It was a middle-of-the-night phone call no husband wants to get. “They called me and asked, ‘What do you want us to focus on – your wife or the baby?’”
Terry Koonkhuntod’s pregnant wife, Prem, was on a ventilator at MUSC Health in Charleston, South Carolina, at risk of dying from COVID-19. And she was getting worse, which put their baby in jeopardy, too.
At one point, Prem’s heart stopped beating. To her husband’s relief, it restarted after the intensive care unit team gave her emergency chest compressions and medication.
“I don’t ask much from God, but that time, I was just like, ‘Please, God, don’t let me be a single dad. I’m not ready,’” Terry said.
How did they get here, he wondered. Just a few days earlier, Prem was home with him and their two kids in Myrtle Beach. She’d been so careful, they thought, taking precautions against the coronavirus. But Prem hadn’t gotten a COVID shot, even as the Delta variant raged across the state.
“She did want to get vaccinated because she wants to be safe. But then again, the vaccine is too new. They haven’t done a lot of study on it. So she decided not to do it,” Terry said.
It was a decision they would both come to regret.
On Aug. 3, the day their ordeal began, Prem realized she wasn’t feeling well. “I got sick and coughed. I was worried, so I went to get tested. It was positive. I was pregnant, so I was worried about the baby,” she said in a later interview, her voice still hoarse from the ordeal.
As her symptoms escalated, she was admitted to a local hospital, then transferred to MUSC Health. “The doctor said they have the right equipment over there,” her husband said.
MUSC Health has doctors and nurses experienced in taking care of pregnant women with COVID. Those women are at a higher risk than people who aren’t pregnant of getting severely sick, as Prem now knows. The Charleston hospital also has specialized equipment to help COVID patients, including a type of machine that would become critically important in keeping Prem alive.
“I remember they took me to the room, and the doctor came and talked. After that, they took me to the intensive care unit. After that, I don’t remember,” Prem said.
It was a shocking turn of events for a couple who met years earlier when Prem left her home in Thailand for an exchange program that brought her to South Carolina. She was working in a Thai restaurant in Myrtle Beach when Terry, also born in Thailand, came in for a meal.
They fell in love, and Prem moved to the U.S. They married, had two children and were looking forward to welcoming their third child. Now, COVID was putting everything they’d built as a family at risk.
“The idea that I could lose her came across my mind a lot,” Terry said.
But Prem had something important going for her: a huge team of doctors, nurses, respiratory therapists and other experts working around the clock. “We have had over 100 people involved in her care,” said Daniel Young, M.D., a critical care fellow who was part of that team.
“We’re a big university hospital, and we brought all of our resources to bear. She probably wouldn’t have survived if she weren’t at a place like this.”
Those resources included something Prem wouldn’t have had access to anywhere else in Charleston: ECMO machines. ECMO stands for extra corporeal membrane oxygenation. ECMO coordinator and registered nurse Lucy Linkowski explained what the machine, which is only used as a last resort, can do.
“For patients like this, it pulls blood out of the right side of the heart into a machine, which spins it around and pushes the blood through an oxygenator. That puts in oxygen and removes carbon dioxide. Then, the blood is returned to the patient,” Linkowski said.
“So we return oxygen-rich blood to the patient because their lungs aren’t able to do the oxygenation and the ventilation that they normally do.”
Prem would need every bit of that help. “She had an acute decompensation early one morning. I actually got called when I was on the way in,” said Young, the critical care fellow.
He arrived to find Prem hanging on by a thread. “We made the determination that we needed support beyond what we were able to provide with conventional ventilation. And so we moved really quickly,” Young said.
“I worked with our interventional cardiology colleagues to stabilize her by putting her on ECMO so we could deliver her baby.”
That was a first, said maternal fetal medicine specialist Rebecca Wineland, M.D. “We’ve never had to deliver a baby while the mother is on ECMO before. At that point, it was life and death for Ms. K.,” she said, referring to Prem.
To everyone’s relief, mother and baby survived. The little boy Prem wouldn’t meet for a few weeks, as the ECMO machine did its work, was tiny, less than five pounds. But Alex’s arrival was a welcome development during an agonizing time for the family.
When Prem finally woke up, she slowly took in her surroundings. “I saw the machine. I felt a little bit scared, but I was happy to be alive. After that, I asked my husband, ‘How’s the baby? What’s going on?’ He didn’t want to worry me too much, but he told me the baby’s strong and healthy. That was good news for me.”
Prem has made remarkable progress since then. She’s working with a physical therapist to recover from COVID’s ravages, and her baby is thriving.
Young is thrilled by their outcome. “To have her and her baby both doing well – that’s the reason we do what we do,” he said.
But his team’s work is far from done. “A lot of the general public doesn’t know how hard the staff here in the intensive care units at MUSC and across the state are working. So I think we really need to give a lot of credit to the ICU nurses and respiratory therapists, residents, advanced practice providers and other health care team members who are working really hard around the clock, dealing with this pandemic.”
He encouraged everyone who can to get vaccinated, which greatly reduces their risk of ending up in the hospital.
Wineland said that advice applies even to people who have had COVID. “We’re seeing pregnant moms get sick again. Even prior COVID should not be a reason not to be vaccinated now, because the Delta variant is 100% in South Carolina and is continuing to cause devastation to those who are unvaccinated.”
Prem saw that firsthand and doesn’t want other mothers to go through what she and her baby have. “I think everyone, even pregnant women, should take the vaccine.”
Her husband agreed. “If I knew this would happen, I would ask my wife to go ahead and get the vaccine to keep her from getting COVID.”