Before the day was over, Meredith and her unborn child would teeter between life and death, their fates in the hands of care teams coordinating between Texas Health Presbyterian Hospital Plano and Texas Health Presbyterian Hospital Dallas.
Early signs of trouble
The numbness in her leg alarmed Meredith, a vice president at the American Heart Association in Dallas. She told her husband, Kyle O’Neal, that she needed to go to the hospital. They grabbed her go bag and headed for Texas Health Plano.
Labor and Delivery charge nurse Susan Neal was having a typical busy morning when the O’Neals walked through the doors that day. She pulled a nurse from another patient to get Meredith admitted, thinking she was having contractions because, at that point, Meredith’s back hurt.
A little later, Neal looked up at the fetal monitors at the nurses’ station and noticed Meredith’s baby didn’t seem to be registering properly on the monitor. Though she had already assigned another nurse to look after the O’Neals, she decided to go in and check. To this day, she isn’t sure what made her head for the room, but the decision was one of many that saved two lives as the day played out.
Signs from the past
When Neal got to the room, she immediately knew something was very wrong, something that wasn’t pregnancy-related. Then Meredith mentioned her family history.
Five family members in four generations had suffered aortic dissections, a dire condition in which the inner layer of the aorta tears apart. The aorta is the largest artery in the body; it runs from the heart down to the abdomen, supplying oxygen-rich blood to organs throughout the body. The middle and inner layers of the artery separate. If blood ruptures through the aorta, massive internal bleeding takes place. Patients usually don’t make it. Time is everything.
Both her grandfather and great-grandfather died from aortic dissections. Her mother and a great aunt survived, but her great aunt later died from complications and, Meredith said, her mother “was never the same.”
Neal quickly alerted Meredith’s OB-GYN, Dr. Christina Woods, who is on the medical staff at Texas Health Plano. She told her Meredith’s condition was worsening and mentioned the family history, which Woods knew about. They conferred by phone and quickly sent Meredith down to the Emergency Department for a CT scan.
“I think all of us knew the answer to what was going on before the scan,” Woods said later. Sure enough, it confirmed the worst: Meredith, in addition to her pregnancy, was suffering a massive aortic dissection.
“I was terrified,” Meredith said. “I was terrified for my baby. I was terrified for me.”
“I was terrified,” Meredith said. “I was terrified for my baby. I was terrified for me.”
Though she and Kyle knew that with her family history a dissection was a possibility, they never imagined that it would happen while she was pregnant.
‘Mommies Don’t Die’
Everything moved quickly after that. Doctors conferred and decided she should be taken by CareFlite helicopter to Texas Health Dallas, where cardiothoracic surgeon Mark Pool, M.D., was alerted, as was an OB-GYN team. They would perform a Caesarean section to save Meredith’s baby before Pool began his work to save her.
Woods and Texas Health Plano Chaplain Lisa Wraith came to the room.
Woods quickly got to the hard truths: “I had to tell her she had an aortic dissection. I had to ask her what her wishes were if it came down to it. I had to ask do we save her or save the baby.” She also found a way to reassure them: “I told her mommies don’t die.”
Wraith also delivered realities to the young couple: “I said, ‘Have you guys had time together, just the two of you? I would encourage you to say whatever you need to say to each other because we don’t know how this is going to turn out.”
Three months later, Meredith and Kyle still choke up when they talk about that moment.
“It was probably the worst moment of my life,” Meredith said, pausing to exchange a long gaze with Kyle. “We said our goodbyes and the doctors and nurses rushed me to the helicopter.”
Kyle added, “It was the last time we saw each other until she got out of surgery.”
A Flight to Texas Health Dallas
In Dallas, Women and Infants Director Suzanne Murphy had gotten the call earlier from her counterpart at Texas Health Plano, Dawn Nichols. She contacted Labor and Delivery and began to mobilize a team for the C-section delivery. Teams also were mobilizing for the surgery to repair the aortic dissection. Nichols had dropped everything and was driving Kyle to the Dallas hospital.
Murphy was among those who met Meredith as she arrived.
“It was the most heart-wrenching thing,” Murphy said. “Tears were rolling down her face and she was saying ‘Save my baby.’”
Meredith remembers meeting cardiac anesthesiologist Thomas Russell, M.D., who is on the medical staff at Texas Health Dallas, as she arrived. “I said, ‘Am I going to die?’ And he said, ‘We’re going to do everything we can to make sure you don’t.’”
Russell also recalls that conversation. “She had been told up north that she has a dissected aorta and she knows from her family history that previous relatives had surgery and previous relatives died. She had been told up there that she had an 80 percent chance of losing her baby and a 50 percent chance of dying in surgery — and that the odds are they are going to have to take her uterus, and she’d never be able to have any more babies.”
“Obviously, she was just scared to death,” he said. “I asked her if her baby was a boy or a girl, and she told me they had named him Geoffrey. I told her that both she and Geoffrey were going to be just fine, and that we would let her husband know that.”
