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RTZ HOPEtober

Shining a light on pregnancy and infant loss

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Angelica, Spreading HOPE for Ezra & Fletcher

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Angelica, Spreading HOPE for Ezra & Fletcher's Story

I am a proud mother to three beautiful children. I was also a nurse in a neonatal ICU when I experienced the loss of two of my sweet babies. I cared for some of the most acutely ill infants in the whole state, and my perception of the world was painted by what I experienced on the unit. There was tragedy, but there were also miracles, and every possible pregnancy complication and outcome was constantly playing in the back of my brain as I anticipated the births of my children. My little girl was born in 2017 via C-section due to a diagnosis of cephalopelvic disproportion.

In November of 2019 we discovered that we were expecting our second baby. I was so excited, but tried to temper my expectations because the anticipatory anxiety was overwhelming and pervasive. Despite my fears, everything was text-book as we hurdled headlong into the reality of the world-wide COVID-19 pandemic. My home and work environments changed dramatically, and I was still working three 12-hour shifts every week. In mid-May I went into urgent care, concerned about COVID-19 symptoms, including shortness of breath. It led me on a wild goose chase, involving a work-up for a suspected pulmonary embolism (PE). Fortunately, in the end I was negative for both COVID-19 and a PE, and I was sent to labor and delivery for a non-stress test. It was also uneventful, but I was asked to come in the following morning for a second non-stress test. It, too, was perfectly within normal limits. Two days later, I followed up with my OB. He checked the baby’s heart rate and sent me on my way until our next regular appointment. That day was the very last time I heard my son’s heartbeat.

On May 31st I headed in to work for my third shift in a row at about 6:15 AM. I was tired and felt a little “off” but couldn’t pinpoint exactly why and shrugged it off. I felt my little boy moving that morning as I got ready for work, and periodically throughout the day. My assignment was really busy, though, and I didn’t get lunch until close to 3:30PM. The last time I can recall feeling movement was between 2:30 and 3 PM. That night, I didn’t head home until close to 9 PM. As I charted following report, I drank cold water. It didn’t prompt any movement, which I thought somewhat odd, but I proceeded home, anyway. During my drive home, I still didn’t feel any movement. My daughter was asleep when I arrived home, and I sat down to dinner with my husband. We talked about our days, I mentioned that it was the 12th anniversary of my maternal grandmother’s death, which felt strangely significant to me at the time, and the conversation went from there.

At this point, I still hadn’t noticed any significant movement, which was strange because my little guy was very strong and moved a lot more than my daughter did in-utero. I figured it was all in my head, took a shower, and got ready for bed. I didn’t have work the following morning, so I stayed up late to do a two-hour kick count. I used an ice pack to see if I could elicit any movement at all. As I counted, I also used my stethoscope to try finding my baby’s heartbeat. I was unsuccessful, and, 23 minutes into the count, I called labor and delivery to ask if they thought I should come in. For peace of mind, they said I should, so I nervously got dressed and woke my husband to tell him I was headed to the hospital. At this point, I thought my concern was an overreaction, so I told him to stay home with our daughter. He told me to call him if I needed him, and I drove to the hospital by myself. When I got to the hospital, I entered through the ED. They gave me a mask and sent me up to labor and delivery with wishes of good luck.

The whole way over to the hospital, I had analyzed what might be happening, if anything, and told the baby that we’d be okay. As I entered the hospital, I began to feel exceptionally uneasy, though. In labor and delivery triage, my nurse attempted to find the baby’s heartbeat with the Doppler, but couldn’t. She calmly said she’d call the on-call OB to get an ultrasound. I was

getting more and more nervous, but drifted off to sleep for about ten minutes. Everything must be okay if I could sleep, right? I told my little boy that we’d be okay...and then the doctor arrived. He said he’d come as quickly as he could, and that he’d said a few prayers on the way down. He sat down to start the ultrasound, and took a very long time tracing back and forth along my abdomen. I could see the screen at a bit of an angle, and my heart sank when I couldn’t see a heartbeat. Again, I thought it was all in my head, and prepared myself to hear that beautiful, familiar whooshing of my baby’s heartbeat. The doctor looked at me and said, “I just want to be absolutely sure.” I had a death grip on my shirt, bunched up above my belly. Then, the doctor put down the wand, tears began to well up in his eyes, and he said, “I am so sorry.” I instantly began to sob. It was 2:20 AM on Monday, 1 June 2020. I was 33 weeks and 5 days along. My husband sent me a text message asking if I was okay. I called him in tears and asked him to come to the hospital, but I didn’t say why; I couldn’t say it out loud, yet. His dad came to stay at the house with our daughter, and my husband arrived 20 minutes later. That whole time I cried while rocked back and forth, clutching my abdomen and saying “I’m so sorry” over and over again.

The doctor came back in shortly after my husband arrived, and he performed another ultrasound. “I promise I’m not trying to torture you guys,” he said with tears still in his eyes, “but this is the doctor in me wanting to be 100% sure. I couldn’t live with myself otherwise.” He traced across my abdomen again, and put the wand back down. “I’m so, so sorry,” he said. He went on to share that he, too, had lost a baby a decade before. He said that we did nothing wrong, and begged us not to turn the hurt and anger inward, thinking that we somehow caused this to happen. My husband held my hand after the doctor left the room and asked me, “What are we going to call him?” We decided at that moment that his name would be Ezra. He then looked at me, and said, “Well, at least the very worst is over.” Still crying, I looked at him and told him,

“The worst isn’t over. We still have to deliver him.” Our doctor came back in to discuss our options, and we decided to have a C-section as soon as we could be placed on the OR schedule. I had to see my baby’s face...and hold him.

