The Nippling Protocol

Our days have almost become routine. We're usually up at the hospital by 8am, or shortly thereafter. We leave from 10 to noon, while the doctors make their rounds, then return and stay until 5, when they kick us out for afternoon rounds. While we're in the NICU, we change dirty diapers, take Frankie's temperature, swaddle him in blankets and hold him in our arms, or naked against our skin. Over the past couple of days, we've even been able to offer him a bottle with a tiny bit of milk (5ml, twice a day). Yesterday, he started something called the "nippling protocol" (which, by the way, would make an outstanding title if Dean Koontz decides to try his hand at pornography). Since he arrived in the NICU, Frankie has received the bulk of his nutrition intravenously through the broviac catheter sutured into his chest. Since the insertion of the NJ tube a little over a week ago, the IV feedings have been supplemented with gavage feedings, which basically means breastmilk is being forced through the tube. While the nasal tube was in his intestine (NJ), he recieved a continuous feed (starting at .5ml/hour, every hour); when they pulled the tube back 19cm into his stomach, he began bolus feeds, which are relatively quick bursts spread out over time. The nippling protocol is intended to acclimate him to the bottle. The pictures I posted of Frankie taking a bottle don't really count as "feeding". Those 5ml teasers were just a way to introduce him to the concept. Now, he receives 30ml of milk in a bottle every three hours. What he doesn't finish is given by gavage. The nurses allow him about half an hour to work on the bottle, but after that he's burning more calories than he's taking in. On Friday, Frankie took 10ml's from the bottle. By Saturday, he was up to 15ml. Once again, the little guy is doing better than we could've hoped.

Frankie's progress has even impressed his doctors. Dr. Josephs, the pediatric surgeon who performed Frankie's surgery, seems more than satisfied with his work. His face lights up every time he stops by to check on Frankie. The neonatologists who've taken over Frankie's day-to-day care continually revise their orders, moving him through each of these phases of treatment much more rapidly than they'd anticipated. On Anna's first visit to the NICU, one of the NICU attending physicians, a humorless man we call Dr. Blunt, told her, "you should hope for the best...but expect the worst." On Friday, he stopped by Frankie's bed and told us, "Frankie's doing exceptionally well," then he paused, obviously realizing that this kind of optimism is totally out of character, and added, "but that doesn't mean he's going home any time soon."

Anna didn't miss a beat. "Oh, we know. We'll give you guys a couple more days with him."

Dr. Blunt, who has the bedside manner of a mortician, was flustered. "Oh, I'm afraid it will be more than a couple of days." Anna and I looked at each other, choked back a laugh, and told him that we were joking. We said his due date wasn't until September 9th, and we knew we'd be lucky to have him home by then. Dr. Blunt mulled over this information, his eyes drifting up to the ceiling, signalling deep thought, then told us, "Well, September may be more likely." Then he walked away, without a smile or any other indication that he appreciated our humor. Then we laughed.

Frankie in the NICU, 7/30

Frankie in the NICU, 7/30
Originally uploaded by silverzephyr.

Frankie in the NICU, 7/30

Frankie in the NICU, 7/30
Originally uploaded by silverzephyr.

Frankie in the NICU, 7/28

Frankie in the NICU, 7/28
Originally uploaded by silverzephyr.

Recognize the outfit, Grandma? Hint: Frankie's dad wore it 35 years ago.

Frankie in the NICU, 7/27

Frankie in the NICU, 7/27
Originally uploaded by silverzephyr.

I can confirm that Kangaroo Care is indeed the greatest feeling in the world. And as you can see, Frankie concurs.

Pride & Joy

Frankie continues to meet each benchmark of progress ahead of schedule. When we first got to the NICU, I asked our surgeon for some kind of table table for Frankie's post-op recovery. He was reluctant to answer, explaining that it was basically impossible to reliably predict the course of his recovery, or to estimate the time it would take. "Each baby is unique." Doctors preface their prognoses with this trite truism in order to spare us the pain of shattered expectations. Instead of telling me what we could expect, Frankie's surgeon laid out the best case scenario. First, we had to make it through the surgery. If there was only one fistula, and it was high enough up on the trachea, the TEF (tracheosophageal fistula) repair wouldn't be a problem. If the the distal portion of the esophagus reached the esophageal atresia, that repair would be relatively simple. Then, there were the immediate post-surgical concerns: Would there be any complications from the anesthesia? Would the sutures hold? How long before he would breathe without the aid of a ventilator? How long would he require sedation? The big questions after that centered around Frankie's ability to hold down food and put on weight. It would be a while before he began breastfeeding, first moving from intravenous feedings to a mix of IV nutrition and tube-fed breastmilk, then graduating to gavage and bottle feedings. Offering a guidepost, he told me that most premature babies don't begin bottle feeding until the 34th week, even if they don't require surgery to fix their malformed esophagi. And of course, there could always be complications related to reflux, a fairly common side effect of this particular surgerical repair. He said we'd be lucky to bring Frankie home within a couple of weeks of his due date - after the due date.

They removed Frankie's chest tube last Friday, confirming that his sutures were holding fine, and exchanging his replogle for a Naso Jejunum tube. Since then, he's been receiving a continuous feeding of mother's milk through the NJ tube, steadily increasing from .5ml/hour to 6ml/hour this afternoon. Over the same period, they've been dialing back his intravenous nutrients; he may be completely off of them as early as tomorrow. We tried giving him a taste of milk from the bottle yesterday, and the nurse practically squealed when we got Frankie to swallow one mouthful. Today, they pulled the tube in Frankie's intestine up 14cm into his stomach, turning his NJ tube into an NG. His second go-round with the bottle was even more successful - he finished 5ml of breastmilk in less than 15 minutes, and swallowed almost all of it, with no sign of reflux. When we left him this afternoon, he was sleeping soundly and in the good care of his Grandpa Frank and Aunt Kristin. He'll be 34 weeks as of Friday, and if things continue progressing this smoothly, he'll start bottle feedings by the weekend, well ahead of schedule. Frankie's surgeon stopped by this morning to introduce himself to Anna and tell us that everything's going better than he'd hoped. Everyone tells us how much Frankie looks just like me, but after watching him handle all of this like a champ, I know what he got from his momma.

Frankie with Dad

Frankie with Dad
Originally uploaded by silverzephyr.

Frankie's first bottle

Frankie's first bottle
Originally uploaded by silverzephyr.

Frankie & Dad

Frankie & Dad
Originally uploaded by silverzephyr.

Frankie & Dad

Frankie & Dad
Originally uploaded by silverzephyr.

The Wrath of Dad

As you might be able to surmise from the pictures we’ve posted, Frankie has slept through most of his stay in the NICU, thanks in large part to mercifully administered doses of morphine. Anna and I have spent hours every day by his bedside, watching him sleep, always ready with a comforting hand or soothing voice should he wake up, or even show the slightest indication of discomfort. Much of this time was spent reading up on the subject of premature birth and preterm babies, and I’m incredibly reassured by what I’ve learned so far. For example, if I had been born with Frankie’s condition, the care I received would have been radically different. Aside from the obvious benefits of 35 years of medical advancements, including improvements in everything from surgical procedures to diagnostic technologies, there is the more significant development in the basic philosophy guiding the care and treatment of premature newborns. Three decades ago, the dominant approach to neonatal intensive care for premature babies did not include pain management. A number of misguided beliefs supported this now-discredited approach: that premature nervous systems were incapable of sensing pain; that the risks posed by pain-relieving drugs outweighed any potential palliative benefits; that preemies wouldn’t remember any of these painful experiences later in life, even if they suffered though them now. As late as the 1970’s, most surgeries on premature infants were performed without anesthesia; forget about generous doses of morphine during the post-surgery recovery period.* Thankfully, this barbaric approach has been eclipsed by the predominant philosophy of Developmental Care. This approach stresses the comfort and well-being of the child, emotionally as well as physically, during all aspects of the treatment process. Pain management is one of the paramount concerns of nurses and physicians adhering to the Developmental Care approach to the treatment of premature infants.

