Jonah’s Story – In Observation of Pregnancy & Infant Loss Remembrance Day

My husband Kevin and I were married in May 2007. I started PA school the next month and he deployed to Iraq within the next year. We had a very busy 3 years, but after he returned and I graduated I started a job in central TX as a PA in pediatrics. Within the first few months, they needed help in the OB/Gyn clinic as well so I started splitting my time.

In 2010 we found out we were pregnant with our first child. At 32 weeks my water unexpectedly broke. We rushed to the hospital to see my team, and I settled in as a patient rather than the provider. Elijah arrived within a few days and thankfully, he was a healthy and a hefty 4lbs 9 oz at 32 weeks 5 days! He spent 24 days learning to feed and grow in the NICU. I went back to work when he was only 2 weeks old – walking across the parking lot at lunch to see my sweet boy and hold him, pumping, delivering milk tio the NICU, all while seeing patients in the clinic. Helping others helped me heal. Elijah and his NICU team made me a better PA and a better provider for the mothers and babies I’ve cared for since then.

In 2012 we moved to the Dallas/Fort Worth area. After a short time of working in private practice pediatrics, I joined the pre-anesthesia team at Children’s Medical Center Dallas. Six months after that, I joined the Cardiac anesthesia team at Children’s.
In the fall of 2013, Kevin did a double take before realizing the test had two lines, it was positive! A big smile came across his face. Will it be another boy or a girl this time? Will he or she have my nose or Kevin’s? He gave me a big hug and we were in love from that very moment. We told both of our families at Thanksgiving about the newest member of the Duke Family.

Everything was going as expected, first trimester nausea and all. My OB was following baby and I very closely because of my preterm labor history with Elijah. We had a plan to start cervical length checks at 16 weeks since we didn’t have a definitive cause of Elijah’s early arrival. Our checkups were going well, until just past 15 weeks. I woke up with bleeding. I went to see my doctor. They did a full check up, and everything looked fine with our baby. They wanted me to just take it easy with some modified bed rest and follow up at my next appointment in 5 days. Kevin and I were both so relieved. My next check up still showed everything was good with our baby. I still had no pain, and I started feeling the little flutters of our little one’s movements. Every visit, each time we heard that sweet heart beat, we breathed a sigh of relief.

The bleeding worsened, and one morning, at 4 AM, we woke up our 2 1/2 year old, and we headed to the ER. I had a cough, but that was not my concern. I wanted to know that our baby was still okay. Trying to be a patient over provider in these situations is so incredibly hard. After 1 hour in the waiting room, 2 hours seeing other nurses and doctors, getting breathing treatments, IV antibiotics, and steroids, they brought us to ultrasound.

The tech started the scan. I could not see the monitor (which drove me crazy since I know what I’m looking for), and he continued for about 10 minutes and finally said, “and there’s a good heart beat”. Kevin and I both collectively breathed an audible sigh of relief. The baby was still okay. So, once again, I was sent home to wait for our next appointment.

At our next appointment we found out it was a boy! Another boy for Eli to run and play with! We already had his name picked out, Jonah Douglas. I went back a few days later, because this was just not normal. I couldn’t accept that this much bleeding could be okay. I had a wonderful OB who listened to my concerns and called a maternal fetal medicine specialist for me to see that day. She also officially put me on bed rest. At the specialist, he had a huge screen right in front of us for the ultrasound images. As soon as he put the ultrasound probe on my abdomen, I noticed something was wrong, there was a beautiful beating heart, but where did all of the amniotic fluid go? The specialist immediately voiced out loud what I was already screaming in my head. He had two good kidneys and a full bladder, but not a lot of fluid. With my family history of autoimmune disease and the new finding of low amniotic fluid, he decided to send some testing for a few autoimmune diseases that could be causing clotting on the placenta. Jonah was moving all around during that ultrasound. He was precious, and so very full of life. At our next follow up, there was even less amniotic fluid. He also noticed Jonah’s perfectly beating heart had slightly thickened; it was working very hard to pump blood to his developing organs. My blood work was back and inconclusive. The specialist wanted me to start taking aspirin, but he was very clear to us that this was an attempted rescue effort with the aspirin and there were no guarantees. The sweet MFM prayed with us. Kevin and I left the office in tears. We just wanted our Jonah to be alright.

