The following was written in 2012, when Prince William and Catherine, Duchess of Cambridge, announced they were expecting their first child. Over the weekend, the couple announced they’re expecting a third baby. As with George and Charlotte, Kate Middleton is reportedly suffering from a debilitating pregnancy complication called hyperemesis gravidarum.
“Only a royal would go to the hospital for morning sickness.”
I saw that comment and other jokes about the former Kate Middleton’s hospitalization last week for extreme nausea and vomiting in the earliest days of her pregnancy.
“Hyperemesis gravidarum” was just fancy talk for morning sickness. Or a “Harry Potter” spell. That if the Duchess of Cambridge couldn’t handle a little first-trimester puking, however would the delicate flower get through the birth?
The Internet is where we go to unload flip, uneducated first reactions to pretty much everything. I get that.
And “HG” isn’t exactly a high-profile disease. There are no consciousness-raising walks. Even if anyone who had it felt like walking, who could afford that many Porta-Pottis? And there are no ribbons that I am aware of.
Still, I shook a little. I whispered, “Oh, dear,” to no one in particular. And I remembered my own long months of desperate isolation, taking the illness not day by day but hour by hour. Minute by minute. Clock tick by clock tick.
I am not the first person to have a difficult pregnancy or a debilitating, long-term illness. They come in so many forms. But hyperemesis gravidarum was the battle of my life. It was my Mount Everest. And it was no more “just morning sickness” than the sniffles are pneumonia.
Nausea ad nauseam
After years of trying for a baby and six months after a devastating miscarriage, I was six weeks pregnant when the vomiting began, suddenly, violently. I called in sick and threw up probably 10 times that first day and up to 15 times a day in the week after.
My doctor treated me with Phenergan and other antiemetics, and I had my husband, Charlie, bring me ginger ale, ginger snaps, Ginger Rogers, whatever, in the hopes that the herb would calm my nausea. I consulted the Internet. I tried protein and soda crackers. I chewed ice chips.
I could keep nothing down. I lost 5 pounds that week and would lose at least 15 more in the four weeks after.
The nausea relented only when I slept. I understand I was lucky that way. Many vomit through the night.
My skin was gray. My lips were pale and peeling. If I bit into the top of my lip, I could feel the ridges of my teeth through the other side. The nausea fed the dehydration, which fed back into the nausea and birthed its bastard children, headache and constipation (about which no force shall make me say more).
My doctor ordered me to the ER for IV fluids. It would be the first of many IV treatments, some at the hospital and others at home. I watched my dehydrated veins collapse one after another as a nurse searched for one strong enough to take a needle. I barely escaped having a PICC line — a catheter to deliver food and nutrients — installed in my neck.
My doctor prescribed subcutaneous treatment with Zofran, a drug commonly used to treat nausea in chemotherapy patients. I was lucky again. My insurance covered the cost of the service — several hundred dollars a day — and I was outfitted with a pump to deliver continuous drips of the medicine into a tube inserted into my thigh. I had another machine just like it for another, unrelated disorder. It plugged into my stomach. I was now a cyborg.
My husband changed the infusion sites every other day or so, sometimes more frequently, and my thighs and belly became Risk maps of purple to faded green. Every morning I peed on a test strip to measure my ketones, a marker for dehydration. I had frequent blood tests, at least once a week (but usually more).
The Zofran slowed the vomiting, allowing me to keep something down, but it didn’t erase the nausea. I stopped losing weight. Well, so fast.
Eight weeks. Nine. Ten. Eleven. Twelve. Thirteen. Fourteen. Fifteen. Circled in neon red on my mental calendar was the 16-week point. It’s there that many women with HG begin to feel better. But on the morning of “V-HG Day,” I awoke to the familiar sensation of nausea settling over me, rather than to Care Bears and unicorns holding banners and throwing confetti, as I’d hoped.
Sixteen weeks. Seventeen. Eighteen. Nineteen.
It’s a blur, but somehow I managed to hold down my job (my husband drove me each way and my co-workers probably silently fixed everything I messed up). I rarely talked to anyone; it took too much energy to concentrate on not being sick. Every bite I took was a force of will. I cried dry tears when no one was around.
Like the myth about Eskimos having many words for snow, I had a robust vocabulary for vomiting: hurl, yack, hork, ralph, urp, gag, etc., etc., each describing a subtle variation on the act. I was a pukologist. I had Terminator vision, mapping out the location of every bathroom and trash can in a 1-mile radius. Complex geometries constantly calculated the time it would take to reach each one. I carried plastic bags in my purse and car.
The sickness had one silver lining, however: A pregnancy afflicted with HG is generally a strong one. And as long as I was feeling ill, I knew my baby was well. I clung to that thought as if it were the last swag bag at the Oscars.
Light at end of tunnel
Around the 20-week mark, the vomiting became infrequent. I sent the pump back to the medical-supply company. But I never felt well. Food tasted off, and I had no appetite. My doctor practically threatened to install a PICC line and pour melted ice cream into it.
I gained weight. And in my eighth month, by some miracle of forbearance, I didn’t throat-punch the person who asked me if I’d tried soda crackers.
My husband, knowing I couldn’t tolerate the smell of cooking food, had eaten nothing but cold sandwiches over the sink for nearly a year. Even so, I complained that I could smell the mayonnaise from my spot on the couch. He was quick to agree when I told him that Mother’s Day better be freaking Christmas for the rest of my life.
Finally, the light at the end of the tunnel, once a pinprick, was the size of a barn.
The doctor induced my labor at 36/37 weeks. But after 32 hours, my labor was going nowhere. Of course, that’s when I threw up (a hork with hints of urp) and instantly went from 1-centimeter dilation to 10 and complete. My daughter, Anya, was born a few hours later, healthy and perfect at 6 pounds, 5 ounces.
The morning of my induction, I weighed exactly 1 pound more than I did on the day of my first prenatal appointment.
One case of hyperemesis gravidarum doesn’t guarantee that all successive pregnancies will be ralphtastic, so my husband and I tried again. Unfortunately, my second pregnancy was nearly a carbon copy of the first, with a few exceptions: I got on the meds sooner and stayed hydrated better; my employers let me telecommute full time; and I gained a whopping 7 pounds before my son, Asher, arrived weighing 6 pounds, 6 ounces.
Also: My daughter said her first sentence: “Mommy’s sick.”
At some point, I estimated about 60 weeks of illness (28 of them gin-hangover bad — or so I’m told), more than 1,200 needle sticks, 40-60 blood draws, at least 1,800 ketone strips, 30 office appointments, 25 hours waiting for office appointments, and six or seven trips to the hospital. Not counting delivery.
When I look at my kids, I see what a bargain I got. But as much as I would like otherwise, there will not be a third child. I am content and count my blessings.
No doubt the Duchess of Cambridge will have the best support possible — doctors, nutritionists, 24/7 on-site nurses, perhaps even alternative practitioners like hypnotherapists and acupuncturists on call, and IVs of Ringer’s lactate with her morning toast.
I hope hers is the kind of HG that ends quickly. I hope she rises from her sickbed to have the kind of stylish, active pregnancy that used to mock me from the covers of magazines in my OB/GYN’s waiting room.
If not, if she is wrapped in the morass of intractable nausea throughout the pregnancy, if she’s vomiting even in the royal birthing chamber, a silent sisterhood stands watch.
And we won’t let anyone call it “just morning sickness.”
Update: I am now participating in a study to find a cause and, hopefully, a cure for hyperemesis. Perhaps my experience and the hard work of dedicated researchers can save someone else from suffering. I never had a third child. Major props to Kate for giving it a third go.