The strongest memory Cathi Aguilera can recall of the day her daughter was born is hearing the doctor call for blood before she fell into unconsciousness. 

She could not see the team of specialists and nurses rushing in and out of her room nor hear the prayers of her mother as she waited in a hospital parking garage. 

She did not see how gray her baby’s skin looked when she was delivered 11 weeks early. And she did not hear the faint gasp the infant made to let everyone know she was alive. 

Because Aguilera was dying. 

But for the next three months, the new mother clung to life, lying in the COVID-19 intensive care unit (ICU) at Methodist Hospital, comatose and intubated with one machine oxygenating her blood and another doing the work of her failing kidneys.

Aguilera, an elementary school teacher, had been back on the job for two weeks in October when her blood pressure spiked, threatening both mom and baby. 

She was admitted to the hospital three months shy of her January due date. As a diabetic, Aguilera had what’s considered a high-risk pregnancy and her doctor hoped she could last until late November before delivering. 

On Nov. 8, Aguilera started running a fever and had trouble breathing. She thought it might be pneumonia, but when a COVID-19 test came back positive, Aguilera was transferred to the ICU, where more than a dozen others were being treated for serious complications from the virus. 

Aguilera became the unit’s first patient who was expecting a baby. “I was alert. I was talking, joking, laughing with the nurses. We were having a conversation and it was like, no big deal,” Aguilera recalls. 

The next day, she became the first and only woman so far to give birth on the unit. 

A team of doctors and nurses rushes to deliver Cathi Aguilera’s baby prematurely in the COVID-19 ICU unit. Credit: Courtesy / Cathi Aguilera

Aguilera was sitting up in bed, she said, when the ICU nurses began to prepare her for a move to the labor and delivery floor of the hospital. She remembers they were discussing whether Aguilera wanted to have an epidural for labor pains when her eyes began to roll back in her head. 

Her oxygen levels dropped suddenly. Aguilera was no longer breathing, said Dr. Tiffany Satterfield. 

As Aguilera’s obstetrician, Satterfield was called from her office to the ICU to perform an emergency cesarean section and was joined by a small crowd of cardiologists, neonatal intensive care specialists, pulmonologists, and their staff, who worked to connect Aguilera to an extracorporeal membrane oxygenation (ECMO) machine. ECMO oxygenates blood outside the body, allowing the heart and lungs to rest.

Doctors intubated Aguilera to put her on a ventilator. “[Because of] the medicines that we give them, we want that baby out right away afterwards,” Satterfield said. “And because of everything that they were doing to stabilize Cathi as the primary patient, it just took a while for her to be stable enough to do the C-section.

“That was a tense moment.”

As they worked to save Aguilera, the doctors could not be sure the baby would survive.

“Because of the situation, I did not know how that baby was going to come out,” Satterfield said. “And I was amazed when … that baby gasped and I said, ‘Oh my God, she’s alive.’”

Born weighing 3 pounds, 3 ounces on Nov. 9, Raya Linda Aguilera was named for her grandfather Raymond, who had died earlier in the year. 

“It was impressively smooth for how much had to happen, but we were all very, very concerned for Cathi – we all wanted her and the baby to make it,” said Felicia Gomez, a clinical nurse coordinator who has worked on Methodist’s COVID-19 unit since March 2020. 

But Raya entered the world early, in an unlikely place, and rather than being held by her mother, like most babies, she was placed in an incubator so her lungs could develop. 

Aguilera’s mother, Amy Aguilera, saw the infant for the first time four days later. Since then, she has resigned from her job at Uvalde High School to care for her new grandchild, feeding Raya daily during her stay in the hospital and then after taking her home Dec. 29, a healthy, thriving baby already weighing 6 pounds. 

But her own daughter was critically ill. 

“The doctor said, ‘I’m sorry that we don’t call you with good news,’” recalls Amy Aguilera, who checked in with nurses twice a day and kept a notebook of her daughter’s condition and the times she had to be re-intubated due to bleeding or had a tracheostomy tube put in place. 

She leaned on her son, a dialysis nurse, for a better understanding of medical terminology and her daughter’s prognosis. She kept her sisters and other family members up to date with text messages and requested prayers. 

“I would start with [the words] ‘faith over fear’ because they were getting really scared all the time and they would cry a lot,” Aguilera said. 

As her daughter’s condition worsened, she cried, too, but only when her son and others weren’t around. “The minute he’d leave, I would just start crying,” she said.

