Friday, April 8, 2011
News from the NICU
My baby's nurse that day was such a grouch! She saw me crying in my chair and told me all kinds of super-unhelpful, non-uplifting things--"Look how his saturation levels are dropping (even though I'd been told by several nurse practitioners that the pulse oximeter is notoriously unreliable when the baby's moving, or the plug isn't on a flat surface).... You need the blow-by (oxygen mask). You know, most babies here have the nasal cannula for oxygen. None of this business with the head box or blow-by. No need to mess with those things." When I told her the head box was mostly for humidity because his nose gets really stuffy, and that they took him off the nasal cannula days ago because his oxygen saturations were consistently too high with it on, she said, "Oh, really?" sarcastically, and shook her head... And here's more from our own Nurse Ratched: "He only nursed for a few minutes, huh? So we probably don't even need to weigh him again" (again, voice dripping with contempt, or sarcasm, or something negative). Then she asked if we could finish his feed with the tube, which is when I basically begged to have the tube taken out. She went and asked the nurse practitioner for permission, and then came back and said, "You want the tube out? Here you go," and roughly wiped his little face with adhesive remover while tugging on the tape. She had been told by the nurse practitioner to wait till he'd digested his last feeding so he wouldn't spit up, but she did it immediately. I SWEAR the feeling I got from her was total spite. Then, as I was sitting in my chair crying after a disappointing discussion with the nurse practitioner, she said, "You know, you COULD sign him out of here AMA if you're so anxious to get him home. But then the hospital would sue you and come after you for all the money you owe them for his stay here. I can guarantee your insurance wouldn't cover anything if you did that. But, it's an option you might not have thought of." I heard her complain about one of the babies in her charge to one of the other nurses. That just cemented in my mind that she was either having a REALLY bad day, or she should maybe look into another profession. She is NOT my favorite nurse, and I'm praying she's not on today....
So, anyway, during and after his last feeding of the day before I came home, his oxygen saturations dropped to the high 50s a number of times, he stopped breathing at least 5 times (apnea), and he had 2 "A & Bs"--oxygen sats dropped AND heart rate dropped to the low 70s. SCARY! I had requested that he be allowed to sleep as long as he wanted between feedings during the night instead of being woken up every 3 hours (who wants to start THAT schedule before he comes home, right? And also, then he could be well-rested for daytime feedings), and the (nice, sweet, compassionate) night nurse said the longest they'd let him go would be 5 hours between feedings, but she'd let him go that long. She told me he hadn't had many wet diapers, that he'd lost weight since yesterday, that he'd needed oxygen through the night before as he slept, and that those things combined with last night's "episodes" were his signals that he was still too weak for oral feedings (all of this was said with empathy and kindness, I should add. She apologized for bringing up that possibility, and said she was just trying to prepare me in case they needed to place the NG tube again.). She said she'd try her best with the bottle-feeding on demand through the night.
I left the hospital scared and sobered and so, so upset. Another month of leaving the big kids to go practice feeding the littlest one loomed ahead, and I felt completely deflated.
Fast-forward to this morning, when the phone rang. The caller ID showed it was the hospital, and my stomach lurched. What bad news were they calling with? It was today's nurse practitioner. "Mrs. McKrola, let's get this boy out of here." WHAT?!?! Not even CLOSE to what I was expecting to hear! I was too shocked to ask what brought about this drastic change of heart. She told me to bring his car seat today to see if he'd pass the car seat test, and then we could consider discharging him sometime tomorrow (IF he does well today)! She said they'd teach me how to place the NG tube and check for placement, and he could come home with oxygen, too (for sleeping and eating). I told her I wasn't expecting any of this, considering what a tough time we'd had yesterday. She said those were all feeding-related episodes, and since I'll be with him as he eats, it would be fine.
Isn't it incredible how quickly things can change (it's quite possible that my constant praying all day yesterday had something to do with it, don't you think?)? I'm off to the hospital to hang out with the little dude. I have so many questions. The answers don't really matter too much, as long as I can bring my boy home, but I'm still curious.... Does this mean he did great during the nighttime and morning feedings? Did they finally get to chat with their lawyers to see what their liability would be, and what waivers they needed me to sign?