The Children’s Hospital of Austin NICU at Brackenridge is run according to the Developmental Care approach, more or less. I qualify that statement because the standard of care differs from nurse to nurse. Most of those we’ve encountered have been compassionate, supremely capable, and extraordinarily patient. In addition to the minutiae of each baby’s care – flushing IV lines, administering medications, changing dirty diapers, measuring and recording fluid output, temperatures, and blood pressure, drawing blood for lab work, bottle-feeding the older preemies, and constantly responding to the various alarms triggered by anything from malfunctioning leads to serious bouts of apnea – these nurses have to deal with the demands of doctors and the concerns of worried parents. Jennifer, Jill, Diane, Kay Kay, Mary - these are just a few of the nurses who've taken such excellent care of Frankie over the past dozen days. Our lives are bearable, Anna's and mine, in large part because of their mostly unsung heroics. We wouldn't be able to leave the hospital if we didn't believe Frankie was being cared for with kindness and tenderness. Our NICU nurses have been both caregivers and cheerleaders, simultaneously nurturing his tiny body and our family's strained spirits. They give us confidence and hope. They afford us the luxury of optimism, without which I can't imagine enduring all of this as well as we have so far. We will be grateful to them long after this little adventure is over, and I'm not just saying that because one or more of them might be lurking about.

Then, there's Hazel.** I'll start this out with a series of qualifiers and indimnifications. It might just have been that she caught us on a particularly bad night. Frankie was just coming off of the morphine and, as I found out later, it hadn't even been tapered (doctor's orders, though for what reason I'm still not entirely certain). He was kicking cold turkey, and obviously pissed. This was two nights ago, one day after Frankie had passed his barium test with flying colors (or, more accurately, without), earning the removal of his chest tube and replogle. It was also his second day receiving a constant 1ml/hr of breastmilk through a tube running from his nose to his small intestine (a Naso Jejunum, or NJ tube). He'd been taking the additional nutrients well, but Anna and I were worried that the switch to real food might bring on painful reflux. We wondered if that wasn't the cause of his current discomfort. And "discomfort" is really putting it mildly. From a few minutes after we'd arrived at 8:30 until almost midnite, Frankie writhed and screamed, his heart rate hovering above 180bpm for a good chunk of that time. This was the first time we'd heard him issue even a minor complaint lasting more than a couple of minutes, and each of those had been followed by long stretches of comforting silence. So, most of my complaints about Hazel might best be chalked up to the tribulations of this particular night. But even with that allowance, Hazel didn't exactly endear herself to us.

My first impression of Hazel was positive. She had a grandmotherly quality about her, which I realize in hindsight is a stereotypical characteristic I project onto all of the nurses who look to be older than fifty, along with such attendant capacities as wisdom and nurturing kindness. In Hazel's case, first appearances turned out to be deceiving. Shortly after we arrived, Frankie began acting uncomfortable, a transitional phase that eventually culminated in the fiercest little tantrum we'd yet encountered. I asked about his pain medication.

"Well, it looks like he got some Tylenol this morning. But he's not feeling any pain right now."

As the words leave her mouth, Frankie's back is arched, his arms and legs splayed wide, his skin growing progressively deeper shades of crimson. I looked up at the nurse, then back to Frankie, then back to her. Was she seeing this? I tried to restrain myself. "Well, he just got off morphine yesterday afternoon, so I'm guessing that a dose of Tylenol twelve or fifteen hours ago might not be doing the job."

"Oh no, he only had a shot or two of morphine. He hasn't been 'on' morphine."

I was appalled. She hadn't even read his chart. I corrected her. "Actually, he's been 'on' morphine - two to three shots a day - since the day after his surgery, after he had a negative reaction to fentanyl. I know. I was there when the orders were given, and I've been here every day since. Check his chart."

And she did. "Huh. So he has. Well, maybe he could use some Tylenol."

I was stunned, and couldn't hold back. "Wow, you think?" She walked away in a huff, and Anna and I returned to the more important task of consoling our screaming baby. He got his shot of Tylenol, which after a week of morphine was pretty much as good as doing nothing, or so it seemed to me. You couldn't prove me wrong by Frankie's reaction. He did mellow slightly for a few minutes, during which Anna had to pry herself away for her regularly scheduled breastmilk pumping session. When she returned half an hour later, he was going at it, beet red and screaming as loud as his lungs would let him. His heart rate had been between 180 and 200bpm since a minute or two after Anna had left to pump. The alarm on his heart monitor had been pinging for more than a minute. I called the nurse back over. "We're just trying to figure out what's wrong. He doesn't usually cry like this. In fact, this is the first time he's ever acted like this. We're just worried. Do you think it might be reflux?"

"Yeah, it could be reflux. But you know, he also picks up on your anxiety." She turned to walk away, and my jaw dropped to the floor. I looked at Anna, tears welling up in her eyes, and I seriously thought about letting loose on Hazel. Somehow, I held it together, comforted Anna, and tried to deflect attention away from what had just happened, back onto Frankie. When the nurse returned, I told her I wanted her to call for a doctor. She looked pissed off that we didn't find comfort in her care.

"Fine." She said it just the way you imagine, like a disgruntled four-year-old, stomping off to her room after being bawled out by dad. I wanted to strangle her. A few minutes later, she returned with a doctor. She stood over the young woman's shoulder, eyeing me the entire time. I explained to the doctor that Frankie had been inconsolable for most of the night, and asked if it could be reflux.

"Oh no. Can't be reflux. He's got an NJ tube, not an NG tube. It goes into his intestine, not his stomach. There's nothing in there for him to reflux." I looked back at the nurse, and she averted her eyes, pretending not to have heard.

"Well, he just came off morphine, and the nurse just now decided to give him some Tylenol. Will that help."

"It'll help, but it's not going to do more than take the edge off. He's coming off of morphine, which we stopped because we're worried that it's going to impede his stomach function. It's going to be a little rough, but not too bad. He's mainly upset because of the caffeine."

"The caffeine?" I looked back at the nurse, her eyes still glued to the floor. "Nobody told us anything about caffeine." I knew Frankie had received a caffeine injection after his reaction to the fentanyl, and i knew they'd continued the shots after they started him on morphine, but I assumed they'd discontinued both of those drugs at the same time. Apparently I was wrong.

The doctor explained, "He's on caffeine to prevent apnea." She looked at his chart. "He's been on it since his he reacted to the fentanyl. It's preventive."

The doctor explained that there wasn't much we could do, but that Frankie would calm down as the effects of the caffeine wore off. Even this small bit of knowledge was comforting. I thanked her and she left. Frankie had calmed slightly over the past few minutes, and Anna and I returned our attentions to comforting him. Hazel slunk back to her seat, hopefully as remorseful and humiliated as she should have been. What kind of nurse blames the parents? Doesn't read the chart? Withholds pain medication from a screaming baby? Like I said, she might have caught us on a bad day, but she didn't do anything to make it easier, on Frankie, us, or ultimately, herself. Today we had a meeting with the charge nurse, a wonderfully understanding woman who assured us that she'd deal with the situation and try to minimize Frankie's contact with Hazel. I tried to explain that we were otherwise thrilled with the care he's been receiving, and told her that I felt a little awkward calling out one her nurses, but she assured me that we'd done the right thing. It's our job right now to take care of Frankie, and it's my job to take care of Anna. So, when the Helgas and Hazels of the world place themselves in our path, they're pretty much fair game.

* OK, there should really be some footnotes here. All of this comes from a brief history of neonatal care for preterm babies in Preemies: The Essential Guide for Parents of Premature Babies. I'm borrowing liberally.

