One Plus One Equals Five

No, this is not a post about a tricky Common Core math problem.

To be fair, I was warned.

When Colin decided he was open to giving Jackson a sibling, he said since we have most of the baby gear we need and we kind of know what we are doing it should only be about 50% more work. "Totally!" was my response despite the fact I have plenty of friends with more than one kid and I knew better. I just didn't want to discourage the idea of having another kid.

I don't think the 2+ years difference in age is a mistake. Sure, Jackson can't really be reasoned with at this point. That is developmental and not his fault. I mean, it really isn't even his fault that he melts down after you put milk in his cereal even though he specifically requested milk. Just FYI: He knows what you are up to when you try to just pour the milk into the sink and give him the soggy remnants.

In my humble opinion, waiting another year to have another baby was not the answer. From my understanding, three is challenging as well. So what is the answer?

We expected a regression, but holy cow!

In his defense, Jackson was traumatized twice in the past three weeks. First, we left him for four days while we were in the hospital having Carter. Then, he was left again when Carter was admitted to the NICU and daddy left for a work trip. There was nothing we could do to prevent any of this, but we sure are paying the price now.

As you can probably imagine, separation anxiety has reared its ugly head. Our independent and flexible little guy is now a stage five clinger. He also has very little tolerance for baby Carter taking up mommy's time (and lap).

That being said, Jackson is trying so hard to be a good brother and mommy's helper. Poor Carter is already so tough. He can withstand a pacifier being forced into his mouth, kicks to his head and body, and even a little bit of smothering. Jackson just wants to engage with his brother. In the meantime, I am realizing the wild two year old boy behavior that used to be tolerable and understandable is now a major source of mommy stress.

It is super important for me to keep in mind that along with the clingy and wild behavior, Jackson is also such a sweetheart. For every behavior that makes me want to pull my hair out, he turns around and melts my heart. He is growing up so fast and I don't want to miss it because I am so wrapped up with trying to keep Carter alive and well in his presence.

I feel complete now that Carter is here. Having both of my sons by my side is the best feeling in the world. My heart feels like it is going to explode when Jackson holds his brother. It is the sweetest thing in the world to witness the blossoming love between siblings. I can't imagine Jackson as an only child and I don't regret a thing despite how hard these past few weeks have been.

All I can hope for is infinite patience and the ability to give my little boy some grace during this transition. Now, if only he would voluntarily go to bed at night and spare us the epic meltdowns. Some decent sleep would do us all some good.

Adding another person to the family does not double the work. It feels like way more than that right now. I am not a math teacher, so hopefully I am calculating this wrong. Perhaps time changes the equation.

Sometimes the answer is there is no answer.

This morning I was awoken by an angel.

I don't mean this one, although he is quite a little cherub:

Her name is Dr. Smith, and she is a neonatologist here in the St. Charles NICU.

She pulled up a chair next to me, introduced herself, and explained that she has very reassuring information to share with me in spite of the disappointing lab result we received. Carter's hemocrit (red blood cell count) level had continued to go down and we were now at 23, meaning we have reached transfusion territory.

Dr. Smith explained that in her 20 years at Dornbecher (the children's hospital in Portland where she practiced before coming to St. Charles), she has seen about ten other cases that look exactly like Carter's. Although there is no medical explanation for it and you won't read about it in any textbooks yet, other babies have also lysed their red blood cells at high enough rates that it caused a late bilirubin spike. The good news is, although there is no technical diagnosis, these babies have gone on to live normal, healthy lives with no issues.

At this point, we have ruled out everything scary. The rare G6PD liver enzyme deficiency that was suspected to be the culprit came back from the lab negative. After days of testing and monitoring, it looks like we have a freak, transient condition that is going to go away and leave us with a healthy baby.

I suppose the big question is: We have had access to Dr. Smith this whole time even though she was not the attending physician until today - why did we not have this information until now?

Trust me, I asked. The fact of the matter is, Carter's story had to play out so everyone could see the big picture. There were a lot of possible reasons why this is happening, so it has been medically imperative to rule out all of the more common causes before we could land here. In the end, it is a good thing is that we landed in the most benign place possible. I will take a transient condition that will stay in my rear view mirror as I drive away from the NICU (hopefully tomorrow).