PS: I just want to add that I'm not a total crazy person and won't insist on bringing him home if he doesn't seem ready.
Thursday, April 7, 2011
NICU black hole
The reason he was admitted to the NICU in the first place was for his suspected heart defect. They've ruled that out (yippee!!!), so what's the deal? Why is he still in there??? Devin and I asked the charge nurse practitioner a couple nights ago why he was still there, since he seems like he may just be the healthiest baby in there, even with his extra chromosome ("genetic enhancement"). She agreed with that, but said he needs to be able to take 100% of his feedings orally before they'll remove the NG tube (the feeding tube in his nose) and send him home. I've tried nursing him about 4-5 times a day for the past few days (he's on an every-3-hours schedule), and he IS really sleepy and hard to wake up before and during, but he's so good at it once he gets going.
Apparently the only reason he's got the NG tube is that babies with Down syndrome have low tone and can't handle nursing or bottle-feeding very well--it tires the poor little things out and they'll develop an oral aversion if they're "forced" to keep trying. Huh! Well, this baby with Down syndrome has a very powerful suck (yowch!), and he's got the suck/breathe/swallow pattern down pretty dang well. It's SO INCREDIBLY FRUSTRATING being told that he can't do something when he's proven time and time again that he can! They automatically give him a tube feeding unless I'm there and ask them to please let me try nursing him first, or Devin's with me and tells them to step away from the feed tube and give him a chance to nurse or take a bottle. If he wakes up on his own, they feed him a bottle (which is actually fine with me--even though I'm stubbornly dead-set on nursing him--because he's awesome at downing a bottle, and if that gets him out of there faster, I'm all for it, even if we have to learn how to nurse once he's home). It IS true, from what I've heard and read from other moms of babies with DS, that they do tend to be sleepier, in general, than other babies. So, it might take a little more effort to get him to wake up for a feeding, but it's worth the effort to try. Sticking a syringe of milk in a feeding pump and pushing a button to get it going is a heckuva lot easier than working with him for almost an hour to get and keep him awake and help him take a whole bottle. It's all about convenience, in my opinion.
So, here's the analysis of the black hole that is our NICU stay:
--goal is that baby takes 100% of feeds orally --baby is automatically given tube feed unless he a) wakes up on his own at the exact time of his feeding, b) Devin or I aren't there, or c) takes too long with nursing or taking a bottle when we are there.
Do you see how mind-blowingly ridiculous this is??? They want him to eat, but they hardly give him a chance to try! If we were to wait for him to take all of his feedings orally using their method, he could be in there for over a month! One of the nurse practitioners told us that they could send him home with the NG tube--that they'd show us how to insert one and check for correct placement--so he could go home sooner. And the very next day, a different nurse practitioner told us she was sorry, that that was something they couldn't do. ARRGH! I just know that if I could bring this boy home, we could work all the livelong day on nursing, since I wouldn't be wasting hours driving to and from the hospital twice a day and trying to split my time between home and the &$*#@ hospital, and he'd rock it! The NG tube is completely unnecessary!
My friend Lexi suggested that I get a pediatrician to evaluate him. I wasn't sure how to go about finding one that would do that, so last night I called my regular pediatrician and explained what was going on and asked him for any advice or names of docs who could go check our baby out. When I was done telling him the whole tale, he was almost as irritated as I've been, and said he'd call the NICU's attending physician and see if we can't get our baby busted out of his jail. So, this morning I called the NICU first and asked if my doc had talked to the attending yet, and he had, but they wouldn't tell me what had been decided. Then I called my doc, who told me he'd reassured the attending that he'd be willing to monitor our baby for weight gain weekly if needed, and even assist in managing the NG tube, if necessary.
