Holy Cow, I nearly died

I nearly died of a very bad post partum hemorrhage on Tuesday.  I  am now in Edmonton, in the women's hospital (Louis Blot or something like that), and will try to tell the story as best as I can, but might give more details later, as I am still shell-shocked.

On Monday I remember having a gush of fresh blood on the pad, despite the fact that I had been without bleeding for a couple of days and was just spotting at that time.  I had not had much bleeding after the C section, and in fact remember wearing white pants that day and going to the mall.  While I was at the mall I bled over the white pants, and had to come home, and changed four more pads that day.  Then, at night, another couple of pads. 

The  next day the bleeding had stopped in the morning, and I remember being happy about that because my hemoglobin was 94 when I got out of the hospital and I was worried about losing more blood.  At lunch however, I was on the phone with a water filter company, trying to get a new filter for our ovopur system, and I felt a big gush of fresh bright red blood.  I hang up the phone, grabbed two towels, and bled through both in what looked like one minute.  I was gushing and gushing.  I felt faint, and lied on the floor, with a third towel between my legs.  I called my husband, who initially did not answer, so I called 911.  Both my husband and the ambulance came at the same time.  I was very hypotensive, probably mostly because of all the bleeding making me vasovagal at that point.  I say this because my pulse was low, and usually when one is hypotensive because of volume loss, the pulse goes high in an attempt to compensate. 

Anyway,  I crawled to the door and waited for the ambulance, who took me to the hospital.  Initially nobody realized how bad it was and they thought I had lost about three cups of blood in total.  My hemoglobin was still around 90, but they had not given me any fluids yet, so the number was of course not accurate, since my blood volume was constricted.  In the ER I continued to  bleed, slower but passing clots the size of a fist.  I  had an ultrasound that showed that my uterus was full of clot.  We had no OB GYN town at this point, so one of the GP's that does dilations and curettages agreed to take me to the OR to evacuate the uterus.  I got a general anesthetic, went to the OR, got the uterus evacuated (mainly of clot, there was not much retained product) and got some misoprostol.  When I came out of the OR,  I started shivering and developped a high fever, which now we realize that was from the misoprostol, but at the time it looked like an infection starting to brew in my uterus.  I got antibiotics IV (cefuroxime,  flagyl and gentamycin) and we waited.  I was getting sicker and weaker.  My hemoglobin continued to drop to 65, my uterus filled up with blood again and was the size of a 20 week pregnancy.  I had to go to the operating room again for a second evacuation.  This time, once I got put to sleep, I did not wake up in my home town,  but in Edmonton, at the Royal  Alexandra intensive care unit, intubated.  I remember trying to write on a piece of paper "where am I?" while I still had the breathing tube in.  I also remember feeling very uncomfortable with the tube in, but I was very edematous (swollen) from all  the resuscitation fluid and the multiple transfusions that I got (I received five or six units of red cells and two units of plasma in total, and would have needed several units of platelets too but my little hospital doesn't have platelets, so my coagulation system was a bit out of whack).  Later, they extubated me, and told me what happened (part of the story I got from MrH  who drove halfway to Edmonton and then flew the other halfway when he  realized that he was a danger on the road from tiredness and stress). 

So apparently they took me to the OR a second time and evacuated 1.5 liters of blood from the uterus, but the uterus would not contract at all and kept on bleeding profusely.  The first GP called another GP in to help, and together they put manual pressure on the uterus for two hours, but it would still not stop bleeding.  They were transfusing me and giving me fluids and the blood pressure would still not come up,  as I kept on bleeding.  At one point, they asked MrH if it would be ok if they did a hysterectomy.  This was a last resort, both because I would lose the uterus, and because neither of the two GP s had done a hysterectomy in a million years.  They both have the ability to do c sections, but a hysterectomy on a large boggy  bleeding uterus is a difficult procedure, so I can only imagine how desperate they must have been that I was dying to prepare for the hysterctomy.  In the meantime, they were also trying to organize transfer for me to a place that had platelets, and an obs-gyn, and preferably the ability to do a uterine artery embolization instead of separating me from my temperamental uterus.   Edmonton accepted me, and they transferred me intubated, with the transfer team holding pressure on my uterus the entire time.  By the  time I got to Edmonton, I had stopped bleeding, and they put me in ICU and eventually extubated me when the edema got less. 

I woke up in this gorgeous hospital, with no possessions or clothes or shoes, and a face that was so swollen that I did not recognize myself.  My eyelashes were shorter than the thickness of my eyelids.  I have not bled since, and gradually my face became more like my own.  When the attending physician saw me this morning, she nearly did not recognized me, that's how much I had changed.  I miss Emma and arranged for my mom to bring her today, as I did not know how long I would be in here.  But it looks like I might be  discharged tomorrow.  I will stick around in Edmonton for the weekend, just in case,  but they think that I will not rebleed.  The ob gyn thinks I have a rare condition called subinvolution of the placental site, where the placental site does not contract properly.  When asked her how rare, she said that she sees  about one every couple of  years at this large referral centre.  Once again, I am left wondering why all these rare things are happening to me.  But we'll dissect the philosophical details later, for now I just want to get better and am glad that I am alive, as I came very close to dying this time.