AFE Survivor Cali

My daughter and I had just gotten home from church and were taking a nap as she was 2 and I was 21 weeks pregnant. My husband, Josh, checked on us, made himself a pizza and then went downstairs to watch TV. When I called him on his phone he giggled to himself, thinking I was going to ask him to come upstairs and grab me something. But all he heard was me breathlessly telling him I couldn’t breathe. 

He ran upstairs, calling 911 on his way up. You could hear the panic rising in Josh’s voice, but he somehow managed to stay calm long enough to answer the 911 operators questions. What’s your name, where do you live… It wasn’t until she asked what the problem was that you could hear his voice break. “I don’t know”. I’ll never forget the pleading and love that was palpable as he said “Cali”. Over and over…with no response. He thought for sure he was losing me and wasn’t sure anyone would get there in time to help save me. I was breathing but weirdly. He couldn’t find a pulse so the operator instructed him to start CPR. “1…2…3…4….I need help” She assured him someone was on the way but she needed him to stay calm and continue compressions. The worst part is that my daughter was there. In the room. Watching and crying. And all Josh could do was focus on me and the operators reassurance. After what seemed like an eternity, there was commotion in the background. “I’m up here!! We are up here!” The Sheriff was there, someone else to help with the rescue efforts 8 minutes later. The Operator hung up hearing “Ok, I’m going to go take care of my little girl”.

While Josh was calling necessary family and friends, the paramedics had gotten me conscious and on the stretcher. 

Back at the hospital, the operators had worked together to assemble an air med team who were airborne only 5 minutes after receiving word. My crew consisted of a high risk obstetrics nurse, a pediatric flight nurse and the pilot. Once landed in a nearby field, the fire chief transported my girls directly to my house, through the crowds. Amanda, the pediatric flight nurse recalled, “As we pulled into the subdivision, we could see a knot of EMS providers surrounding Cali’s stretcher outside on the lawn and bloodcurdling screams reached us as we exited the vehicle; I looked for law enforcement to help contain what I thought was a distraught family member, but no such person was in evidence. Instead, we saw Cali, a tiny 120 pound women shrieking, kicking out of the spider straps on the backboard and vomiting violently. Those helping her struggled to keep her from hurting herself and my years of emergency nursing and EMS experience made me wonder if we had a substance abuse problem on our hands. Windi’s OB instincts, however, immediately put amniotic fluid embolism (AFE) at the top of her list.”

Because of my hostility, they immediately decided to intubate, in order to transport me (and my flight crew) to the hospital safely. Windi completed a rapid OB assessment, the baby’s fetal heart tones were present and good. There was no sign of bleeding but my once cute little belly was very hard, getting harder by the minute, which is a sign of intra-uterine bleeding.

I was stable the entire ride to the hospital; still intubated, sedated, oxygenated, and ventilated but they noticed the hardness of my belly had turned into rapid growth. One hour and five minutes from Josh’s initial 911 call, they could not have arrived at the hospital with more perfect timing. Some of my family arrived minutes before I did, and watched as my helicopter landed and I was wheeled to the Emergency Department. 
As I was making my way to the trauma room the head nurse rounded up the staff that would be working on me. One recalled to me later that he would get excited for trauma’s. They helped pass the time, he was able to really help people and the high from his adrenaline was something he lived for. As he started to show his excitement the head nurse turned to him and said, “You won’t like this one, it’s a 24 year old pregnant Mom, who is not going to make it.”

I defied them all that day but not before my world came crashing down…

I had started to steadily lose blood. Josh had arrived at the hospital by now, along with his family and the rest of mine. They just waited in the waiting room with a social worker, who updated them as frequently as he had information. Doctors would come in with questions; How is her health, what medications is she on, how was her health as a child, is there a family history of ___? Does she have a history of seizers because they are pretty sure there was one in the ER, and Josh thinks I had one while he was working on me. They would come and go, sometimes looking more confused than before and preparing my family for the worst- IF she lives, she might have severe neurological damage… 

Eventually they moved my family to the Medical ICU floor, where a conference room was reserved for them to be in. I can’t even begin to imagine this time… waiting, anticipating, their minds running wild on them while Dr’s eliminated one thing after another. Still not knowing if I was out of the woods. 
After hours, they finally allowed Josh to see me. Josh explains it in broken sentences when I ask him… ” It isn’t what I would consider a good time of my life. Cali, it’s not something I want to talk about. Feelings? Scared, sad, anxious- You think of your worst nightmare and tell me words for it.” I guess I don’t blame him. When I think about it happening to someone I love, I get sick. 
What they had determined was that my INR was elevated and an Ultrasound showed I had suffered from a placental Abruption, which led to the Amniotic fluid Embolism- just as Windi had expected. They needed to do surgery but because of my INR, they continued transfusions throughout the night to normalize it. My family was sent home, they were going to need sleep for the days to come and there was nothing happening that night…

That morning they took some members of my family back to explain just what an Amniotic Fluid Embolism is. They also explained DIC (disseminated intravascular coagulation). DIC causes blood to leak from the body because it can no longer clot. This was the stage I was in and the solution would be to take our almost 21 week old baby. There was no way he could survive this pregnancy but I still had a chance.
My Mom talks about how hard it was for Josh to struggle through this decision. How he knew what he had to do but the pain was evident in his eyes. This boy… He made the hardest decision a parent could on his own because they were afraid to wake me up- afraid of how I would respond and what it would do to my health. But he made them, he couldn’t do this without at least telling me.