So, now we wait. The attending physician still needed to do rounds with the NICU staff, where they discuss all the babies' issues, so I won't know till later what's been decided. Meanwhile, I'm going to assume he's coming home TODAY, and bringing a car seat to the hospital with me. He still needs to pass the "car seat test" (he has to show he can hold his head up while seated in it, without his head falling forward, potentially blocking his airway). Now that I think of it, this may actually be a challenge.... Because of his low muscle tone (courtesy of the Down syndrome), he's really, really "floppy" like a rag doll. So, this is what I'll fervently be praying for today--that the attending physician signs his discharge papers, and our boy passes the car seat test. Wish us luck!
Sunday, April 3, 2011
Awesome news!
Thursday, March 31, 2011
New baby update--skipping birth story for now....
Thursday, March 24, 2011
My version of events
I'd half-heartedly tried to get him to flip during the past couple weeks using various methods I found online, but since they mostly involved hanging out partially upside-down, so that my lungs and stomach were squished by fluid and baby, I was less than diligent about continuing any of them. I found a couple videos online of an ECV being done, and the women having the procedure seemed like it was no big deal, like this one: http://www.youtube.com/watch?v=6AM6wDwTjmc. She seems so placid--no grimacing, flinching, crying out in agony. So I thought, after watching her, that maybe it'd be a little like a rigorous massage, and I wasn't all that nervous going in today.
Yeah, it's not like that. That woman's either doped up on painkillers, or she's a psycho who enjoys pain, or the doctor's just not pushing very hard. I should've known something was up when almost every medical staff member who came into my room told me to relax about it. Well, I WAS relaxed, till they all started talking like that. So here's how my version went down:
First of all, I had Devin and Christian (the 3-year-old) with me. Christian should've stayed with someone, but I didn't realize it'd take as long as it did. I was thinking 2 hours, tops, and he's come with me to lots of appointments and done great, especially since I started bringing the Backpack of Fun with me. Still, even though Devin was there for emotional support for me, he wound up keeping Christian entertained a lot of the time. It took over 3 1/2 hours. Take it from me, if you ever have to have a version done, find someone for the little kid(s) to hang out with. I wound up squeezing a nurse's hand instead of Devin's, since he was keeping Christian distracted. Hers was tons daintier, too, and I may actually have inflicted a little damage....
I'd been thinking it'd go something like this: bare belly, ultrasound to check position, shove baby up and over, monitor his heart rate, go grab a burger at Red Robin. Nope. Not exactly. When we got there, I was asked to strip and don an airy hospital gown. Anytime one of those gowns is involved, you know you're in for some good times. Then they checked me in as an inpatient, got an IV going, and took some blood (all of this in case something scary happened and baby K-sound needed to be taken by emergency). This was starting to feel like a little bit bigger deal than I'd anticipated. They explained the procedure, I signed some consent forms, and a resident came and checked baby's position with an ultrasound, and a nursing student came and watched everything and listened to my lungs and checked my reflexes and junk. When you go to a teaching hospital, you get lots more involvement and observing from seemingly random people than you would elsewhere. Fine by me. I'm no prude.
I signed some more forms, and then waited. For quite a while, actually. I got to listen to and watch baby's heartbeat, and watch the strength of contractions, on the monitor next to me. Devin took Christian for a little walk because I was afraid he was getting antsy (Christian, not necessarily Devin), and I wanted to avoid a meltdown in the middle of the procedure (from either one of them). As they were roaming, I got some Fentanyl (a painkiller similar to, but more potent than, morphine. AH-HA! I figured that explained the psycho lady's calmness during her version. I asked for the smallest dose, because I'm particularly sensitive to pain killers) in my IV, and a shot of terbutaline in the arm (to relax the uterus so it wouldn't contract while they were smashing on it).
Just about the time the Fentanyl took effect (which I knew had happened as soon as I felt like I was floating and nothing was real anymore) an audience of scrubs-clad people filed into the room. A nurse, an ER doc whose aspiration is apparently obstetrics, a resident, a fellow, a nursing student, and an OB. One of them did another ultrasound, and they discussed things amongst themselves, and I'm pretty sure I cracked a couple jokes, because that's what I do when I'm hopped up on stuff, or when I'm nervous or in pain. I still felt nervous, too, in spite of the drugs. But it was a good nervous, a happy nervous, and a funny nervous.