As I sit here and write, Carter is having a blood transfusion. It sounds scary, but it is a simple procedure where he has to lie in his bed for four hours while red blood cells are pumped into his body via an IV. It is quite peaceful so long as we can hold him off that long without eating. His bilirubin finally fell off the plateau and went down another point, so we are on the downward slope. The hope is that the transfusion will "top off the tank" and give him the red blood cells needed to get his levels normal again. As a result, we expect to see his oxygen saturation levels to stabilize because he will have more hemoglobin in this blood for it to bind to. If all goes well, we get to go home soon and be a family again.

For now, I guess I will continue to binge-watch Mad Men on Netflix and read way to many parenting articles on Scary Mommy. I can't wait to get out of this recliner and into my Tempurpedic bed. My chiropractor is going to directly benefit from this experience.

Our brave little guy receiving extra gas for his tank:

The makeshift IV boot ensuring we only have to do this once. The blood cells are being pumped in from the tube at the top. Notice his battle wounds from all the heel pokes - they are all over his heels. Poor baby!

Perspective

 

 Although cliche, find these phrases helpful and meaningful right now:

• What doesn't kill you makes you stronger.
• Life is 5% what happens to you and 95% how you react to it.
• Every cloud has a silver lining.
• Its always darkest before the dawn.
• When the going gets tough, the tough gets going.

I like to think of myself as a Tigger, rather than an Eeyore. Most situations in life can be seen from two perspectives: positive or negative. As I have gained life experience through age, I have learned that life is a lot easier if you focus on the positive.

As I sit in the NICU with Carter, I am blessed with time to reflect and process this situation. As I rub my bleary, tired eyes and look at my beautiful baby boy, I realize that we have so much to be thankful for. The ability to do this really has nothing to do with being a strong person; it simply comes from putting things into perspective.

There are many definitions for perspective. In this situation, it means "a particular attitude toward or way of regarding something; a point of view".

For example: as I sit in the NICU with a relatively healthy, full-term baby boy, hundreds of people in Paris are dealing with losing a loved one at the hands of terrorists. Putting my family's situation in perspective, we actually have it pretty good right now.

It would be easy to spiral into a dark pit of despair and wallow in self-pity right now, but what good would that do? I think most people would excuse my selfishness and even give me a free postpartum depression pass. Don't get me wrong, I have my moments. This is just a short list of emotions and thoughts I have experienced over the past four days:

• Indignation - "This is not fair - haven't I put in my time here already?"
• Anger - "We made it to term and even ten days at home - this is B.S.!"
• Sadness - "My poor baby boys - one is constantly being poked and prodded and left alone by mommy and the other is being neglected by mommy because she is never home anymore."
• Coping sarcasm - "Cool, another reason to stay here another day. Any more tests we can perform to keep me here longer? I am getting the sleep of my life in this recliner."
• Anxiety - "I will keep you updated as I sit here and wait for another round of test results."

 All of that being said, my family honestly has so much to be thankful for. Specifically:

• Carter was full term - I did not get sick so I am capable of taking care of my boys. Also, the fact that he is a fully-cooked kid is helping us get out of the NICU so much faster.
• I got this - I can function in a NICU room standing on my head. Been here, done this.
• Support - We have amazing family and friends that are supporting us in a variety of ways. A special shout out to the grandparents who are taking care of Jackson in our absence. It really does take a village. 
• NICU Staff - Colin and I once again stand in awe of the NICU nurses and doctors who are taking care of our son. So many people here recognize our family and have made us feel at home (reluctantly - no one wants anyone to be here) all over again. I find myself surrounded by personal cheerleaders, counselors, confidants, and friends all disguised cleverly as nurses and doctors. 
• Carter's Overall Health - Yes, we are in the NICU. Yes, Carter is enduring many pokes, prods, and other uncomfortable tests. Yes, my heart breaks for my son multiple times a day as he cries through more pain. However, having all of these tests done confirms that other than the bilirubin issue, he is a healthy boy and we have no reason to worry once we get past this little bump in the road.
• Carter - This kid is tough. There is a part of me that believes that he is out to prove he can endure the NICU just like his brother did. Sure, he cries a little when he is poked. Otherwise, he is a mellow, sweet little guy and everyone here loves him. No one wants him to leave (it is fun for the nurses to have a well-done baby to play with - he can withstand contact and interaction that preemies cannot) but everyone wants him to go home and be with his family.

