They cried until they had no tears left. Then they both tried to take a few deep breaths to study themselves. When they finally managed to calm down a bit, the nurses came back and Alex hopped off the bed so they could move her to a room. Jo never let go of his hand and he held onto her like a lifeline.
They got her settled and hooked up to a fetal monitor and a heart monitor. Along with some supplemental oxygen through a nasal cannula. She knew that part made him worry, but her oxygen levels weren't too low and Addison assured them it was mostly just a precaution. Yet, she knew Alex didn't believe her.
They tried to distract themselves, Jo turned on the tv and Alex flipped through the food magazine looking through recipes. But both of them kept their hands on her bump and counted every single kick that their baby gave them. Alex rubbed the spot up by Jo's ribs where they were kicking her and Jo managed a smile as she rubbed her thumb over her bump. As she read, she watched Alex as he watched her. She watched him count her breathing and glance at her swollen ankles. She knew he was watching all the other little things that made him worry about her health.
Nurse Ginger stayed nearby and checked on them often as they waited for Maggie. They didn't have to wait long for her. Maggie rushed into the room like a family member and not their doctor. She hugged Jo, giving her a tight squeeze before she turned and hugged Alex just as tightly. Then she pulled back and shifted into her roll as she grabbed the tablet.
"Addison told me everything," Maggie said as she took a deep breath and looked over Jo's chart.
"So what do you think caused my arrhythmia?" Jo asked as she looked up at her hopefully.
"I'm not sure yet, but we'll run a few tests and figure it out," Maggie said, giving her a reassuring smile as Jo and Alex both nodded.
"Thank you, Maggie," Alex said as Maggie just nodded.
Maggie took out her stethoscope and listened to Jo's heart, her face stone as she listened. But she nodded and pulled back, putting her stethoscope in her pocket. "I agree with Addison's conclusion that you do have an arrhythmia, so let's try to figure out why and if it's just that or something more. I'd like to start off with an EKG then do a Cardiac MRI."
Alex and Jo nodded as they expected this. Maggie stayed with them as the techs came in and did the EKG first. Then they took Jo down for the MRI in a wheelchair as no one wanted her walking. Alex dawned the lead vest as he stayed with her. He held onto her foot as she went into the machine. She didn't ask him to, but he did it anyway, and she appreciated it. He didn't want to leave her as much as she didn't want him to leave.
Once they got back to their room, Jo crawled back into bed. Then they waited for Maggie to return with a diagnosis. They both knew that this part could take a little while, but knowing that didn't ease their minds, especially as the minutes ticked by. Although it was at least a small mercy that they weren't rushing her into an OR room. Thus, it couldn't be that serious, but it could have been any number of things as his mind turned and twisted. Alex could see how anxious Jo was as her heart rate was higher than usual.
"You should go get the girls soon. It's a pickup time," Jo said as she looked up at the clock.
"Not till after we talk to Addison and Maggie," Alex said, as he waited for them from the window.
"You should take them home after," Jo said as he paused and looked back at her. She seemed reluctant, but firm in her words. "Just because I'm staying in the hospital doesn't mean they have to."
Jo looked up at her IV and monitors and then down at her belly. They both knew Luna hated the hospital. Even going for a check up was a struggle. She still had lots of checkups and growth progressions scans on top of all of her hearing appointments. Although she loved going on rounds on the Ped's floor, she just didn't like being the one examined. They didn't know how she would do if she saw her mama in the bed with all the monitors, oxygen, and wires.
"I'm not leaving you here alone. It's just one night at the hospital. If we set up the pack and play or have them sleep down in the daycare, they'll be okay," Alex said, firmly as Jo softened, he knew she didn't want him to leave. They could get Luna settled for one night for a fun little sleepover.
Alex paced back and forth watching the window and waiting for Addison and Maggie to return. Jo watched him walk back and forth from one side of the room. She knew he hated being on the outside waiting for them. He was restless without something to do. Jo was restless watching him. She tried to read to focus on her medical journal and rubbed her belly as she felt her baby kick, but she was just as bad at waiting. She fidgeted with her fingers in the blanket while he placed on his feet.
Soon enough, all their friends started to gather around the room. Meredith was the first to swoop in with Link closely following her. Jo was relieved to have them as they waited silently next to her. They hugged them before and exchanged what little information they knew. However when Amelia and Teddy came to check in with Owen, Jo looked over at him and Alex knew to stop them. She never liked a crowd and she hated being in the hospital with everybody looking at her.