So then when they figured out their plan of action--which included lubing my belly up with gel--they told me they were going to start shoving on me so hard I'd feel like my skin was tearing and probably all my ligaments and other abdominal tissues, too. Actually, they should have told me that so I'd be ready for what was coming, but all they said was that I'd be feeling some pressure and some pain. Quite frankly, it hurt like the fiery depths of hell. These 2 female doctors were small, and yet surprisingly strong (is there a strength-training program specifically designed for physicians, I wonder?). They put their hands around the baby and pushed till their arms shook from the effort, never slackening or releasing, so baby wouldn't slip out of their grasp. Apparently, I did super awesome--I know because that's what they told me. I don't remember swearing or kicking anyone or even drawing my breath in sharply. I know I cracked a couple more jokes, though, very quietly and with my eyes closed, so that was Devin's clue that I was in mega-pain. Oh, I should probably write an "I'm sorry" note to the sweet nurse who offered to let me squeeze her hand. As I said, she was dainty, and I squeezed hard. All of the effort I put into keeping my tummy relaxed I diverted into squeezing her poor little hand.
So after they quit pushing and I quit seeing stars, they did another ultrasound to check the little mister's position. After all that, his head was smack-dab in the middle of my belly. What the...? They all seemed very amused by his antics, but me, I knew this only meant they'd have to shove and brutalize some more. Apparently he was all in a ball. So they decided they'd try turning him the other direction, but no matter how hard they shoved that way, he wouldn't budge. Back to the drawing board... OK, let's try one more time turning him the first way, and this time, we'll give it all we've got. What? You mean you've got more brute force in reserve??? Alright, I guess let's just go for it. (They actually asked me if I was ready. I don't remember saying yes.) So again they pushed, again I focused on the hand-squeezing and tummy relaxing, and again I saw stars all around. I don't think I cracked any jokes this time, though. I just focused on those stars and the hand-crushing. They told me over and over again how great I was doing, and I wanted to ask how they figured that--do other women make primal, guttural noises or scream or something? And if they do, do the nurses tell them they're doing crappy and to get a grip? Maybe they'll use me as an example to the loud, wussier women who come after me--"I don't see why you're making such a fuss. This lady was in here the other day for the same thing, and all she did was close her eyes and crack jokes."
So, eventually, they felt like he was head-down, and another peek with the ultrasound machine confirmed he was. Hooray! So they monitored his heart rate for about 30 minutes (with me sitting up to encourage him to stay head-down) to make sure he'd tolerated it all well, and the Fentanyl wore off, and my round ligaments hurt like a mother for about 15-20 minutes--which they would, I suppose, after being torn to shreds like they were. And then, when they were satisfied he was doing OK, I got to ditch the gown, get dressed, and be released to Red Robin for that burger I'd been craving (oh, I forgot to mention I'd been fasting since 8:00 the night before). So far, no bruises have appeared. If I develop some gnarly ones, I'll be sure and post a picture! Ha! So, actually, this procedure (for anyone who might one day be facing one) was extremely uncomfortable and even hellishly painful, but in all, the suffering only lasted a total of about 15 minutes. Totally doable!
The next step is a non-stress test on Monday (like I've been having for weeks), and a routine visit next Thursday with my high-risk OB (followed by another NST), and then an induction is scheduled for 7:30 am Monday, April 4th! That's 11 days from now! I need to figure out what to do with my other kids. And buy a car seat. And all kinds of other stuff I've been putting off.... I'm just gonna hope and pray this little boy keeps his head down till then (they told me there's only a 3-5% chance he'll revert to the breech position. He does like to defy odds, but maybe this time....)