This is merely a short list of things that are helping me keep my head up. I cannot wait to be home again, but when I put this seemingly devastating situation in perspective, we have it pretty darn good. There are people out there right now dealing with WAY worse problems than we are, and I believe it is important to keep that in mind.

In other news, I realized today that I have way too much time on my hands when I found myself watching this video:

Carter, perhaps we should think about leaving now.....

NICU Part Deux

According to the Urban Dictionary, part deux is "a superficial, unnecessary, or overly bad sequel to a classic film".

This seems fitting for how I feel about blogging from the St. Charles NICU, again.

We thought we were in the clear. Carter had a tan that we knew was not a genetic blessing and it had a certain yellowish hue. However, he was checked twice during his first week of life and the numbers said he was fine and did not qualify for photo therapy.

Fast forward to Carter's tenth day of life. He was scheduled for his circumcision so it was already not going to be his greatest day ever. The nurse and his pediatrician agreed that he looked pretty yellow so we decided since he was getting messed with anyway we might as well go for another heel poke. He was an angel; he slept through the circumcision and did not make a peep until they poked his heel. The pediatrician said she has never sent an almost two week old baby back to the hospital to go under the lights so it was clearly just a preventative procedure.

Um, yea, not so much.

Four hours later I got a call from the doctor. She felt so bad because she had big news. Dr. Azimi and his nurses in the NICU had a bed prepared for Carter and we needed to go immediately. His bilirubin level was dangerously high and it was imperative to get him there ASAP to mitigate any further damage done.

As I drove Carter back to St. Charles, I did my best to keep my cool. Of course, I hit every light and got stuck behind every speed limit law abiding citizen on the road. Colin called as I was on my way (he was waiting for our personal life savers - aka: the Grandparents - to get to our house to stay with Jackson) and told me to leave my car right out front and he would take care of it. I pulled up and happily obliged and that is when the waterworks started.

Terrified of the neurological damage that can result from high amounts of bilirubin in a newborn's blood, I did my best to contain my tears as I realized I was living the nightmare again. Doing my best to answer questions and provide updated medical information, I struggled to not completely melt down. The idea of brain damage is enough to send any parent over the edge, so in hindsight I must cut myself some slack for not being more stoic in the moment.

Carter's bilirubin was 26 in the office during the afternoon. Another heel poke in the NICU showed 25.4, which confirmed that we were in the danger zone. Dr. Azimi had explained to us while we were waiting for the lab to confirm this number that we may have a tough decision to make. The reason we were in the NICU rather than the PICU is at a level of 25 or higher, a blood transfusion is protocol and only the NICU can do this on a newborn. There is a 5-10% chance of serious complications, so it would not be an easy decision for us to make.

Fortunately, at 25.4, we were just on the cusp of the danger zone and Carter was showing no signs of neurological damage. In fact, the NICU staff was very surprised at his vitals and responses considering the story the labs were telling. What we were looking at was an apparently healthy, yellow baby. When it came down to the decision to transfuse or not, Dr. Azimi told me he would not go into "if this were my kid I would...", which was nonsense. He was just recognized with a national NICU heros award and I wanted to know exactly what he would do if this were his kid. He said after conferring with a colleague, his recommendation would be to treat with photo therapy rather than risk a transfusion.

Done and done. Time to get in the tanning bed kiddo.

This may be a good time to mention the fact that Carter is following in Jackson's footsteps in one specific way. It is NICU protocol to monitor heart rate, breathing rate, and blood oxygen levels. Carter has been desating (blood oxygen dropping) during deep sleep and has been wearing a nasal cannula with the same slightest whiff of oxygen that Jackson had for weeks upon weeks. It is the tiniest amount of oxygen (we breathe 21%, he is getting 22%) but he can't keep his levels up while sleeping without it. Despite the fact this is too much information (many newborns are doing this at home without the parents knowing) and we are completely micromanaging him, it is not acceptable in the NICU world and should not be happening for no good reason.

