Being Unable To Breathe
By Leslie Shalduha
“What part of I can’t fucking breathe don’t you understand?” These are words I found myself saying to a nurse with whom I stood nose to nose, my nine-month pregnant belly allowing the only distance between us. She sputtered, pointing out that I was hooked up to an oxygen port – she could clearly see the tube attached to my face, running directly to the wall. She, trained to only see what she sees, was incapable of believing a clearly agitated and panicked (read: hysterical) woman. However, the oxygen port was not working and I had been trying to tell her for what seemed an eternity that I could not breathe.
Due to give birth to my first and only child in about two weeks, I awoke one morning to a very painful sore throat. Scheduled to manage an event, I dismissed my pain and drove into town. Funny, now I cannot even remember what it was for, only that I was hosting some sort of luncheon at a local pizza place. Once I finished the work, I returned home. Unsure and nervous about what kind of medicine to safely take at nearly nine months pregnant, I called in to the nurses’ advice line where they assured me I simply had a cold and could take regular cold medicine, such as robitussin or sudafed.
By the time I went to the doctor’s office for my normal weekly appointment, cold medicine had done nothing to ease my symptoms and repeated calls to the nurse line resulted in no concern or help. My breathing was labored and unable to breathe lying down, I had been sleeping on the couch every night in a sitting up position, my hands cradling my large belly, as they had been for most of my pregnancy. At the appointment, my blood pressure was quite high. The doctor sent me home with more cold medicine and instructions to “keep an eye on my blood pressure.”
Two days later I drove into McConnelsville to the squad – what we call the ambulance side of our local fire department – and asked them to take my blood pressure. This time it was 170/100 and they said to call my doctor right away. I drove home and called the doctor, who said to come down to the hospital for more testing but not to rush. He said he would meet me there later in the afternoon and would call the hospital to let them know to expect me. My partner Ty and I grabbed the bags we had packed in anticipation of the birth and headed south to the hospital in Marietta.
Along the way, Ty stopped to purchase a used washer. I waited in the truck as he concluded this important business and they loaded the appliance into the back of the truck. Next, he drove me to Marietta Memorial, a small city hospital, where they checked my vitals, listened to the baby’s heart and gave me a stress test. After those tests, the nurse put me on the phone with Dr. Myers. He wanted to give me medicine to prepare me for being induced the next day. I said I was uncomfortable with that since I was having such trouble breathing. I was given to understand, you know, from movies and books, that breathing is an important part of labor. He told me the only other option was to be admitted for 24 hours to monitor my urine for protein, to which I agreed. I did not know then that he suspected preeclampsia, for which the normal response would be to induce labor. In an eerie foreshadowing, I did not agree to this, perhaps having some innate maternal sense that doing so would not end well.
I was checked into the Maternity Ward where I was given a comfortable room and settled in. By now, it was late evening and the medicals* told my partner he should go home. The nurse instructed me to lie on my left side, hooked me up to a potassium saline IV and encouraged me to drink as much as possible since they would test my urine for protein every hour.
In the morning when I awoke, I asked about seeing the doctor. The nurse said he had come before I awoke and would check back in after church. Mid-day, he did stop by, in a way. Standing in the doorway, he asked me how I was feeling and said he would check in at the conclusion of the urine test late that evening.
Over the course of the day, I felt as if I was drowning, suffocating. I spent the day telling myself that drowning in one’s own body was not even possible, that I should stop being so dramatic. After all, I was in the hospital, being monitored by trained medicals. Their lack of concern meant I was simply hormonal, perhaps even hysterical. I continued to drink copius amounts of water while that potassium saline IV drip, drip, dripped into my arm. Every time the medicals came into my room, I told them I was having trouble breathing. The doctor continued to encourage me to be induced as I remained steadfast in my refusal.
Finally, late in the evening, I began to panic. The nurse called the doctor and asked him to order a breathing treatment. By the time a medical showed up with an incentive spirometer (helps one take deep, slow breaths) and a nasal cannala (hose for breathing oxygen through one’s nose), I was crying so hard that I was unable to do the exercise. They hooked me up to oxygen and tried in vain to calm me. Dr. Myers ordered a chest x-ray from his distant vantage point, which they performed in my room. The nurse said the results would come in about an hour, so I lay, gratefully breathing in the oxygen, trying to calm myself.
Very shortly, the emergency room doctor on call arrived to listen to my chest. He stated that I had “either pneumonia or a little bit of congestive heart failure.” No need to panic or call my family, however - they had everything under control. I did call my partner, who said he would come right away. It was quite late by then and it would be almost an hour drive for him. Unbeknownst to me he called his father, who lived near the hospital and came to be with me until Ty could arrive.
