Friday, November 27, 2009

Eclampsia

Here is what the medical people say:
http://en.wikipedia.org/wiki/Eclampsia

http://www.umm.edu/ency/article/000899prv.htm

Here is what the mother-in-law witness has to say.
First of all, and rather calmly, let me say that convulsions are terrifying to witness.
The person convulsing has no memory of the 'incident,' which is merciful. No one would want to remember the utter helplessness of that. Elana started to convulsive and was instantly 'outside' herself in the sense that whatever makes her herself was overcome by the electrical storm in her brain and the resultant physical spasms.
She had gotten up with a headache and blurred vision. She had had an odd headache a couple of weeks before and not been herself for the past week. I knew immediately (see my earlier post)
what was happening, so I did what we all do these days; I went to the computer. Seth started yelling "Mom." When I ran up the stairs, Seth was holding her up, barely, trying to lower her onto the floor of the shoebox-sized bathroom they were in. This was hampered by the fact that both of them are tall and there is a giant stuffed bear in the corner because that room is usually only used by his younger sister.
Ron drove up, at that moment. I yelled out the kitchen window for him to come. He was walking, tired from a night shift, but instinct and training will override most anything. In an instant, he broke into a run, dashed up stairs in time to help Seth get her to the floor.
By this time, I was on the line with 911, a maddening experience for the caller. The operator asks all these questions without telling you she had all ready hit a panic button somewhere on her end and the EMTs are rolling out of their station, while she wants to know the color of the patients toenails or some such other stupid thing. I was yelling that we needed an ambulance, Ron is yelling from up stairs, Seth was silent. After she said the EMTs were on their way, I calmed down a bit and was able to give them information in a polite, businesslike way, which I had NOT been doing up to that point.
The EMTs rolled in, looked at Elana and said we don't have the drugs for this. They called another ambulance service and opened their cheat sheet for what to do with mothers in full blown eclampsia. By this time Ron and I were in their bedroom, trying to stay out of the way.
J was in her room, where I had also stuffed the dog. I think J just cowered under the covers. Elana breathing was so loud, J said later, that she could hear it through the closed door. It was awful: load, laboured, grating, as if it came past the coarsest sandpaper you can imagine. They started an IV and gave her Mg to control the seizures and start to reduce her blood pressure which was somewhere over 280(top number, I kid you not).
The EMTs are pros, but clearly they were freaked out too, consulting a guide book of some kind for dosages. The other service arrived fairly soon. By that time, time was, to use a bad metaphor, dilating and contracting. The EMTs stabliized Elana as best they could and then tried to move her down the stairs. Elana is tall and the bathroom is quite small. They couldn't turn her. They couldn't get the stretcher in the bathroom. They dragged her out, almost literally, turned her in the hall, while I waited for one of them and her to fall down the stairs. Finally they got her on the stretcher, and then couldn't get it down the stairs. They couldn't grip it or they were afraid she would fall. So they back up into the bathroom. A stair chair seemed to be what was wanted next. They get one and bring it upstairs and manoeuvre it into the very small bathroom behind her. This then requires them to lift her again, this time into a sitting postion, and this time they can carry her down the stairs. Outside they transfer her to the stretcher again. She lolls, her head and arm off the side for a moment. She looks dead.
At that point, I think we've lost her.
The ambulance takes off, Seth follows in another. While all this has gone on, I have called work to tell them I won't be in, called a neighbor to take J to work and to watch the dog. Ron and I dress and get in the car. I've talked to Amy, pediatrician daughter, who says they will deliver the baby and everything will be all right. Not so sure, we head for the hospital.
What I can't reproduce here is the terrible gurgling, rasping breathing, the seizing, and then the deathly stillness after. She was totally unresponsive, limp, just like a body, not a person. My response to terror is to go cold. I don't cry and I don't go hysterical. I drove. Ron and I talked, but we didn't know much to talk about. I had heard of eclampsia, Aunt Mattie had nearly died from it and her baby had. Among older women it was whispered about. Now it is so rare that pregnant women hear about it, out there in the distance. "Oh yeah, eclampsia" seeps in from the remote reaches of the pregnancy universe. But I know nothing. And Ron, though he has been an ICU nurse for 35 years, knows nothing.

Post Thanksgiving

More about Thanksgiving later. Right now there is snow on the ground and my neighbor's 140 pound mastiff is sequestered in J's room. She loves us, is less certain about my son. She is here because J locked herself out the dog's house. She was dog sitting, opened the door to take the dog out this morning. And the door closed behind her. The key, of course, was inside. We suspect the cats actually shut the door all the way. We don't know when the neighbors will be back, sometime today. In the meantime, there is this large dog in my house who is hostile to one of the house members.
On the up side, there is turkey left over. Lots of turkey for sandwiches and pot pie or some such.
And much cranberry salad. So much to be thankful for.