We had a one week follow up appointment scheduled to come back and see if there had been any improvement. We did not make it to that appointment. One day before the appointment, we were in an ambulance on our way to the hospital. I had to answer so many questions, explain everything from the beginning to

the paramedics, and relive the last 4 weeks. It was their job, but it was so painful at that moment. I knew our sweet Jonah was gone.

The nurses were so kind. I labored for about an hour and Jonah was born. It was the most painful experience of my life, both physically and emotionally. Kevin was so gentle and kind to me through it all, encouraging me through labor, even though I could tell he was hurting so much. We had sweet moments holding our perfect son, and he definitely had Kevin’s nose.

I am so grateful for the hospital experience we had in such a terrible time of our lives. My OB was on call (I could not have done this without her) and she told the paramedics and ER to bring me straight to L&D even though we were just a week shy of 20 weeks gestation. She didn’t want me to labor in the ER. She wanted the time and space that L&D would provide. The nurse in our room that night told us she couldn’t understand how we felt, but she could understand Kevin’s mother’s pain as her own grandchild had been stillborn recently. The tech in the OR with me when I had to go for an emergent D&C after we delivered Jonah shared with me that she had just recently lost her own child at 18 weeks just a few short weeks before. She cried with me and held my hand in that OR. I’m grateful to see the beauty during such a terrible time after reflecting back many many times over the years.

We left the hospital that evening, without our Jonah. I remember feeling so raw, so hurt, so abandoned, and so alone.

I had so many hard questions and so many emotions. If that was where our story ended, it would seem pretty hopeless. But that was not the end. It was only the beginning. The rest of our journey can be described in one word…Hope.

I was introduced to a group called Hope Mommies shortly after that. I received a hope box from a friend in Temple, TX who had it delivered by a precious hope mommy who lived near me. I joined a hope group that spring, and that next fall started leading a hope group for other moms. Our Dallas chapter of Hope Mommies was born the following year and we’ve gone from 3-4 of us using our own personal funds or hosting fundraisers to put together hope boxes, to now hope box gatherings to put hundreds of hope boxes together for hospitals and clinics all over North Texas. I also have the joy of continuing to see one of my wonderful L&D nurses every few months to deliver hope boxes to that very hospital we delivered Jonah in. In such a desperate time of grief, when you feel so alone, it’s so important to know there is Hope and you are not alone. That’s what hope mommies showed me.

I remember walking back into work just the day after our memorial service for Jonah, only a week after we delivered him. I wasn’t sure if I wanted to hide in my office all day or if I wanted to go on rounds with the team which I knew would include going to the NICU that day. I knew it would be so hard to see the little ones so close to the age and size Jonah was. However, I knew I needed to be back at work – not just to be “busy” but to be helping. Being a helper is what brought me to the PA profession. I love what I do. I love helping others, and I love helping care for some of the smallest humans. The first person I spotted crossing the skybridge into the hospital was one of the cardiologists I worked closely with at that time. She said no words, she asked no questions, she stopped me and gave me the most precious hug. After a few minutes, and some ruined makeup (why did I even wear any that day?), she said, “I’m so sorry. I’m here, whatever you need. I’m here.” I know she said more than those words that day, but those are the ones I remember so clearly. My team echoed the same sentiment in every interaction I had that day and that week. They are my extended family and they are a big reason why I love being a PA.
We’ve gone on to celebrate the birth of our two daughters in 2015 and 2016 after pregnancies that included cerclage placement early in the pregnancies. I truly believe every experience I’ve had as a patient or the parent of a patient has made me the PA I am today. It’s made me better, and even those painful times have given me the compassion, empathy, and strength to continue to practice medicine today.
– Lindsey Duke, MPAS, PA-C
Our most recent family photo and we include a small white bear, “Jonah bear” that Elijah made at build a bear just after Jonah passed to represent him as a missing piece in our family.

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