"No, guys please just leave us alone," Alex said, not so politely, shutting the door in their face as he saw Bailey and Webber come around the corner.
"Well you heard him," Bailey said, turning around to address them all. "Leave the Karev's alone!"
All of their friends left after that, but they lingered in the hallways and Bailey was posted at the nurses station. Alex shut the blinds and Jo breathed out a little bit of relief although she still felt like a fish in a bowl.
"Link, can you go down to the daycare and check in on the girls," Jo asked before they left.
"Yeah, do you want me to pick them up today?"
"No, Alex should be able to just let them know it will be a little later tonight."
"I'll leave you alone after that but call me if you need anything. I've canceled my surgeries for the day so it's just paperwork," Link said, leaning in and giving her a long hug as Jo relished the hug from her best friend.
Link left, but Meredith lingered as Jo looked over at her. "Can you stay with us?"
"Of course, and if at any point you want me to leave I will," Meredith said with an understanding nod.
"Thank you." Jo said as they both relaxed, Meredith was the only one they both trusted to keep them sane and Link was the one they trusted to check on the girls without alerting the daycare staff that something was wrong.
"What if we talk about something else, how did you guys like the tulip fields?" Meredith said, trying to distract them. "I heard you had quite a day up there."
Jo nodded as she relaxed. "Yeah we had a good time. Until Helena hit her head."
"I heard that too, but Alex said, she was a trooper as you fixed her up."
"Yeah, and we got lots of good family photos, I'll show you."
Jo showed her some of the pictures she had and Meredith smiled at the pictures of the girl. They all made small talk, but Alex remained silent and focused on the results as he looked out the window again. Jo saw this and patted the bed next to her and he reluctantly got in next to her. He wrapped one arm around her and she rested her head on his shoulder as they both put their hands over their baby. Jo started to sing the familiar little lullaby. She had a different one for each child. For this baby she hummed "Baby Mine," from Dumbo and she could feel the baby fall asleep under their hand.
Finally Addison, Carina, and Maggie came in and stood around them. They all had somber faces and Jo squeezed Alex's hand. Maggie came and sat down on the bed next to them. She never did that and Alex wasn't sure if it was because they were family or if she was preparing to tell them difficult news.
"Jo," Maggie said before taking a deep breath. "You have a Mitral valve regurgitation which has led to Congestive Heart Failure."
Jo nodded as tears appeared in her eyes. She knew what this meant for herself and their baby.
She tried to hold them back but she couldn't. All of her worry and her emotions from the day bubbled over in the pot and this diagnosis was like the last pour of water and caused it all to spill over. All the tears she had been holding back came flooding down as she finally broke down into sobs.
Alex looked over at her, and instantly moved to comfort her. He climbed in the bed next to her, putting his arm around her as she took a second to bury her head in his shoulders hiding from all of this as she cried. Alex seemed to break as well, as he silently cried as well. She wasn't sure who was squeezing their hands harder, but he held on to her hand with a death grip. He didn't want to let go and Jo wouldn't let him.
"Jo listen to me okay," Addison said as Jo felt the bed dip and as she sat next to them putting a hand on her legs. "You and your baby are not going to die. This is reversible, and after surgery to replace your valve, you are going to be okay and you continue to have a healthy pregnancy. There's a good possibility that your heart failure will reverse itself. I've looked at the numbers and I see a good outcome for you."
"You can't promise that," Jo cried, still hiding in Alex's shoulders as he gripped her tightly in his arms.
"No, but I can promise you that Maggie and I are going to do everything in our power to make sure that you leave this hospital with a healthy heart and a healthy baby," Addison said, reaching out to put a hand on Jo's bump as their baby kicked her in response.
"Jo listening to her, I trust Addison with you and our baby. If she says you'll be okay you'll be okay," Alex said, despite this his voice breaking at the end.
She looked back at him and stared into his eyes as he quietly nodded to her. Jo took in a shaky breath as she wiped away the tears that still streamed down her face. She didn't have the strength to stop her tears. Addison looked at her and gave her a little smile as Jo reached out and grasped her hand and Addison gave her hand a squeeze. She looked back at Maggie who nodded and she continued.
"As you know, Mitral valve regurgitation is a type of heart valve disease where the valve in the left chamber doesn't close properly. It allows blood to leak backwards from the valve. As a result there isn't enough blood being pumped from your heart to your body which is causing the fainting as well as your fatigue and shortness of breath. This is what has led to heart failure. While it isn't severe, it is still concerning. I believe your heart is working too hard to pump blood out to you and your baby. With the surgery to replace the valve it will give your heart a break and hopefully it will recover on its own. However, your oxygen levels are low as a result of the decreased blood flow. For now, we're going to keep you on supplemental oxygen."
