Delivering new life, needing new lungs
A Wisconsin mom gave birth in a COVID-19 coma. It was only the beginning of her fight for life.
First of two parts.
Kelsey Townsend delivered her fourth child deep in a coma, her lungs scarred and inflamed from COVID-19, her body starved of oxygen. She’d been minutes from death, her obstetrician said.
Seven weeks later on Christmas Eve, the 32year-old office manager still clung to life at University Hospital in Madison, two machines delivering the oxygen her lungs no longer could.
On that night, of all nights, the doctor had more bad news to deliver, and it appeared Kelsey would have to face it alone. Pandemic restrictions had put an end to regular hospital visits.
“This has to be an extenuating circumstance,” her husband, Derek Townsend, 32, pleaded on the phone. “You’re not breaking that news to her without me at the bedside.”
No. He would come and tell her himself.
So, while their children — Payton, 8, Beau, 5, Faith, 11⁄2, and newborn Lucy — waited at home with their grandparents, Derek drove to the hospital past streets aglow with Christmas lights. His gut churned.
How could he tell Kelsey that the only way she’d come home was with two transplanted lungs in her chest?
Home for the Townsends is a fourbedroom ranch in the small, central Wisconsin village of Poynette. Farm country. The Townsends grow most of their own vegetables and butcher their meat. They recite the Lord’s Prayer before each meal because they want the children to grow up remembering to be thankful.
The family had big plans for the coming years. In spring, they would break ground on a new house, 10 miles north on land Derek’s father had bought — 40 tillable acres they would operate together as a hobby farm. The whole family would pitch in with daily chores.
A double-lung transplant was not part of those plans.
When Derek entered Kelsey’s room in the intensive care unit that evening, she lay in bed, awake but groggy. They’d lowered the sedation levels to bring her out of the coma long enough to hear, and perhaps understand, what needed to happen.
Derek looked into her brown eyes and held her weak hand. His own eyes were swimming.
One of the doctors began to describe her condition. Every few sentences, Derek stopped him and leaned close to Kelsey, trying to clarify the situation as best he could. Her lungs were shot. Her name would go on the waiting list for a transplant.
If all went well, she would come home to her loving family. But like many of the families ravaged by COVID-19, the rest of their lives would be different. Hers would be a life of limits: medications she would be unable to live without; favorite activities, such as swimming, that she would be unable to do.
Derek asked over and over if she trusted him. Later he explained: “You’re not making a decision for yourself. Someone else’s life is in your hands.”
Again and again, he turned back to the doctor: “Are you sure this has to happen, that her lungs can’t turn around on their own?”
The damage, the doctor said, was irreversible.
The talk lasted an hour, maybe longer, then Derek walked back to the dark hospital parking garage. He got into his truck and tried to drive home, but made it only as far as the second floor of the garage before pulling into an empty space.
There, he broke down weeping.
A full life — busy but blessed
Derek and Kelsey had known each other almost 10 years. They had grown up just 16 miles apart, Derek in Poynette, Kelsey to the south in Waunakee.
They met in a volleyball league and went to the Columbia County Fair on their first date.
In July 2013, on a trip to Panama City Beach, Fla., Derek wrote a message on a seashell and planted it, half-covered, in the sand. They were walking on the beach when he got down and uncovered the shell. Imprinted in black Sharpie were the words: “Marry Me.”
“Derek, put that back,” Kelsey scolded. “You’re going to ruin someone’s engagement.” That’s when Derek showed her the ring, and she understood and began to cry. They married one year later on July 13, 2014, before 350 guests at a barn venue called Harvest Moon Pond.
Theirs was a full life — busy, but blessed. Derek owned a flooring business. Kelsey was the office manager for a window cleaning firm.
Besides planting and picking vegetables at the garden, which belonged to Derek’s father, the Townsends enjoyed 5-mile walks, and boating and swimming at the family cabin up north. In early February 2020, Derek and Kelsey decided to try for a fourth child.
