This afternoon I printed, addressed, sealed, and mailed a letter that I have wanted to write for nearly 3 years now.
Dr. Daniel Rzepka of University Hospitals,
In
the parallel of a life that should be mine but is not, there is a preschool
class I would be making cupcakes for next week. They would be to celebrate my
daughter, Peyton’s, 3rd birthday. It has taken me all of these 3
years to sit down and gather my emotions to write you this letter. To admit the
fact that you neglected my concerns, my health, and my daughter’s life.
Just
over 3 years ago, early in my 3rd trimester of pregnancy, I saw you
for a regular visit. You asked me if I had any questions or concerns since the
last time I saw you and I told you I did. I told you that I was experiencing an
extreme itch on the palms of my hands and soles of my feet, but there was no
rash. I told you how miserable I felt. You insisted that everything was fine,
that it was just pregnancy hormones and so you prescribed me Benadryl.
Nevertheless, the itching continued, only getting worse. The itching got so
intense that I was scratching my skin open. With no idea of where to turn, I
turned to the internet. I found stories of women with symptoms identical to
mine that suffered from Intrahepatic Cholestasis of Pregnancy (ICP). I spent
hours on www.icpcare.org reading
everything I could on ICP. I called your office as soon as I felt that I truly
did have a problem. When I spoke to you, I requested a fractioned bile acid
test and a liver function test. You insisted that I did not need these tests,
but I did not take no for an answer this time. You told me you put the order in
and that I could go to the nearest lab to have the blood work done. A few days
later, I saw you for a regular scheduled office visit at 35 weeks gestation.
The results from the blood work were back. You told me that although my LFT’s
were elevated there was no cause for concern since I had an otherwise healthy
pregnancy. I later learned you did not order the fractioned bile acid test. I
began to cry to you as I questioned the risk of fetal distress and stillbirth.
I told you that I knew this was not right… I begged you to do something. I will
always remember the exact words you stated to me, in your cold and harsh voice,
with a laugh to follow, as I cried, “You have to look at the population as a
whole… you have a greater chance of walking out of my office today and getting
hit by a bus.” You will never truly understand how I wish I were hit by that
bus that day.
I
searched for an obstetrician that would see me for a second opinion so late in
my pregnancy, but I was offered appointments after my due date. With a knot in
my stomach, I remained in your care. I saw you for my last office visit on
Wednesday November 14, 2012. Though the itching was still present, you told me
that Peyton would be making her arrival in the next day or so as I was dilated
and effaced. You were right, mostly.
On
Friday November 16th, I called your office and spoke to a nurse. I
was experiencing back labor and had not felt Peyton move. You quickly called me
from home and instructed me to go to Hillcrest, and that you would meet me
there. In the parallel, this should have been one of the greatest days of my
life. When I arrived at the hospital, I was taken into triage in Labor and
Delivery immediately and hooked up to fetal monitoring. The nurse could not
find placement. The second nurse could not either. I waited in a room for 45
minutes longer, crying, as I waited for you to arrive, for you to tell me what
I already knew - “There is no heart beat.”
As
you continued talking, almost casually, I pleaded you to tell me if her death
could be related to Cholestasis. You insisted that this was not a result of
Cholestasis because I did not have it. You told me that things like this
happen. That you were sure when Peyton was delivered that there would be a
cause of death, like a cord incident. You did not tell me how immensely sorry
you were or that together we would find the cause of Peyton’s death. In fact,
you never even spoke her name. Instead, you continued on that your “…wife is at
home so upset and crying…” Next thing I knew you were discussing my delivery. Then,
you were gone.
I
suffered an excruciating labor and delivery. On November 17th at
8:53p.m Dr. Snelson assisted me in delivering Peyton. She was 6lbs 15ozs and 20
inches long. Her lips were ruby red, and her head was full of soft dark brown
hair. Peyton was perfect in every single way, but her heart was not beating.
I
want you to know that I needed you. You were my doctor. Moreover, you walked
away from me. We never spoke again. However, your actions dangled over my life for
months to follow.
