#4 - The Journey with Twins: Laser Ablation Surgery
*Originally posted on December 15, 2016 - Dates changed so the Journey with Twins posts could all be found in one spot together.
On Tuesday, July 12, we checked into Huntington Hospital in Pasadena, California to undergo Fetal Laser Ablation Surgery (see previous post HERE for video and purpose of the surgery). Burkie was by my side, staying upbeat and encouraging to help keep me calm and positive. I often think about how going through these experiences this year would have been so vastly different without him there to keep me laughing and grounded. How thankful I am to have gone through this with my very best friend.
At one point a snippity nurse came in demanding that I remove my contacts. As I am nearly blind without them, this demand suddenly sent all my repressed fears and stress into overdrive and I started to bawl. It terrified me to think about being in surgery and trying to open my eyes to see what was going on to only have it be a foggy blur. The anesthesiologist had just stepped away for less than two minutes and when she came back to me crying (where minutes ago I had been chipper and joking) she asked, "What on earth happened?!" The nurse said I wouldn't remove my contacts and she replied in a dismissive tone, "Oh, I don't mind if she keeps them in." I can't tell you how thankful I was to hear that! The cranky nurse apologized a bit curtly, but even after she left I couldn't seem to stop the tears and kept doing that embarrassing hiccup-cry. Sweet Burkie kept stroking my head and squeezing my hand, talking softly to me to try and calm me down. When Dr. Chmait returned, he too was surprised to see me in tears after our cheerful consultation that morning. He was so kind and sympathetic and helped to soothe my fears before they wheeled me away. I remember telling Burke I loved him about a half a dozen times as we parted, maybe because I was afraid that I might never wake up.
In the operating room I vaguely remember hearing the fetal therapy team joking all around me and I remember thinking they must all feel like family, they seemed so close with one another. Once I was strapped down to the table, they began to "sign in" and Dr. Chmait said, "Emily, can you please tell us your name and why we're here." Again I tried to recall words through my foggy brain, but I remember getting emotional and saying, "My name is Emily Adams. And we're here to try and save the babies."
I know we were in surgery for nearly two hours, but I only remember snippets. Dr. Chmait warned me that there would be a pressure in my side and I heard and felt a sickening pop as they inserted a metal tube into my side and uterus. He then inserted the camera and attached laser down the shaft to explore the placenta, find the connected blood veins and destroy them with the laser to separate the twins' blood connection with one another. There was a TV screen up by my head where I could see the camera footage making its way through a hazy world within my body and I kept trying so hard to pry my eyes open so I could watch this miraculous procedure I was undergoing. Unfortunately, the drugs were far too strong for me and I could barely flutter an eye open for a moment before zonking again.
Picture Dr. Chmait took of baby toes inside the womb while navigating towards the placenta. I wish he had taken a hundred more, especially of their faces.
I do remember feeling quite panicky a few times and the anesthesiologist holding my head in her hands and speaking gently, but firmly into my ear that I needed to hold still and calm my breathing. Even panicked breathing could be dangerous to the babies during this procedure and it was imperative that I hold absolutely still so as the laser was being utilized I wouldn't shift and damage something besides the blood veins Dr. Chmait was working on. It was quite frightening to me as I imagined my babies inside possibly being hurt and I found myself praying the same pleas over and over again, begging the Lord to protect my babies and help comfort me. I think each time I started to get nervous the anesthesiologist must have shot in something to soothe me as well, because it was almost uncanny how her cautions and my relaxing were quite simultaneous.
At the end, Dr. Chmait came up and held my hand and told me how brave I had been. He said, "Emily, you did such a great job. The surgery was a great success. You just rest now." And I did! Knowing that the surgery was over, I was able to collapse into sweet oblivion for who knows how long.
Eventually I was reunited with my Burkie, but besides him kissing my forehead and tell me how proud he was of me, I can't remember much until a couple of hours later when the anesthesia began to wear off and I was given the clear to order some food. I was absolutely starving and so relieved to be able to chow down at last!
Me post-surgery ordering everything on the menu! Burke could not believe how much food I packed away.
Burke said Dr. Chmait had hustled out to the waiting room directly after the surgery to relieve my poor stressed husband of some worry. He immediately said, "All good things Burke, all good things." In explaining how the procedure went, he said it had been very difficult but successful. He explained that most of the TTTS surgeries feel like running a marathon along flat pavement, but in my case with ISUGR it could be like a marathon run through a steep mountain terrain. In the end he was very hopeful, feeling confident that all ties between the twins had been severed.
The first hurdle to clear would be the initial 24 hours following surgery. There was a small risk that the invasion to the uterus might cause my body to go into labor. If they couldn't stop it, they would have to take the twins c-section and we would be stuck in LA for months until the twins would be secure enough to transfer closer to home. Worst.nightmare.ever. The worst risk of course was that one or both of the babies could pass away. However, I don't remember feeling afraid when faced with these possibilities. I knew that we would all be ok.
The hours flew by and in no time our ultrasound tech Katie was back. In less than a few seconds she immediately confirmed with a quick smile of relief, "Two heartbeats." Then it was all business as she explored every nook and cranny of the babies.
Katie Confirming Two Heartbeats - Beautiful Moment
Dr. Chmait, Kris and a couple of residents came in during our final consultation there in the hospital. As before, Dr. Chmait was so enjoyable to talk with. There were a couple of things in this conversation that I will never forget. The first was shortly after he entered the room, he said how pleased he was with the two heartbeats we had heard and said that the next hurdle would be the one week mark. He reminded us that this surgery had not changed things for our Baby A, but had successfully separated the babies's shared blood veins so their fates would now be their own.
He then gestured to the ultrasound machine and said, "I hate that thing." This clearly startled us as ultrasounds are how Dr. Chmait does much of his work. He elaborated with, "We treat that machine like it's God. When we have a healthy baby it gives us a great picture of how they're doing, but when we have a baby that is struggling it gives us hardly any information at all. Although things aren't looking well for your Baby A based on the ultrasounds, he could still surprise us all. I've been surprised many times by babies who made it."
The second thing he said that became ingrained in both Burke and I was the counsel to not take the babies before 32 weeks. As we were currently sitting at 25 weeks gestation, this seemed like eons away. Dr. Chmait said, "Your Baby B is essentially an innocent bystander. He is developing perfectly. If this was a singleton pregnancy, he shows all the signs of going full term with no problems. If you intervene too early in order to save your Baby A, you will put Baby B at greater risks for cerebral palsy, blindness, spina bifada, and a host of mental and physical problems without any guarantee that you will be able to help your little guy at all. If you make it to 32 weeks, the chances of many of these issues diminish significantly for Baby B, but due to Baby A's restricted nutrients, he may already have severe problems to deal with if he makes it."
Left to Right: Dr. Reid (resident doctor), head nurse Kris, Dr. Chmait, me and Burke.
Although the conversation ended on a positive note with the staff teasing us about being too ritzy for them with our pending flight home on the private jet, my heart felt heavy with the weeks that lay before us. Could we, the babies, my little family and I make it through them?
Read the next installment: The Journey with Twins: Post Surgery until the Scheduled C-section
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