To the Townsends, and no doubt to many Americans, the new coronavirus registered as a distant concern at that point. The U.S. had only confirmed a half-dozen cases; no deaths.
Two months later in April, Kelsey took a home pregnancy test. She and Derek waited for the result together.
Two lines appeared on the test. Pregnant! They embraced and kissed.
By this time, the COVID-19 pandemic had become the most pressing crisis on the planet. In a space of days, life changed for every American. More than a half-million in the U.S. had tested positive; deaths exceeded 25,000. Schools closed. Stay-at-home orders spread across the country.
Kelsey knew the new coronavirus would complicate her pregnancy. Yet the pandemic still felt somewhat distant, something that could not cause the same devastation in their small Wisconsin community that it was causing in places like New York City.
Besides, they were having a baby. They were overjoyed. They couldn’t help themselves.
Not that they were taking any chances. Kelsey and Derek followed the advice of the experts. They wore masks in public, avoided crowds, washed their hands frequently and practiced social distancing. Their masks stayed on, even as their truck idled at the curbside during each grocery pickup.
Kelsey visited a doctor in Sauk Prairie for her prenatal checks, all of which went well. She entered the ninth month feeling fine. She was due Nov. 5.
A quirk of her previous pregnancies had been that in the final week or so she would get sick, usually a cough and body aches. The Townsends had devised an explanation that reflected their optimism.
The sickness at the end was the baby telling them: I’m here. It’s time.
Coronavirus hits the family hard
Looking back, the Townsends cannot point to one moment when the family might have been exposed to the new coronavirus. They believed they were doing everything right, following all of the medical guidance.
Still, on Oct. 27, Payton’s school called to say that she was feeling sick and would need to be taken home. By the next day, she and Kelsey were both sick, though their symptoms seemed mild and neither was tested for COVID-19.
The same day, Derek grew sick. He was driving his truck when he started to feel so bad that he briefly considered pulling over and calling an ambulance.
“It hit me immediately and it was very hard,” he recalls. “I had extreme body aches. From the back of my neck to my lower back was just excruciating pain. I had the chills. I was driving and having trouble breathing.”
Derek made it home safely. Later, in the middle of the night, he sat up in bed in a panic.
“You have to take me to the hospital. I can’t breathe,” he told Kelsey. It felt as if an elephant were crushing his chest. He assumed he had the virus and feared that if he fell asleep he would never wake up.
But Derek recognized too that going to the hospital would be a major headache for the whole family. He would have to wake the three children and have his pregnant wife drive all of them.
Instead, he gutted out the pain. After 20 minutes, it eased.
The following morning he felt better. Kelsey, however, felt much worse. Derek drove her to St. Mary’s Hospital in Madison, where she was admitted on the 29th and kept overnight.
It’s not clear why St. Mary’s released Kelsey the next morning. Doctors felt that her COVID-19 symptoms appeared stable. Derek remembers thinking that if her condition worsened, she would be better off in the hospital than at home. But looking back, he said, “I don’t think it’s anything that the doctors did wrong.”
“Like Derek,” said Kelsey, “I tried to be strong and stick things out.”
Five days later, on the morning of Nov. 4, Derek walked into the living room and found Kelsey sitting on the couch. It was a day before her due date and she looked odd.
The whole right side of her face had turned blue. Her lips had no color at all. She was struggling to breathe.
Trying not to panic, Derek helped her into the truck and they rushed back to St. Mary’s. As he drove, Kelsey slipped in and out of consciousness. Her eyes kept tilting toward the back of her head.
Derek talked to her constantly, willing her to stay awake. He talked about the children. He talked about how excited everyone was for the baby. They’d already decided to name her Lucy Kyu; Lucy after Kelsey’s great grandmother, and Kyu after Derek’s grandmother.
Because Derek had been sick recently and was likely infectious, he was told that he could not stay with Kelsey. She would be giving birth for the first time without him beside her.
He returned to the parking garage and started to drive off. Almost immediately his cellphone rang.
“Where are you?” the voice on the other end demanded.
“On the fourth floor of the parking garage,” he said.
