unsolved problem, experienced centers now report the survival of both twins in more than 70 percent of TTTS pregnancies.
In her book, Crystal tells the story of the highs and lows in her desire to have a successful pregnancy. She shares with the reader the sorrow of pregnancy loss and the elation of discovering that she had spontaneously conceived identical twins. Her joy is short-lived when she is diagnosed with TTTS. The reader is then taken down a journey of treatment, complications and the need for a prolonged stay in the hospital before she delivers her premature twin girls. The author‘s narrative is told in a unique first person perspective that allows the reader to look in on the emotions of separation from Crystal‘s husband and her first born daughter while she is hospitalized before delivery. Unique bonds are developed with the nursing staff, her obstetrician, and her sonographer. Crystal also shares the anxiety of separation from her newborn girls as they mature in the neonatal intensive care unit. The book concludes with a return to elation as the new family of five is finally reunited at home.
Medicine is a unique profession. A patient like Crystal meets you in the worst of circumstances, yet she is willing to place complete trust in your knowledge and skills to care for her unborn children. There can be no greater privilege than this. Since I learned to perform laser treatment fifteen years ago, I have undertaken over 700 procedures. Each case is unique. There have been many successes such as Crystal‘s pregnancy. And yet, there have been frustrating losses even when the procedure goes well from a technical point of view.
To be asked to author the introduction to this book is a unique honor. It truly tells the story of a patient‘s trials and tribulations with TTTS. The book is a must read for any patient diagnosed with TTTS. It will provide hope that all is not lost in their pregnancy.
Kenneth J Moise Jr, MD (a.k.a. Dr. Miller)
Professor of Obstetrics, Gynecology and Reproductive Medicine
McGovern School of Medicine – UT Health
Co-Director, The Fetal Center
Children’s Memorial Hermann Hospital
Houston, Texas
Chapter 1
The Ultrasound
Certificates and degrees crowded the wall above a large wooden desk full of patient charts and scattered papers. The perinatologist seemed well-accredited, but not particularly neat. A trickle of natural light illuminated the mostly darkened room, let in by a folded-back corner of the blackout curtains over the room‘s sole window. The doctor specialized in high-risk pregnancies, and the ultrasound he was about to give me could forever change the course of mine. Or, it could be just another routine scan and all would be the same as it was before.
My mom, dad, and two-year-old daughter, Abby, were in the exam room with me. They were seated on a black upholstered couch angled in such a way that they could view the large ultrasound screen on the opposite wall. My dad‘s sneakers tapped on the linoleum floor. Abby lay on her stomach, her elbows pressed up against my mom. She kicked her legs gently back and forth. She giggled as she held up the screen to her iPad while she watched Curious George.
There was a brisk knock on the door and a nurse, a petite brunette in her mid-twenties, entered. She asked me to lie back on the exam table. The paper crinkled loudly beneath me as I struggled to find a comfortable position—a nearly impossible task for a twenty-three week pregnant woman with twins. A few days before, the everyday discomfort of gestating two babies had taken a sharp, dangerous turn. I was suddenly in agony, an intense pain that I had not been able to fully articulate to Dr. Cooper, my OB. Painful spasms were shooting down my spinal cord, and I’d started to feel a continuous sensation of a hard, tightened abdomen. I was suddenly expanding rapidly—and it wasn’t just in my mind. I recalled the previous week‘s conversation with Dr. Cooper during a routine visit; as I stood on his scale, it showed me I’d gained eight pounds in a mere week. “Are you kidding me?” I said to him. “How is this possible?” I felt like Violet, the rude girl in Charlie in the Chocolate Factory who inflates hugely after she chews the forbidden Wonka gum—like I would burst at any moment.
The nurse wrapped the cuff around my arm and took my blood pressure, scribbled the numbers in my chart. “This might be a little cold,” she said as she pulled up my blouse. She grabbed a small white tube of ultrasound gel and began to rub it all over my belly. Her touch was soothing. It reminded me how I missed having massages at the spa. After I have the babies, I’ll have to book myself an appointment, I thought.
My massage was interrupted by a knock on the door. I sat up instinctively, dripping some of the gel onto the top of my shorts. “All right, Crystal,” said the perinatologist, as he walked into the exam room. A soft-spoken man with warm brown eyes, salt and pepper hair, and a red polka dot bow tie under his starched white lab coat; he bore a strong resemblance to Bill Nye the Science Guy. “Let‘s have a look at these babies,” he said.
I nodded my head fiercely and leaned slowly back on the examining table. “Okay,” I croaked as I adjusted my shorts. My heart was pounding so fast I wondered if anyone could hear it. No doubt my babies could as they were kicking up a storm, probably telling me to chill out.
Dr. Bill Nye sat down on his medical stool, grabbed the wand and began sliding it across my belly. He scanned silently for a few seconds. Then he leaned in close to the monitor and glided the wand back to the other side. He bit his bottom lip, steadied his shoulders and looked directly at me. Then, without preface, conveyed the devastating information.
“Mrs. Duffy, as I suspected, you have Twin to Twin disease. There is a lot of fluid here. There is also a clear size difference—it appears that one of the babies has stopped growing.” He scanned the instrument around my belly more fiercely, his eyes never leaving the screen.
I stared at the screen. I saw two little teddy grahams floating around the excess amniotic fluid. My heart thudded painfully, and my face felt hot. I closed my eyes to prevent the salty, fresh tears from streaming. I didn’t know what the heck all of his words meant. My brain was on overload. The only information I could really process was the fact that one baby had stopped growing, and they were both in grave danger.
The pregnancy had started in a normal enough way. My husband Ed and I were both ecstatic that our family would be growing. The day after we found out we were having girls, we painted the spare bedroom a pale pink and purchased two matching cribs. Two years prior, we had been blessed as parents for the first time, and I’d been given the greatest title of all: mother to our daughter Abigail. But, though the positive pregnancy test made me feel like I was on cloud nine, my anticipatory excitement and happiness was tinged with fear. We’d suffered the traumatic and abrupt end to two previous pregnancies we thought had been healthy—one before Abigail and one after—and they had left us heartbroken. With our joy came unanswerable questions: What if something goes wrong? What if this pregnancy results in another miscarriage? What if the problem is me?
When I hit the seven weeks pregnant mark a couple of weeks later, the fear had finally started to dissipate. And then, abruptly, I started bleeding heavily, soaking through my clothes and onto the furniture. It was déjà vu; I’d done this all before. I thought I was having yet another miscarriage. Ed drove me to the ER and we waited what felt like hours to see a resident who of course couldn’t tell us anything—until the Obstetrics attending arrived.
