All of Hope's heart belongs to her baby, the child she never thought she could have.
She has always been in the background on Mother's Day, celebrating others. Now it is her turn. She has to say it over and over, to make it even more real.
I am a mother. I am so grateful for Annabelle. I am a mother!
On Jan. 15, Hope Senkeleski gave birth to her 5-pound, 11-ounce daughter. Except for an emergency C-section, it was a smooth pregnancy, carefully monitored by a team of medical professionals.
They had good reason to be cautious. Hope is a heart-transplant patient.
With Annabelle's arrival, Hope became Tampa General Hospital's first heart recipient to give birth. Nationally, she is only one of about 60 such patients to get pregnant, and not all of those resulted in live births.
A mother's love for her infant is almost indescribable. For obvious reasons, Hope has a hard time finding the words to express her gratitude.
“Absolute pure, overwhelming joy,” says Hope, 35, nuzzling pink-cheeked Annabelle Paige. “Such an incredible blessing. I am so, so grateful.”
Life was good and full of promise in spring 2002.
Hope and her longtime sweetheart, Bobby, both 24, had been married a year. A 1995 graduate of St. Petersburg High, she juggled a full-time job in a doctor's office and was studying part time for a business degree at the University of South Florida. He worked at Lowe's. The St. Petersburg couple began talking about starting a family.
Her downward spiral came out of nowhere.
Hope experienced flulike symptoms during a late-May vacation celebrating the 50th anniversary of Bobby's grandparents. After returning home, her primary physician diagnosed a bladder infection. When that medication didn't make her feel any better, she was scheduled for a follow-up appointment with a gastroenterologist.
She never made it.
The night before, Bobby rushed Hope to the emergency room after she began vomiting violently. They knew something was terribly wrong.
This time, doctors said it was her gall bladder. They removed it three days later. Bobby kissed his wife in the recovery room and marveled at how good she looked after surgery. Then he went into the waiting room to tell family members she was doing well.
Within minutes, a flurry of doctors and nurses rushed to Hope's room. She had gone into cardiac arrest and needed immediate attention.
“It was so scary,” Bobby says. “I was just 24 years old and I thought my wife was going to die. Nothing can prepare you for something like that.”
They brought Hope back, but tests confirmed she had a mildly enlarged heart. Though her father and uncle both died of congestive heart failure, she had no reason to suspect that hers, too, was diseased.
“It's called the silent killer for women because our symptoms are different,” she says. “It can sneak up on you with no warning.”
She remained in the hospital for several weeks. She was so sick that she doesn't remember much from that time. Bobby kept his game face for his wife, dividing his time between the hospital and work. We'll get through this, he assured her, though deep down, he was so frightened.
Then the cardiologist told Hope: There's nothing more I can do for you. I'm going to refer you to a heart-transplant specialist.
She and Bobby didn't see that coming.
“It was like getting whopped on the side of the head,” she recalls.
Because her condition was so grave, Hope got an expedited evaluation. She was given a 1-A status, considered “highest urgency” for a donor heart. They had no idea if an organ would become available in that short window of time. Like they had so many times before, the couple leaned on their Christian faith for strength. Hope and Bobby held hands and prayed, putting their future in God's hands.
Thy will be done. Whatever you decide, we will be OK with it.
Just 30 hours later, they got their answer. A match was found.
Two weeks later, Hope went home with the gift of a new life.
For obvious reasons, heart-transplant patients aren't supposed to get pregnant.
The anti-rejection and the immunosuppressant drugs can have an impact on the fetus. Stress can put undue pressure on the donated organ. And Hope's case was further complicated by her dependency on insulin to keep her Type 1 diabetes in check.
The couple abandoned their dream of becoming parents and settled on being “the cool aunt and uncle.” Still, it hurt.
“No matter how much you dote on your nieces and nephews,” Hope says, “you know that at the end of the day, they go home to their mommies and daddies.”
