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San Marcos mom's pregnancy becomes fight to survive COVID-19, 3 strokes

Austin American-Statesman - 9/11/2021

On July 10, Jennifer Douglas texted her husband, Nick, that she didn't feel well.

They were counting down the days to Aug. 18, the due date for their first child.

"I just thought it was a head cold," she said. The 24-year-old from San Marcos had a headache, sore throat, cough and fever.

She also noticed that her baby, whom she described as being previously a "jumping jelly bean," wasn't moving around as much.

Douglas couldn't get in to see her obstetrician right away and was told to go to the hospital to check on the baby.

She learned there that she had COVID-19.

In the next seven weeks, Douglas would be in four different hospitals, have an emergency Cesarean section, be put on a ventilator and suffer three strokes.

"This is my miracle baby," Jennifer Douglas said of her son Hudson.

The new mom from San Marcos was told when she was 14 that she wouldn't be able to have children because she had polycystic ovary syndrome.

She worked with a nutritionist to lose weight and get healthier. She didn't smoke; she didn't have diabetes; her blood pressure was good. She walked 4 miles in the morning and 4 miles at night and loved hiking.

She and her husband were thrilled when she became pregnant.

"My pregnancy was incredibly normal," she said, with just a little morning sickness. "My mom and mother-in-law were jealous. It was so easy. ... Sometimes I would forget I was pregnant except for my giant belly."

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When the COVID-19 vaccine became available in March to pregnant women in Texas because of their higher risk of developing severe COVID-19, Douglas didn't feel like there had been enough research on pregnant women and the vaccine, she said. Pregnant women were not included in the initial vaccine trials.

In spring the federal Centers for Disease Control and Prevention followed pregnant women who got vaccinated and did not find higher rates of side effects. In August, the CDC released safety data and recommended that pregnant and postpartum women get vaccinated.

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Douglas said that throughout her pregnancy she was being very careful to avoid contact with anyone with COVID-19 and stayed at home except to go for walks.

As she got further along in her pregnancy and as more pregnant women had been vaccinated, Douglas and her husband made appointments for their first vaccinations.

They were scheduled for June 27, the day his grandfather died.

"It got pushed back in our minds," she said. They didn't make it to their vaccination appointments.

They attended the grandfather's funeral and went to a restaurant afterward. "I left the security of my home," she said.

She thinks she contracted COVID-19 on July 3, the day of the funeral.

Two days into feeling sick, and not feeling the baby move the day before, Douglas ended up in the hospital where she learned she had the virus.

Everything with the baby and her own oxygen level looked OK. She went home.

"I thought it was a simple cold," she said. "I thought I could take care of myself."

She checked in with her doctor two days later. The doctor asked her to breathe as deeply as she could. Her doctor sent her to an Austin hospital, which X-rayed her chest. She was sent to a different hospital with a higher-level maternity ward for more tests. She and the baby were monitored, but they looked OK and were sent home.

On July 19, 10 days into her COVID-19 symptoms, Douglas was getting worse. She had spent the day before in the bathtub trying to get her fever down.

She also had early labor pains.

At 3 a.m., after she had fallen asleep in the tub, her husband took her to the hospital in San Marcos. She was flown by helicopter to St. David's Medical Center in Austin for an emergency C-section.

"I don't remember much," Douglas said, but she remembers thinking she didn't want to do this alone. Her husband also had COVID-19 and couldn't be with her for the C-section.

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Hudson was born at 35 weeks and six days and weighed 6 pounds.

Doctors had to balance Douglas' health and the baby's health when they decided to do the emergency C-section, said Dr. Ryan Peterson, a critical care physician at St. David's Medical Center. They determined Hudson was far enough along in the pregnancy to be safely delivered.

Douglas' oxygen levels were falling.

"We were pretty concerned and worried when she underwent the C-section," Peterson said. She needed to be put on a ventilator because of the COVID-19.

Hudson did well and was healthy at birth except for some jaundice. He tested negative for COVID-19 and was able to go home with Douglas' mother, who also tested negative.