Not on Our Watch
Russell said the resolve of the clinicians who began to assemble in the OR, a number that quickly grew to more than a dozen, never wavered. Their focus only intensified once they checked for the baby’s heartbeat.
“After she arrived in the OR and we heard the baby's heart tones, the entire team, and myself in particular, took the position that neither mother nor baby was going to be lost on our watch,” he said. “This is a very unusual combination of surgeries. I had never seen this in over 40 years of experience as a cardiac anesthesiologist.”
Russell said Meredith’s aortic dissection extended from her aortic valve to her leg arteries. Pool said about half of patients die in two days if no surgery is performed and ultimately 95 percent die without any surgery, according to surgical literature. In an emergency operation, he said, about 30 percent of patients will not survive.
After she was alerted that Meredith was on her way, Jennifer Muller, M.D., the obstetrician on call, who is on the medical staff at Texas Health Dallas, ran to the operating room with her staff, where she scrubbed and was ready in 16 minutes.
It was going to be a complex C-section, Muller said, for many reasons. For one, Meredith would have to be given heparin, a blood thinner, immediately after the baby was delivered to prepare for the aortic dissection surgery.
“I’m making an incision in her uterus and that bleeds about half a liter a minute,” she said, adding that the pregnant human body only has approximately six liters of blood total. Therefore, good technique to prevent bleeding during and after the C-section was crucial, but she also had to be fast — every minute counts with an aortic dissection. Another factor that forced a speedy delivery: Meredith was under anesthesia, which could affect the baby if he stayed in utero too long.
As the teams prepared, Kyle was taken to a conference room near the OR, where he would learn of developments during the surgeries.
“They got me some food and brought family back there. They were unbelievably accommodating. It was super comforting to have that but also like ‘Well, this is not good,’” he said.
The Delivery
Geoffrey O’Neal came into the world fast.
“We had him delivered in 10 minutes,” Muller said. Normally, she said, a C-section takes 30 minutes to an hour.
Russell, who performed anesthesia for both surgeries, said, “The Lord took a hand to her. There was an incredible amount of teamwork going on. The OB-GYNs did a tremendous job getting the baby out in a hurry and closing the uterus.”
The OR next door was taken over by a care team of neonatal specialists, labor and delivery clinicians and nurses, ready for anything Geoffrey needed.
“We had a warmer to do resuscitation, a baby crash cart, everything the NICU team would need, we had set up in the OR next door,” said Kati Bartlett, M.S.N., RNC-OB, manager of Labor and Delivery.
Once Geoffrey arrived, a nurse went to Kyle with the news.
“I went to see him and stayed for about 45 minutes,” Kyle said, while Meredith was still undergoing surgery.
Bartlett said she spent much of her time that day moving back and forth, escorting the family between the baby, who was taken to the NICU in the Perot Center for Women and Infants, and Meredith, who was still in surgery.
“Once they were able to see the baby and saw he was doing well, it helped relieve some stress,” Bartlett said. “But she was still on the OR table and it’s kind of a lengthy surgery. They had to go back and forth from the NICU to worrying about her.”
Muller closed the uterus, but didn’t close the abdominal incision so that Pool and his team could begin to repair the aortic dissection.
‘A True Miracle’
Meredith woke up in the ICU. Though Kyle was the first to see her, she has no memory of seeing him in those first minutes. Nurses and physicians visited over the next few days, including three nurses from the OR who brought her a book for Geoffrey called “I Love You Mommy.”
“I cried my eyes out,” Meredith said.
The ICU isn’t the usual landing place for a new mom, so nurses made an extra effort to help her get settled with Geoffrey. After she moved to a step-down unit, lactation consultants came up to help. Suzanne Murphy paid her a visit.
“For the first time in my life, I witnessed a true miracle,” Murphy said after seeing Meredith and Kyle two days after the surgeries.
Geoffrey went home after a few days and Meredith went home after six.
Recovery from “the day that changed everything,” as Meredith calls it, was up and down and continues to be something of a rollercoaster.
“Coming home was really hard because this was where it happened,” Meredith said. “And I wasn’t connected to any machines here. That first night home was very difficult. There was a lot of panic.”
The couple said she’ll have good days and bad days. Of course, caring for a newborn is not easy, even for someone in perfect health.
Her doctors have told her she won’t be running a marathon — “it wasn’t on my bucket list anyway” — but she will otherwise lead a normal life.
Meredith is progressing in cardiac rehabilitation, but has been hospitalized for scar complications. Mentally, the trauma of that day has taken its toll — she’s seeing a therapist for PTSD and anxiety.
She’ll start work again at the Heart Association next year.
“But,” she said, looking down at Geoffrey three months after the traumatic day, “overall, I’ve been very, very blessed.”
How Old is Your Heart?™ Take our assessment to gauge your risk, and to find out more about Texas Health heart health services near you, visit our Heart and Vascular Services page.