Saturday, March 12, 2011
The flip side of the coin
I just got home from a funeral. It was my friend's little boy who passed away. He was almost 6 months old, and he died in his sleep, in the middle of the day, after she put him down for a nap. He had fought valiantly through 2 months in the NICU after being born 10 weeks early at 2 lbs. 12 oz., and had been home almost 4 months. As a mom, I can't think of anything more devastating than having to bury one of my children. When the 4 pallbearers walked into the chapel carrying that little miniature coffin, it was so heart-rending--it literally took my breath away for a few seconds and made me weak in the knees and my body tremble. And the poor mommy looked like she hadn't stopped grieving and crying since Monday, when he passed away. (And I wanted so desperately to take all that aching pain away.) We came home after the funeral, and of course, the family went on to the cemetery to lay his little body in the grave. I can only imagine the heartbreak of this poor mommy as her little boy's body, which she'd held and kissed and rocked and loved for such a short time--and yet so fiercely because he was almost taken from her right after his birth and she wasn't going to let him go that easily--is separated from her for the rest of this life. I'm sure that for now at least, even the knowledge that she'll get to hold him again is minimal comfort when her arms ache for his warm little body to snuggle right now, and tomorrow, and next week.
Last week, one of my good friends rushed from her home in Idaho to central Oregon to be with her family as her brother died in a hospice room. He was about 30 years old, and left behind 3 little kids and a sweet wife. He'd had melanoma a few years ago, which had gone into remission, only to resurface as a tumor somewhere else, and that cancer spread so horribly rapidly and took over his whole body in just a few months. His suffering was terrible, and he's now thankfully been released from all his pain, but still--his wife is now a widow, and his little kids have no daddy.
Why do I share these 2 terribly gut-wrenching stories? Because I know that what I'm dealing with and fretting over with this baby I'm carrying really is so very, very small in comparison to so many tougher things in life, and I've lost perspective. It's like crying over a hangnail when the person next to you has no arm. Or something (this makes sense in my head). And the hangnail hurts and you don't have nail clippers to cut it off, and you obsess about it and it snags on your clothes and other things, and it's always right there, driving you crazy no matter what else you happen to be doing. But, still, it's only just a hangnail, and that person next to you has no arm. And you look at them and realize that even with your painful hangnail, you can do lots of things like play with your kids and fold laundry and make the bed. It might be annoying, but you have both your hands to do the things you need and want to do. And that poor person next to you with no arm is, well, basically just much worse off than you are. So you're maybe crying about the stupid hangnail bugging you (haven't you ever cried about a hangnail? Let's pretend you have), and through your tears you look over and glimpse that person missing an arm and realize how foolish your tears are over something so insignificant. And you remember your blessings and feel so grateful.... But, still, maybe when you haven't seen that armless person in a while, you forget and start feeling sorry for yourself again about your dang hangnail.... But hopefully you're smarter than that and remember that your life is so good and you have a great family and wonderful friends and access to wonderful truths contained in scriptures, and a personal relationship with a God who really does love you and won't leave you alone, ever, (and this is where the hangnail analogy falls flat on its face because it's so shallow), and because of all these wonderful parts of your life, you can have the strength to make it through whatever comes your way. Not to mention that you really don't have to look very far to see someone whose life sucks a WHOLE lot worse than yours does. That's all a part of perspective, and I'm so glad Lexi reminded me of it.
Friday, March 11, 2011
I feel a gloomy, self-pitying post coming on....
The reason this feels like such a big deal to me is that, really, this baby so far has been not a whole lot more to me but 5 months of constant puking, overlapped by 5 months of worrying about diagnoses and bad news and more bad news and doctor visits and tests and more doctor visits and then more bad news and pain everywhere and dealing with insurance companies and worrying some more about surgery and wires and isolettes and when and where do we start the clubfoot treatment if he's at this hospital for his heart surgery, instead of the other, free hospital where I had treatment set up, and oh yeah, he's breech and I may need a c-section (which isn't such a big deal, but come on--we've got so much other crap going on with this kid, couldn't we at least skip one surgical procedure?). And my mind always, ALWAYS flashes forward to what other issues will crop up because of the Down syndrome once he's here. Feeding, breathing, gross motor, fine motor, immune deficiencies, bowel problems, leukemia? In contrast, what have I worried about with my other babies? What colors to do their room in? How they'd fit in with the other kids? How overdue they'd be? And I know that this baby will be a huge blessing in some miraculous, beautiful way that I just don't understand right now, because lots of people have told me that it would be that way, and I trust them. But I don't get it yet. So far, he's just thumps and bumps in my belly and a blurry image on a screen and a heartbeat I get to hear at least twice a week and a diagnosis or two and several pending procedures. Oh, and looming, friggin' gigantic hospital and doctor bills.