Almost two days later, it feels like Carter has endured every test imaginable. Tons of blood has been drawn to rule out metabolic disorders, enzyme disorders and deficiencies, respiratory panels, (Jackson has been fighting a cold and in an effort to be a good big brother has likely shared some germs), and a total of three bilirubin checks so far. He has also had an echo cardiogram and lung x-rays for good measure. Everything has been coming back clear, normal, and healthy, which is awesome but makes you wonder what in the hell are we doing here again.

Dr. Azimi had a conversation with my mom yesterday and things may finally began making some sense. He had asked me every question you could think of, except if we had any family history of jaundice upon birth. In a caffeine-induced moment of clarity earlier that day it dawned on me that we have had jaundice upon birth on both sides of Carter's family. In addition to my week under the lights, my brother, mother, Colin, and Colin's nephew were all jaundiced when they were born. The doctor was most interested in my family and now suspects that this is a genetic thing - we are born with immature livers that need some extra time to process bilirubin.

Finally, a test came back early this morning showing something that is not normal. Carter is anemic today. His red blood cell count has gone down during his stay, which indicates that his red blood cells may be fragile and bursting more than normal. A blood sample was sent to Salt Lake City yesterday to screen him for a rare enzyme deficiency that may or may not be the root cause of all this drama. We will not get those results back for another four to five days and the implications of a positive result (other than an explanation/diagnosis) would be very minor and not really even treatable. In the case that this is his diagnosis, there is a chance that he would become slightly anemic when he gets sick in the future. For example, if Carter develops an upper respiratory infection we will have to keep an eye on him to make sure he is well-hydrated and perhaps give him some iron supplements to help him through the illness until his body fights it off. All things considered, easy peasy lemon squeezy.

So here I sit, two days later. Carter's bilirubin level has dropped 13 points (from 26 to 13) and we are so close to getting him out from under those lights. We will do another heel poke this evening to see if we are in the "no treatment necessary zone" again (12 or less) so we can start weaning him off the lights. Today he has gone from five lights to three, so we have already started the process. Next, we will have to make sure he does not rebound for a minimum of 12 hours after he is completely off the lights. Also, he had more blood drawn this morning as well as a sterile urine sample drawn from a catheter (poor guy!) to test for an unlikely case of a urinary tract infection, which can cause jaundice. Just another thing to rule out. Waiting for those results means we are here until at least Monday.  Finally, why the hell won't this kid breathe when he is sleeping?! He has to stop desating or else we go home on oxygen.

I would love to tell you that once we realized a transfusion was not necessary and that no apparent damage has been done I became the pillar of strength that Carter needs. However, that is not really the case. There have been lots of tears and my mindset and emotions have been all over the board. Although we have so much to be grateful for and we know from our past and far more traumatic experience with Jackson that this will just be a blip on the radar, I have struggled this time around. How did I end up back on the NICU roller coaster again?

The bottom line is, I am not worried about Carter. He is apparently on a mission to prove that Jackson is not the only one who can tough out the NICU. I have watched this amazing little person endure so much these past few days and he is such a trooper. I am so proud and in awe of our handsome, full-term little guy. What I have worried most about is Jackson's well-being. I can't see him and leave him without crying and apologizing over and over for not being there for him these past weeks after having Carter. Now I have been ripped away again as I sit here all day waiting to nurse Carter and sleep in this hospital every night.

Come to find out, the person I should worry about the most is me. My lovely mother-in-law pointed out that I have two sons who have different needs right now, which can be hard on a mother. I pumped a bottle for Carter and went home this morning to spend time with Jackson. Colin left early for a work trip (which we decided as a family was the right decision) so Jackson is at home Gramma and Papaw. Although he was ecstatic to see me and sweeter to be around than ever, he was apparently not even bothered when I had to say goodbye again.

I don't know if it was the hot shower, fresh clothes, familiar smell of home, or the time I spent with my precious little boy, but now I know that this too shall pass and we will come out on the other side a stronger family, again. The postpartum element pretty much ensures I will still cry a little, but hopefully there will be more tears of joy and relief rather than sadness and frustration.

Like the story about the little engine that could that Jackson has made me read so many times, I think I can...I think I can...I think I can...I think I can.

