Laura Abkarian
February 2017
Labor and Delivery
Orange Regional Medical Center
United States




Our story is no fairy tale, but it needs to be told. When I discovered I was pregnant in late October, I was ecstatic. The second line on the home pregnancy test appeared and my life instantly changed. My husband Ted and I had been trying for almost a year, and finally, our dream of starting our family seemed to be coming true. The months of disappointment we endured trying to get pregnant suddenly became distant in the rear view mirror. We were going to be parents! It was such a magical time. The possibilities were limitless, the hope was boundless, the excitement was uncontainable, and the joy was all-consuming. That bliss, however, was not fated to last. Superstition kept us from sharing our news right away. We waited until the first trimester was behind us before we told our parents that they were going to be grandparents. We revealed our big secret by unveiling custom made ornaments and ultrasound pictures right around Christmas. Our parents were overwhelmed with excitement. My mother held our first ultrasound picture to her heart and cried with a giant grin on her face. My father decided he would try to quit smoking once and for all. My mother-in-law couldn't wait to start knitting us one of her famous baby blankets. And my father-in-law mustered up the courage he couldn't find before and started candidacy screening for weight loss surgery. The 2016 holiday season was enchanted, and 2017 looked bright. Together we celebrated our baby's fetal development each week. There was always another milestone to be thrilled about. The baby had a heartbeat at six weeks. The baby had fingernails at twelve weeks. The baby could hear us sing lullabies at sixteen weeks. The baby would be old enough at eighteen weeks for an ultrasound technician to determine a gender. We were stoked! Girl or boy, we just wanted to know so we could bestow a name on our growing bundle of joy.
We scheduled our anatomy scan on February 10th, my birthday. We were exactly eighteen weeks and two days. I thought finding out our little one's gender would be the greatest birthday gift I could ever receive. Nervous excitement prevented me from sleeping the night before the scan. I held my hands over my expanding uterus and wondered if my baby could feel my embrace. My husband and I left for the Crystal Run office at 7:30 AM. We held hands in the waiting room, and couldn't keep the smiles from our faces. When they called us in, I lay down on the table and stared eagerly at the computer screen. The transducer slid across my stomach and a picture appeared on the monitor. Our little baby was moving those tiny arms in what looked like a wave. The technician, Megan, said the baby was a boy, and we were over the moon. Megan said he wasn't quite old enough for her to get all the necessary organ views she was supposed to, and that we'd probably have to come back again in two weeks to finish. She told us that was very normal, and often times some views are impossible until after twenty weeks. She wiped the gel off my stomach and asked that we not leave the office until she spoke with the radiologist in case he wanted her to redo the scan. I thought that was strange, but I didn't question it. We went back to the waiting room, but we didn't have to wait long before Megan returned for us. She said the radiologist didn't require more images but was sending us across the hall immediately to see Dr. K. She would not say why. But we knew something was wrong. The drunken-like giddiness we felt upon learning our baby was a boy gave way to frantic panic that he was in trouble. We both had clean bills of health. Neither of us was carriers for genetic disorders. I'd been taking prenatal vitamins since we started trying to conceive. I exercised with moderate intensity for thirty minutes daily. I was sure to eat a balanced, nutritious diet. I read every book about pregnancy, childbirth, breastfeeding, and parenting that Amazon had to offer. From the layman's on What to Expect to the physician's Anesthesiology Algorithms in Obstetrics, I read everything. What could have possibly been the problem? What had I left undone? I was an overachieving control freak determined to be an excellent had I failed?