“You need to come back right now.” Wearing a mask, Derek was escorted to the emergency room where doctors explained what was happening to Kelsey. The body’s oxygen level is measured on a scale of zero to 100, with 95 to 100 considered normal. A level of 60 is considered extremely low. Kelsey’s was 45.
Doctors told him Kelsey was gravely ill. To save her life, they would have to place a breathing tube in the main airway to the lungs, a procedure so uncomfortable the patient must be sedated. The sedation would, in effect, send Kelsey into an induced coma. While she lay in the coma, they would deliver the baby by emergency Caesarean section.
“Derek, I’ve never had a C-section,” Kelsey pleaded. “I can’t do this. I’m scared.”
He told her everything would be OK. He and baby Lucy would be waiting for her after the delivery.
In the confusion of the moment, he did not realize his own illness precluded the possibility of waiting for her in the hospital.
The full weight of the doctor’s words had not sunk in. Derek still thought Kelsey would recover in a few hours and rejoin the family in a day or two.
“I didn’t know,” he said, “this was the last time I’d see her for three months.”
A delivery in about 40 seconds
The birth went quickly.
Kelsey lay in the delivery room, an oxygen mask strapped over her nose and mouth. Her blood-oxygen level was now 65; her skin still blue.
Thomas Littlefield, a 42-year-old doctor of obstetrics and gynecology, cut a horizontal incision of about 4 inches through the skin just above the pubic bone, then deeper through the tough layer of connective tissue called the fascia.
Kelsey’s abdominal muscles were separated. Pressure was placed on the outside of the upper abdomen to help guide the baby through the incision. The umbilical cord was clamped twice and cut away from the placenta. Then Lucy Kyu, all 6 pounds and 5 ounces of her, was handed to a nurse.
The entire procedure, from incision to handoff, took about 40 seconds.
Doctors upgraded Kelsey’s condition after the delivery. She went from critically ill and unstable to critically ill and stable.
The day after her birth, Lucy Kyu Townsend was tested for COVID-19.
Her test came back negative.
Protection in the placenta
“Derek, put that (shell with ‘Marry me’ written on it) back. You’re going to ruin someone’s engagement.” Kelsey Townsend just before this photo
Scientists had been studying the new coronavirus for barely 10 months when Lucy was born. As a result, advice to doctors was fairly vague.
The American College of Obstetricians and Gynecologists advised that doctors urge pregnant women to protect themselves against the virus. Pregnant women already infected were to be informed that they were at higher risk of severe illness requiring mechanical ventilation.
Two days after Kelsey gave birth, the U.S. Centers for Disease Control and Prevention published a large study of more than 400,000 women who’d tested positive and shown symptoms of COVID-19. About 23,000 of them were pregnant.
“After adjusting for age, race/ethnicity and underlying medical conditions, pregnant women were significantly more likely than nonpregnant women to be admitted to an intensive care unit,” the CDC reported. In fact, pregnant women were nearly three times as likely as nonpregnant women to require ICU care.
The finding makes sense because COVID-19 attacks the lungs, making it hard to breathe. The lungs of a woman in the latter stages of pregnancy are already under greater pressure from the expanding fetus and uterus.
However, scientific papers have also suggested that pregnant women often mount a strong immune response against COVID-19 and seldom transmit the virus to their babies.
“The placenta is swimming in maternal blood and is exposed to everything that is in the mother. But the placenta has maintained many of the characteristics of the shell of an egg,” explained Gil G. Mor, scientific director of the C.S. Mott Center for Human Growth and Development at Wayne State University.
“The shell allows some nutrients to go inside but protects the egg from the environment. The placenta has a lot of antiviral factors.”
Mor co-authored a paper last August that noted COVID-19 does not increase rates of miscarriages, stillbirths or preterm labor.
Further, Weill Cornell Medicine in New York recently released a study of 88 pregnant women sick with COVID-19, finding that 78% of their babies had antibodies against the virus in their umbilical cord blood. None of the babies were born with the new coronavirus, suggesting that antibodies from the mothers had crossed into the placenta, according to the study published in The
American Journal of Obstetrics and Gynecology.
