Prologue: When I was pregnant, I spent countless hours on the internet looking for stories of working women who were experiencing hyperemesis gravidarum and had hope and coping ideas to share. Especially the moderate variety- the kind that only puts you in the hospital a few times, instead of the poor women who just have to quit their jobs and live with an IV trolley next to their couch. The middle ground of this sickness was emotional torture because I would have moments of feeling ok, which made me (and others) think it shouldn’t be getting in the way so much. Or that I could predict and/or control it.
The stories I found were of women who lost their jobs, or who couldn’t take care of their kids, or even stories of women who had husbands that didn’t believe how sick they were and were dealing with guilt/shame on top of the physical trauma! So, I’m sharing this story because it massively affected my work and personal life, but also because maybe there is a newly pregnant woman out there who has been run over by the vomit truck and needs to know she isn’t alone. Part 1:
The George and Charlotte Effect
Oh if the author of that clever headline only knew.
In late 2012 Kate Middleton, one of my girl crushes (and also the Duchess of Cambridge) did me a huge favor when she got pregnant with Prince George: aside from providing royal family watchers with a new heir to obsess over, the princess became hideously sick. During her first trimester, Kate’s pregnancy was actually outed due to an emergency visit to the hospital, presumably for an IV of fluids and drugs to suppress her nausea and vomiting.
She was in such bad shape that she was diagnosed with Hyperemesis Gravidarum (HG), which literally means “barfing your body weight daily”. Or at least it should.
HG is excessive nausea and vomiting in pregnancy, and while few are actually diagnosed (figures are quoted at anywhere from 0.5% to 5% of all pregnancies) my personal experience leads me believe many more women are suffering without access to the the knowledgeable care and diagnosis that Kate, and luckily myself, were able to receive. And while horrible for her, Kate experiencing HG brought a new awareness to the illness previously dismissed as just a little morning sickness. To my knowledge, Kate experienced the same thing during pregnancy #2 with Princess Charlotte. Actually, seeing the magazines above at my dentist really reminded me I needed to share this story. The headline made me laugh out loud for its likely unknown double-meaning.
How it all began:
The early weeks of my pregnancy (as in weeks 3-5, because I felt the moment baby implanted– more on that here) I was on top of the world. My skin radiated, not a pimple or flush cheek to be found. I was a little tired, but nothing a few naps didn’t relieve. I was even running multiple times a week. My plans to have one of those enthusiastic, fit, and healthy pregnancies were falling in to place! Except that my already keen sense of smell was quickly ramping up, and I was soon able to sniff anything foul within a 500 ft radius…
It was a sunny Sunday afternoon, I was 5.5 weeks along, and I just returned home from a 4 mile run. We ordered Indian food from an Irish Pub and I found that I couldn’t eat as much as usual…this was odd; I generally have unlimited capacity for naan, paneer and samosas.
The next day would be the first day of what I would predictably call “morning sickness”. I woke up feeling like I had been hit by a semi, but presumed this was just part of the experience.
At work, I distinctly remember sitting at my desk, teetering at the edge of barfing, just staring at my keyboard wondering how difficult it was going to be to clean out the vomit from between the keys.
I presented a business recap in our regular Monday meeting, and received a few comments from my co-workers about looking pale. I got home that afternoon, absolutely exhausted and sank into the couch. Little did I know that was to be my routine for the indefinite future.
The next few weeks passed with increasing sickness. I started vomiting every morning and many evenings, but the vomit wasn’t the worst of it. It was the nausea, the I-am-about-to projectile-vomit-any-moment-and-yet-it-hasn’t-happened feeling that was unbearable. Later I would christen this state of being affectionately as “puke purgatory”. I could hardly look at food, so my consumption steadily dropped. I had a rough morning one weekend, vomited bile and dry heaved 20-30 times, and then, feeling the brief post-barf-relief, (which should never be trusted, ever) I ate some peaches n’ cream oatmeal that Brandon made for me. No sooner had I swallowed than I found myself sprinting for the toilet, and I got to relive the peaches, and the cream. Simply put, I could not keep anything down. This cycle seemed more extreme than the morning sickness I had read about.
Even water, my favorite beverage, made my cringe. I tried things like Gatorade and soft drinks, with mild success at best. The beautiful yet torturous thing about the internet is that every morning when I would wake up and feel like the world was ending, I could grab my iPhone and google a new version of “cure for morning sickness”. After several weeks of this practice (which yielded all sorts of miracle tricks that did nothing for my symptoms, I’ll share those another time if you are looking for ideas) I had to quit as each instance resulted in failure, which sent me on the road to depression.
Frankly, this wasn’t traditional morning sickness, and there was no clear solution. (Read about dear Bronte and her fate) What I have learned is that mild to moderate morning sickness can be controlled by a variety of home remedies and lifestyle adjustments. But these home remedies and lifestyle adjustments were just making me feel like a failure.
I was incredibly optimistic for my first doctor appointment, which was at week 8. Surely a medical provider, once hearing about the hell I’d been living, would have a solution? It’s modern medicine after all.
We’ve eradicated smallpox, developed transplants for vital organs, cloned cows, and mapped the entire human genome. I’m sure SOMEONE stopped and took the time to help women with uncontrollable vomiting and nausea during pregnancy… right?
