There are probably taxi drivers who have covered the dozen or so blocks between Foggy Bottom and Dupont Circle faster than the one carrying Andrew Mosley on Sept. 22, but not many.
When his pregnant wife, Erin, called to say that her water had broken, Andrew sprang from the meeting he was in at the State Department, hopped into a cab and ordered the driver to step on it. Once at Erin’s office, he pulled her car from the garage, then sped with her toward Washington Hospital Center.
At the same time, nearly three-dozen medical professionals were starting to converge at the nearby Children’s National Medical Center. As I described in Wednesday’s column, the Mosleys’ daughter, Addison, had a growth around her neck that doctors feared would interfere with her breathing. A team of more than 30 doctors and nurses planned to partially deliver Addison — a technique called an EXIT procedure — and then help her breathe before delivering her fully.
But Addison had decided to arrive about a month early. Erin remembers thinking, “We don’t even have a name picked out!”
Erin met her obstetricians, David Downing and Melissa Fries, at Washington Hospital Center, then was wheeled to Children’s through a tunnel connecting the two hospitals (actually, the parking garage).
Shawn Safford was the fetal surgeon overseeing Addison. Although the object of a typical birth is to deliver the child as quickly as possible, that isn’t the case with the EXIT procedure. Erin was sedated, and an incision was made in her abdomen. With the umbilical cord still attached, Addison’s head and shoulders were eased out and a baby-size intubation tube was inserted down her throat.
So far so good, but as doctors monitored Addison, they saw that she wasn’t getting the oxygen. They quickly changed plans, performing a tracheostomy.
Why didn’t the intubation work? “I don’t think any of us know for sure,” said Mary Donofrio, a cardiologist who heads the complex fetal delivery team at Children’s. The tumor could have been pushing on Addison’s windpipe, displacing the tube. Anesthesiologists used something called an LMA mask to give Addison oxygen as an airway was made in her trachea.
In the final analysis, the EXIT procedure did buy time, Dr. Donofrio said. “Certainly we would have wasted a lot of time putting a tube in without EXIT and then struggling to see it wasn’t working.”
Addison, now 11 weeks old, experienced some bleeding in her brain — neurologists are keeping an eye on that — but she appears to be responding well, moving her limbs, moving her eyes, tracking visitors to her room in the neonatal intensive care unit from amid a profusion of pink blankets.
Surgeons have started to eliminate the mass of around her neck, a condition known as lymphangioma. It happens when lymphatic fluid pools in one place, rather then being flushed through the body. Some of the pockets of lymph are injected with a solution and then drained. Others will be surgically removed. Addison will not be a stranger to the operating room.
(Why did Addison come early? While they’re in the womb, babies sip at the amniotic fluid. Doctors hypothesize that the growth was interfering with Addison’s mouth, making it difficult for her to swallow. The fluid built up, and Erin’s water broke.)
With so many ups and downs concentrated into the first few weeks of their first child’s life, Erin and Andrew are undergoing a crash course in parenthood.
“We just bought an anatomy and physiology textbook,” Erin joked recently as Addison slept nearby. They can’t wait to show her the world outside of Children’s Hospital.
Said Andrew: “There are angels working on Michigan Avenue. She wouldn’t be here if it wasn’t for the doctors here.”
The next stop for Addison? Soon, hopefully, the family’s home in Silver Spring.
“It would be a wonderful Christmas present,” Andrew said.
Addison has been lucky. Not only did she have the resources of Children’s to help bring her into the world, her parents have insurance.
That’s not the case with everyone treated at Children’s. That’s why I invite you to make a tax-deductible contribution. Send a check or money order (payable to Children’s Hospital) to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390. To donate online, go to washingtonpost.com/childrenshospital. Contributions help pay the bills of poor children.