"What about my baby? They can't survive an open heart surgery. I'm only 27 weeks along. I can't have this baby now. I know I can technically deliver them, but I don't want to have another NICU baby," Jo asked, moving one hand to fearfully protect her bump.
"Your baby is just fine and I'm not looking to deliver them until I absolutely have to," Addison said with a gentle reassurance as Jo nodded and looked down at her bump and began to rub her hand over their baby.
"What could have caused this though?" Alex asked, looking from Jo back to them. "Jo and the baby have been perfectly healthy until now."
"We're not sure. However we believe it was either a Mitral valve prolapse or a Congenital heart defect. We're also concerned that it was also aggravated by your pregnancy," Maggie said, with a frown as Jo let out a breath and nodded.
"Don't blame yourself Alex please," Jo whispered as she looked over at him with pleading eyes, she could always read his mind.
"I'm not," Alex promised her although it was a lie and he was sure she knew he was lying.
She could see the guilt in his eyes. This pregnancy was a reason Jo's heart condition was progressing. He was the one who wanted them to have another baby. But Jo wanted another child just as much as he did. Although, she was happy with their two girls. However she never wanted him to think it was because of him. She wanted this baby just as much as he did.
"So what's the course of treatment?" Jo said, trying to sound confident as she looked back over at Maggie, Carina, and Addison.
"Given how severe your symptoms are, I'd like to do a valvuloplasty for an artificial valve replacement," Maggie said as agreed with a nod.
"Okay," Jo said, sounding unsure despite her words.
She looked over at Alex. He had barely said anything this entire conversation, but she could see his thoughts in his eyes. She knew that he was taking all of this in strides. As was she, she had a heart condition. She and the baby were at risk and they would be in the hospital for a while. She knew the next step was surgery, but she couldn't imagine his wife going into heart surgery.
It was a simple surgery and they would keep an eye on her, but Jo would be okay if she had convinced herself of that. She had to be fine. Jo took it in all over Alex and her tears continued to fall from her eyes as she quickly brushed them away. Alex just looked at her and moved to hug her close. They both looked back at Maggie and she nodded before she continued.
"Okay," Maggie said with a sure nod. "So I'm going to take a scope in through your femoral artery and feed it up to your heart. I'll place the new valve that will work to increase blood flow. Although it's not open heart surgery, it's still not an easy surgery. There will be an extensive recovery period especially until your heart failure reverses. I also don't want to wait for surgery and I'd like to get you prepped to do the surgery tomorrow."
"The baby should be safe, and the surgery doesn't pose a risk to your pregnancy, but we're still going to monitor you while you're in surgery," Addison said as Maggie nodded in agreement.
"Does it have to be tomorrow?" Jo asked, biting her lip if she lived over them.
"Yes," Alex said his anxiety in his words as he looked over at her full of concern.
"I know but it's just all so soon," Jo said, her fingers tingling into the blanket as if pulling it further up her chest would protect her. "We don't even have the nursery ready and nobody's told the girls they're just done in daycare. What if something happens to me and they lose their mom and don't tell me that it's not a possibility because I know the statistics. I can't do this without having a plan in place to protect my girls."
"Okay, It doesn't have to be tomorrow, I can give you time to get your affairs in order," Maggie agreed with a slight nod, her eyes still full of concern. "However, we should schedule it for this week. The state of your heart combined with your symptoms tells me we can't wait for this surgery."
"Okay," Jo agreed, letting out a breath. She knew she'd have to face this sooner however, she just wanted one night with her girls and her husband.
"Then we should do the the day after tomorrow," Jo said looking over at Alex who nodded in agreement for his own support.
"Okay," Maggie agreed, looking down at the tablet, presumably scheduling the surgery.
"I would also like for you to stay in the hospital for as long as possible so that we can monitor you and the baby and to keep you on bed rest until you deliver. We will monitor your heart and make sure it all goes well, but I don't want to stress it out too much. Your heart won't be fully recovered by the time you give birth and this could lead to complications," Addison explained to them. "And I'll stay in Seattle until then."
Jo nodded, holding her belly protectively with both hands as Addison answered her question.
"So the delivery will be hard on her heart?" Alex asked, placing a hand over her belly too, worried more now then he thought was possible.
