I remember the first time I ever heard of HELLP syndrome was as a PA student. I was on a surgery rotation and during routine pre-operative questioning, I asked a patient why she was on dialysis for kidney disease. She replied, “have you ever heard of HELLP syndrome?” Up until that point, I had never heard of it. Fast forward 5 years later, I was pregnant with my first child. I was a fit and healthy 27 year old, with no health conditions and a normal BMI. My son’s AFP levels were very high, and the team could not figure out why. We had extensive testing done that all came back normal. At week 17, I received a call from my OB. They wanted me to start aspirin due to being classified as a “high risk pregnancy”. A high risk pregnancy?! I could not grasp the concept. I was young and healthy, with no pre-existing medical conditions. I started the aspirin right away, not knowing this addition may have ended up saving my baby’s life. Fast forward to week 32, where my son’s growth had slowed down significantly. We were going for growth scans and NSTs. At NO POINT IN TIME was my blood pressure high or was protein present in my urine. I kept having nosebleeds. I brushed it off, because I have always tended to get nose bleeds in dry weather. One day at work (I work as a hospitalist PA-C in a small community hospital) my nose started bleeding during my shift. A physician colleague asked me to sit down and said “I am getting someone to check your blood pressure”. In my head I thought — I am on aspirin and the air is dry, maybe that is why my nose is bleeding so easily. My blood pressure was NORMAL (but I am very thankful for that physician for being so genuine and caring). Over the last 3 weeks of my pregnancy, I developed severe facial swelling which I ignored as “part of pregnancy”. Skip to week 37. I woke up after my cousin’s first birthday party feeling ill. Maybe I ate too much pizza and had indigestion? I laid on the couch all day. I felt like I had the flu. Towards the afternoon, I started feeling pain in my stomach. At that point my husband came home from work. I just had a very uneasy feeling. I then started developing pain in my right upper quadrant. It felt like someone had taken a vice and wrapped it around me, squeezing tighter and tighter. Then I felt a sensation of fire and burning under the right side of my ribs. I checked my blood pressure and it was fine. I felt reassured with a normal blood pressure that this was heart burn and I needed to relax. At this point I told my husband I wanted to go lay down. I am thankful to God every day that he said “You have a baby inside of you and that is not normal. Call your doctor.” When I called the on-call physician, I told her this hurt worse than when my appendix ruptured. She asked me to come in right away. The pain continued to worsen as we drove an hour to the hospital (rookie mistake, we did not even have a car seat installed in the vehicle yet!). My blood work showed my liver tests were high. My platelets were dropping, and my hemoglobin was beginning to drop. I STILL DID NOT HAVE HIGH BLOOD PRESSURE OR PROTEINURIA! They started me on magnesium and called the MFM specialist. I will never forget when the doctor told my husband you are having this baby tonight (the stunned look on his face even though I was already 37 weeks along)! They tried inducing me, but my condition deteriorated quickly. The anesthesiologist told me he had never seen platelets drop so rapidly. The team advised an immediate C-section. I don’t remember much at this point. I don’t remember holding my son for the first time. He was born healthy and I am one of they lucky ones. They told me my liver was swollen and that the reason my memory of his birth was so poor was likely due to brain swelling and the magnesium. The symptoms of HELLP can at times be so vague. I am a medical provider and I ignored the signs. Don’t be afraid to ask questions. Speak up and always be your own advocate!