I was transferred to the emergency room, where I was connected to oxygen, a variety of machines, another potassium saline IV and given lasix, a diuretic pharmaceutical that helps to reduce pressure caused by extra fluid in the heart and lungs. Ironically, giving a person in congestive heart failure a potassium saline IV is an unwise decision for two reasons. First, saline is made up of water and sodium chloride which causes the body to retain fluid, quite unfortunate in one already drowning in her own body. Second, high potassium levels contribute to heart failure by causing irregular heart rhythms in an organ already incredibly stressed and not functioning properly. The diuretic did work somewhat - if I remember correctly, after some fluid was drained from me via a urinary cathether, I lost ten pounds in a very short amount of time. I began to feel some better and was able to rest through the night.
Early the next morning I was transferred to the Cardiac unit and once again hooked up to oxygen. I was still having trouble breathing. The medicals assured me I was getting plenty of oxygen, I should just relax. Ty called my mom and she and her husband drove to the hospital immediately, furious with the staff for informing me not to call them sooner and terrified of what was happening.
Dr Poland, a cardiologist, came in to say that I would be taken for a heart echocardiogram (echo), a type of ultrasound. They helped me into a wheelchair and hooked me up to a portable oxygen canister. Immediately, I could breathe better. Upon our return from the echo, everything started to happen very fast.
I started sweating profusely, heat radiating from my core as if molten lava was running through my veins and my breathing continued to be very difficult. Panic set in once again. The medicals placed several standing fans beside the bed, the cool air blowing directly on me. At some point I found myself standing again, struggling to breathe, panicking. The nurse placed an oxygen face mask on me, asking if that was better, bringing us to the “What part of I can’t fucking breathe don’t you understand?” Finally, realizing the oxygen tubing was plugged into a dysfunctional wall port, saying “Oh my god,” she quickly switched me to another one, allowing me the tiniest bit of breathing relief.
Standing close to me while holding my gaze and hands, Ty gently told me that my heart was not working well, and I would be transported by ambulance to a hospital in Columbus, normally a two-hour drive away. Unable to control myself, I began again to cry and panic, saying “No, no, no.” The next thing I remember is being placed on a bed in a small room, with medicals telling me “This will make you sleepy.”
I was put to sleep by way of a pharmaceutical drug used to inhibit one from later reliving a medical trauma; it is more commonly known as the “date rape drug.” It was determined that I should be life-flighted instead of taken by ambulance. However, they could not do so until a bed was free at Ohio Health & Sciences University (OHSU) hospital in Columbus. Six or so hours later, I was flown to OHSU. Medical records indicate that I came to during the helicopter ride. My daughter, Emma, was delivered by cesarean section that evening. I have no memory of any of these happenings.
During the time between when they put me to sleep and the birth, medicals were conferring with both my mom and partner. Questions such as “Whose life should we be concentrating on saving” were asked. I am not quite sure who leaned which way – let’s just say there was disagreement amongst my family and my partner. I suppose I have an idea of how that went, though it matters not now. What does matter is that must have been an excruciating time for all of them, with emotions running high and impossible questions being asked. I hold no enmity for any of them in this regard, rather I hold space for the trauma they experienced through this ordeal. At least I was knocked out.
My mom told me later that she came to see me in the back, private room, that she hit her knees, praying over my swollen, pregnant belly for our safety and lives. That image haunts me, still, and I can only imagine how it haunts her. She has been unable since then to listen to Tim McGraw’s song, “Don’t Take The Girl.”
Once I was taken by Lifeflight my family and partner hit the road, separately, and drove up to OHSU, arriving before the birth. When I awoke, 24 hours later, I was tied to a bed and unable to speak. I was intubated, though I had no idea at the time what that was or why I could not move my hands or speak. My mother handed me a polaroid photo, saying “Here is your daughter.” I did not understand what she was saying, did not remember being pregnant, why I was here or what was happening. I used my fingernail to scratch questions on my leg –
“Does the Herald know?” – my hometown newspaper. Apparently, I was concerned that they should know what just happened to me.
“Does the Corral know?” – this, the restaurant I had been managing up until about three weeks before I was due to give birth.
“Take my picture.” – yes, my zodiac sign is Leo and being on center stage comes naturally, even under duress as it seems.
Across the hall from my room, I could see medicals scurrying about. I could not understand why no one was coming to remove the uncomfortable tube from my throat and release the ties binding my wrists. Once they did, the pain of having the breathing tube removed became only relief to breathe, finally and easily on my own. A nurse detangled my matted hair and placed a light French braid in it. There was a heart catheter, used to measure how well my heart was pumping blood, in both my neck and upper thigh, stitched in to keep them from dislodging. The medicals moved me to the cardiac unit.
Emma had been taken to the Neonatal ICU where she would be monitored for the next six days. Thankfully, she was truly healthy with no lasting effects of my heart problems nor the drugs given to me during the crisis.