 Top: Jackson's tiny foot under the lights in the NICU; below: full-term Carter under the lights

Spending time with J today (the lack of a shirt is a long, typical story!):

Jackson was in the room just next door to us just two short years ago. It is amazing how many nurses here remember us, and of course we remember them!

We just want to go home and get back to this:

  

What To Expect When You Are Expecting.....a C-Section

It is hard to believe that it has been ten days since Carter was pulled out of my belly.

Seriously, he was forcibly removed via a large incision in my stomach.

Knowing that c-sections are so common, it is still hard to comprehend the process. It was brought to my attention by one of the many nurses who took care of me last week that caesarians are one of the few remaining "common major surgeries" now that so many are done with small incisions and scopes. Basically, she was telling me to respect what my body had endured and cut myself some slack in regards to the healing process. As I recover, I try to remind myself of this every day.

Keep in mind, my first c-section was a completely different experience. I had to be put completely under anesthesia and miss out on the entire experience due to my low platelet count because of HELLP syndrome. Moreover, this meant that Colin missed out on the experience as well since he could not be with me in the operating room.

This time things were different. As far as birthing experiences go, I am convinced that we had the most mellow experience possible. We were borderline boring for the nurses. Rather than being the high-risk sick patients, the nurses barely had anything to do for us. However, this does not mean that the experience was not a little surreal and crazy for us. This was all new.

My doctor and a labor and delivery nurse both did their best to talk me through the process and set expectations. All things considered, they did a pretty good job. Still, I feel like I was not completely prepared for what this experience would really be like.

I am aware I am not a highly trafficked mommy blog, but I want to put this out there in case someone stumbles across this and wants to know what to really expect when expecting a c-section.

1. Your scheduled c-section is not a priority.
In my situation, a micro-preemie coming into the world took precedence over my cushy little full term procedure. Don't get me wrong, if anyone understands the urgency of a premature birth, Colin and I feel pretty well-versed in what these people were about to experience. That does not change the fact that we were sitting in our birthing suite waiting hours past when we anticipated our delivery. This can be a little nerve-wracking. In an effort to keep this in perspective, I know a couple that was sent home twice (once for each baby they have) because the family birthing center was full and there was no room for them. That would be even worse I think.
Lesson here: You are not as important as you think you are! If you are told your delivery is at 5:00 p.m., be prepared for it to be anytime after that.

2. Shower first, but prepare for a different kind of bath before the procedure.
You are not trusted to take a shower before your procedure at home and apparently a shower still will not get you clean enough! You will be given an awesome hospital gown, adult-sized baby wipes soaked in chemicals, and very explicit instructions. Good luck maintaining your dignity as your partner helps you scrub down your large, pregnant body. Also, you get to thoroughly coat the inside of your nostrils with thick, syrupy iodine formula. Ain't no germs gonna be on you!
Lesson here: Prepare to feel sticky and gross until you get to take your first post-op shower. Also, get that crap out of your nostrils ASAP once you are back in your room. It starts to ball up in your nose and itch. You will have dark reddish-orange boogies going on until you can clean it out.

3. You are not completely numb during surgery.
This was the part that really freaked me out. After the numbing agent was placed on my back (this is literally the most painful part; it feels like a bad burn for a few seconds) and the needle was injected into my spine, (which I actually felt despite the numbing) my feet and legs almost immediately felt warm. The anesthesia caused a quick drop in blood pressure, which translated to dizziness and nausea. Also, I reacted to anesthesia by shaking vigorously as if I was freezing cold. So there I was, dizzy, nauseated, and shaking violently as they helped me lay down on the table. As distracted as I was by all of this, I quickly realized that I could not move, but I could feel them preparing me for surgery. Trying not to sound completely panicked, I reminded the doctors, nurses, and anesthesiologist that I could feel what they were doing. They reassured me that I would not feel any pain and that they would to a "pinch test" before cutting me open to ensure that the anesthesia was doing its job.
Lesson here: You don't feel the pain of having several layers of your body being cut open, but you do feel pressure and movement as you are being operated on. This is seriously one of the craziest experiences I have ever had.