Thursday, November 19, 2009

Comfort Food

Comfort food
The food you eat when you are sad, sick, lonely, in short, in need of comfort. It may be food your mother made when you were a kid. It may be some food you have come upon as an adult that you eat to feel better: cereal, toast and butter, mac’n’cheese, pasta. For me it can be oatmeal, poached eggs on toast, toasted cheese and tomato soup. That last most clearly demonstrates the distance I have come as an eater since growing up in my Central New York, working class family.
What is to change about toasted cheese and tomato soup? The name for one thing. It is most often called grilled cheese now, implying the sandwhich is made on a grill. Toasted cheese is actually another dish in which cheese is put under the broiler and toasted. My mother made toasted cheese sandwiches with American cheese on white bread, which may have been home made when Iwas a kid. And she made Campbell’s tomato soup with milk. The sandwich was cooked in butter. The basic ingredients.
Later, in the pressure of the food industry in America she switched to Roman meal whole grain bread. I can’t remember if I protested. If I did it wasn’t as vociferously as my children complained about whole grain breads. Sometime the cheese was Velveeta. Sometimes chedder.
We never cooked with margarine, a holdover from my mother’s Depression experiences. I switched to making the soup with water as a teen ager worried about my weight. I my twenties, with small kids of my own, the combination began to evolve from its middle class beginnings into a lunch or snack of a much different character.
With very little money to live on, I made a lot of my own bread. For awhile, when we got surplus food, we went back to Velveeta type cheese. Once we got on our feet, we could buy the real stuff: Munster, Swiss, Aged Chedder, Provolone. And those are just the sandwich cheeses. I continued to make and buy whole grain bread in a brazen disregard for my children’s preferences and in the firm belief that it was better not to eat any bread than to eat the Styrofoam stuff that came from the store. I still cooked in butter. I mean olio is some kind of goo that is derived from non-food material, right? So the sandwich changed, but not so much as the soup.
I still use Campbell’s tomato, still don’t use milk. But over the years I have added various things: garlic, a bit of olive oil, a dab of butter, dill. Mostly dill, because it tastes so good with the tomatoes. And there is always basil, another real tomato compliment. Basil, fresh from the garden, spicy-sweet, filling the kitchen with its sharp scent. Basil, dried. Basil and garlic with perhaps a bit of parmesan. The soup grows richer, “mouthier’ acquiring what flavorists call umame: Umami, popularly referred to as savoriness, has been proposed as one of the basic tastes sensed by specialized receptor cells present on the human and animal tongue. Umami (旨味?) is a loanword from Japanese meaning roughly "tasty", although "brothy", "meaty", or "savory" have been proposed as alternative translations.[1][2] In as much as it describes the flavor common to savory products such as meat, cheese, and mushrooms, umami is similar to Brillat-Savarin's concept of osmazome, an early attempt to describe the main flavoring component of meat as extracted in the process of making stock (http://en.wikipedia.org/wiki/Umami).
Thus what started out as simple comfort food has become a marker of education. My palate has changed and developed as I have eaten around the world and among friends with more food sophistication than I have. My vocabulary has changed; I know words like umami, that my parents would have though pretensious. My class has changed. I am not a blue collar person now, though I began there. Toasted cheese sandwiches and tomato soup, then and now, mark my progress through life.

Wednesday, November 18, 2009

A yard full of EMTs

I was brought up (mostly) and deeply loved by my Aunt Mattie who nearly died from eclampsia and who lost her only child in that process. The family told the story as families do, in whispers and allusions. I don't know the details. I do know the Protestant Irish side of the family blamed the Catholic hospital for her near death: "You know," they murmured, "they save the baby first, and then worry about the mother." I might try to find the death records later. I am just reporting now.
So eclampsia niggles around in the back of my mind every time someone I know is pregnant. And then Elana has headaches. I am mentally running in circles and shrieking. When she gets the blurred vision, I know what has happened. I am on the computer searching for eclampsia when Seth yells from upstairs in a tone that brooks no hesitation. I sprint for the stairs to see him struggling to hold her as she goes into grand mal seizures.
grand mal seizures.
The following are the immediate notes, from that day:
Eclampsia. An angel delivered Ron into the house from work
at exactly that moment.
EMT's arrived. They raced off to the hospital, had to
trach her, her airway and tongue were so swollen. C-section.

Immediate delivery is the only solution to eclampsia, the only way to save the mother.
When they put her in the rig, I was pretty sure we had lost her. Had no idea about the baby.
They got to the hospital and most of the ER, OB and Neonate workers were waiting in the ambulance bay. We learned later that student nurses were called down to watch. This is not voyeurism.
No one sees eclampsia any more. Better prenatal care catches the pre-eclampsia. They put the woman to bed and give her stuff to lower her blood pressure. Full blown eclampsia is such a rarity that the OB who delivered the baby had not seen it.

All this sounds calm. We are educated. We are a medical family. We handle panic through information.
NO WE DO NOT.
Information is good. But it does not control the terror, not horror movie, fun terror, the real terror in the face of the death of a young woman and her baby. A daughter-in-law, a grandchild.
Terror possesses the body, inhabits your stomach, your head, you shoulders and toes which curl under. Really. And then it crawls off and lurks in the form of anxiety. It keeps you up or puts you to sleep. It makes you weepy or surly, snappish and stupid. Deep breathing helps, maybe. It did keep me from screaming and running around. Various things helped at various times: prayer, a friend showing up, mostly Amy's calm transmission of any information we needed and Ron's interpretations of all the ICU speak.
I never liked horror movies. I don't like being scared. I like it a lot less now. I need a Doris Day movie, I think. Or maybe just another long walk with the dog.