It isn’t always the babies who face risk in complicated pregnancies. One mother says she owes her life to Sunnybrook’s expertise.
Myla Lopez, 41, was 36 weeks pregnant with twin girls when she told her husband, Joel, that she had a headache. She went to bed. Hours later, Myla was making strange noises in her sleep, and her breathing seemed strained. Alarmed, Joel tried to wake her. When she wouldn’t wake up, he called 911, and Myla was rushed by ambulance to a local hospital.
“They did a scan … the doctor told me that there was nothing they could do and she wasn’t going to recover,” says Joel, who had been pacing the waiting room with Myla’s sister and 18-year-old daughter. They had found a blood clot in Myla’s brain. “I was crying my eyes out,” he says.
Just as he was taking in this horrible news, a nurse touched Myla’s arm, and the doctor and Joel both saw her hand flutter. “Wait a minute,” the doctor said, circling around her body, and tapping her knees and elbows to test her reflexes, which were strong. “There’s a chance.”
That “chance” was at Sunnybrook, where neurosurgeon Dr. Leo da Costa
was on call at his home when he was awoken by a 6 a.m. phone call. He received word about a pregnant, unconscious patient with bleeding and swelling in the brain who was about to be taken to Sunnybrook. It was Myla.
Dr. da Costa immediately got into his car and started making calls on his hands-free set. He knew Sunnybrook was the best place for Myla. “I said, ‘She’s not going to find the care she needs anywhere else but here,’” he recalls. One of the few Greater Toronto Area hospitals with both neurosurgical and obstetrical expertise, Sunnybrook is renowned as the go-to hospital for complicated trauma cases, especially those requiring outside-the-box thinking.
By the time Dr. da Costa arrived, Myla had been taken to Sunnybrook where there was an operating room and an anesthesia team in place. In just over half an hour, the 14-member team was ready –
including obstetricians, neurologists, anesthetists and two teams of three for the twins. Their first priority was to try and save Myla, then her baby girls.
Before Myla was wheeled in, Dr. da Costa with obstetrician and gynecologist Dr. Howard Cohen ran through a series of “what ifs” and made a game plan. There were competing factors to weigh. If high blood pressure was causing the clot, it may be better to birth the babies first. But a caesarean section could also cause a sudden drop in blood pressure, and Myla’s blood pressure needed to be high enough to pump new blood and oxygen into her brain. “It was a delicate balance,” says Dr. da Costa. In the end, they decided to start with a craniotomy – which would reduce the pressure in the brain caused by the clot – and immediately move on to the C-section.
Dr. da Costa met Myla’s family in the waiting room. He told Joel there was a significant chance Myla would never wake up, or would survive with permanent brain damage, even paralysis.
To perform the craniotomy, Dr. da Costa temporarily removed a piece of the skull so that the brain could swell out and pressure could be relieved. “The head wasn’t even closed and the belly was being opened,” explains Dr. da Costa. The girls, Jamie, just under six pounds, and Samantha, just under five pounds, were immediately ventilated and rushed to the Neonatal Intensive Care Unit (NICU).
By that time, Myla’s grandmother, friends and cousins had arrived, and they were joking about how Jamie looked so chubby compared to skinny Samantha.
“I was half and half,” says Joel. “I was so happy to hold them, but I still didn’t know what would happen to Myla … we wouldn’t know until she woke up.”
Miraculously, three days later, Myla’s left eye opened (her right was still swollen shut from surgery). “It was like nothing happened,” Joel says. Her memory was unaffected, and as the days progressed, she made it clear that she was back to her usual, strong-willed self.
“Trauma and emergency are the rules here. If you ask for something out of the box, everyone’s willing to go along with it.” Dr. Leo da Costa
“She was surprised when we mentioned she has two beautiful babies, and she was a bit upset, because she always wanted to have a natural delivery,” recalls Joel, smiling.
After a week, the nurses brought the babies to the critical care unit to meet their mother. “Everyone was clapping,” recalls Joel.
Myla’s recovery exceeded everyone’s expectations. “It was enlightening. She’d improved so remarkably in such a short span of time,” says Dr. Cohen.
Joel credits Myla’s desire to take care of the babies, as well as the care she received for her miraculous transformation. “On every unit, on all the floors we went through, the staff were all offering their help,” recalls Joel. “They would say, ‘Anything you need, you tell us.’ I felt like I was home there.”
For Dr. da Costa, Myla’s case demonstrates how quickly Sunnybrook's teams are able to mobilize, and how well they collaborate across multiple departments. “There are very few hospitals in Canada where the routine is the exception. Trauma and emergency are the rules here,” he says. “If you ask for something out of the box, everyone’s willing to go along with it.”
Three weeks after the 911 call, Myla, a clinic assistant at Toronto’s Women’s College Hospital, passed all the physiotherapists’ tests and was able to go back to the family’s Woodbridge, Ont., home. Now, the only thing she complains about is feeling tired, notes Dr. da Costa. “I think with twins you would be tired anyway,” he adds.
However, just being with little Jamie and Samantha is all Myla needs to forget about her fatigue. “Just seeing them is a joy, seeing them grow, and coo and start talking to you and start smiling at you,” she says.