"That will most certainly be the case as you will only have had 10 weeks to reverse your heart failure and recover," Addison said as Jo nodded. "But we won't know how strong your heart is until after surgery."
"Okay," Jo said with a nod although Alex could tell she was still taking it in, though she started to process it more like a doctor. "Would a C-section be safer?"
"Possibly, but we can make that decision later down the line," Addison said with a nod.
"Right now the main concern is getting you and your baby through surgery. The recovery part will come after," Maggie said as Addiosn nodded in agreement.
Surgery, she needed surgery. Jo looked over at Alex and could tell the same thing was running through his mind. Jo just nodded and there was an awkward silence that filled the room and no one knew what to say, but of course Meredith did. She put her hands over Jo's, giving them a squeeze.
"So this is what's going to happen. You two are going to spend the night here and the girls are going to spend the night in the daycare. As soon as you're ready, I'll go get the girls and bring them up here to spend some time with you both. You're going to say hi to them, you're going to hold them, and love them and play with them. Meanwhile you're going to send out Link to your house to get a couple bags and things for you both to spend the night here. Then you two are going to settle in for the night and you will worry, but I'm not worried about you, you are in excellent hands, Jo."
"Then tomorrow, you're going to get up and relax. I'll make sure you have everything to get your Affairs in order. Then you're going to spend the day with your girls doing whatever you want. Then you'll go to bed and get up tomorrow and we'll do the surgery. Maggie and Addison are going to come get you. We're all going to walk you into the cath lab and Alex is going to hold your hand until you fall asleep. Then while you're in surgery, Alex and I are going to take the girls down to the park across the street."
"No, I'm not leaving the waiting room," Alex said, shaking his head as he looked over at Jo.
"Yes you are," Jo said with a firm tone. "There's probably going to be an intern in surgery with me and they can text you about what's going on. The second Maggie is done you are going to know about it."
"Jo's right," Meredith said, looking over at him. "You shouldn't stand in the waiting room worrying and pacing, you should spend some time with your girls, it'll help."
"Okay," Alex sighed but nodded in agreement.
"Then Jo is going to come out of surgery and you're going to come up here and greet her. You're going to wait by her bedside until she wakes up and when she does, you're going to smile at her and tell her it went well and that she and the baby are alright. The recovery will be tough for a while, it's going to be okay."
Jo nodded in agreement as she looked over at Alex. She knew she had a million things to do but right now her mind was numb with pain and the possibilities of everything it was all too much to think about. She knew he was on board with everything, but he would still worry to no end, and he nodded too.
"Okay, thank you," Jo said, letting out a shaky breath and Alex squeezed her hand.
"Yeah, thank you," Alex said with a nod as they all nodded back and Maggie gave them a small smile.
The three of them left and they closed the door quietly behind them, leaving the two of them alone. It was then that Jo broke down crying again and Alex couldn't help but cry too. They had their answers, they knew what was going on and they had a plan for a place, but that didn't stop the feeling of how scary it all was.
"You're going to be fine and the baby's going to be fine," Alex said as he wrapped his arms around her.
"You don't know that!"
"No I don't, but I have to say that because I can't lose you, Jo."
Jo could only cry as she gripped on to him and hid her face in the crook of his shoulder. She sobbed for a long time, they both did, until the tears finally dried up. Even then held each other for a while, until Jo pulled back and looked up at him. Although she was still heartbroken and looked as if she would fall apart at any second. She took a deep breath and seemed to pull herself together as she looked more sure and settled.
"Can you go get the girls please?"
"Yeah, but I'm going to call Link and have him bring them up. I don't wanna leave you."
"No, please go get them. It's already been a scary day and I don't want them to walk in on their Mama in the hospital without their Daddy holding them," Jo said pleading with her eyes as she grasped onto his shirt with her hand. "Besides, Meredith and Link can come back in and keep me company."
Alex followed her eyes as she looked behind him to see that they were waiting outside for permission to come in. "Okay."
Alex kissed her, savoring the feeling of her lips and holding his wife before he reluctantly got up and went and got their girls. Jo instantly felt the loss of his arms around her like a sudden chill. She pulled the blanket around her further but didn't say anything to stop him from leaving. Before he left, he looked back at her and Jo managed to smile at him.
He took a deep breath, not waiting to go. Thoughts of what could happen while he was gone filled her mind, but Jo knew the girls should have him with them when they saw her in the hospital bed for the first time. So she watched him go and tried to hold it together until Link and Meredith came into the room.
