Twin to Twin. Crystal Duffy
We waited some more. In total, we waited about two hours. The pressure was building in my back, and my sciatic nerve hurt like hell. How much more of this torture would I have to withstand? Finally, Jessica came back into the room.
“Dr. Miller will discuss the results with you now,” she said extending her arm to help me out of the exam chair. “Come right this way to the conference room.”
We were finally going to find out the severity of the disease. Terror manifested itself. deep inside me. I could feel the chunks of bagel I’d had for breakfast threatening to forcefully come back up. I took a deep breath and wiped my sweating palms on my skirt. The consultation room was very different from the waiting area. It was what I imagined a modern-day psychiatric hospital room would look like. The walls were blank—no posters of sleeping newborns, no floral artwork, no seaside landscapes, no TV—nothing but white-painted sheetrock and laminate floors. There was a tiny window on the far-right wall, and in the middle of the room stood a round, wooden table with cushioned chairs. There was a large whiteboard on the opposite wall and a side table stocked with different colored Expo markers and erasers. Jessica turned and left the room, and a brief few seconds later, a tall doctor appeared in the doorway. He was wearing dark blue scrubs and looked as if he just came out of surgery. He pulled off his hat and introduced himself.
“Hello there, Mr. and Mrs. Duffy, I’m Dr. Andrew Miller. Call me Andy. I’m one of the MFMs here at the Fetal Center.” He had a gentle voice—not soft, but not abrasive either. He had piercing blue eyes and a moustache; his hair was gray with traces of white. He reached for our file which Jessica had set on the table.
“Why don’t we all have a seat,” he motioned for us to sit around the conference table. “Can we get you two anything to drink? Or a snack?”
“Oh yes please, I’ll take a water and anything you have to munch on.” I said rubbing my grumbling belly.
“I’ll grab you a water and a chocolate chip cookie,” Jessica said leaping up from her chair. “And I’ll grab one for Dad too.”
“Thanks Jess,” Dr. Miller said, and then turned his attention back to us.
“So I’ve just looked over the results of the ultrasound scans we did here today.” He paused.
This is it. How bad can it be? Not that bad—right? Or tragically, irreversibly bad? My thoughts ricocheted from best-case to worst-case and back again.
“Before we begin, I just want to give you a little background about myself. I’m one of the few MFMs in the country that specializes in twin to twin transfusion cases. I’m one of the pioneers who trained in Europe when these surgeries were being developed. I also teach at the medical school here and have published a ton of articles on Twin to Twin cases that I’ve seen over the years. I want you to rest assured that you are in the best of hands with us.”
A high-risk pregnancy genius with a passion for TTTS. He sounded heaven-sent.
He opened our chart, did one last skim and then closed it shut again.
“Guys,” his blue eyes widened as he looked both me and Ed in the eye.
“Let me give you an analogy,” he said.
“Imagine a tornado has just formed up north in Oklahoma. It‘s formed out of nowhere, faster than any meteorologist could have predicted. Now, this tornado may destroy everything in its path, or it may dissolve, leaving only slight winds and light rain with minor damage. That‘s similar to how TTTS works.”
“Oh, my goodness!” I interrupted, “What do you mean?”
“Well, I’ve just spent the morning looking at your chart, reviewing your history and past reports from Dr. Bill‘s notes. It appeared as though everything in your pregnancy was going as it should have. Look here,” he opened to a page in our file and pointed at the top, “it shows on this timeline that you were going to Dr. Bill every two weeks as a precaution per your OB‘s request.” He paused. “Every two weeks is great, it‘s exactly what we recommend high-risk pregnant moms to do.”
“Okay, good,” Ed said, nodding in agreement. I said to myself, So, we were doing what we were supposed to be doing and…your point?
“You went to Dr. Bill the second week of April. There was no excess amniotic fluid showing at that time, and you hadn’t experienced any symptoms.”
He lowered his finger and pointed to another date. “Here, you returned to see Dr. Bill at your usual two-week mark, and discovered that not only are your babies suffering from TTTS, but it has already progressed to stage three within a matter of days.”
“Oh no!” I gasped. “Like a tornado, out of anyone‘s radar.” I screwed my eyes shut and put my head into my hands.
“The best case scenarios are when we can diagnose TTTS very early on in the pregnancy at around weeks fifteen to eighteen, at which point we just monitor the mom and babies and see how the TTTS progresses. Sometimes, the only thing necessary is to drain some of the excess amniotic fluid—nothing invasive—but in your case, it has developed further along in the pregnancy, so there are different courses of action.” And then he backed up and explained.
“My point with the tornado analogy is not to scare you, but I want you guys to know that this disease is crazy and unpredictable, like a tornado. There‘s things we can do to monitor and correct problems, but we can never be absolutely positive of the outcome. We can only hope for the best.”
“So, Dr. Miller, how bad is it?” Ed asked.
Dr. Miller minced no words.
“Looking at the results of the scans, it‘s apparent that one of the twins—Baby A—is very sick.”
“Oh no, Baby A! That‘s Katherine—our little Katie,” I shrieked.
“How? What specifically?” Ed interrupted.
“Well, you see, the transfusion that has occurred here between the twins has resulted in Baby B, who we call the donor twin, to experience low blood volume. So, our focus with this baby is that she is growing at a slower rate than her sister.”
“That‘s Lauren—Baby B—is Lauren Elizabeth,” I said. I wanted to identify these babies that he was analyzing from charts as real live individuals. They were our daughters. The medical terms were starting to annoy me. They were so impersonal.
“And with the recipient twin—err Katie,” he corrected himself, “her heart has been overloaded with blood from her sister. All this excess blood has put a strain on her heart and…” He paused for a moment.
“She‘s in heart failure right now. If we don’t operate, there‘s a 90 percent chance that both babies will die.”
He stopped talking. I stopped breathing. What? Die? Are you kidding me?
I started silently panicking. I couldn’t wrap my mind around the doctor‘s words. My stomach was cramping. I tried hunching over which made the pain in my back from lying on it during the scans worse. I wanted to scream. I wanted to throw something—perhaps the chair I was sitting on—across the room. And then throw up—that was how nauseated I was. I could feel my face turning burning red as I choked back tears. I couldn’t look in Dr. Miller‘s direction any more. I turned away—I wanted to turn my thoughts to something else.
We had just received the results of the blood screening. It was time to reveal the gender of the babies.
“GIRLS! TWO MORE GIRLS, NO WAY!” I screamed when Dr. Cooper told me.
My heart skipped a beat. I was still beaming at the news that we were having identical twins, and finding out that they were girls sent me over-the-moon. It was absolutely precious. Three little girls. Half a pep squad, ha-ha. Maybe they would all have Abby‘s sparkling blue eyes? But really, I was just happy that we were having two healthy babies. I couldn’t have cared less