4. To them, this is just a typical day on the job.
As I was lying there on an operating table, everyone around me was carrying on regular conversations. In addition to checking in and telling me what they were doing and how it was going, there were a variety of matter-of-fact conversations and little jokes happening. Thankfully, I had Colin there to talk to so I could feel like one of the gang rather than the human who was cut open.
Lesson here: Be prepared to find out how doctors and nurses interact socially during common surgeries. Rest assured that you may hear things from your doctor, such as "Your insides look really healthy and great!", that will actually make you feel a little better about what is going on around you.

5. The first 12-24 hours after surgery are deceptive.
Even though I could move my legs a few hours after surgery, I was still numb. The anesthesia is combined with pain meds and I was quite comfortable following surgery. Actually, I did not experience any pain around my incision and in my stomach despite having several layers of my body cut open, a baby pulled out, and a tubal ligation. I was so impressed with how I was handling all of this. Then the next afternoon happened. A little over 18 hours post-surgery, the pain set in. Oh, I am not so tough after all. Percocet please!
Lesson here: Enjoy the deceptive hours after surgery when you feel comfortable. Not to freak anyone out, but I have a pretty high pain tolerance and the pain since has been pretty brutal.

6. Be kind to your body. After all, you have endured a lot.
My doctor told me the tubal would not affect my recovery. That being said, I thought there was something seriously wrong once the pain set in. Perhaps my memory from my first c-section is a bit fuzzy, but I don't remember it hurting so much. I mean, I went to a concert five days post-surgery! Here I am, ten days post-surgery, and I am still in pain. Fortunately, several nurses confirmed that many patients have expressed that the tubal does make a difference in the pain levels during recovery.
Lesson here: This too shall pass. However, don't be scared to take your pain meds. I am on my second prescription, but I requested a more mellow pain reliever and I am only taking them at night so I can function during the day as best as I can.

7. Be flexible about giving birth.
Even though scheduled c-sections are more common nowadays for a variety of reasons, I believe that most women imagine experiencing childbirth the way the body intended. Rather than dwell on the fact I was robbed of this opportunity because I got sick with Jackson (and I was unwilling to brave the risks of a VBAC), I have to accept that this was my path. Sure, I did not endure hours of labor and the pain of natural childbirth, but I did get a taste of it this time around. As I was on the monitor waiting for my c-section I was having pretty considerable contractions. The way I look at it, I am enduring the majority of my pain after delivery rather than during delivery.
Lesson here: No matter how it happens, you have grown a human and given them life by having them taken out of your body. I don't believe that there is a big conspiracy in the medical community and that doctors are incentivized if they can get more patients to deliver surgically. If you feel that is the case, you have chosen the wrong doctor. Childbirth is unpredictable and can be risky; consider being flexible about how it happens and just be happy that everyone is alive and well when it is over.

Besides, according to several labor and delivery nurses I have met, this is truth:

Dear Prince Jackson,

Today your world will change. In fact, all of our worlds are going to change. However, I worry most about you, my sweet Prince Jackson.

You have lived in a kingdom where you rule. The first born son. The only child. Our little everything.

Over the past two years, we have watched grow from a determined little preemie into an amazing toddler. Keeping us on our toes seems to be your goal. You do things in your own time, but when you are ready it is nothing short of incredible what you are capable of.

These past few months have been both the most challenging and most fantastic times with you. Every day you do something or say something new that never fails to surprise us. You are rapidly turning into a little boy, and I wonder every day where the time has gone.

Everything changes today. Despite the fact you have been hugging, kissing, and petting your baby brother in my belly, I know that you are still too young and the idea is too abstract for you to really understand what is about to happen.

Having another baby is exciting and daunting at the same time. Our lives are about to get harder and more fulfilling at the same time, but I know we can handle it and will be a better family for it.

The only thing I worry about, Prince Jackson, is you.

How are you going to handle Mommy and Daddy being in the hospital? Are you going to feel abandoned and sad? Will you be scared when you see Mommy hooked up to machines tonight? Is the new baby going to be exciting for you or a source of resentment and jealousy? Are you going to understand what is happening? Will you be willing to share Mommy and Daddy?

My hope, Prince Jackson, is that you quickly accept your brother into your kingdom. What you may not realize is that we not only have created a new life, we have created your best friend. You can rule our world together.

I love you to the moon and back, sweet Prince.

Love,
Mommy