Dr. K met us in an exam room. She was soft-spoken and solemn. She explained that our ultrasound revealed that my Amniotic Fluid Index (AFI) was dangerously low. Our baby's gestational age required there be between 10-15 cm of fluid, but the radiologist alerted that there was only 3 cm present. My heart tore in two. My eyes flooded with tears while my husband and I bombarded Dr. K with questions. She was as gentle as she could be while giving us the harsh truth. She said that there were really only two possibilities; either my amniotic sac ruptured or the baby had a very serious kidney problem. More likely, she told us, was that the sac had ruptured. In other words, my water had broken. My head was spinning. I couldn't wrap my mind around it. There had been no evidence of broken water, no sudden gush of fluid. There had been no trauma; I wasn't thrown from a horse or hit by a car. Our last doctor's appointment was two weeks prior, and all signs pointed to this being a healthy, uncomplicated, uneventful pregnancy. Essentially, once the sac is ruptured delivery is imminent. The baby is no longer protected and the mother becomes susceptible to infection. Babies younger than 24 weeks are not viable outside the womb. I walked into the office that morning expecting to hear the best news of my life, instead, I received the worst. It's termed Preterm Premature Rupture Of Membranes, shortened PPROM. Midtrimester spontaneous PPROM only complicates 0.1-0.7% of pregnancies. My own research on the subject has led to many more questions than answers. The pathogenesis of this horror is not well understood, even among experts. I knew I would probably never find out why this was happening. There was no comfort in the unknown. In my case, there was also no comfort in the known. Because I knew I was going to have my baby too early, and I knew he wasn't going to survive. Dr. K took me by the shoulders and looked into my eyes as she spoke. Her face was sincere and her calm resolve helped to steady me. She called my doctor, Dr. Z, on his day off and had him speak to me over the phone. She thought maybe a familiar voice, one I knew and trusted, would soften the blow. Of course, there is nothing to ease the pain of loss or impending loss, but Dr. K was sure to not compound our pain with insensitivity. She hugged me and whispered well wishes in my ear before she sent me on my way to Orange Regional. Though she had entered that room a perfect stranger to me, and though our time was very brief, Dr. K and I parted ways with a feeling of closeness. She reached the limit of her capacity to help us in that office, and it was quite obviously as crushing for her as a provider as it was for us as patients. We went hurriedly to our car, sped down the road, and raced into the hospital parking lot.
We briskly walked to the registration desk, still stubbornly clinging to the naive hope that maybe something could be done to save our little boy. The clerk worked expediently. Within two minutes, she placed a hospital ID band on my arm and directed us to precisely where we needed to go. At 10 AM, we were admitted to the hospital. Upon entering the Labor and Delivery Unit on the sixth floor, we were greeted warmly by a nurse named Laura Abkarian. She said Dr. C was expecting us. She helped us into a private room and sought to make us as comfortable as reality would allow. Every time she asked a question, she intently listened to the whole answer and made us feel heard. Laura actively involved my husband in the interview process and initiation of care. She was hopeful but honest. The situation was grim, but Laura remained optimistic. She offered no false hope, but she radiated positivity and strength. She earned our trust immediately and made herself constantly available for us to lean on emotionally. I could not have been in more capable hands. Over the course of our time with her, Laura helped explain every detail of our care plan and made sure we were in agreement before she proceeded. She never made us feel like we were without choices or options. Not once did we feel coerced or pressured into doing anything or abstaining from it. Laura was a fierce patient advocate from the moment we walked into the ward. I not only felt cared for but cared about. This wonderfully skilled nurse became invested in our well-being, and it was apparent in every action she took. Dr. C and Laura worked well together, and they seemed to have complementary strengths. Dr. C was also obviously concerned about us from the moment of our meeting. He was knowledgeable and willing to answer all our questions to the best of his ability. He and Laura performed a simple test called an AmniSure, which identifies the presence of amniotic fluid outside of the womb. A positive result on this test would confirm a rupture. To everyone's surprise, the test was negative. Wanting to cover all bases and ensure the accuracy of findings, Dr. C ordered a stat ultrasound to confirm the level of fluid in the amniotic sac. And Laura, in an effort to minimize trauma and maximize normalcy, insisted we get something to eat. She brought us a menu and told us both to get whatever we wanted. Neither of us had eaten anything yet, and we were in for a rough day. We appreciated her forward thinking. As soon as we'd placed an order, a young lady from transport had arrived to take us to the ultrasound. There was no wait time at all. As soon as we were ushered into ultrasound, a technician named Kathy was ready to perform the scan. She noticed I was shivering and without missing a beat, she draped my shoulders in heavy linen. She was polite, professional, and exceptionally fast. Kathy showed us our baby's little movements and narrated what she was looking at. Just as quickly as we arrived, we were escorted back up to L&D by a man from transport named Brian. He was friendly and wished us luck when he brought us back to our room. Laura was waiting for us there with a tray of water, tea, coffee, and assorted snacks to tide us over while we waiting for our meals to come. Right after she made me comfortable in bed, food service arrived. Perhaps it was mere coincidence or maybe lucky timing, but it felt like every department's efforts came together seamlessly. We were so very well-tended. Dr. C returned to our room with an ultrasound machine in tow. He wanted to perform another scan personally to compare his observations with those of the radiologists at Crystal Run and ORMC. He was insistent that every attempt be made to triple check the findings before a definitive diagnosis was confirmed, especially if it would be irreversibly life-shattering. We were thankful for his dedication to the truth. Surely, had one or both of the radiologists made a mistake, Dr. C would have caught it. Unfortunately, his findings were nearly identical to theirs. All three doctors concurred that the AFI was between 3 and 4 cm. Even though three trained professionals agreed that the baby was anatomically perfect, we were still going to lose him. Dr. C repeated the AmniSure test, and this time the results came back positive. Laura held our hands while Dr. C explained that it was now time for a tough decision. Regardless of our action or inaction, I was slowly leaking fluid and would continue to do so. Regardless of our action or inaction, our baby would not make it to term or even to a point of possible viability. Regardless of our action or inaction, labor would begin within a week. Our options were to let nature take its course by allowing labor to start naturally or induce labor on the spot since we were already in the hospital. Letting nature take its course would definitely prolong the agony of losing our baby and probably cause infection. Inducing labor would shorten the process of inevitable loss and minimize the risk of infection. It was going to be torturous no matter what we chose. We ultimately decided to do what was safest and consented to induction. Helpless to change the construct of reality, we were forced to accept it. Onward we went into uncharted depths of unimaginable suffering. My husband held me in his arms as we tumbled into a bottomless abyss of sadness. Any remaining hope was slain by an onslaught of doubt and despair. All of our love and prayers would not spare our son. The most fundamental responsibility of any mother is to protect her child from harm, and despite my greatest endeavor, I was powerless to save the life of my precious boy. I wept for the life he wouldn't live. I cried for the family we wouldn't have. And I cried for the dreams that would die that day with my baby. In the late afternoon on February 10th, 2017, without question my worst birthday on record, I was given my first dose of Cytotec.
