From my many years experience providing obstetric care to pregnant women, I know all about HELLP, its signs and symptoms, how to medically manage it and that it is one of the few things that pregnant women die from in the US. I'd medically recognized HELLP in many of my patients and diagnosed this syndrome myself many times over the years. Yet even I, with all of my medical knowledge, was unaware just how sick was was becoming with each passing hour. My symptoms were subtle, arguably caused and justified by other things and deceivingly minor in comparison to how sick I was getting.
He shuffled me into an exam room, rechecked my blood pressure - 130/86, checked my fundiscopic exam (optic nerve in the back of the eye to look for swelling) and checked my reflexes. Eyes were normal but I was impressively hyper-reflexic and brisk - another key physical exam finding of pre-eclampsia and HELLP. I had lower extremity edema but had been experiencing that to an impressive degree since 28 weeks and it was just as bad as usual. Hindsight, I look back at pictures of myself upon admission to the hospital that night and I also had facial edema but it was subtle and I didn't notice it that night, nor did anyone else.
I ambled over to the hospital lab in the beginning flurries of a snow storm, went home and argued with myself over eating and going to bed. I convinced myself I just had a little PIH and would be off work until I delivered. I ate a quick snack and got ready for bed. Within the hour, I got the phone call regarding my labs. My transaminases (liver tests) were over 1000 (should be under 30) and my platelets were 80,000 (should be above 150,000). I knew I had HELLP.
The following days were a magnesium haze of blurred vision, hot flushing, rubbery arms and legs and cognitive fog. I had my hospital room windows open most of the time - during a snowstorm no less - because of the incessant hot flushing! My postpartum BPs remained fairly labile and I remained on mag until postop day 4. Bright lights and lab draws at all hours of the day and night are what I remember most. The end of the magnesium came on that 4th day after delivery when I was alone with my son for the first time. The nurse wheeled him into my room and left. He was perfectly burrito wrapped and peacefully sleeping in his bassinet. I distinctly remember my internal dialogue at that moment as I looked down at him - "Well, there he is. There's my baby. I have absolutely no emotion for him and THEY are going to MAKE me take him home!"
I picked up the phone, called my doc and told him to discontinue the magnesium. My medical brain knew my emotional bluntness and weirdness was, in large part, due to the mag but dang, I had NO idea of the extent and depth of emotional emptiness that mag patients go through. It took weeks to completely clear, though it was better within a few days of stopping the magnesium.
Ultimately, for me, the magnesium was the worst part of HELLP above and beyond the actual syndrome itself. And let's just say that what I remember of my son's birth and first few weeks of his life are very different than what other people describe of those days. I am missing things like signing the birth certificate, settling on his name and I don't have recall of that moment finding out if he was a boy or a girl since we didn't know gender before hand. I really am sad about that - there are very few surprises in this life and that was one we wanted to experience. At least my husband remembers that moment. Frankly, I don't recall exactly when I knew he was a boy - it's just all blurred in those first few days that I recall bits and pieces of now.
But in the end, if I was destined to have HELLP, I did it the best way possible and better than many of my patients. I was ok. My son was far enough along that he was ok and had no issues with prematurity. My recovery, though bumpy and rough due to the expected things given the circumstances, was complete and without significant complication compared to many HELLP mommas. I'm incredibly grateful for that. It took me a little time to get over maternal guilt, especially since I'm a health care provider - in obstetrics no less! What did I miss? What did I ignore? What should I have done differently? But ultimately, I didn't do anything wrong (except eat that dang chicken pot pie before my labs came back) though it took me a long time to realize that.
That was 13 years ago. Once my husband got over his emotional trauma (not at all kidding) and would consider another pregnancy, we got pregnant with our second son. I started to have lab changes at 37 weeks and we delivered him in much better and safer circumstances that my first.
Since then, I have no doubt that my personal experience impacts me in my job as a PA. I look for HELLP everywhere all the time. I don't ever discuss my personal experience with any patient during their pregnancy - their pregnancy is about them, not me - but it does reinforce to me how dangerously subtle HELLP symptoms can be and how difficult it can be for mommas to recognize that they're headed to a bad place. I didn't and I'm supposed to be the one who should have recognized it easily and readily.