Chicago artist, Michelle Hartney, is bringing national attention to the devastating problem of maternal mortality in the US with her work, Mother’s Right. Michelle sews a hospital gown to represent each woman who lost her life during pregnancy or the postpartum period. As she points out, many of these deaths are preventable. Her work inspired the following piece about one such preventable death, recounted by an obstetrician who has chosen to remain anonymous.
She’s not just a gown to me.
I remember when she got pregnant. She was thrilled. I was not. She had a condition called antiphospholipid syndrome, a disease which puts her at high risk for blood clots and pregnancy complications. She would need blood thinners and close monitoring during her pregnancy and postpartum, if she made it out of the first trimester. She had already had two miscarriages due to this disease. Her last pregnancy ended with an emergency c-section at 27 weeks for severe pre-eclampsia (high blood pressure in pregnancy). Her little girl had spent quite a while in the NICU but was doing well now. She came with her mom to prenatal visits, watching Peppa Pig on her mom’s phone.
“My mommy having a baby,” she looked up at me with dark eyes. “I know! Do you think it’s a boy or a girl?” I ask her. “A boy!” she says as she jumps, hands in the air. She was right. I think children have a sense about these things. My own children knew I was pregnant days before the pink line appeared.
Regular prenatal care was difficult for her. She didn’t have a car, so she relied on rides from friends and family, most often her grandmother. Sometimes she rode the Medicaid van. That meant she might be hours early or thirty minutes late. But she was always there.
The first trimester passed without incident, no bleeding, no cramps. Women with antiphospholipid syndrome are at risk for stillbirth. The window between the pink line and feeling consistent movement is always anxiety provoking. Listening for the baby’s heartbeat causes me to hold my breath. But it’s there, galloping away.
She made it to thirty weeks this time before her blood pressure changed. “160/100. That’s too high,” I told her. She knew. She knew it meant admission to the hospital. She knew it meant labs and urine studies and monitoring and medicines and surgery. And NICU. She knew it meant NICU. She remembered how hard it was to get a ride to the hospital to see her daughter when she was in NICU. She remembered the days of diapers and feedings and coos that were lost because she didn’t have a car.
“Are you ready to meet this little guy?” I asked as I placed the blue surgical drape on her tiny basketball belly. “Oh yeah!” she said laughing. He let out one little half-cry before he needed to be intubated. “Oh! Was that him?” she asked. “Yes, that was him!” I told her as the NICU team worked, heads down, helping him to breathe.
She recovered well from her surgery and her little man improved as well. Before she was discharged from the hospital, I went over warning signs, when to call or come to the hospital. I gave her prescriptions for pain medicine and blood thinners. We talked about when her next appointment was, how often she could get to see baby and who would drive her. Her grandmother was there, offering to help as much as she could. “You see my baby boy?” her daughter asked. “I did! Your brother looks just like you!” I told her. He had her dark eyes, though they were rarely open.
Three weeks later, an ER doctor calls my office. “I need to update you on one of your patients,” he said. “She delivered at 30 weeks, about three weeks ago. You did surgery on her.” “Yes, I know her…” I said. “She came in with a clot, a massive PE. We couldn’t get her back.” “What? When?” I was in shock. “Earlier today…yeah…I’m sorry.” he replied. “Ok…thank you.” I hung up the phone.
My head was spinning. Massive PE? I gave her blood thinners. Didn’t I? I pulled up her chart on the computer. My eyes darted frantically over the words of her discharge summary. “Discharge medications include: LOVENOX.” Yes. Yes, I had given her the correct medicine. Did she get it filled? I called her pharmacy. “Yeah, it looks like she dropped the prescription off to be filled about two weeks ago, but never picked it up.”
Why didn’t she pick it up? What happened? I couldn’t stop thinking as I tried to push through the rest of the day’s patients. Her grandmother called the office to cancel her appointments. Her voice broke as we talked. “I’ve been sick myself, so I couldn’t take her. I couldn’t bring her to see the baby. I couldn’t take her…” Her voice trailed off.
She couldn’t take her. My patient died because she didn’t have a ride to the pharmacy. Why didn’t she call? We could have gotten it to her. Someone could have taken it to her. I could have taken it to her.
I think about her daily. I think of her when I ask my patients if there is anything preventing them from getting their medicine. I think of her when I say, “If you can’t get your prescription, call me.” She pushes me to consider what happens in the hours of my patients’ lives that are spent outside of hospital and office walls. She, and many others, stay with me. I remember her name. I remember her family. And I remember those dark-eyed babies that are growing up without her.
She is not just a gown to me.