By Mary Frances Emmons, Editorial Contributor
Say her name! Lilliana! SAY HER NAME!
It was one of the worst days of Paola Gambini’s life. After delivering her daughter, the COVID-infected mom was critically ill, exhausted and terrified. She was ready to give up. But her nurse was not.
Gambini had been rushed to Orlando Health Winnie Palmer Hospital for Women & Babies when she started having difficulty breathing. After an emergency C-section, she was immediately transferred to Orlando Health Orlando Regional Medical Center in a desperate bid to save her life. She had not even held her new baby.
Gambini struggled, even yanking out her ventilator, as the doctors and nurses tried to help her. “I wasn’t thinking about getting better; I was just miserable,” she says.
I looked at my fiancé and said, ‘It’s bad, isn’t it?’ and he said, ‘Yeah, it’s bad.– Paola Gambini
“The nurse was like, ‘You have a baby!’” Gambini recalls. “She ordered me, ‘Say your baby’s name!’”
“Lilliana! Lilliana!” the two women cried out together, the last thing Gambini remembers until she awoke nearly two months later, kept alive by a machine that oxygenates blood outside the body, allowing the heart and lungs to heal.
Scared and depressed, Gambini felt defeated. “I looked at my fiancé and said, ‘It’s bad, isn’t it?’ and he said, ‘Yeah, it’s bad.’
Gambini’s journey to recovery and motherhood was about to begin. And that nurse was not the only one who would not let her give up.
An Unthinkable Loss
Gambini and her fiancé, Michael Hazen, already had endured the loss in 2019 of an infant born prematurely due to “cervical insufficiency,” a cervix that opens too early and is unable to support a baby to term. Treatment includes a cerclage, which essentially sews the cervix shut until term is reached. At 19 weeks — much later than the usual 12 to 13 — Gambini had undergone an emergency vaginal cerclage, but it was too late. She delivered at 26 weeks, and the 2-pound baby did not survive long. But Gambini was determined to have a child.
Searching the internet, she discovered the “Abbyloopers,” a group of moms who had undergone a more complex form of cerclage: a stitch through the abdomen instead of the vagina. Two women were patients of Dr. Cole D. Greves, director of the Center for Maternal-Fetal Medicine at Orlando Health Winnie Palmer and co-director of fetal surgery, who had 15 years of experience with the procedure, available at only a handful of hospitals. Greves was the expert Gambini had been looking for.
The near-miraculous surgery is as fascinating as it is difficult.
“In abdominal cerclage you open the abdomen as in a C-section, expose the uterus, lift it up — along with the fetus, amniotic membranes and fluid — identify where the cervix attaches to the uterus, dissect the bladder off the uterus, place the stitch and tie it together, encircling the cervix. That’s a lot of anatomy to cope with, and much is done by feel, as visualization is often limited,” Dr. Greves says. Pierce the uterine blood supply and you can have life-threatening blood loss; place the stitch incorrectly and “it’s game over for the pregnancy,” he says. “Every time you hold that 13-week fetus in your hands, you realize how intricate and complicated life really is.”
Although the process is not without “some white-knuckle moments,” Dr. Greves says Orlando Health Winnie Palmer has a success rate with abdominal cerclage that’s well above 90 percent. But it comes with a cost, mainly a “pretty significant recovery period,” he says. Gambini was insistent.
“The will to reproduce is a powerful one,” he says. “To deliver a beautiful newborn at term — priceless. These moms will do anything to achieve that goal.” But no new mom could be prepared for what came next for Gambini.
“All it Takes Is Will Power”
In the summer of 2021, Orlando was experiencing a rash of young COVID patients who needed the most advanced treatment. “A lot of very young patients had profound inflammatory reactions resulting in lung failure that could not be managed with a ventilator,” says Dr. Kalei Walker, a cardiac surgeon with Orlando Health Heart & Vascular Institute. “Their only option was ECMO.”
Extracorporeal membrane oxygenation, or ECMO, is a revolutionary technique in which blood is drained from the body, passed through a pump and an oxygenator, and then returned to the body. Complicated at best, it’s far more so for pregnant women and new moms, who are subject to fluid shifts and clotting problems, risks intensified by ECMO. Gambini had lung damage from COVID and bleeding from the C-section. Recovery seemed like one more uphill battle. But she would not be alone in her fight.
“I’ll never forget Dr. Walker,” Gambini says. “She’s the reason I pushed so hard. I had been crying and not motivated, and she talked to me about her sister,” who had Guillain-Barré Syndrome, a temporary paralysis that requires months of intensive physical therapy to overcome.
“She said, ‘Do you want to see somebody who looked like you?’ She showed me a picture of her sister, who was way worse off than me. ‘Want to see her now?’ Literally a picture from the day before — she’s beautiful, walking, smiling. Normal. Dr. Walker looked at me and said, ‘All it takes is willpower. You’ll be normal again.’ If it weren’t for her telling me that, I wouldn’t have had the motivation” to push through weeks of physical therapy after months on ECMO.
“When I saw Paola wondering if she would survive and have a normal life, I chose to share a personal story to let her know she had the potential to recover. I wanted to give her hope,” Dr. Walker says. “Sometimes you can help someone by being in the moment with them.”
Gambini, a salon studio owner, took the advice and ran with it, impressing her doctors and nurses, who arranged a motivational surprise for her 32nd birthday: a visit from baby Lilliana.
“Every day they would come on rounds and say they couldn’t believe I was walking and talking,” she says. The first time she navigated a hallway by herself, “they all stopped working with their patients and came out to watch — it felt like I was part of a Grey’s Anatomy episode!”
Eighty-five days after being admitted to the hospital, Gambini was able to go home, and her new family was reunited at last. But she stays in touch with the caregivers who supported her for so long.
“They said, ‘You’re the reason we do this,’” Gambini says. “You’re our happy ending.”
By Mary Frances Emmons, Editorial Contributor