I was wheeled into the OR at about 6:15 AM and saw my hard chart in the corner of the room as I shifted myself onto the operating table. It had a giant butterfly on it. I had been crying nonstop for several hours, but began to sob again. My son was born asleep in a silent OR at 6:42 AM on Monday, June 1st, 2020. He was 4lbs, 15oz, and 19in long – remarkably robust measurements for a baby born at 33 weeks gestation. I knew the moment he was born, despite the fact that he would never cry; I just felt so suddenly...empty. I heard a nurse begin to cry. She said, “He’s beautiful!” My husband left my side to look at our son in the radiant warmer. He turned to me and said that he looked exactly like his big sister, which only elicited more tears. Ezra was swaddled, and my husband brought him over to me. His cheek was so warm against mine that I could’ve been fooled into thinking he was alive. My attending OB came into the OR shortly after Ezra was born. He said he was so sorry, and that we were going to figure out what had happened. Then, my husband left the OR with Ezra to go to the recovery room.

The doctor dropped the drape. He had been crying through the whole surgery. He said it wasn’t a cord accident, based on his initial assessment, and that the placenta looked fine. We sent the placenta to pathology for testing, and every lab value was within normal limits. We elected not to have an autopsy done since Ezra’s physical assessment was also normal. It wasn’t until August of 2021, after a placental slide analysis performed by Dr. Harvey Kliman (Yale School of Medicine), that we discovered Ezra died as a result of several days of cord compression and subsequent anoxia.

My husband was holding Ezra as I was wheeled into the recovery room. He said that he’d heard another baby being born as he walked into our room a little earlier. I began to cry again, and my husband said that it was okay. He was just so happy that everything had worked out for them...that their baby was okay. We got to hold Ezra for almost nine hours, and the hospital graciously allowed all four of our parents, my brother, and my future sister-in-law to meet him...and say goodbye. Nick briefly asked me if we should try to get our daughter in to see Ezra, too, but I shook my head. There was no way they’d let a minor into the hospital unless they needed to be there. They definitely weren’t going to allow a wildly energetic two-year-old into my hospital room. It breaks my heart that she never got to meet him, and that we will never have a family photo in which every member is present.

I felt peaceful for the very first time that morning while holding our baby. I didn’t want to let him go, and I didn’t want to fall asleep. My husband said that he’d been born with a full head of dark hair, but it hadn’t been washed. When I fluffed some of it up between my fingers, I was surprised to see that it was dark blonde. Just like his sister and papa. I’m Hispanic. Don’t ask me where those genes come from, because I am just as baffled. Ezra also had long feet. His second toe was longer than his big toe, just like my husband’s. My husband said that he thinks Ezra had my nose (poor kid), and an upper lip in the shape of Cupid’s bow. I will never know what color his eyes were, but I dream about it all the time. His skin was so fragile that it eventually began to shear. My husband and I knew it didn’t hurt him, but we felt wrong keeping him for much longer. We sang to him, told him about his sister, said how much we love him over and over, and gently traced the lines of his face with our fingers so we would never forget how beautiful he is. Our nurses were amazingly kind, and promised that he’d never be unswaddled or left alone while he was in their care. Letting him go was the most painful, difficult part of the whole experience

for me. That pain will forever be ingrained in my memory.

When I was discharged, I was wheeled down familiar hallways – hallways I now avoid at all costs while walking into work. I was given a weighted bear after Ezra was taken from our room. The blanket in which he was swaddled, the bear, and a paper memory box sat in my lap. I saw people I work with on my way out of the building, and they all looked at me with tears in their eyes. Some gave me hugs, despite the strong recommendation of six feet social distancing. I got so many hugs in the days after my son’s death. More than in the previous three months, combined.

Every loss mother wonders what happened, and if their child’s death could be their fault. I have analyzed my whole pregnancy, and the days leading up to Ezra’s death, from every possible angle. I’ve blamed my anxiety and stress, poor observation skills, and self-doubt. I’ve hung my head in shame for not knowing something was wrong so much sooner. Because, not only am I Ezra’s mother. I am a nurse. I am a nurse in a neonatal ICU. It is literally my job to keep babies alive, and I couldn’t fulfill that most basic of tasks for my son. I am told that there was nothing more I could have done in a seemingly impossible situation. I am told that this was not my fault. And I am working, but mostly failing, every day to convince myself of that. 20 months after Ezra’s death, on Tuesday, 15 February 2022, we lost his little brother, Fletcher Atlas Kovach, to a missed miscarriage at 14 weeks and 4 days gestation. His death has made the work of forgiveness that much more difficult. It is so easy for me to look at other bereaved parents and tell them to give themselves grace, but telling that to the person in the mirror feels like a herculean feat.

I will forever be grateful for, and absolutely never take for granted, my sweet babies.

Despite the occasional discomfort, and this incredibly profound heartache, pregnancy and motherhood are the most magical things I have ever experienced. And my children will always be, by far, my greatest achievements in my lifetime.

In addition to being a bereaved parent, I am also a registered nurse. When Ezra died, I was working in a neonatal ICU. I have cared for babies who did not survive, and, as a provider and a parent, it always hurt. But I never could fully understand the magnitude of the grief and pain one could feel until my own babies died.

RTZ Hope has been an important resource for me both before and after my sons’ deaths. I actually watched the movie when I was about 35 weeks pregnant with my daughter. I knew what stillbirth was before Ezra died, and I knew it was a possibility for me. Having that knowledge — having seen the movie and read through the free documents on the webpage — validates my experience.

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