By Kaitlin Lewis

Parent Melissa Krawecki shares her story of HELLP syndrome, loss of her beloved daughter Ava, and the near loss of her own life in her recent book, In the Shade of Ava's Tree (2015, Praeclarus Press). Kaitlin Lewis, intern at Praeclarus Press interviews Melissa about her experience and shares an excerpt from the book below. - Sharon Muza, Community Manager, Science & Sensibility.

Melissa Krawecki, author of the recently published memoir, In the Shade of Ava's Tree, tells her story of pregnancy, loss, and life after losing a child. The narrative style of the book gives the reader a sense of presence during the heart-breaking time in Melissa and Matthew Krawecki's life. From the first sentence, it is clear that this story is not one of "rainbows, lollipops, and sunshine."

We follow Melissa through her first pregnancy, which goes along quite smoothly, until 34 weeks 6 days. The night of February 7^th and early morning of February 8^th forever change Melissa and Matthew's lives. After an emergency trip to a hospital and three hospital transfers later, their daughter Ava is stillborn and Melissa is in a coma due to a syndrome she has never heard of: HELLP. (A combination of the breakdown of red blood cells (hemolysis; the H in the acronym), elevated liver enzymes (EL), and low platelet count (LP) occurring in pregnancy.)

As Melissa tells her harrowing story, we follow her from the edge of death through the rebirth of a new life.

Katilin Lewis: Welcome, Melissa. It is a joy to be able to interview you today. Let's dive right in, shall we? What was your purpose for writing In the Shade of Ava's Tree? Was the experience cathartic?

Melissa Krawecki: My purpose in writing In the Shade of Ava's Tree all stemmed from the first time I looked up HELLP syndrome on the internet. I was home from the hospital for only a few days and I felt desperately alone. I spent hours that day looking for fellow HELLP syndrome survivors online and found precious few. I wanted to write In the Shade of Ava's Tree for the mother or father that was sitting alone in their grief and trauma looking to know there was someone else out there that had experienced this as well.

The process of writing the book was not cathartic for me, however, hearing the reactions, reviews, and feedback has been very much so. Getting to hear back from families that they value the book, that professionals have learned from it ,and that it has opened minds and helped the bereaved has made all the hard work worthwhile.

KL: Can you tell me more about HELLP and how it presented for you?

MK: I am not an expert in HELLP syndrome however I can tell you that HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy or after childbirth. HELLP stands for:

H (hemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)

HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder disease, or other conditions.

My presentation of HELLP was very unusual. Upper gastric pain usually presents under the ribs, as it did for me on February 5- 6^th 2011. By the next day my pain moved between the shoulder blades and was very acute. Liver pain will refer to the shoulder blades in rare cases, however, it is not the norm. As the pain was not where HELLP syndrome normally presents it elongated my diagnosis. I cannot quote my liver and platelet numbers as they fluctuated dramatically over the 10 days of my recovery, I did require 11 blood transfusions and 3 platelet transfusions to resort my red blood cell count and platelets. HELLP syndrome has a long list of symptoms that often mirror "normal" pregnancy symptoms, such as malaise, fatigue, headache, swelling, and an increase in blood pressure. This is why it is important to be vigilant in involving care professionals, and discussing how you feel without shame or reservation.

KL: It is clear in your memoir that EDMR therapy played a very important part in your healing and coping process, can you tell me more about it?

MK: EMDR therapy yanked me out of the trauma so I could grieve. As my grief and trauma were interlaced it was difficult to grieve without flashbacks of the operating room, disturbing memories or full-body flashbacks stopping me. EMDR allowed me to work through the trauma of my time in the hospital and of losing my daughter so I could then grieve. No one knows exactly how EMDR works. The brain becomes overwhelmed and stuck in emotion when traumatized, by allowing both sides of the brain to work together the brain can process the trauma and emotion and allow for new processing to begin. After EMDR, I no longer felt stuck in the same pattern of thoughts and was able to reframe my understanding of what had happened to our family with greater clarity.

KL: Having a support system is great even in times of joy, but absolutely essential in times of pain. The people who surrounded you in your time of need sound amazing. This situation was as new for them as it was for you. Did you find it helpful to join a loss group?

MK: I did not join a grief group, as there was not one in my town. After the birth of my second daughter, I was approached by a member of our community, and together we co-founded Elgin Community Pregnancy, Infant, and Child Loss Peer Support Group. Now having the support and fellowship of my fellow loss mamas, I realize what I was missing out on in those first two years of my grief journey. Before losing Ava, I used to think I would never join a support group, and that I could never share how I felt with a group of strangers. But I was very wrong, and I highly encourage anyone struggling with grief to look up local resources near them.