Contractions began within two hours of administration. I refused pain medication. Unable to alter the course of fate, I decided to embrace the experience of simultaneous physical, emotional, spiritual, and psychological pain. After induction, there were even more difficult decisions to be made. Somehow the most horrific day of my life kept getting worse, even after it seemed it was impossible for it to be more devastating. We had to answer questions that were truly distressing to our very souls. Did we want to see our baby after delivery? Did we want to take pictures of/with him? Did we want an autopsy done? Did we want the hospital to discard the remains? Did we have a funeral home we'd prefer to use? Would we like to bury our baby or cremate him? I couldn't believe we were actually talking about burying my baby before he was even born. Laura arranged for a social worker named Michelle to come speak to us and help us navigate these terrible decisions. She was a godsend. Michelle was sensitive to our needs and respectful of our choices. She was an excellent resource, and I'm glad to have had her with us. Nothing was easy, but I imagine it would have been significantly harder without the intense compassion we were shown. Michelle made preparations to ensure we'd be able to preserve and honor the memory of our son. I will be eternally grateful to her for the dignity she afforded to my baby boy. I will never forget her patience, understanding, and determination to support us. Laura did not leave my side until her shift ended at 7 PM. She was relieved by an equally fantastic nurse named Dawn. Laura introduced us and gave a flawless transfer of care report to Dawn in our presence to allow us the opportunity to mention additional details if we wished. Though, there was no need for us to say a word because Laura recounted every aspect of our case from memory. She recited every one of our preferences to Dawn, and Dawn repeated them all back to confirm everyone was on the same page. These two nurses demonstrated attention to detail and excellent practice of closed loop communication. They are a perfect, shining example of what healthcare could be if everyone cared as deeply and behaved as admirably. Both should be commended.
Dr. C's shift also ended at 7 PM, at which point Dr. T took over our care. L&D was extremely busy for the entirety of that overnight, yet Dr. T still made the time to oversee treatment personally. She was so gentle and did everything she could to remedy and alleviate my discomfort. She had the sweetest sadness in her eyes every time she spoke to me, and I knew my heartache had genuinely become hers too. Even through the growing intensity of my physical pain as my labor progressed, her hand on my shoulder was a comfort. Her voice was reassuring. I felt safe with her. I had the utmost confidence in her abilities as a physician and in her upstanding character as a person. Dr. T administered my second dose of Cytotec at midnight. My contractions intensified in severity and increased in frequency. Unsure of how long the process would be and already exhausted, I accepted Dawn's offer for medicinal relief. She gave me Nubain for the pain and lactated ringers to keep my hydrated. The Nubain gave me the opportunity to rest for about two hours before the pain came back with a vengeance. Dawn hurried to get me a second dose, but it had no effect. Dr. T rushed into the room to find me in writhing agony. I was no longer able to breathe my way through the contractions. There was no position of comfort I could contort my body into. There was no physical motion that eased the torment. She offered me an epidural. I refused it, certain I could carry on without one. But an hour later, I was overcome. I began vomiting and shivering uncontrollably. I couldn't formulate a simple sentence or hold a thought in my head. Again, Dr. T, desperate to help me to get through this, offered an epidural. This time, unable to help myself, I accepted. I remember thinking that I'd have to wait a long time for an anesthesiologist. But, I don't think more than ten minutes went by when Dr. L arrived at my bedside. He might as well have been wearing a cape because he was my hero from the moment we started talking. I told him I was terrified. He helped me not to be. I wish I could remember exactly what words were spoken, but that part has become a bit hazy to me. What I remember with absolute clarity is that one moment I was doubled over on the floor in the most excruciating pain of my life, and the next I was reclining comfortably in bed shaking hands with him. He worked as quickly as the medication did. I was so thankful for his speed and his skill. Truly, this man was incredible.