“About 99% of babies don’t get COVID-19. We don’t really know what is (protecting the babies), but it’s probably the placenta,” said Vincenzo Berghella, director of the Division of Maternal-Fetal Medicine at Thomas Jefferson University in Philadelphia.
Although Berghella was not involved in the Weill Cornell study, he led a group of researchers who tracked results from 64 pregnant women hospitalized with severe or critical COVID-19 at 12 U.S. institutions. The women and their babies all survived, though one woman suffered a cardiac arrest. Again, none of the babies were born with COVID-19.
Both Berghella and Mor said pregnant women should be vaccinated against COVID-19. Mor said he worries that the new coronavirus could mutate in ways that will allow it to infect the placenta.
Clinging to life after the birth
Lucy left the hospital on her third day of life.
Although Derek felt fine, he got tested for COVID-19 on Nov. 8 and learned that he was positive. A family friend, Lucy’s godmother, took the infant to stay with her.
Kelsey remained in a coma, dependent on a breathing tube. Her sister, Kassy, typed a prayer onto Kelsey’s online CaringBridge journal:
God, if you can hear me, please I beg you to bring my sister back to me and my family. The devil named COVID has tested her strength and right now he’s winning ... She has a brand new bundle of joy that needs her momma’s hand and heart to hold.
Friends and neighbors organized a meal train so that Derek would not need to cook. Kelsey’s cousin, Janel Hellenbrand, took charge of updating the CaringBridge journal.
On Nov. 9, Janel wrote:
Kelsey has taken a turn in the wrong direction. She remains dependent on the ventilator and has been transferred to the UW Hospital ...
PLEASE, PLEASE PRAY!!
The ventilator, which carried oxygen through her windpipe and into her lungs, was no longer enough. Her lungs were too scarred, stiff and inflamed. In addition to the ventilator, Kelsey now needed the assistance of a heart-lung machine known as ECMO.
Blood from the femoral vein in her groin was drawn into the ECMO machine, which acted as an artificial lung, adding oxygen to the blood and removing carbon dioxide.
The machine then pumped the blood back into the jugular vein in Kelsey’s neck. The tube carrying the blood passed through the jugular and into another vein; its tip extended just barely into the top of the heart’s right atrium.
“I think of it, not as a treatment. It does not make the lungs better,” said Dan McCarthy, director of the ECMO program for UW Health and the doctor who took charge of Kelsey’s care.
“It supports the patient while their lungs heal.”
For Kelsey, that would mean reducing the inflammation and removing the excess fluid collecting in her lungs. Kelsey’s chest X-rays left no doubt something was terribly wrong.
“Usually lungs look gray or black (on X-rays),” explained McCarthy, who is also the hospital’s surgical director of the lung transplant program. “For periods of time, her lungs were completely white. They call that ‘white out.’”
McCarthy, the son of a surgeon, was accustomed to treating the severely ill. Yet he found the tide of critical COVID-19 patients “wrenching,” an emotion echoed by doctors, nurses and medical staff the world over. Among the disease’s most alarming features, is the extreme, sometimes deadly, response it provokes from the body’s immune system.
“It’s kind of like collateral damage in a war zone,” McCarthy said. In its effort to destroy the infection, the immune system begins “indiscriminately bombing,” attacking both diseased and healthy tissue.
Kelsey’s immune system had reached this point, known to doctors as a cytokine storm.
At the time McCarthy began treating Kelsey, the doctor had already witnessed COVID-19 patients her age who’d had to be placed on the ECMO machine. Some had died anyway.
During his first week treating Kelsey, McCarthy realized she might need a lung transplant. And if she did, Kelsey would need to grow stronger to survive the procedure.
In her room, the ventilator made a compression sound, air passing in and out. ECMO worked silently. Both machines had different settings and could be adjusted to fit the patient’s condition.
At one point, Kelsey would need both pushed to their maximum settings just to survive.