Douglas is not the only pregnant patient with COVID-19 who has been cared for by the ICU team at St. David's. Pregnancy and or having given birth recently add a level of concern, Peterson said, because of all the physiological changes the body has gone through from the pregnancy and from having a surgery. "The body is very stressed," Peterson said.

Being sick enough to be on a ventilator also put her at a higher risk of not surviving and for more complications. COVID-19 is a disease of inflammation, which means it can affect all the vital organs, including the brain, Peterson said.

"I wished I would have gotten the vaccine," Douglas said. "I would have gotten to see my son be born; my husband would have gotten to see my son be born. We would have had that moment of welcoming him into the world."

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Douglas did improve, and on Aug. 2, two weeks after giving birth, she was taken off the ventilator.

But on Aug. 4, doctors and nurses began to notice something was wrong.

She wasn't moving any of her limbs well. She was confused and hallucinating. She just didn't seem like herself. Her personality, which is normally happy and upbeat, was muted.

Dr. Elizabeth Carroll, a neurohospitalist at St. David's Medical Center, saw her and thought: "She has a lot going on. I don't know where we're going to go from here."

They did a lumbar puncture and an MRI. They found that she had a brain bleed and had suffered three strokes. She also had something called central nervous system vasculitis, which is a rare inflammatory condition of the brain that has been found in people with COVID-19.

"I was terrified," Carroll said. "Not only was her vasculitis not something we see, it was the most impressive case of vasculitis we've ever seen. Every single blood vessel had disease in it. Every single one had the ability to be a stroke at any time. It felt constantly anxiety provoking."

Carroll treated her with steroids and looked for signs of improvement. Slowly Douglas returned to the person she is and regained some motor function in her limbs.

"They never gave up on me," Douglas said of the staff. "I wasn't just a patient. I was Jennifer Douglas who hadn't seen her son. I was Jennifer Douglas, the mom who was going to get out of there."

On Aug. 11, when she could put enough weight on her limbs to stand, she was released to St. David's Rehabilitation Hospital.

On Aug. 10, a month after having first felt sick and three weeks after her C-section, Douglas was well enough for a visit from the person she couldn't wait to meet.

"You spend eight months creating life and building this bond, and then you're waking up and he's not there," she said of Hudson.

Hudson rested on her chest over her heart and stopped fussing. He opened his eyes and looked at her. Then she was able to breast-feed her baby, which had been one of her goals.

"It feels like you've lost something and you have that relief of being able to find it," she said of that moment.

Douglas was strong and had a great attitude, her doctors say, but recovery was hard.

COVID-19, the vasculitis and the strokes left Hudson weak. Dr. Robert Lee, the medical director of stroke and neurological recovery at St. David's Rehabilitation Hospital, said that when he first met Douglas, she couldn't even lift an ankle off the bed.

St. David's has a young stroke patient program that focuses on what the patients need to do in their everyday lives.

Physical therapy was about "me being able to be his mom," Douglas said.

She practiced walking around and carrying a pillowcase made to feel like a 12-pound baby. She practiced diaper changes and lifting a baby in and out of a bassinet.

Lee said Douglas' youth helped tremendously in her recovery. An older stroke patient would have taken eight months to get to where she is now, Lee estimates. He said it will take her between three to five months to walk normally around the house. It will take an additional eight months to a year before the cognitive symptoms clear up and she is 99% to where she was before COVID-19, he said.

Doctors in both the ICUs and the rehabilitation centers are seeing a change in who they are now treating. The first and second waves of COVID-19 patients were older. Now, Lee is seeing much younger people like Douglas who need help after being on ventilators and having had strokes or other debilitating COVID-19-caused conditions.

By Aug. 25, Douglas was able to go home. She said she walks like Godzilla, but she's able to feed Hudson, burp him and change him.

She looks forward to each day with Hudson and plans for what books she going to read to him. She loves all his grunting noises and facial expressions.

"This kid just wants to bounce on your lap," she said. "He just wants to be sitting with you."

She and Nick Douglas scheduled their vaccinations for the week after she returned home. She saw that her family members who had been vaccinated didn't get the virus, she said.

"Life shouldn't be taken for granted," she said.

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