The suckiest part of all this worrying (well, there are a couple suckiest parts) is that I'm so wrapped up in worrying about stuff I can't change that I obsess and research and forget how to enjoy great stuff around me. I have 2 sisters-in-law who are expecting babies a few months after my baby's due. That should be so fun and exciting, right? In fact, we were pregnant together when I was expecting Christian, and it was so fun. We took belly pictures together and stuff. But what do I do this time? I cry when I'm around them and they're talking about baby stuff. I picture their babies next to mine in a year or so, and their babies are doing all the stuff my baby can't do because of his delays. And my baby will be getting all kinds of awesome therapy from the 3 types of Early Intervention therapists who'll come to our house and work with him and teach me how to work with him. And he'll still be way behind, even with all of his hard work and their hard work and mine. And their babies will just learn that stuff, because they'll try it and they're at the right developmental age for it. And so I'm a horrible, horrible sister-in-law who can't be happy for her family members who are excited about adding to their own families. They're talking about accessories they're buying and stuff they're making and diapers they're stockpiling, and I haven't even bought a single thing or pulled out a single onesie from the storage bin, all because I've been so afraid since hearing those 2 words in the doctor's office--Down syndrome--and making the terribly ill-conceived decision to research stillbirth rates.
I don't like being stuck in this gloomy, self-pitying place. I want to be excited that there's a new little spirit joining our family who'll bring us joy I can't conceive of. And sometimes I actually am. I get glimpses of peace and comfort, but only when I allow myself to, when I shut off the worry roiling in my mind. I read stories of other parents who've started along this journey before me, and I think maybe it won't be so bad. Maybe it'll actually be really, really good. But before I can join them on this journey, I have to get past the scheduled external cephalic version (where the doc will attempt to physically force our baby to tuck and roll into the vertex--head-down--position in my pelvis). And then the scheduled induction if that works. And then maybe I'll get the chance to hold him and kiss him for a minute before he's whisked away for echocardiograms and tests and his own little isolette in the NICU. And I'll get to hold him and feed him and snuggle him in there sometimes before a surgeon cuts him open and cuts into his tiny little heart and stitches the broken parts back together. And I'll continue to worry for a while, because even though the surgeon will have done this procedure hundreds of times before on babies just as tiny and fragile as mine will be, it'll be the first time I will have handed over my own little infant to a team of gowned and masked surgical team members and trusted them to return him to me safe and alive, and I will have a hard time pushing the fear out of my brain that there are always risks involved in surgeries like his. And my friend Lexi promised me just the other day that somehow I'll be able to handle it, and even be strong through it. And the angels who will have accompanied this sweet baby to earth will attend to me while I wait for him to recover. Only the way she told me was so much more eloquent and lovely and believable. And I do believe her, because she's already been through the wringer with her own special little spirit who came to her in a body affected by Down syndrome.
But I'm not there yet. Right now, I'm stuck in this place of worry and wondering about things I can't see yet. And I know that there are people in this world who are worried about things much more serious and difficult than this, but I can't shut off the worry. I can count my blessings, which are so plentiful, but when I'm done counting, I always go back to the worry. Maybe because it's become familiar territory, and we as humans tend to stick with the familiar. I suppose it's a great thing that I only have a few more weeks of this worrying to do before I'm thrust into the reality of it all. I'd better start getting things ready for this little boy.... Maybe that'll make it feel more real, and I can start moving into the part where I feel peace and comfort. It's worth a shot, right?