**Again, not her real name, but this particular nurse is a throwback to a bygone era, so Hazel seems appropriate.

CAVEAT LECTOR

Looking back over what I've just written, it occurs to me that the ol' blog has taken a turn for the nastier of late. Don't get me wrong - this is an acknowledgment, not an apology. If the worst thing that happens to the Helgas and Hazels of the world is an unflattering, anonymous blog entry, they're far better off than we are after our encounters with them. Most of the folks caring for Anna and Frankie have been especially conscious of both their physical and mental well-being. Most, but not all. A sad few seem to think that dispassionate skill and expertise can somehow compensate for an absence of compassion. But I'm ranting again. Thankfully, the Helgas and Hazels are the exceptions to the rule. For every Helga there's an Ann, quick to offer sympathetic advice without the condescending, judgmental overtones. For every Hazel there are a dozen nurses making our days glide by as painlessly as possible. On the whole, Anna and I couldn't be happier about Frankie's care in the CHA NICU at Brackenridge. I'm continually amazed by the balletic grace with which the unit functions, the cool ease with which the nurses execute each task, the calming confidence they exude. Anna and I actually feel comfortable, to the extent that's possible, and are glad to be going through this we these particular folks. Frankie is gaining weight, steadily increasing his milk intake (he's up to 4ml/hour), and pooping like it was his job (which it pretty much is). The Reglan has kick-started Anna's milk production, so she's keeping up with the demand spike. She even soaked a pillowcase last night. She's starting to work from home, which is a helpful distraction and a good way to counter-act the depressive side-effects of the Reglan. Our life is slowly approaching normal, or something tolerably close.

There's an awful lot of good news to report. If we use the Department of Homeland Security Advisory System Threat Level Indicator as a guidepost, I'd say Anna, Frankie and I are at Threat Level Green at the moment. The doctors would probably put us at Blue, but I'm pretty sure the nurses would side with me. At least I hope so. If not, they put up a convincing facade. At any rate, we're doing well, all things considered. Don't let my spleen venting fool you. I suppose I'll try and balance things out with a happier tale or two over the next couple of days. Let's hope Frankie cooperates. He's pretty much dictating the direction of the narrative at the moment.

Frankie in the NICU, 7/24

Frankie in the NICU, 7/24
Originally uploaded by silverzephyr.

This one's for Grandpa Frank.

Frankie in the NICU, 7-18

Frankie in the NICU, 7-18
Originally uploaded by silverzephyr.

We're sharing these pictures now because Frankie's improvement is visibly dramatic. This particular shot was taken on the Monday following his surgery the previous Friday. He has a ventilator tube and a replogle tube down his throat, the former feeding oxygen to his lungs, the latter siphoning excess acid from his stomach, protecting the sutures in his esophagus. The arterial lines in his right arm are held in place with a metal brace and two pieces of foam. They provide the nurses easy access to blood, and keep them from turning Frankie into a pin cushion. He has a broviac catheter sutured into his chest, primarily delivering nutrition and sedatives (fentanyl, then morphine). They'll leave it in right up until Frankie's ready to be discharged. Heart monitors are attached to his back, a blood pressure monitor to his foot, and an oxygen sensor on his right side. There is even a body temperature monitor connected to both Frankie and the bed, which regulates the ambient temperature around him. The bright light is cast by a photothermal lamp, prescribed for the treatment of jaundice (thus, the mask over his eyes). The site of the surgical incision is an inch-long scar on his right side, barely visible in this picture. As you stand by his bedside, you hear the whirring of the ventilator, the clicking of the IV drip, the periodic bleeps of various alarms, triggered whenever his heart rate, or blood pressure, or oxygen saturation levels dip below or climb beyond the range of acceptability. The doctors and nurse constantly reassured us that he was doing fine, but under the circumstances, it was difficult to believe them.

Frankie in the NICU, 7-18

Frankie in the NICU, 7-18
Originally uploaded by silverzephyr.

Another Monday shot.

Frankie in the NICU, 7-21

Frankie sans ventilator tube and arterial lines.


Frankie in the NICU, 7-21
Originally uploaded by silverzephyr.

Frankie in the NICU, 7-21

Frankie in the NICU, 7-21
Originally uploaded by silverzephyr.

Frankie in the NICU, 7-22

Frankie in the NICU, 7-22
Originally uploaded by silverzephyr.

Frankie in the NICU, 7-23

Frankie in the NICU, 7-23
Originally uploaded by silverzephyr.

Mama & Frankie

Mama & Frankie
Originally uploaded by Critical Mess.

You'll notice a little bit of surgical tape residue around Frankie's mouth, and a circular bandage near his temple. The tape residue will wear off in a few days - a baby's skin is too tender to be scrubbed clean. The circular bandage is used to hold a canula (nasal breathing tube) in place. Frankie hasn't needed oxygen for a couple of days, but they leave the bandage on just in case.

My boy

My boy
Originally uploaded by Critical Mess.

Got Milk?

Yesterday we met with one of the staff lactation consultants, an awkwardly tall, ghost of a woman. We'll call her Helga.* Her fair, Scandinavian features appeared to have been uncomfortably stretched and forced onto a hard-angled, Teutonic frame. The iceberg-white skin of her nose and shoulders had the painful, reddish hue that extremely pale people acquire when they spend more than a couple of hours outdoors. At some point in our conversation, she mentioned that she'd just returned from vacation, and I imagined her suffering for a week beneath the unrelenting Caribbean sun. She had a sort of sad cow demeanor, and spoke with an ill-fitting, mousy voice. She wore her white-blonde hair in the standard issue Mormon bob, and in that respect looked as if she'd been plucked from some tabernacle in the middle of Utah. Or maybe it was just that she offered her advice with the same shrill, judgmental certitude that one usually expects from proselytizing religious zealots.** If all this seems like a less-than-flattering description, consider Anna's more succinct take on Helga: "I wanted to smack that lazy-eyed bitch." I was willing to leave her lazy eye out of it.

The worst part was that we'd waited for Helga all day. Since the day after Frankie was born, Anna has been expressing breastmilk and storing it for later use. She uses a hospital-grade breast pump (the Medela Symphony, which came highly recommended), maintains a rigorous schedule (every three hours during the day, every four hours at night), drinks plenty of fluids, eats well, and otherwise follows all of the advice and suggestions offered to improve production. Still, her output has been less than she'd hoped, and over the past couple of days has even seemed to decline. In layperson's terms, her milk supply hasn't "dropped." She's still pumping out a thin trickle of colostrum, and we're saving every precious bit, but it's disheartening to spend two-and-a-half hours each day strapped to a machine for that kind of pay off. Then, of course, there's the added worry that her milk supply will simply dry up, and the associated guilt and second-guessing: Did I wait too long to start pumping? Was I doing it frequently enough? Was sleeping through the night a mistake? Are my boobs simply defective? Does this mean I'm a bad mother? Anna shared these fears with me, and I tried my best to console her, but we both wanted the reassurance and practical wisdom that only a professional could provide. So, we waited for Helga.

On our way to the hospital yesterday morning, we stopped at the maternity supply store to stock up on nursing bras and to pick up another pumping bustier (those of you with the appropriate security clearance can backchannel me for some priceless shots of Anna in full breastmilk pumping regalia). We also bought a book with tips for breastfeeding a premature baby (appropriately titled Breastfeeding Your Premature Baby). We're studious folks by nature, so we've been reading pregnancy books and baby care manuals throughout the pregnancy. Since Frankie's early arrival last week, we've turned our attention to the more specialized subject of preterm birth and premature babies. All of the experts weigh in on the subject of breastfeeding, and they are unanimously and enthusiastically in support of the practice. In fact, the lion's share of information on the subject focuses on the benefits of breastfeeding and the drawbacks of bottle-feeding. At first glance, Anna and I were confused by these impassioned appeals. We wondered, do women really need to be convinced to breastfeed? Now, in hindsight, we're beginning to understand the desire to present a compelling case. For many women, breastfeeding is difficult, painful, and a source of significant anxiety. In Anna's case, these drawbacks are magnified by Frankie's absence from the process. Aside from the obvious psychological trauma of trying to provide milk for a machine instead of your baby, there is a very real, biological obstacle to be overcome. Several factors cause a woman's breasts to begin producing milk, among which is the triggering hormone that's released when the nipple is stimulated by baby's mouth. Physical touch is the best way to promote the production of this activating hormone, and Anna won't be able to place his mouth to her breast for at least another week. That she's having difficulty producing more than a few cc's of fluid with each pumping session is hardly shocking, and certainly not her fault, but you wouldn't know it by the way Helga responded to our concerns.