My Mom said, “I’ll never forget how Cali looked at Josh; with such love and devotion, and you could tell he was her strength. I was just off to the side holding her hand being the third wheel until she signed, “Baby.” Then Josh looked at me with absolute terror in his eyes which made Cali look my direction. I don’t know which one of us told her the doctors would have to take the baby to save her life, but I’ll NEVER forget the pain, the anguish that we all felt in that room while Cali screamed “NO!!!” in sign language, without a sound coming from her because of the breathing tube, but with that word reverberating through the room. Then silence. They had put her back under.”

After the surgery, I stabilized for 3 hours. 

Then my blood pressure plummeted and my heart rate sky rocketed. An ultrasound at my bedside determined that there was a large amount of free fluid in my abdomen. I had to return to the OR for a third time, with the fear of a hysterectomy being the solution.

My family was in the waiting room way too long without any news so called the crisis phone line, who guaranteed a call back. The phone rang and my Mom answered to someone from the operating room who told her that I had gone through a lot of blood, that they had had to revive me a few times (she believes he said 4 times) but I was still alive and someone would be out to talk to us soon. As they hung up the surgeon came in.

He explained to the crowd that I had just barely survived the surgery. Only after an estimated blood loss of 4,200 ml and receiving 14 units of packed red cells, 13 units of fresh frozen plasma, 4 units of platelets, and one unit of cryoprecipitate (combined for more than 2 times the volume of blood a body holds) and reviving me multiple times. They discovered a large 5 cm defect in my uterine wall, necessitating the hysterectomy. Post- surgery and I was finally not bleeding and stable once again so they transferred me to the surgical ICU.

What happened next? I slowly started to recover. My memory is really scattered around this time frame. I remember things but am not sure if it’s my actual memory or people telling me the stories and me seeing pictures. I remember so many CT scans, MRI’s, moving from room to room and a lot of Dr’s and nurses and yet I don’t remember them at all. 
I still can’t recall the conversation where Josh told me I had lost our son or they had to do a hysterectomy. I just knew it. He said that he had told me over and over. Every time I woke up, I wouldn’t remember and he would have to tell me again. Live through it again. Watch my reaction again. He had so much patience and love during this time- regardless of the emotional pain he was going through. The next few days are all clumped together. 

What I do remember most was the pain. I ached from the surgeries. I couldn’t sit up, roll over or really move because of the emergency hysterectomy which left a stapled shut incision from my belly button down. There was a dull persistent pain in my lower back from just laying on the bed. My throat was mostly always on fire. Maybe from being intubated, maybe from not having a drink of water for days, could have been from being on oxygen- which made my nose dry. I was covered in bruises; IV’s and the blood pressure cuff made my arms look like I had been hit multiple times- by a bus. And then there was the emotional pain…
On day 6 of the hospital I started to develop a fever and low blood pressure. After a very intense workup of CT scans and MRI’s, they located a septic ovarian vein thrombus (blood clots in my ovaries). To keep the clot from potentially traveling to my lungs, they placed an inferior venacaval (IVC) filter and I would have to get back on blood thinner. 

Every day still I would get a little better, but sometimes would feel worse. They had to remove the IVC filter when it got closer to me going home. They also had me up and walking with Physical Therapists every day. They eventually took out my catheter so I had to start getting up and trying to make my way to the bathroom. Eventually they said that I was ready to start introducing food back into my body. The nurse came in to take the staples out on day 12 of being in the hospital.
After 14 days, I was going home. My discharge diagnoses included several that are only seen on death certificates; suspected amniotic fluid embolism, cardiopulmonary failure, disseminated intravascular coagulopathy, intra- abdominal hemorrhage after uterine rupture, emergent abdominal hysterectomy, septic ovarian thrombus, factor V heterozygote, and IVC filter placement and removal. It all seemed so bizarre. Having gone through something like that, my emotions were obviously the thing I had to focus on now. My life had been turned upside down. I still had a long way to go to heal, my body was exhausted most of the time and I wouldn’t have 3 nurses by my side constantly. I was nervous and anxious but ecstatic to finally be home.
6 years later, looking back, I am just always beyond grateful for my husband, 911 operator, AirMed Nurses and countless Dr’s who worked around the clock to keep me alive. My family and friends for pulling me through every day and my faith for giving me reassurance.