In April 2016, Ruth was 28 weeks pregnant and experiencing the ‘normal’ effects of pregnancy, feeling nauseous, exhaustion and breathlessness, in addition to a constant cough and trouble sleeping. All of these symptoms were put down to potential pregnancy anaemia, age and general working life.
With her cough persistently getting worse, Ruth went to her GP who arranged an ECG and blood tests, including a review of her B-type natriuretic peptide (BNP) – a measurement to help healthcare professionals diagnose heart failure. Whilst waiting for her test results, she confessed to friends at work that she was really struggling and not feeling well; she was sent home. Ruth contacted her midwife, who sent her to the obstetrics unit in Sheffield, where she was put under the care of a consultant.
Following a chest x-ray and an echocardiogram (type of ultrasound scan of the heart and nearby blood vessels), the consultant confirmed Ruth had pneumonia, an enlarged heart and that her baby would have to be delivered imminently. He also diagnosed Ruth with heart failure, which made her feel like she was an aeroplane with a failing engine. Ruth was promptly admitted to the coronary care unit (CCU) in the hospital. Even though Ruth was in the fortunate position of understanding all the tests and the implication of her diagnosis due to her healthcare background, she still found it unbelievably shocking that she had been diagnosed with heart failure.
She had many questions due to her unique scenario (being young and pregnant). She feared that waiting any longer for a cardiology intervention would make her situation even more challenging and had never imagined that at her age she would have to face her own mortality.
The diagnosis came as a shock to all of Ruth’s close family and friends. One of their family friends was a cardiologist and took the time out to explain to Ruth’s family what exactly was happening and what the diagnosis meant – this helped them to better understand the situation. It was important for Ruth’s family to be informed due to the possibility of a familial link – her sister was subsequently diagnosed with heart failure as well.
Discussions then began with the cardiology and obstetrics teams on how to manage both Ruth’s heart failure and the safe delivery of her baby. Ruth was on regular diuretics and cardiac monitoring, but her blood pressure was low and her heart rate was high – it was clear that her baby would have to be delivered soon.
Over the coming days, Ruth began to prepare for the delivery of her baby. She wanted to know the gender of her baby in case she never got to meet them. Ruth kept this information to herself, as she and her husband had previously decided not to find out. She wrote a letter to her family and gave it to her parents for safekeeping. She said her goodbyes to her husband and family before going into theatre for her baby to be delivered.
Ruth’s son, William, was born six weeks and two days prematurely, weighing 5lb 6oz. He initially required some help breathing as well as a feeding tube, but was generally in good health. With Ruth needing specialist cardiac care, she and William were looked after in different hospitals – something the new mum found challenging. Although she couldn’t reach out from her bed to touch, cuddle or feed him, Ruth still felt very fortunate to have made it through the delivery to meet him and in the long run, to be able to care for William.
The COVID-19 pandemic has been a concern for the entire population, but for people living with long term conditions, like Ruth, it has been an even bigger worry. From the moment the virus reached Europe, Ruth understood that she would have to protect herself against it.
Her role as a nurse provided her with an employer who understood her need to shield. She was able to work from home during lockdown and isolate herself from others. Ruth had continued access to medical care from her GP and received her medication without an issue. She also reached out to her healthcare team over the phone as needed. COVID-19 is a constant reminder of her heart failure as she knows she’s needs to be careful and remain vigilant about social distancing outside of her closest family.
Overall, the situation has been worrying for Ruth. Still, due to her remote living location, family support network and supportive employer, she has been able to avoid any significant challenges during COVID-19.