a long way to go to get out of danger. No one said that she was at risk of permanent neurological deficit or at risk of other adverse side effects that would last a lifetime. Everyone mentioned that Steph’s heart had stopped for less than a minute, which they said was good, and that her blood remained oxygenated for the duration. I interpreted that to mean Steph had a chance, but only a chance, of coming out of this okay. Over the subsequent days the doctors would be more explicit about the risks, but I was already prepared.

  “My voice mail was piling up. Family members wanted updates. I called Steph’s parents and told them Steph gave birth and that Jacob was fine, in fact, doing great. And I told them Steph was sleeping. All true, of course, with one great omission. But I needed to focus on Steph and not try to manage family issues. I had to make a decision, as hard as it was.