I know now that had Dr. Myers succeeded in convincing me to induce labor that the increased stress on my failing heart almost certainly would have resulted in the death of both my daughter and myself. The small hospital in Marietta would not have had the necessary resources to handle that high-risk situation. How thankful am I then, for that eerie foreshadowing of innate maternal sense. I did, later, report this doctor to the medical board of the state. At the end of their investigation they said, essentially, “Since you did not die, we find no wrongdoing.”
Once I was settled into a room on the cardiac floor, family and friends began to come and visit. As I coughed and hacked up gobs of phlegm from my lungs with a vacuum tube that emptied into a plastic container, I listened to their words of care, concern and congratulations. The violent coughing and hacking made my chest hurt terribly. The nurses gave me a red heart-shaped pillow to hold tight against my chest while coughing which helped ease the pain. Visiting friends and family signed that pillow with loving thoughts and well-wishes, giving me a bittersweet reminder of that time.
As my breasts began to leak milk, I stared at the wet spots on my hospital gown in shock. Having had a breast reduction surgery in my teens, the surgeon had explained that I would never be able to breast-feed nor have feeling in my nipples ever again. It turns out she was wrong on many counts, a story for another day. My cardiologist said they could probably alter the medication keeping my heart working properly so that I could breast-feed. At constant risk of cardiac arrest, I was terrified that altering the medication would lead to my death. How I wish I had been brave enough to make the decision to breast-feed. They bound my breasts to stop the milk flow. I held that heart-shaped pillow tight against my bound breasts, transferring all the pain and grief that so clearly needed to leave my body.
Nearly twenty-four hours after my daughter’s chaotic entrance into the world, I met her. A nurse brought Emma to me that evening and taught me how to hold and feed her. I stared deep into this dear, sweet child’s eyes, unable to process as yet what she means to me. After about 30 minutes, the nurse took her away, back to the NICU. Nurses brought Emma to me for about fifteen minutes a day. Hospital policy was such that a nurse had to attend Emma at all times and the NICU could not spare a nurse for longer than that.
Three days after Emma’s birth, the medicals stated they were going to send her home, hours away, with her father. As panic rose through me and I began to cry, the medicals reacted instantly, assuring me the most important thing was to remain calm. They would allow her to stay for a few more days so my own condition could be re-evaluated.
That evening my best friend stayed overnight in the room with me. I wanted very much to bathe myself but was unable to shower due to the quantity of wires attached to my body and the cesarean incision. Manda requested privacy from the medicals, closed the door, helped me to stand and remove my gown. Holding on to the IV pole, I shuffled over to the bathroom sink which she had filled with hot, soapy water. I began to wash, the roughness of the warm washcloth and the dry, cool air making my skin tingle like stars exploding. I remember the deep intimacy of her washing my back and legs, the raw vulnerability of standing so exposed in my nakedness, ever reliant on her care as weakness engulfed me. She gently dressed me and helped me back to bed, my soul laid bare in all that had passed over these last few days.
An Ejection Fraction (EF) is a unit of measurement used to determine how much blood is being pumped out of the left ventricle with each contraction, with 55% to 70% being ideal. My first echo measured at 15%, considered severe heart failure and which can also indicate cardiomyopathy. In my case, it was Peripartum Cardiomyopathy (PPCM). Many of us are familiar with Postpartum Depression (PPD), which occurs after pregnancy. Peripartum describes the short time-frame before childbirth.
PPCM is difficult to identify at late-stage pregnancy due to a similarity in symptoms – shortness of breath and swelling in the legs and feet. I have been doing some research to help guide this writing to ensure I am accurately depicting information about PPCM. I was very interested to discover that recent research suggests that overactivity of certain hormones may cause damage to the vascular system. This idea is something I have been intuitively feeling since this traumatic experience, one that became crystal clear once I began hormone replacement therapy in menopause. But that, too, is another story, one coming over time.
Two days after they wanted to send Emma home without me, medicals performed a second echo on my heart. Unfortunately, my ejection fraction was still at 15%. The doctors reluctantly gave me a choice – I could continue to stay at hospital, alone, or go home with my daughter whom they were ready to release. They said that the only real treatment was rest, rest and more rest, which could be done at home with a strong support network. I was on plenty of meds at this point – an ace inhibitor, beta blocker and blood thinner. Due to the nature of the blood thinner, I would have my blood drawn twice a week for some time to be sure of the right dosing. My small-town primary care physician was brought into the loop and she felt confident to manage my care. Appointments were made for me with an incredibly caring and supportive cardiologist, Dr. Haas, for follow-up care over the next few months. Medicals removed the heart catheters from my neck and thigh – a very painful procedure due to the stitches being very difficult to remove. I packed up my belongings, received my daughter and we were escorted out of the building in a wheelchair. My partner met us outside the hospital doors, loaded Emma and I into the back seat and drove us home. I am not the first mother to look at my newborn in her car seat for that first drive home and feel terrified that I had no idea how to do this. Underscoring that was my very understandable fear that I was going to die at any moment, leaving this sweet baby without a mother.