I knew we were in trouble less than half a minute into our conversation with Helga. Anna explained that she was having trouble expressing milk, and that her output remained little more than a trickle. Helga asked when Frankie was born, then began to frown as she counted the days between then and now. "So, when did you start expressing milk?"

"Well, Frankie was born Thursday morning, and I guess I started on Saturday morning."

Helga didn't even try to conceal her concern. "Oooh, that's bad. Who told you to wait that long?"

I stepped in, appalled by her utter lack of tact. "Let's see, the doctor who delivered Frankie, Anna's admitting physician, the nurses, even the lactation consultant." The tone of my voice should've tipped Helga off, but she was undeterred.

"Well, that's not good. And how often are you pumping?"

Anna looked a little stunned, but answered honestly. She told Helga that she was now pumping every three hours, but only for the past couple of days. "At first, I was sleeping through the night to heal up from the surgery, but now I'm even waking up twice during the night."

"Well, that's just not enough. You should really think about pumping every two hours. Usually, milk production begins within three days. With some older mothers, such as yourself, it may take between 6 and 8 days. So, you still have another day or so before we need to start worrying. Let's see how it goes. Have you tried massaging your breasts?"

At this point, I was ready to strangle Helga. Not only was she the single most uncompassionate person I've encountered in the last couple of weeks, but she essentially laid the blame for our breastmilk production difficulties squarely at Anna's feet. I tried to help. "Well, it's not that unusual for mothers to have problems producing milk when they don't have contact with their babies, right? I mean, it's at least partially a hormonal problem, right?"

"No. Once the placenta is out, milk production should begin." She turned back to Anna, gave her one or two more bits of advice, then left us alone. I turned to Anna as soon as Helga was out of earshot.

"You realize she's totally out of it, right?" I thought I'd have to do some serious damage control, but Anna didn't seem too upset. We've both read enough about breastfeeding to recognize misinformation when we hear it. Still, when the staff lactation consultant tells you there's a good chance you're not going to be able to lactate, it's cause for concern. So, this morning we made an appointment with Anna's new Ob-Gyn to get another perspective. As we sat in the waiting room, I tried to figure out why the blonde woman talking to the receptionist looked familiar. Anna nudged me with her elbow, her eyes wide as saucers, just as the woman turned. "Hey you guys! We met yesterday, remember?" It was Helga. I choked back an ironic guffaw and mumbled through several uncomfortable seconds of small talk before the nurse called for Anna.

As I suspected, things aren't nearly as dire as nurse Helga made them out to be. In the first place, the circumstances of Frankie's birth make breastmilk production especially difficult for Anna. Because Frankie was born prematurely, Anna's body was not geared up for milk production. Preterm births often result in delayed and diminished lactation. Additionally, giving birth by cesarean section bypasses long hours of labor, which sounds like a great deal, but in fact often results in diminished milk production. It seems the struggle and pain of labor acts as a stimulant for lactation. Finally, add to all of this the stress of being separated from your baby and you can easily understand Anna's difficulties. Instead of callously blaming Anna, the nurse reassured her that her troubles were natural, and easily treated with medication. Anna felt especially upbeat after the nurse practitioner explained that injections can even make women who haven't been pregnant lactate. Anna still might try to strangle Helga next time we run into her, but for the moment, we both felt a little better about the whole situation.


* Not her real name, but Anna can confirm that she "looked like a Helga."
** Not that all Mormons are proselytizing religious zealots. Some of my best friends are Mormons. I mean, not really, but you know...

Banal chores in a surreal world

Our nurse in the NICU yesterday was Jill, a confident and bubbly gal, probably a couple of years younger than Anna. Each NICU nurse rotates between two babies, and but for lunch, dinner, and the occasional restroom break or supply run, they stand (or sit) between them for the entirety of their shift. Anna and I haven't seen the parents of Frankie's nearest neighbor, the other baby under Jill's care at the moment. That leaves the three of us more or less alone for long stretches of time that lend themselves to conversation. Given the intimate nature of the situation into which we've been thrown together, our talk begins at a very personal level. After an hour or so of increasingly self-revelatory banter, she offers as a clarification appended to her standard issue sympathetic condolence w/r/t our situation, "I mean, I don't have any babies of my own, but I can just imagine...I mean, I know I can't really imagine...I mean, it's just so..." Her voice trails off because she, like 95% of the doctors, nurses and technicians we've dealt with, is incredibly sensitive to our feelings, which should apparently be more fragile than mine seem right now. Perhaps it's denial or some related, subconscious defense mechanism, but I feel confident that Frankie is going to be okay, even if we've got a ways to go before he gets there. I realize this is a totally irrational optimism to which I subscribe, but it seems to be working. And so, when Jill stumbles awkwardly onto sensitive ground, I redirect the conversation with a question that's been on my mind since we arrived here Thursday. "Does being a NICU nurse make you think twice about having babies?"

As I've mentioned at least a dozen times, we were totally unprepared for this little adventure. We survived as well as we did because of sheer luck and the support of family and friends. Everything from flexible bosses and sympathetic employers to above-average insurance coverage have made this whole thing manageable. But for our good fortune, this could have been a soul-crushing experience. What few advance preparations had been made before all of this began were primarily a result of Anna's innate proclivities. We certainly didn't plan for this, largely because nobody suggested it as a possibility. And it's not like we weren't actively seeking information. I've complained before about the woeful inadequacy of our birth and baby care class, and I can honestly say that I can't recall a single mention of the possibility of preterm birth, other than a blithe dismissal of one expectant mother's concerns about the subject. "That won't happen to you," or some such misguided reply. And the pregnancy books aren't much better. In Planning Your Pregnancy and Birth by The American College of Obstetricians and Gynecologists, discussion of preterm birth and premature babies is limited to four pages at the end of the book, in the chapter on "Complications of Pregnancy." It's here, on page 366 (of 422), that we are finally informed that "about 1 of every 10 babies born in the United States is born preterm." See, to me, 10% is kind of a large number. Every tenth baby born in the United States arrives before the end of the 37th week. Now, admittedly, those born after 36 weeks suffer very few of the complications generally associated with preterm birth, but still, that's a lot of babies. What little information PYP&B offers on the issue of preterm birth and preterm babies is limited to identifying the symptoms of preterm labor and describing the process for preventing its progression. Less than half a page is dedicated to the discussion of preterm babies. The remaining references to preterm birth, premature rupturing of the membranes, and preterm babies are scattered throughout the latter pages of the book, always in association with a discussion of some risk factor, such as drug use, alcohol consumption, smoking, sexually transmitted diseases and other medical conditions or physical abnormalities, none of which applied to Anna. Nothing in this book indicates that we should have been even slightly concerned about preterm birth. The Mayo Clinic Guide to a Healthy Pregnancy is slightly better, boasting both a 4-page section on preterm birth in the last part of the book, "Complications of Pregnancy and Childbirth," and also an 8-page section on premature newborns in the chapter "Your Newborn." Still, there's nothing in the book to indicate that we should be concerned. If these books are to be believed, the ten percent of birth parents who go through preterm birth must be two-pack-a-day, diseased drug addicts, not tobacco/alcohol/drug-free women who go to the gym four times a week and subsist on a diet comprised entirely of organic foods. So naturally, we weren't prepared.

But what were the books and birth instructors supposed to tell us? That every woman is at risk of preterm birth, regardless of their medical history or the precautions they've taken throughout pregnancy? That nobody really knows why membranes spontaneously rupture months ahead of schedule? In short, yes. Everyone should be aware of the risks going in. Even if there's nothing you can do to prevent pre-term birth (although I'm not convinced that's necessarily the case), preparing yourself financially and emotionally ahead of time can certainly soften the blow. I guess I just wish I could've seen it coming. Like I said, we got lucky. How many among the unfortunate ten percent don't?

I suppose I really don't know that it's possible to prepare emotionally or psychologically for preterm birth. The question about whether or not being a NICU nurse made Jill more reluctant to have babies stemmed from my own uncertainty about whether or not knowing about this in advance would've really helped. Would knowing this was a possibility have changed anything, or would it have just added another element of anxiety to an already overburdened mind? Like Jill said, sometimes knowledge is counterproductive. Still, I think I'd like to have known.