KL: Throughout the memoir, we see your growth into a self-aware woman who knows her power. Is there any advice you would give to expectant mothers about how to understand and utilize that power?

MK: I think every woman is embarking on a journey of self-discovery when she becomes a mother. Perhaps that strength or power won't be found in pregnancy, but rather in walking the halls with a colicky baby, or learning to trust your own intelligence and knowledge of your child. The only advice I can give is that as a mother you are the best mother for your child. That means you are now your child's number one advocate, and that responsibility supercedes your fear and any shame others may place on you for doing what is necessary in your child's best interest. Embrace your role as protector, as well as mother, and you will find your own power and way in this journey.

KL: I want to thank Melissa for allowing me to interview her today. For more on her story please visit this link.

Excerpt from In the Shade of Ava's Tree by Melissa Krawecki

"The morphine wasn't really doing much for the pain. Ripping, constant, sharp, stabbing pain, right underneath my left shoulder blade. It merely lowered it from a 10 on the pain scale to a 9.5. In and out, the nurses came as we would wait for results. Dr. Bishop returned and states that they did not find any clot in my lung. That he had one other idea as to what this pain may be and said they needed to do one more blood test to be sure. After it was done, and the nurse had left once more, Laura asked if I would like to hear the baby's heart beat again.

I laid back and watched Laura's face as she put the Doppler to my belly. Nothing came through. A long silence followed. Laura repositioned the Doppler once more on my belly, moving it from the top of my belly, downwards towards my left hip. All of the sudden, the familiar, "thump, thump, thump" came through.

"Oh," Laura said, "the baby must have moved. There it is.

But I had not felt the baby move. Adrenaline ripped through my body. I had not felt the baby move. I glanced up at the clock on the wall. It's 9:30 p.m. Why isn't the baby moving? Nine p.m. was always baby party time. Breathing shallow breaths, I looked down at my belly. I could not remember the last time I had felt the baby move.

Oh, God.

Just then, Dr. Bishop came back into the room.

"I have a diagnosis for you," he said. "You have HELLP syndrome."

I glance up at Laura and see her soul sink into her body. HELLP syndrome? What is that?

"HELLP syndrome stands for Hemolysis, Elevated Liver Enzymes, Low Platelets. It is a pregnancy-related condition of which the only cure is to deliver the baby. The pain you are feeling is liver pain."

"But I am only 34+6. What about the baby?"

Melissa is then transported to her second hospital of the night, one equipped with a NICU ready to work on the baby if need be. In the ambulance ride, Melissa realizes the gravity of the situation. Here she was 34+6 and about to give birth.

"I am so sorry, sweet baby," I pleaded. "I am so sorry. I do not know why Mama's body is broken. Please, baby, please just hold on. Oh, your Daddy can't wait to meet you. I promise you I will do everything I can to make it be okay. Mama will try."

Being wheeled into the Catholic specialty hospital, I was determined. I had just spent the last half an hour promising this baby I was going to fight, and fight I was going to do.

I was greeted by a friendly-faced nurse. She smiled at me and said that they were going to get the doctor who would start the induction. I suddenly remembered I had not completed a birth plan yet. That was supposed to be done in three days.

"My name is Dr. Dewitt." He made no eye contact with me or my husband. His face downturned into my chart, his cold, standoffish nature immediately set me back. "You have HELLP syndrome. We need to check on the baby's position prior to us beginning induction. We will do an ultrasound of the baby and then start the Pitocin."

He looked up from his chart. "Any questions?"

Both Matt and I shook our heads no.

The ultrasound technician came in. A young girl. Matt was by the head of the bed, helping me with my pillows.

"This will feel a little cold," she said as she sprayed the jelly onto my stomach.

The screen was pointed away from us as she scanned my tummy. She went over and over one spot on my belly repeatedly. She then clicked the screen off, looked down at her feet, and said, "I just need to get the doctor."

I took Matthew's hand. Filled with fear, I gripped his hand hard. This cannot be good, to go and get the doctor. I look up at Matthew and see his tired eyes. I know what is about to come for us, and I am terrified. I know what this means. Just then, I looked up and saw Dr. Dewitt enter the room. The door was wide open into the hallway as he began to scan my belly. I looked through the doorway and saw my mother standing there, her eyes tired.