At about 6 AM, I felt pelvic pressure. I knew it was my baby descending, just about ready to emerge. My body was acting life support for my son. Delivering him would effectively be pulling the plug. Physically and emotionally, I was exhausted and I wanted this labor to be over. But I also couldn't bear the thought of labor ending because it would mean my baby was gone. His little heart did not stop beating until delivery. At exactly 6:40 AM on February 11th, 2017, our son was born perfectly formed and beautiful, but lifeless. Dr. T cleaned up our baby, covered his head in a turquoise beanie hat, and swaddled him in a yellow knit blanket while Dawn attended to me. A few minutes later, he was brought to me and placed in my arms. The room cleared to give us privacy. My husband held me while I held our little baby. We were enveloped in our grief. He looked exactly the way a baby is supposed to, only smaller. He was so handsome, so physically flawless. Together, we held our boy until the warmth left him. The first time I hugged my son was our last embrace. The first kiss I gave him was the last time I touched his face. As soon as he entered the world, I got everything I ever wanted; just not the way I wanted it. When he was born, I became a mother, and we became a family. He was miraculous and extraordinary, just as I dreamed he would be. He was all I ever hoped for, but I wouldn't get to keep him. It was the most magnificent tragedy.
Both Laura, the nurse, and Michelle, the social worker, were scheduled to have February 11th off from work. However, both of those beautiful women came in anyway and looked after us. Michelle put together a memory box for us with our son's footprints and hand prints. She made sure we got to keep the clothes he'd been swaddled in. And she staged pictures of him where he looks like a sleeping angel and had them placed on a flash drive for us. Laura made sure pastoral service came to pray with us. Dr. T made sure to leave a care plan in place for me. Dr. L came back when he heard I'd delivered to offer his condolences. Dawn remained on the floor until two hours after her shift had ended. The nurse who took over for Dawn at 7 AM was a great lady named Maddie. She stayed within earshot in case we needed anything. She made sure that we ate and stayed hydrated. And she put us in touch with the lovely funeral home that Laura told us about. When another patient needed Maddie, a nurse named Yvonne came to look in on me. I asked her to remove the catheter from my back, as the tape holding it in place had become uncomfortable and the medication was no longer needed. She immediately sought out a doctor to give the order and returned to remove it herself. She handled me so delicately that I didn't even feel it when she pulled the tape off. She then proceeded to wash off my back to get rid of the remaining stickiness from the tape. I was so grateful for her caring. And then I was overwhelmed by her kindness when she offered to rub my back because she knew the ordeal I'd gone through. She couldn't massage away the pain of losing my baby, but she was able to loosen the tightness of my muscles. I wasn't even her patient, but she treated me so tenderly and kept coming back to check up on me. This event, from scheduled anatomy scan to hospital discharge, was cataclysmic for me, my husband, and our families. We were blindsided with the worst news any parent could get. We lost our baby boy. Nothing will ever take away the pain of that loss. There will always be a void in our lives. The two days over which these circumstances unfolded will forever be the darkest days of our lives. However, every kindness afforded to us by the outstanding staff at Orange Regional Medical Center will stand out as a light in that darkness. Every single member of the team who cared for us showed unparalleled empathy. The loss of our little boy so deeply affected everyone we came in contact with. Every single person shared in our heartbreak. All four of the nurses who looked after us, Laura, Dawn, Maddie, and Yvonne, shed tears with us. Not because they were weak or unprofessional, but because they were strong enough to face the bitterness of grief with us, and they cared enough not to let us bear the burden alone. Every doctor who cared for us made it clear through their actions that they too would always carry the weight of this sorrow with us. The point of telling our story is not to highlight the unfavorable ending, but to shine a spotlight on the amazing people who helped us through it. I want the hospital to commend each and every one of these providers for their individual clinical excellence and their combined outstanding team effort. I would like to nominate all four of the aforementioned nurses for The DAISY Award. And I would like to further nominate every single named person in this letter to be recognized as Partners In Excellence. Everyone went above and beyond the call of duty. They all far exceeded the standard of care, not because it was their job, but because it was the right thing to do. Everyone lent a shoulder to cry on and a hand to hold, not because they expected to be rewarded, but because they were trying to help someone in terrible pain. Most importantly, I want every single person named in this letter to know that although no one could do anything for our son in Heaven, they all made a great deal of difference to me here. Truly, thank you all.