There are certain things that can only be written in hindsight. Some moments over these past few weeks have been unspeakable until now. For instance, from the time we checked into the hospital at the end of June, right up until the time Frankie arrived, I had a frequently recurring nightmare. I can't remember any of the dream but the very last moments, and it was always the same. I'm holding Frankie in the palm of my hand. His head rests near the tips of my fingers, his bottom against the ball of my thumb, his tiny legs dangling on either side of my wrist. His chest is heaving, his breath keeping pace with his racing heartbeat. His eyes are closed, and he reminds me of a featherless baby bird, fallen from the nest. When I was very young, probably six or seven, my cousin, my sister and I found such a bird on the concrete breezeway outside of the reception hall where my great-grandmother and great-grandfather celebrated their fiftieth wedding anniversary. In the dream, the sight of Frankie in the palm of my hand conjures vivid memories of that event. As I'm staring at Frankie, thinking of that dying baby bird, I remember that I couldn't save it, and I become panicked by the thought of just how fragile my son is. I don't know how long I am transfixed by this terrifying image, but each time the nightmare ends with Frankie's tiny head lolling to one side, his tiny chest collapsing, then motionless. And then I'd wake up, lying on a cot next to Anna's bed, my heart pounding as I strained to hear the reassuring thuka thuka thuka of Frankie's heartbeat on the monitor across the room. My sister took a picture of my dad and I shortly after Frankie arrived, before the doctor told us about the complications. The ecstatic expression on my face is at least partially attributable to the huge sense of relief I felt when I saw how big Frankie actually was. And of course, the nightmares stopped immediately thereafter.

You don't have to be familiar with Freud or Jung to parse that particular dream, but I find it interesting that it is the only one I can recall in any detail. Throughout our pregnancy, I remember few dreams about Frankie. I definitely had a couple, but they were infrequent, and for the most part unremarkable. I don't think I ever thought about one for any longer than it took to finish a first cup of coffee. But this nightmare stuck with me. Not only did it occur on multiple nights, but the image haunted me at various moments throughout the day, when my mind would wander into the forbidden territory of Things That Could Go Wrong. I employed the usual tactics of distraction and misdirection to exorcise my imagination, with limited success.

If this post seems disjointed, it's because I'm grappling with a series of events that make little sense to me, but which have utterly consumed my life. I wasn't lying when I said that I am optimistic about the eventual outcome, but the moments between are strung together with doubt and frustration. As fortunate as we've been, and as positive as Frankie's prognosis is, this has been the most emotionally taxing episode in my life. Somehow, telling y'all about it seems to help. Now, I'm going to buy groceries.

Where did the day go?

Once again, I am derelict in my blogging duties. I've already received two backchannel emails asking if everything is okay, and neither was from my mom. Sorry if I worried anyone, but yesterday was pretty uneventful as far as Frankie is concerned. Anna, Joann and I went up to the NICU around noon and sat by his side until 5, when they kicked us out. I've become more accustomed to the tangle of transparent tubes and monofilament-thin sensor wires that criss-cross Frankie's body. I'm inured to the cacaphony of buzzing, whirring, beeping machines. Each of the half-dozen babies in this single-room branch of the NICU is hooked up to some combination of heart and lung monitor, ventilator, IV and catheter pumps, and other unidentifiable medical devices, all of which produce a unique amalgam of sounds without regard for harmony or melody. Even this discordant symphony has faded to thin, white noise; background sounds drowned out by my concern for Frankie and his mom. Anna is still getting used to the sight of her son under heavy sedation and constant mechanical surveillance, but by the time we left, she was in better spirits than I've seen in a while. She was even up for a well-earned Mexican martini at Curra's, her first since finding out about the pregnancy (and yes, we threw away the tiny bit of milk she expressed afterwards). We've still got a long way to go, and there are still moments of doubt and anger, but we both know everything will be alright in the end, and that certainty helps.

Mystery solved

Anna left the hospital today and saw Frankie for the first time since he was transferred to the NICU at Brackenridge on Thursday. At first glance, he looks a little worse for wear. He has a Broviac catheter in his chest, heplocks in his left foot and right arm, a breathing tube and a feeding tube down his throat, and a blindfold to shield his eyes from the thermal lamp they're using to treat his mild case of jaundice. They're keeping him sedated with morphine, so he's more or less unresponsive to touch, although his fingers close lightly around a finger placed in the palm of his hand. Anna was understandably upset, but once the initial shock wore off and the doctors and nurse answered her questions with overwhelmingly positive responses, she settled down. We spent several hours sitting beside our son, reassuring one another that everything is going to be alright. We both know we're not out of the woods yet, but having Anna home and Frankie stabilized is a damn good first step. She's asleep now, resting well in spite of the stress and pain, thanks in no small part to her new best friend, Darvocet. I'm about to crawl into bed next to her, happy to be back home but wishing Frankie was with us. I'll be counting the hours until he's discharged, which probably won't be until early September. Looks like we're both in for a crash course in the sublime art of patience. Wish us luck.

In other news, I've finally solved the mystery of this "Morris" character. Turns out my friend Yuri, and his wife Michelle and daughter Jordan, sent us an enormous Harry & David gift box (and by box, I mean crate). Apparently, some nurse by the name of Morris signed for it, and since Yuri hadn't heard from us, he was beginning to wonder if it hadn't been hijacked en route to Anna. I should've known.

Esophageal Atresia & Tracheoesophageal Fistula

Esophageal Atresia & Tracheoesophageal Fistula
Originally uploaded by Critical Mess.

Now that Frankie's surgery is over and his mom and I have had a chance to let out a huge sigh of relief, I'm in good enough shape to fill y'all in on the details of the procedure. The diagram to the right illustrates several variations on the theme of Frankie's condition, his particular case most closely resembling example D, an esophageal atresia with a tracheoesophageal fistula. Simply put, his esophagus did not fully develop during gestation. The upper portion of the esophagus formed a small sack, or atresia, which prevented it from growing into the distal portion of the esophagus (attached to the stomach). In turn, the distal esophagus attached to the trachea instead, and a small opening (fistula) created a passageway between the stomach and the lungs. Had Frankie not been a preemie, this condition might not have been discovered until after he began to breastfeed, which would have created the rather more serious complication of pneumonia (fluid would travel down the trachea instead of the esophagus, and therefore into both the stomach and the lungs). In a way, it was fortunate that he came early, as the atresia was discovered when they tried to insert a feeding tube into his throat (something they general don't do for full-term babies). The procedure to correct the atresia and fistula involves two primary steps: first, the distal esophagus is detached from the trachea, and the fistula is sealed with sutures; second, the atresia is opened with an incision, then attached to the opening at the top of the distal esophagus and sealed with a circular suture. All of this is done through a small incision on the left side of Frankie's chest. The surgery did not require his ribs to be broken or his chest cavity to be opened, and he lost only about 1cc of blood. The doctor also inserted a Broviac catheter into Frankie's chest, which will minimize the number of times they have to fish for a vein when inserting antibiotics and other medications, and which will later be used for introducing fluids and nutrients. Really, it's amazing what they did, and as of this morning, Frankie is doing great, and there are no signs of any complications. If the sutures hold, he'll be ready to begin ingesting food by the end of next week.

great news

This will be brief, because I'm feeding Anna a couple of Darvocet and then leaving the room for a couple of hours so she can sleep undisturbed. Frankie's operation went off without a hitch. The doctor started at 2:30 and said he'd be lucky to finish by 6. He walked into the waiting room at 6:05 with a big ol' shit eating grin, and told us that everything went even better than expected. The fistula was closed without a problem, and the esophageal atresia was easily repaired. Frankie's lungs are as healthy as a full-term baby's, and if he wasn't a preemie, they wouldn't even have left his breathing tube in (as it is, it might be out by tomorrow). I'll post a lengthier post tomorrow, but I just wanted to let everyone know that one major hurdle is down, and although he's not out of the woods quite yet, Frankie took a quantum leap forward health-wise today. Your thoughts and prayers are appreciated, moreso than we'll ever be able to adequately express. Keep 'em coming.