Peyton
was born deceased on November 17, 2012. The paper work for her death
certificate was submitted by my husband and I, and Maryann, from the funeral
home, immediately. You and Dr. Snelson, however, did not submit your portion of
the paper work for the death certificate. Maryann would call me weekly to see
if I had heard anything from your office concerning the death certificate. I
left message after message for you, but never received a phone call back. Maryann
also attempted to contact your office several times. After thirteen long weeks,
I called your office to inform you that if I did not receive the death
certificate in a timely matter (the funeral home told us that death
certificates usually take a week to fill out and file, and families usually
receive the certificate at the funeral) that I would seek legal counsel. The
receptionist I spoke with for the umpteenth time informed me that I would hear
from someone by the end of the day. No one returned my phone call that day, or
even the next day. I waited another three days and called back, stating the
same thing. Still, no one returned my phone call.
I
decided that it would be best to get into contact with the President of
Hillcrest Hospital vs. someone at University Hospitals because we had a
wonderful experience with Hillcrest and we delivered at their facility. They
also conducted Peyton's autopsy and other examinations at the Cleveland Clinic
Main Campus. When I called Hillcrest's information desk I asked to be directly
transferred to the President's voicemail. I left a very nice but firm message,
and within an hour I received a call back. He personally told me that he was
going to transfer me over to someone who would be able to walk through the rest
of this process with me, but if that I did not have the certificate in my hands
by Monday to call him back.
The
woman I spoke to was in contact with Maryann and your office that day. The
death certificate was filed on Wednesday February 27, 2013. Maryann called us
that Friday and informed us we could pick the certificate up from the funeral
home in the morning. On Saturday March 2, 2013, after fifteen long weeks, the
death certificate was in my hands.
Additionally,
I fought to receive the autopsy…. an autopsy that you did not sit down with me
to discuss. I however did find a wonderful Maternal Fetal Medicine Specialist
who explained Peyton’s autopsy to me. Peyton had a subgaleal brain hemorrhage
and thrombosis of the umbilical vein and proximal umbilical cord. However, the
gross and microscopic findings suggest "subacute abruptio placentae"
which led to meconium release and increased circulating nucleated red blood
cells to be "at least" a contributing cause of Peyton's death. Peyton
had several blood clots in the umbilical cord and the maternal section of the
placenta. Blood was built up behind the placenta. The placenta also had a
concealed abruption, which probably happened over the course of a few days to a
week.
After
undergoing genetic testing, my husband and I became pregnant again. The
Maternal Fetal Medicine Specialist that discussed Peyton’s autopsy with me saw
me exclusively through my subsequent pregnancy. She treated me for Cholestasis
of Pregnancy beginning in my 2nd trimester of pregnancy. In my 34th
week of pregnancy, she suspected a placental abruption and induced me
immediately. My son, Matty, turned 2 last month. He is a happy and healthy
toddler.
I
want you to know that you could have been proactive. You could have listened,
really listened to my concerns. You could have treated me as if you would wish
someone treated your wife and your children. However, you did not. I want you
to understand exactly what happened the day I was not hit by that bus.
Your
actions, or lack thereof, have left a deep impact on my life. I did not just
lose my baby. I lost a toddler, a preschooler, a ballet dancer… a little girl
and a young woman I will never know. In the parallel, there is an entire lifetime
of memories that should have been mine, should have been Peyton’s, but are not.
I
held onto a lot of anger, resentment, sadness, and pain towards you for a long
time, and maybe I still do. However, I do want you to know that although your
actions have completely broken my heart and my spirit, I have been able to
positively grieve the immense loss that is my daughter because of the people
who did not walk away. Now I Lay Me Down to Sleep, an organization that
provides infant remembrance photography to parents experiencing the loss of their
infant gifted us photographs of Peyton. We held a fundraiser in April of 2013
to give back to Now I Lay Me Down to Sleep. We are also actively involved in
the infant loss community and bringing awareness to Intrahepatic Cholestasis of
Pregnancy.
I forgive you.