I try not to hold a grudge, but my doctor was a huge disappointment. She was ~36 weeks pregnant herself and in her last week of work. We had never met, and I had signed up to actually receive my primary care through a midwife, so our meeting was essentially a formality. I sensed an element of “I’m never going to see you again” in her demeanor. But I had filled out the medical history questionnaire with distinct effort to draw attention to some of the key symptoms I was feeling — my awe-inspiring nausea and real inability to consume food, specifically. Diarrhea was also alarming. Here was the breakdown of my day, which I shared with her:
Wake up with painful need to pee. Go pee. Pee is radiating gold…too tired to be alarmed.
Go back to bed, wake up 30 minutes later with need to diarrhea. Go diarrhea.
Go back to bed, attempt to nibble a cracker, wake up 30 minutes later and dry heave my guts out.
I would then try to clean myself up to a respectable level and go to work. I usually spent most of the work day roaming around puke purgatory, always teetering on the edge of another explosion. But being at work somehow helped– it was incredibly distracting. Trying to fake normalcy didn’t leave me as much mental space to feel what I was feeling, which was miserable.
Evenings involved tears, more bile, diarrhea and finally crashing to sleep from exhaustion.
I found the situation to be alarming, but my doctor was nonplussed. In fact, I believe the words “welcome to pregnancy” were used. She was on child number 2, working long days and ready to pop. I was just a young first-timer with a bit of morning sickness. In her mind I needed to buck up. But what she failed to understand or acknowledge was that my reality was not typical. I had already lost about 5-6 pounds in just a couple weeks, which was obviously the wrong direction. She offered to prescribe me a drug called Zofran, which is typically given to cancer patients to suppress vomiting caused by chemo/radiation treatments. She said “just having it will make you feel better, I only used it once or twice myself”.
Is it even ethical to prescribe a medication with the stated intention of some sort of pseudo-placebo effect? “Just tap the bottle 3 times” she says…
I left with my half-hearted prescription in hand, along with the general feeling that I was just supposed to toughen up. That week we flew to Chicago and I worked from a hotel, thank goodness. I could hardly pry myself out of bed to pee and vomit, but was I was able to hide behind my computer screen and play the part of a functioning manager. I mustered up sheer will to meet up with a dear friend one night, but bailed out at 9:15 pm. Yes, the time when most people are just leaving home. Husband and I tried to see some of the city, (we made it to the bean so I could take a cute “2 months” picture that I would never use… my goal of having monthly pictures in interesting places ended at our next destination) but I may have broken down in tears at the beautiful Field Museum where his work held a glamorous dinner party. It was full of people, music and all sorts of food; food that smelled and was everywhere…I left sobbing because I thought I was going to pass out. We spent most of our next two days in the hotel room, waiting to fly home.
Following our trip to Chicago we had planned a wonderful long weekend in Cabo with a couple of our best friends. We were going to leisure and adventure together, and actually they were expecting their own little bundle of joy, though she was ~3-4 months ahead of my pregnancy. Sadly, I’m not sure if I can ever go back to Cabo. Focal memories for me include trying to pretend I didn’t want to actually die when we took local buses to various places like San Lucas and San Jose. The crowds, the smells, the jostling. It brings tears to my eyes just to remember. I tried really hard to be normal, which was easiest when we were just lounging in the cabana. We would go on long walks where I would count my own steps to distract myself from wanting to puke. But I absolutely had to draw a line at the party cruise. I get sea-sick, and pairing that with pregnancy-sick? I would have tossed myself overboard.
(There was one magical highlight in Cabo that I will treasure– we got to see baby sea turtles hatch and make their way to the ocean water. I would get all metaphorical about how the difficult journey for those turtles was like my own journey getting my baby to the world, but I didn’t see any turtles barfing, so that metaphor is rejected.)
The following couple weeks are a blur, as I was just trying to survive until my next appointment (this time with the midwife) and a visit from my sister. Each day I woke, threw up for 20-30 minutes, went to work if I had to, and left early to answer emails from home when my schedule allowed. Naps were like poison, I would sleep from exhaustion and then wake up feeling worse than I did even in the mornings, and violently vomit up more bile. Day by day it was increasingly difficult to eat and drink enough. Evenings were the worst, falling asleep was actually painful. But once I got to sleep I generally would stay asleep for awhile, until about 10 weeks, and then the nights were bad too.
Finally, my sister came to visit during my 11th week. Having her wisdom from her own 5 pregnancies on my couch was comforting. So as not to raise suspicion before we shared the news, I choked down part of a burrito during dinner. We told her and shed some celebratory tears together, though I also cried a little extra thinking I would never be able to eat Mexican food again. (It would be months). She told me she was pretty sick with her first child too, and said things got better after 14-16 weeks. It gave me hope. She didn’t mind me barfing each morning and night, and she forgave me for skipping a trip to Alcatraz because I was afraid of the boat ride. (I should mention here that motion sickness is common among those diagnosed with HG)
My appointment with my midwife finally arrived. Her name is Florence and as soon as she entered my room and the words “how are you feeling” left her mouth I burst immediately into tears. She already noted I had lost another 10 lbs since my first appointment, a mere 20 days prior. I had hardly peed in the last 48 hours, and when I woke up in the mornings I would catch myself pinching my eyes closed, hoping that I didn’t really have to re-enter consciousness again. No one except my husband knew what I was feeling, and the isolation was the icing on the cake of misery. But Florence herself had HG during her pregnancies, and after reviewing my vitals, symptoms and abysmal keytones, diagnosed me on the spot. It was not just morning sickness. I could quit with the lemon water.
Coming soon in Hyperemesis Part II: It will end at 12 weeks. Or 16. Certainly by 20…
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