Against all odds, my heart did recover over time. It has been a difficult road, one filled with scary twists and happy turns. I was not in any physical pain; exhausted, scared and weak, yes. Taking that first shower, unassisted, in my own home, felt indescribably good and also completely debilitated me.
My family and friends rallied and helped me very much those first few months. My stepfather, now passed, was my champion, attending all medical appointments with me, taking notes and asking questions I did not know to ask. My partner, a chef, prepared delicious food to meet my new normal of healthy eating, where low fat, salt and potassium were necessary. A diet I followed so strictly that after a few weeks my doctor called after a blood test to tell me to “eat a bag of chips!” I had been so afraid to eat sodium and had stopped it completely – my first lesson in nutrition, that our bodies need sodium to survive.
I laid on the couch by day, my daughter atop my belly, watching the leaves shimmer outside the wall-to-wall windows, for long summer days. I lay in bed at night, watching documentaries on how to live healthy, my daughter snuggled by my side. We made up in spades for the missed bonding of that first week that kept us separated, at a time when mother/child bonding is at its most critical.
After fifteen months of building my strength, I was ready to enter the real world again. We lived quite a distance outside of town on a private blueberry farm in a very rural, poverty-stricken county. I had no income and little support from my partner. The Bureau of Vocational Rehabilitation offered support with a program designed to help those who need to learn new skills for work due to a major life crisis. They helped me with child-care costs, a laptop computer and a reliable vehicle for the hour drive to my college, in addition to counseling as needed for professional or academic reasons. Over the next three years, I earned my Bachelor’s degree in Human and Consumer Sciences, specifically Child and Family Studies.
As a veteran of the US Navy, I also received medical and psychological care through the Veteran’s Administration once my state-sponsored pregnancy medical care expired about six months after Emma’s birth. The VA hospital for specialty care was a three-hour drive from home, however, the mental health facility was located in the same town as my college. Without these valuable programs, our story would likely have a different ending.
Emma began attending an early childhood center, Sycamore Run, near my college, which became a home of sorts for both of us, as I did my internships and volunteered there. During my long recovery from heart failure, I became a strong supporter of small, local “happy” farms and ethical animal agriculture. This from a woman who had consumed processed, pesticide ridden food on the regular, who had no idea what the standard American diet is doing to our health and zero understanding of the disgusting nightmare of “bad guy” animal farming. In those first few years at Sycamore Run, I designed and implemented gardening and composting programs with the children, started a non-profit focused on getting local foods into day care centers and worked as assistant to the visionary director who mentored me, opening my eyes to a world of justice and innovation.
Though this story does have a happy ending, it comes with its own share of long-lasting trauma. Over the years I have experienced panic attacks and fear related to my heart health in varying degrees. I have seen counselors and psychologists, worked with Eye Movement Desensitization and Reprocessing (EDMR) and overcome levels of anxiety only to find that the anxiety and fear returns at the most unexpected times. During those moments, I sometimes revert to the hysterical woman that many medicals find most inconvenient. I watch as their eyes glaze over or fill with pity. I listen as they question me –
“Am I receiving mental health care for my anxiety?”
“Have I considered taking anti-depressants or anxiety medication?”
“I see you have a long history with anxiety.”
“Let’s just wait and see if your symptoms get worse.”
My initial EDMR experience helped me to overcome sudden visions, similar to what I imagine ‘acid flashbacks’ must be like. There were three that would overtake me at the most inopportune times, such as when I was driving. I can only remember two; the first is of being unable to breathe, both the literal feeling and the memory of the nurse dismissing my words telling her so. The second was of my mother, my mind providing its own image as I did not see it myself, hitting her knees at my bedside and praying. I still see both of those events though panic no longer attends them, rather they come as a hazy memory.
I again engaged in EDMR about fifteen years after my first experience. A local psychologist wanted an EDMR session on her website so that prospective clients could see a real-life example, her hope that it would give them an understanding of what to expect. On the first visit, she explained the process and asked me what I was hoping to gain from the experience. At the second visit, I entered her cozy, dimly lit home office. She introduced me to the cameraman, who sat quietly in the corner filming, and we began. After the session, as I drove home, I felt a complete absence of……something, and have found that since that session, I can share this entire experience without my body shivering as I speak, my voice quivering or tears sliding down my face.
As I write this, then, I feel fairly confident and strong in the telling, as if I am finally over the trauma. Truly though, I know this is something I will continue to manage, as the sweat pours from under my arms, giving truth to the lie my mind tries to tell me.
*Medicals – a term I use to describe those working in the medical community as a whole.
(https://www.ahajournals.org/doi/10.1161/circulationaha.115.020491)