Even with insurance, their medical bills were daunting. Out-of-pocket expenses for prescription drugs run about $300 a month. They moved to Wauchula, where Bobby got a higher-paying job with the phosphate mines. Hope finished her bachelor's degree at USF in 2008, becoming the first person in her family to graduate from college.
On Memorial Day weekend 2010 while on vacation, Hope felt queasy again. Only this time, it wasn't her heart.
She told Bobby she had some news for him.
“Honey, I think I'm pregnant,” she said gently. Her shocked husband, who already worried enough for the both of them, slowly lowered himself on the couch. Questions raced through his head: Why didn't their birth control work? How will her drugs affect the fetus? Worse, will the pregnancy endanger Hope's heart?
He wanted to see the results for himself. He went to the store and bought three pregnancy kits. The first was inconclusive; the other two confirmed the news.
“I had mixed feelings,” he admits. “Of course, I wanted to jump for joy and tell the world. On the other hand, the unknown really, really scared me. I almost lost Hope before, and I didn't want to go through that again.”
The next week, there was no mistaking the reaction of Hope's transplant cardiologist, Debbie Rinde-Hoffman.
“I almost had a heart attack,” says Rinde-Hoffman, medical director of TGH's heart transplant program. In her 22 years as a physician, she'd never had a case like this. But this was her patient, so she embraced the challenge. Her goal was to keep Hope stable and healthy without compromising the baby.
She lowered doses of the medication and did regular biopsies of the heart to make sure it wasn't in danger of rejection. Other doctors monitored the baby and Hope's diabetes. The couple had to make weekly trips to Tampa from Wauchula to keep all the appointments.
Hope also relied on the Philadelphia-based National Transplantation Pregnancy Registry for research and support. Since 1991, the voluntary registry, which operates out of the Gift of Life Instatute, has tracked and studied the outcome of more than 2,000 female and male organ recipients reporting more than 3,000 pregnancies. It is funded by major pharmaceutical companies.
Though heart patients only make up a small percentage of the participants, “they actually fare better than other organ recipients,” says Lisa Coscia, a registry coordinator. “Their babies are born closer to term, and their birth weight isn't as low.”
Hope's outcome shows that with careful medical attention, there's no reason why a transplant patient can't have a successful pregnancy.
“That's the ultimate goal of a transplant, to restore good health and a normal life for the recipient,” Coscia says. “Every case is individual, but we're seeing more success stories like Hope's.”
Hope had an epidural, so she was awake for Annabelle's rushed arrival by C-section. Laying her eyes on her daughter for the first time took her breath away. This much-anticipated baby was the most beautiful sight Hope had ever seen. She was pink with a round little face and a perfectly shaped head.
I am a mother. Thank you, God.
For Rinde-Hoffman, seeing a healthy Annabelle in the flesh was exhilarating as well.
“No question, this was the highlight of my career,” she says.
Some 18,000 people are waiting for a life-saving organ transplant. Of that number, some 3,500 need a new heart.
Without a donor, Hope knows she wouldn't be here. Annabelle wouldn't be here. She is so grateful to individuals who make the decision in advance, and to family members who make it at their darkest hour, to give that gift of life.
“Not only does an organ donation benefit the recipient, you have no idea of its ripple effect, from family to friends to friends of friends,” says Betsy Edwards of LifeLink of Florida, a nonprofit organ-recovery agency. “And in Hope's case, this beautiful baby is here because of it.”
By nature, Hope is a positive person with a sunny disposition. The average lifespan of a donated heart — 10 to 15 years — doesn't faze her in the least. She knows of cases where hearts survive 25, 30 years.
“God didn't get me this far to not be around to see her graduate from high school, graduate from college and get married,” she says. Their journey is just begun, and Hope believes it will be a long and happy one for her, Bobby and Annabelle.
As much as they would love more children, the couple know not to push their luck. There won't be any more accidental pregnancies. Hope had her tubes tied right after the baby was born.
Like most parents, they have silly little names for their new arrival. Snugglebug, or Bug for short, is their favorite.
But perhaps the best name of all is engraved on a tiny gold bracelet on Annabelle's wrist, given by her late aunt: