The Tree of Knowledge

Eclampsia

"You have sever, early-onset eclampsia." Doctor Charlie says gravely.

Six hours passed before Mara woke up. We spent them in the waiting room, sitting on hard chairs drinking bad coffee and trying to keep Little Bird entertained.

While she slept, Doctor Charlie had ordered some test, deftly carried out by a revolving door of nurses. Her blood pressure was very high, 160/110. They took a urine sample and found unusually high amounts of protein in it. When she woke up, they asked her:

Have you gained weight suddenly?

Any nausea or vomiting?

Abdominal pain?

Have you experienced swelling in your feet, hands, and legs?

Yes, yes, yes, yes. Weren't these all just symptoms of being pregnant?

Is your vision sometimes blurred, or do you experience "floaters"?

Do you have severe headaches?

Changes in reflexes?

Yes, yes, yes.

Check, check, check, goes the ballpoint pen.

And all of those check marks point to severe, early-onset eclampsia. A condition more common in older women, and in women giving birth for the first time. It means there isn't enough blood flow to the placenta.

"What do we do to treat it?" Mara asks.

"That's the trouble," Doctor Charlie says. "There's isn't any treatment available."

It turns out the only way to get rid of eclampsia is to not be pregnant any more.

In most cases, women develop pre-eclampsia. They get the high blood pressure and swelling and vomiting without the seizures (at least not yet). The doctors then try to get this whole pregnancy thing wrapped up before it turns into eclampsia. Because eclampsia comes with seizures, strokes, the lungs filling with fluid, bleeding from the liver, and systematic organ failure. The prognosis for baby is not much better. There's a high chance of miscarriage or still-birth. Baby could have a variety of physical or mental abnormalities.

For most women, pre-eclampsia sets in at about week thirty. Thirty isn't such a far cry from thirty-four, when baby's lungs develop. The "treatment" is bed rest for those last four weeks, then induced delivery or cesarean of a premie baby that will most likely survive.

But Mara is only at twenty weeks. And has already pushed past pre-eclampsia into eclampsia. Doctor Charlie makes it very clear, his unfortunate recommendation is terminating the pregnancy as soon as possible. There is a great risk that Mara will not live to see week thirty-four.

Doctor Charlie has actually used the phrase "systematic organ failure" and Ryan still asks, "But there's still a chance the baby will be alright?"

Doctor Charlie looks taken aback.

"I don't think you understand, sir."

"Ryan, it's going to kill me." Mara says pleadingly.

I don't care if it kills you.

"I understand." Ryan says. "If she can survive the next fourteen weeks, you can deliver my baby."

"But...sir..." Poor Doctor Charlie looks lost. "You can't ask her to risk her life for-"

"I am not asking. My wife is my property. I can do what I want with my property. I'm the husband and I know what's best for my family. That's God's will. Are you trying to question God's will?"

They're just talking over Mara now, Ryan on one side of the bed, Doctor Charlie on the other. Like she's not even there. Lying on the bed in between them, listening to two men debate whether she lives or dies, Mara cries. I reach out and grasp her hand.

"Well..." Doctor Charlie begins, "If that's your decision, then I'd like to perform an immediate cesarean section."

He turns to a nurse. "Tell NNICU we've got incoming. And I want Ms. Williams prepped for surgery immediately."

The nurse rushes off with his orders. Doctor Charlie turns to Mara. "You're going to be alright, I promise you. And we're going to do everything we can to save your baby."

"Thank you." Mara whispers, gratitude in her eyes.

"But, but you said the lungs-" Ryan sputters.

"Mr. Williams, the earliest a baby has ever been born premature and survived is twenty-one weeks and five days. Twenty weeks and three days doesn't seem such a far cry from that. Maybe they'll give me a prize..."

Several nurses rush back into the room and begin preparing to wheel her out.

"If you'll excuse me," Doctor Charlie says, "I have to go prepare for surgery."

"No!" Ryan shouts, now standing in front of the bed, blocking them from leaving the room. "We're not doing this now! You're waiting until she's at thirty-four weeks!"

"There's a ninety-five percent chance that at thirty-four weeks your baby will be dead and so will your wife!" Doctor Charlie shouts. "Are you really asking me to kill her for that sliver of a chance your baby will survive?!"

"I told you," Ryan answers calmly. "I'm not asking."

Doctor Charlie seems to deflate. He looks at Mara helplessly. The nurses are frozen there, unsure of what to do. He takes a deep breath before turning to them.

"I want her on twenty-four hour bed rest, on her left side as much as possible. Keep an eye on the fetal heart rate monitor. Start her on magnesium for the seizures and hydralazine for her blood pressure. I want her scheduled for a fetal steroid injection-"

"What's that for?" Ryan interjects.

"The steroids will help speed the development of the baby's lungs so we can deliver sooners and I need you to GET OUT while I'm working!"

For a moment, I think that Ryan will hit him, but he has the grace to finally back down. Him and Rebecca retreat out of the room. I go to follow them. Doctor Charlie turns to me.

"You can stay if you like. As long as you're quiet."

I nod and settle into a chair next to the bed, grasping Mara's hand.