Dad & Son

Dad & Son
Originally uploaded by Critical Mess.

Franklin Duke Breshears

Franklin Duke Breshears
Originally uploaded by Critical Mess.

Perspective

Perspective
Originally uploaded by Critical Mess.

Frankie

Frankie
Originally uploaded by Critical Mess.

Happy Birthday, Son

At 6am, Anna began having terrible stomach pains. She told me she might just be constipated, and that sounded like a good enough reason to me, but we called in the nurse anyway. She asked Anna a series of questions, the answers to which all pointed to her pain being related to contractions. I held firm with the constipation theory. "Did you have a good bowel movement yesterday?" I was trying to be helpful, and hoping the time had not arrived. By 6:30, the constipation theory was pretty much blown out of the water. The contractions were about 6 minutes apart, lasting for almost a minute. By 7am, they were 4 minutes apart, slightly over a minute each. By 8, they were three minutes apart, a minute long, and the doctor decided he'd seen enough. "It's birthday time." I called my dad while the nurses prepped Anna, then changed into surgical gear as they wheeled her out of the room. At 8:20, they led me into the operating room where the doctors were already busy at work. Anna was conscious, and in better spirits than I expected. Our doctor du jour, Paul "Buzz" Bushart, was joking with the nurses, and with me, which Anna and I both found reassuring and relaxing. At 8:40, the nurse announced the arrival of Franklin Duke Breshears. I won't even attempt to put into words what I felt at that moment. They whisked Frankie from the room, and I stroked Anna's hair and told her how much I loved her. A nurse poked her head back in and told me I could see my son. I followed her to a room across the hall, and saw my boy for the first time. Again, there aren't words for this feeling. I returned to the operating room as the doctors finished the surgery. After a few minutes, they rolled Frankie in to meet his mom. Anna turned her head and fought her way through the chemical haze, reaching up through a small circular hole in Frankie's plexiglass encasement to touch his tiny hand. It was the most beautiful moment of my life.

I followed Frankie and the nurses out of the operating room and up to the Neonatal Intensive Care Unit. I watched them weigh him (3 pounds, 10 ounces), measure him (42 cm long), and check his extremities (10 fingers, 10 toes, 1 penis). Then, I touched him. I held the palm of one hand against his head, and rested the other against his chest. He cried, drawing in deep gulps of air, his skin turning darker shades of pink. After a few minutes, I left him to see how Anna was doing. I arrived in time to see her wheeled out of surgery into the recovery room. I left her to rest, and began making phone calls.

Shortly after 10, I got a call from the NICU doctor. He wanted to meet with us immediately. I knew from the way he stressed that word that something was wrong. I caught him in the hallway outside of the recovery room, and told him I wanted to know what was going on before we talked to Anna. He was very matter-of-fact: Frankie has esophageal atresia and tracheo-esophageal fistula. I didn't know what the words meant, but I got the gist of his message: Frankie required surgery, and he needed to be transferred to another hospital. Fuck. That's the only thought I could manage. Just fuck. After all we'd been through, I actually thought we were in the clear. We both entered the recovery room, and he told Anna what he'd told me, in slightly more detail. I choked back tears, trying my damnedest to maintain a strong facade, thinking that would somehow soften the blow. I told her everything would be alright, but the doctor kept emphasizing the seriousness of the situation. He wasn't helping, or apparently didn't understand the game plan. No matter. Anna took the news better than I expected, and I assured her that I'd take care of everything. Then I left her to sleep, went out to the parking garage, locked myself in the car, and cried. I came back into the hospital ten minutes later, helped my dad and sister pack up the room and move across the hall to Anna's new post-partum room, and steadied myself for the hardest day of my life.

I'll skip ahead. It's almost 11pm now, and I'm back in the post-partum room with Anna. I've spent most of the afternoon and evening with Frankie. My mom and dad showed up at the Neonatal Intensive Care Unit at Brackenridge around 6:30pm, and I left them there just after 9. The surgeon who'll perform Frankie's operation explained it to me in great detail, and I felt a little more reassured. Then I met some of the other folks who have kids in that unit. One baby has been in for 81 days. He's smaller than Frankie. Another couple told me they've yet to hold their baby, who was born two weeks ago but wasn't due until the end of October. Another couple told me their baby was born three months early, and that the doctors still don't know if she'll leave. I know we're not out of the woods yet, but even in the midst of what I considered to be crushing news, I'm constantly reminded of just how lucky we really are.

For all of you who've been sending thoughts and prayers for Anna, I'm hoping you'll redouble those efforts and send all you can to young Frankie, who'll undergo a very tricky procedure tomorrow at 2pm. I'll let you all know how it goes as soon as I can.

What the books don't tell you

This is hard - a lot harder than I'd imagined. Nothing prepared us for a weeks-long stay in the hospital. The baby books and our birth & baby care class briefly mentioned the possibility of premature birth, but nobody told us we could literally spend months in the hospital, with Anna more or less confined to a bed. Even after being admitted, the doctors told us not to expect a stay of more than 7 to 10 days. We're now starting our 16th day, and there's no indication anything is going to change soon. I've said numerous times that we've settled in for the long haul, but the realization of just how long that haul could turn out to be is only just now sinking in, and it's hitting Anna particularly hard. When the doctor stopped by this morning to deliver the perfunctory holding pattern/hang in there speech, she asked Anna if there was anything special she needed. Her deadpan answer: "Prozac." I laughed, and Anna smiled, but the doctor didn't take it as a joke. "We can get you something if you really need it." Up until that moment, I didn't fully recognize the severity of the toll this ordeal is taking on Anna. I'm doing everything I can to make her stay comfortable, but I can't take her home, and I can't even get her out of this room, and that's really all she wants right now. Even my words of encouragement seem like they may be doing more harm than good. I tell her that she's being strong for Frankie, and that every day she's in here is one less he'll spend alone in the NICU. I can't help but wonder if my well-intentioned cheerleading is accomplishing anything more than instilling in her an enormous amount of guilt and anxiety. And if I can't be a cheerleader, what exactly is my job? How am I supposed to carry my share of this load? I've joked before about how pregnancy can make a father feel both helpless and extraneous, but in the months leading up to this hospital stay, I was able to channel my overwhelming sense of uselessness into various projects around the house, preparing the nest and trying desperately to demonstrate my utility. Now, I'm stuck in this hospital, unwilling to leave Anna for anything more than a couple of hours at a time, and then only to do laundry or pick up groceries. And I don't want to leave. On the couple of occasions when I let Anna's mom spend some time alone with her daughter, I was basically a nervous wreck. She may be the one stuck in the bed, but I feel like I'm right there with her. Dr. Cosantino, one of our rotating obstetricians, likes to remind me that sometimes parental sacrifice starts early. The books don't tell you that.

Meet The Bedresters - The Series!

We see a lot of TV here and to my disgrace, I’ve found the Bobby Brown and Whitney Houston series both awful and impossible to not watch. There seems to be an influx of new reality shows that pale in comparison (does anyone care about Hulk Hogan for chrissakes?) however, which leads us to believe that overpaid TV execs are simply running out of ideas. So, we decided that we were just as suited to have our own reality show about our trials and tribulations in the hospital as anyone else. It would be incredibly boring, but the repetition would ensure that an excellent drinking game could be created around it. And by excellent, we mean you could get super drunk watching it.

Here are the rules so far:

Frankie’s heart rate drops below 100 and Anna has to be flipped on her side = take a shot

Anna goes to the bathroom = take a drink

Anytime someone tells Anna “Just hang in there!” = take a drink

Nurse takes Anna’s vitals = take a drink

Anna sinks into irreversible depression = pop a Prozac

Dave brings Anna morning latte = take a drink

Every time Anna is told to put Flowtron leggings on = take a drink

Doctor says any sentence including the phrase "holding pattern" = take a shot

Suggestions?

Purses 1&2 (back)

Purses 1&2 (back)
Originally uploaded by Critical Mess.