In mid-December, doctors finally allowed Aguilera to see her daughter prior to a surgical procedure to repair her incision that wasn’t healing. But the muscles in Cathi’s arms and legs had atrophied, and she could barely respond to her mother. 

“So I walked out of there, and I called my sister,” Aguilera said, her voice breaking at the memory. “And I said, ‘She’s not going to make it.’” They began talking about planning a funeral. 

Amy Aguilera shared posters that the NICU nurses made, writing letters of encouragement from Raya Aguilera to her recovering mother, Cathi, who was in the COVID-19 ICU.
Amy Aguilera shares posters with notes of encouragement that the NICU nurses made for Cathi Aguilera, who was in the COVID-19 ICU. Credit: Bria Woods / San Antonio Report

On the COVID-19 unit, the nurses and doctors also worried about their postpartum patient. They gave her daily updates on Raya and put up photos of the baby in the room. But Cathi Aguilera was not improving.

“Cathi and a lot of our patients experience depression,” Gomez, the nurse, said. “I don’t know if it’s linked to COVID or the anxiety or what it is. But Cathi wouldn’t really speak to anybody. She was never showing any signs of happiness on her face. You could tell she was sad and she was scared.

“She was just kind of stepping away from us.”

The care team, trying desperately to help her survive, began to plan a reunion between mother and baby, who by this time was 5 weeks old but still in the incubator. 

“We’ve seen young people die, people die alone,” Gomez said of caring for COVID-19 patients. “So those patients that we see they fight and they get those wins, they do just as much for us.”

With clearance from the infectious disease doctors, Aguilera was wheeled out of the ICU, still attached to the portable ECMO machine and heavily medicated, to meet Raya for the first time. 

“My mom said, ‘Look, Cathi, she’s 5 weeks,’ and I was like, 5 weeks? How did five weeks pass by like that?,” Cathi Aguilera said, remembering her disappointment at the time she had missed.

Too weak to cradle her daughter, Aguilera was frustrated. “I can’t even pick up my hand,” she said.  

Though Cathi’s eyes lit up at seeing her baby, her mother knew she was suffering. 

“I said, ‘I know that you’ve been really, really strong, but we’re at peace and we want you to be at peace – you can let go,’” Amy Aguilera said. “[Raya] is going to be taken care of.”

But Cathi, still intubated and unable to speak, shook her head no and clenched her fist. “I said, ‘You’re going to fight?,’ and she just nodded,” Amy Aguilera said. “Then we’re going to fight together.”

The moment Cathi Aguilera could hold Raya would finally come a week later. 

“She’s really what kept me going,” she said. “There were times I was like, really tired,” and she wanted to give up. She was intubated five times in all and remained on ECMO for three months. 

On Feb. 21, days after a record winter storm and nearly four months since a storm of a different kind nearly took the life of her and her child, Aguilera was well enough to leave the hospital.

“This is the little rainbow that we got,” Amy Aguilera said, admiring her granddaughter.

Five-month-old Raya Linda Aguilera weighed only three pounds when she was delivered by a team of doctors and nurses in the COVID-19 ICU unit of Methodist Hospital. She wears a onesie that says, "I'm the rainbow after the storm."
Five-month-old Raya Linda Aguilera weighed only 3 pounds when she was delivered by a team of doctors and nurses in the COVID-19 ICU unit of Methodist Hospital. She wears a onesie that says, “I’m the rainbow after the storm.” Credit: Bria Woods / San Antonio Report

At Cathi Aguilera’s tidy house on the far West Side, a “welcome home” banner is hung in the dining room and Raya’s bedroom is painted pink and stacked with boxes of diapers and gifts from well-wishers. In the living room, Raya nestles in a rattan papasan chair. Having grown so accustomed to noise during her time in the hospital, she sleeps undisturbed near the television.

Though still on supplemental oxygen, undergoing dialysis treatment three times a week and regular physical therapy to regain her strength, Aguilera said she’s now able to care for herself and help her mother feed and care for Raya. On Wednesday, she baked cookies. But with both women unable to work due to Cathi and Raya’s health care needs, their future is uncertain.

“We forget as moms how strong we are,” Satterfield said, who is in awe of how Aguilera overcame so much for the sake of her child.

“This was an honest-to-God miracle, the fact that she and her daughter left that hospital,” she said. 

“Those are the stories that everybody wants out of COVID, that aren’t very common, that we all want, and that’s why we push to the breaking point of the system. Her recovery [was] nothing short of a miracle.”

Shari Biediger

Shari Biediger is the development beat reporter for the San Antonio Report.