Dr. Dewitt suddenly turned the screen to face us. The baby's profile was on the monitor. "I am sorry," he said, "your child has expired."

Lying on that bed, I stare at the completely still profile of my beautiful child on the monitor.

My mom had heard it from the hall.

Matthew's hand grips mine hard.

The room spun. I turn my face to his and say, "Oh, God. We killed our baby."

My Mom's face breaks out in pained horror, and we are left in emotional chaos.

I clung to Matthew's shirt and did not cry. We held each other, staring at the ultrasound monitor in complete silence. Dr. Dewitt left us in our silence, my Mom now at my side. The first question I ask is,

"Why? Why, Mama! Why?"

Her eyes fill with tears and she shakes her head no. She has no answer for me. Blinding, horrific heartbreak fills me.

I did not scream. I did not cry. I asked a lot of questions. Why? How? What is happening? Why didn't you get the baby out in time? Why didn't we know the baby was in distress? How could you let this happen? You said the baby was fine!

Melissa shuts down as they prep for a vaginal birth and ignore her cries of pain.

"I am in so much pain, Laura. My back," gasping between breaths, "I can't take much more of this."

"Tell me about the pain," she asked as she had a thousand times before.

"Sharp." Gasp. "Constant." Gasp. "Bad, Laura, bad."

"On a scale of ten?"

"Fifteen! Please!"

"Okay, let me talk to the doctor." With that, she left.

...

It is now 1:00 a.m. I am in horrific, screaming, stabbing pain from my liver. It is rupturing and bleeding out into in my abdomen, but no one knows. It is bruising, covering itself in a bruise so deep, it would cover 80 percent of this large organ in my body. No one knows. They remain fixed on "delivering this baby vaginally." They remain fixed on the fact that is best. Dr. Dewitt is not permitting any pain medication other than an ineffective morphine drip, as my liver ruptures, and I begin to contract to deliver my baby into a storm of chaos.

...

I remain in this place for hours, in pain, writhing, and begging for mercy, waiting to dilate, and having no answers, until suddenly, at 7 a.m., shift change occurs... [Dr. Lopez] comes over to my bedside and takes my hand. He listens to me with earnestness and his pained concern is evident, even through the hazed cocktail of medications I am swirling in.

"This pain isn't normal. Something is really wrong with me."

[H]e starts to run tests to investigate the crippling back pain. It is now mid-morning on February 8, 2011, and the pain increases ever more. I am dilated about 5 centimeters, the contractions are not even noticeable next to the excruciating pain rippling through my right side, my ribs, back, and neck. We do an ultrasound and they see blood in my abdomen. They then order a CT. The pain is increasing as they visualize my liver. They finally know what we have all along. I am dying. Part of me wishes I could die alongside my baby, but I will never leave my Matthew.

I am taken back to my room, and I am met with Dr. Lopez and a new face.

Dr. Lopez sees my confusion and does not sugar coat it,

"Melissa, you are dying. We must operate to save you."

They transfer Melissa to another hospital to perform emergency surgery on her liver.

The morphine drip has entirely worn off and I am grunting in pain.

"Please! Please! Just put me to sleep!"" I beg them.

Someone places a mask over my mouth and tells me to breathe. They miss my mouth and the mask is half covering my eye and my cheek. I struggle, attempting to show them,

"I can't breathe! Please! Help!"

The person holding the mask is busy, frantically yelling at the person across the room, and does not heed me. Instead, I am pressed harder into the table, and my scalp is smashed into the cold hard table beneath it.

"Please! Just please!" I yell.

Immediately, a kind-faced nurse comes into view and adjusts my mask. "You are going to have to calm down."

"The pain! My God! Help me!"

She says nothing in return. Two people beside me arguing that certain tests were not performed, and they will not put me to sleep. I begin to scream in pain, begging for my life. I scream until I am hoarse, until the back of my head begins to throb from being thrown onto the table, until I am put to sleep.

In the Shade of Ava's Tree chronicles Melissa Krawecki's life beginning with her first pregnancy when she suddenly became very ill with HELLP syndrome. She loses her baby and came close to dying herself. After emergency surgery and four days in a coma, Melissa gains consciousness and must slowly heal both her physical and mental wounds. After taking a year to grieve and gain back strength, she and her husband decide that they would like to try to have another baby. Her second pregnancy is closely monitored and rife with regulations, but through diligence and EMDR therapy, Melissa and Matthew welcome Lillian into their family with no complications.

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