Since moving from Seton Northwest to Seton Main two weeks ago, we've had 8 doctors, all of whom work for the same practice. Each doctor works a 24-hour shift, from noon one day to noon the next. Anna wanted to thank our doctors by embroidering a little something for them. Monogrammed handkerchiefs were her first thought, but she wanted to do something special for Dr. Cherry, the tall, giggly obstetrician who reminds us of an awkward high school honor student. A change purse with embroidered cherries seemed the obvious choice. About halfway through the project, she realized she could do purses for all the female doctors, and embroidered handkerchiefs for the men. Of course, the 3:1 female-to-male ratio means she's bitten off more than she intended. Two down, four to go.

Purses 1&2 (front)

Purses 1&2 (front)
Originally uploaded by Critical Mess.

In a holding pattern

It's 11am, and we've now been in this hospital room for two weeks. A full 14 days. A fortnight. We've exceeded our hopes of making it past the first 72 hours by 264 - and counting. Our doctors are baffled and our nurses are impressed. Even Anna seems to be in better spirits today. She's already had breakfast, showered, and started another embroidery project. I chased a nurse out of the room at 4 this morning, but other than that ill-advised interruption, they've been letting Anna sleep through the night. We didn't wake up this morning until just after 9. Not bad for hospital sleep.

We're still in a "holding pattern," as more than one of our doctors is fond of saying. In fact, our situation is so stable that our doctors now pop in just to tell us that there's really no reason for them to be popping in. Even these visits have become increasingly infrequent. After two weeks, we've actually settled into a routine, and this incredibly strange situation has evolved into something approximating normalcy. They keep telling us that things could change at any minute, but my gut tells me that we might be here for a while. I've even replaced the first wave of flowers, that's how sure I am. Anna hates hearing it, but I think she's resigned herself to a good, long stay.

On the bright side, we've accumulated a good deal of practical knowledge that we're happy to pass on to folks who might someday find themselves similarly situated. For example, if you have a heplock (an IV line-in, minus the line) in your arm, you have to cover it before you shower. Some nurses prefer to cover the heplock with a surgical glove, sealed off with tape around the forearm. Others use a piece of plastic wrap, taped around the forearm and the hand. Both of these methods failed to keep Anna's heplock dry. Our favorite nurse, Hurricane Karen, came up with the ideal solution: a premie pamper, sealed at the hand and forearm with surgical tape. Good for a bone-dry heplock every time. The premie diapers also make a great koozie to soak up the moisture from an ice bucket (fig. 1). And a little consolidation of medical paraphernalia can turn any cabinet into a pantry or wardrobe (fig. 2). Seriously, we're chock full of handy tips. I should really make a list.

fig. 1

fig. 1
Originally uploaded by Critical Mess.

fig. 2

fig. 2
Originally uploaded by Critical Mess.

Monkey Bib

Hospital 014
Originally uploaded by Critical Mess.

Monkey by Dad, embroidery by Mom.

Curious George blanket

Hospital 011
Originally uploaded by Critical Mess.

Potholder #1

Hospital 013
Originally uploaded by Critical Mess.

Potholder #2

Hospital 012
Originally uploaded by Critical Mess.

Dereliction of Duty

Yeah, I know. A whole weekend without word of our goings on. Believe me, you haven't missed anything. Days 11 and 12 passed without incident. Anna and my sister spent Saturday afternoon painting and embroidering while I took care of things at home. Yesterday, I went home in the morning to wait for the DirectTV technicians, then stayed a couple of hours longer to give Anna some time to herself. She was bored and lonely by 2pm. Now that we're approaching the two-week mark, it's becoming clear that boredom is our biggest enemy. It seems strange to be worrying about how long we're going to be here, given that this whole thing started with us praying we'd make it through the first three days. This morning, Dr. Cherry informed us that they'd probably just take the baby out if Anna makes it to 36 weeks. That's right - 36. I've been hoping Anna could make it to 32, and she's been looking forward to 34 as the point at which this waiting game would end. Hearing that it could be two more weeks beyond that hit her kind of hard. We're both happy that Frankie's staying put, but we have a hard time imagining another month of this. Anna's a great sport, and she's doing everything she can think of to stay busy, but there's only so much embroidery a gal can do. She's finished two potholders, a bib, and a blanket. Now she's turned her attention to a change purse for Dr. Cherry, and monogrammed handkerchiefs for the other doctors. If anyone has any other ideas that'll chew up huge chunks of time, and that can be done from the semi-prone position, let us know.

Other than suffering through the tedium, we're both doing well. The doctors and nurses all tell us that Frankie is in great shape, and although she doesn't like to hear it, they tell us there are no indications that Anna's going anywhere fast. Thanks for keeping us in your thoughts and prayers, and I'll let everyone know as soon as anything changes.

A Contract

I just want to put this in writing. If I make it to 32 weeks, David will smuggle Malcolm (cat) up here. You are all witnesses to this agreement. At the very least, it will make for an amusing blog entry. As long as we don't get kicked out of the joint. Two nurses have said that they didn't think that it would be a big deal at all and even seemed to encourage it arguing that people did that with dogs all the time. I think we just need to get a leash and muzzle for him and tell everyone he's a "service cat".

Fun with Fetus

Today marks the beginning of our 31st week of pregnancy. Three weeks ago, I'd have been hard pressed to tell you what week we were in; now, I've got it down to the day. I find myself counting the hours from one week to the next. Surprisingly, the time is moving much faster than you'd think. It's a little after 11am, which means we've now been in the hospital 10 full days. We're both going a little stir crazy, but we're also amazed that it's already been that long. Then again, I've got it pretty easy. Anna has endured pokings and proddings, examinations and extractions, and all of the miscellaneous invasions and indignities that go along with intensive medical surveillance. She's been flat on her back 23 hours a day, sensors strapped to her belly, a heplock taped to her left wrist, the Flowtron Excel leg massagers wrapped around her calves. I feel slight pangs of guilt just stepping out of the hospital to pick up our morning coffees. Leaving for more than a couple of hours seems unthinkable, but that's exactly what we have planned for tomorrow. Anna and my sister, Kristin, are spending the morning together, and I'm heading home to take care of the cats, check on the house, and water the plants. Frankly, I'll be surprised if I can stay away for more than an hour.

8:30pm. Our room is never silent. The percussive thuka-thuka-thuka of Frankie's heartbeat is our constant companion. His presence is not just palpable - it's audible. And we have a new favorite game: Where's Frankie? Every once in a while, his heartbeat disappears from the monitor, and the game is on. I slather conductive jelly on the circular, plastic sensor, then slide it around Anna's belly until the heartbeat reappears. A variation of the game involves Anna flopping from one side to the other in an attempt to jostle Frankie back into position for the monitors to pick him up. It's almost more excitement than we can handle, but we're getting pretty good.

For those of you checking in on us for updates on Anna's condition, I'm happy to report that absolutely nothing has changed. The doctor tells us that Frankie looks great - even better than a lot of the full-term babies they're monitoring. Anna's missing the cats, and the gym, and the sun, and just being vertical for more than an hour a day. But we're both holding up quite well, considering the circumstances. Keep sending us your thoughts and prayers, because it seems to be working.

Still life with Mama

Still life with Anna
Originally uploaded by Critical Mess.

Those white and orange leg wraps are the Flowtron Excel Prophylactic DVT System Anna mentioned in her veal calf post. Anna's got a great view of the flowers in the mirror across from her bed. They really do make the room look and smell 100% better. It's not quite home, but at least Anna's comfortable. She's hiding behind her latest project, an embroidered potholder.

Anna and friends

Anna and friends
Originally uploaded by Critical Mess.

The cat is from my dad, the monkey's from me, and the quilt and pillows are a little taste of home. Anything to make my baby mama comfortable.

Cyborg Mama

Cyborg Mama
Originally uploaded by Critical Mess.

Heplock in her left hand, monitor cords in her right, and twin sensors attached to her belly, Anna sports the latest in Labor and Delivery chic. So 2005.

Embroidery for Bedridden Mamas

Embroidery for Bedridden Mamas
Originally uploaded by Critical Mess.

She's working on potholders at the moment, but she'll probably finish a quilt by the time she's out of here.

No more complaining

We slept until 8 this morning, at which time I rolled out of bed and headed to La Madeleine, a little cafe around the corner from the hospital, to pick up a nonfat, decaf latte for Anna and a coffee for myself. Waiting for the elevator down to the ground floor of the hospital, I ran into a now-familiar face. We've been exchanging brief greetings in passing for the past week, but have yet to actually meet. He's a tall, thin, shy-looking guy, no older than 25, and probably a couple of years younger than that. I introduced myself, and he said his name was Andre. His wife is the unfortunate lady down the hall who's been lying with her feet elevated above her head. I ask how far along she is, and it turns out it's farther than we thought: 28 weeks. "But they want to keep her here until she reaches 34." Damn. Six more weeks, if she's lucky. Suddenly our stay seems infinitely more bearable. Andre continues, "I'm going home to Waco today, and I won't be back until Tuesday." His eyes are aimed at his feet, and I can tell he feels a little ashamed of this admission. I've complained about feeling helpless and useless, but at least I've been able to be at Anna's bedside for the vast majority of her stay. I can't imagine leaving her for an entire day, much less 5. I asked Andre if they had family in town to look in on his wife. He told me no, and my heart sank. The elevator doors opened and we walked toward the cafeteria and the south entrance. I told Andre I'd be happy to look in on her while he's gone, and that he could stop by our room any time he needs anything, but he seems like the kind of guy that doesn't like to ask for help. I told Anna about our encounter, and we both just about cried. We feel very fortunate at the moment, and even more appreciative of all the help, love and attention we've received.

Uneventful is good, right?

Anna's feeling good this morning after another restful night. Frankie seems less hellbent on escape, and the only things Anna's really suffering from at the moment are boredom and a sore ass. After the stress and anxiety we were feeling at this time last week, it seems strange to be enjoying these placid moments together, she reading a magazine, me beside her, quietly pecking away at the keyboard. Anna's doing so well that I'm going to venture out this morning for a haircut. She's going to enjoy an hour or two alone for the first time in days. We couldn't have gotten this far without the love and support of our family, but I think she's going a little nuts from the constant attention. Anna's a fiercely independent woman, and she's used to getting plenty of time to herself, so she's having to adapt to letting folks take care of her. As for me, I'm having to rein in my overprotective tendencies. I sometimes have to remind myself that she's not made of glass, and that the situation isn't as delicate as my paranoid mind would like to imagine. Then again, the risks aren't entirely in my imagination.

We finally talked to a doctor from the Neonatal Intensive Care Unit last night. He answered our barrage of questions and gave us a much better idea of what that experience is going to be like. It sounds like we'll have very little contact with Frankie for the first few days as they stabilize him and assess his situation. That's going to be hard on us, because the focal point of our birth plan has been to spend as much time as possible with Frankie after he enters the world. At Seton Northwest, the hospital at which we'd intended to deliver, the newborns stay with the parents from the moment they're born until mother and baby are discharged. I kind of assumed that every hospital had a "nursery," where babies are lined up in neat rows, tucked into identical bassinets, identifiable only by a tiny sliver of a wristband and a pink or blue skullcap signifying gender (or, as Judith Butler might prefer, signifying biological sex). We liked the idea of getting to monopolize Frankie's time for his first few days on the planet, but now it appears that isn't going to happen. While we're more than a little disappointed, the reasoning seems pretty sound: the goal of the NICU staff is to keep premature babies as quiet and calm as possible so that they can continue to mature and avoid complications associated with high blood pressure, elevated by excitement. So, if it's in Frankie's best interest, we're willing to suck it up and restrain ourselves. Luckily, those first few days will coincide with Anna's recovery from the C-section surgery, so it will be easier for me to focus the bulk of my attention on her, and for her to focus on recovering so that we can be there for Frankie when he really needs us. After the first few days, we'll be able to increase our contact with Frankie, and when he's sucking and swallowing, consuming mostly breastmilk, and able to maintain his body temperature without assistance, we'll be able to take him home. That could take anywhere from weeks to months, depending on his progress. In the meantime, we get to worry about spontaneous brain hemorrhages, blindness, and a couple of other random catastrophic occurrences that translate into a survival rate for 30 week old babies that's somewhere between 75 and 99%. Neither of us have really thought about the fact that survivability is still an issue, but it is. We're not out of the woods yet, but the doctor was quick to point out that the low end of that percentile figure applies primarily to babies that don't have access to NICU facilities. In this hospital, the survival rate for 30th week newborns is in the upper 90's, and only a rare few of those suffer any significant complications. On the whole, the news from the doctor sounded positive, and we actually felt reassured by the visit. This will be tough, but we've resigned ourselves to what's ahead, and we'll do whatever's necessary to bring Frankie home safe, happy and healthy. That's what parents do, right?

My Life As A Veal Calf

As I lie here with my retro-styled (Developed for astronauts! As seen on TV!) Flowtron leg massagers, sensing my ass turning into something akin to aspic, I think I know what veal calves must feel like. I am being prepped for slaughter. Sitting upright is discouraged in this battle of wills to keep Frankie inside my belly.

However, Dave and I have both decided that it isn’t right for me to complain after finding out yesterday that there is a woman on our floor who is at 22 weeks and has to sit with her head and body below the level of her legs, so that what remains of her fluid stays inside -- plus she has to eat hospital food. We have parents running around grocery shopping for organic chicken and vegetables and nightly visits from our very own dessert fairy, Kristin. At any rate, we figure we have years of good guilt inducing labor stories for Frankie. “Oh? You want a larger allowance? Well, as soon as you pay us back for your Mom’s three week hospital stay when you were born, we’ll get right on that.” “Oh sure – ride your bike off that ramp and get hurt – after all we went through to have you!” The possibilities are endless.

Certainly one of the most important things this experience has taught me besides the fact that “bed rest” might sound fun and relaxing but really is not at all, is that I spent way too much time being upset by little things before. A sense of renewed perspective has overtaken my worries and concerns from before. Yes, I will still get pissed off about animal cruelty and the lack of healthcare in the US, but less so if someone is just being an asshole to me or I discover that someone has written something derogatory about me in a local bathroom (true story!).

It sounds squishy and sentimental but we feel very encouraged knowing everyone is rooting for us and Frankie. Finally! A sport I can get behind! We appreciate the cheers and the waving of the collective pointy foam finger on our behalf.

Frankie Doodle Dandy

Monday, July 4, 10am. A while ago we learned that our boy's name, Franklin Duke, translates into something like "Leader of Free Men." My sister reminded us of this last night, and pointed out that if he arrives on the 4th of July that'll pretty much guarantee he'll be President someday. I prefer to think of him in more revolutionary terms, perhaps as some kind of modern day Spartacus, rising up to overthrow the globo-corporate oligarchy, or some such thing. But that's just me. In either case, that window of opportunity closes in about 14 hours, and Anna and I are both fairly confident that she can suppress his rebellious attempts to break free from her ovarian Bastille for at least that long. Our moms think he'll be here on Tuesday, and my Dad's guess is Sunday, which also happens to be my grandpa's 80th birthday. At this point, I wouldn't be surprised if Anna's in this bed until August. Her ass is sore, but her will is strong.

Last night we had a Sunday family dinner in the hospital room. My sister, Kristin, and our moms made halibut and tilapia, asparagus, basmati rice, and a spinach salad with avocado and grapefruit. They also smuggled in a couple of bottles of wine, which made my night a lot more relaxing. We're lucky to have so much support, and such a great family. My heart goes out to couples who have to go through this alone. I'd be a wreck if, in addition to taking care of Anna, I had to worry about feeding our cats, watering our plants, or waiting around for the AC repair person (because, of course, our AC stopped working yesterday, right in the middle of the 4th of July weekend). And I don't think Anna could've held on this long if she had to subsist on hospital food (really, worse than you'd imagine, I swear to God). The nurses are all very impressed by how well we're holding up, but the real credit goes to our behind-the-scenes support network. We'll never be able to adequately thank them. I sure hope Frankie grows up to appreciate the importance of family as much as we do right now. Maybe that'll be thanks enough.