You make everything NICU

Taking care of five children is chaotic, and writing about time spent in the NICU can be exhausting, so I slipped into a pattern of not getting back to continue the blog.  But a couple of weeks ago, during a field trip to Children's Hospital of all places, I found out that one of the parents in my 2nd grader's class also was a NICU parent.  Even though we didn't get to share but just a few moments, it was clear that she had been scarred deeply by the incident.  It's a common saying that time heals all wounds, but nobody mentions the scars.  It was a bit comforting, extremely comforting really, that I was speaking to someone who knew how I feel and vice versa.

Being somewhat nomadic doesn't help my case, because nobody outside of family has known what we've gone through these past few years.  We moved to Knoxville right at a year ago and it is such a drain meeting new people because you explain who you are, but when you are still reeling from the trials that have been hurled at you, talking about hurt feelings isn't exactly on the topic list. Instead we put on the mask of the person that we would like to be.  That's extremely easy too since many cannot possibly empathize with the NICU parent.  The problem is that to miss out on being understood becomes a hurdle to actual healing.  Sad thing is that when we camouflage our selves that well, we hide from the ones that can truly empathize with us.

Doing what I do, which is working things out inwardly, I put together a slideshow that scratches at the surface of what it means to go through the season of having a child in the NICU.

Initial Moments in the NICU

By time a mother is released from Post-Op, a micro preemie has received more medical attention in the NICU than a normal healthy child will receive during their entire childhood.  During the pregnancy, as much as we had been guaranteed that our children would spend some time in the NICU, prior to the delivery of our triplets, I really knew nothing about what goes on.  Earlier in the day, as we were learning that our children would need to be delivered via C-section, we got a visit from one of the NICU doctors who gave us the five-minute explanation of what we needed to know.  That sounds hurried, and yes it is, although five minutes is about all of the time it takes to explain those parts of the NICU that can be understood without a first-hand experience.  Basically it is broken down to establishing respiration through intubation, maintaining body heat via incubation, nourishment via an IV, and maintaining proper body chemistry also via IV. 

The first visit to the NICU is a complex mixture of childlike wonder and trepidation.  The initial room that our children were in was small and just outside the operating room.  This is where doctors and nurses started to care for our children and create the environment as close to in utero as possible. Instead of having an isolet commonly seen on television, the children were in a tray-like bed with a heat lamp.  They used an artifical lambskin to cocoon around the babies to establish a confined space much like a womb.  Each child had their intubation tube coming out their mouth and tethered with a brace that secured to each cheek.  The line for the IV came out their umbilical arteries.  Each child had a heel bandaged from which they took blood for analysis.  Their eyes were covered and the tiny diapers that they wore were grossly enormous on their tiny frail bodies.  There was a pulse/oxygen sensor affixed to their feet that gave off a soft orange glow. All of the items affixed to their bodies extended to some form of medical contraption that beeped or alarmed--ventilators and flow meters, monitors and pumps.  Their beds were covered with stretch wrap to ensure their environment was sanatary.

As we visually took all of this in, our journey in the NICU had began. 

Whisked Away, Moments Lost

FYI, as much as I want to tell in my own words the story of our NICU experience, I do want to leave something meaningful to those that may stumble through the information highway and somehow land on this blog.  So if you have some feedback, anything at all, please feel free to post feedback/criticisms/questions/etc. in the comments or email me. 

Anyway, after the weekend and not continuing my story for a couple of days, I am at the point of questioning where I had left off.  Having three children in diapers plus two more, has an effect that you definitely may not remember anything that happened during the current day, let alone three days prior. 

I do believe that I was giving account to the birth of the triplets and left off with all three having been intubated in the NICU, pretty much straight from the womb to their incubator.   The medical necessity rightfully so renders forfeit the parents' first moment with the newborn children.  I have been reading the accounts of other parents having experienced the same and this moment is almost universally described as being one of those components of the childbirth experience that is lost.  Whether by natural childbirth or a non-emergency C-section, mothers and fathers are afforded the opportunity to see their newborns.  (If it's a C-section, the father lucks out as being the first to hold the newborn since mom is still on the operating table.)  As far as bonding with your child, this moment is important.  It is the first time you get to know your child outside the womb and distinguish all the minute features that makes your child an individual.  It has been my observation that the mom is acutely equipped for this moment as they can visualize, isolate, and associate physical features seemingly instantaneously.  Eyes, ears, nose, hair, etc.--it's a visual DNA test with impeccable accuracy.

On the other hand, fathers are ill equipped for that moment.  Speaking for myself, the totality of the moment left me awestruck.  To put proper perspective on things, I have to return to the birth of my oldest child, Madison.  Working for a very small company on a very big project, I had facilitated scheduling of a backup for me so I could take a week off.  This notion was very fitting for my wife as well since she would rather know the time instead of waiting for the natural onset of labor.  We arrived at the hospital very early and by 7:00 am, the doctors had broken the water and my wife was on a steady pitosin drip.  From the moment of waking up and then driving to the hospital and checking in to the moment the water broke, the day was filled with excitement.  Every time a doctor or nurse came in the delivery room there was news.  My wife was dilating beautifully and vitals were fine.  At every turn there was good news and today we were going to have a baby.  After months of preparation--picking out newborn clothing, and bedding, and a crib, and a rocking chair, and painting the nursery five different colors and getting carpeting, and every other thing imaginable that first time expectant parents do--after all of that, this was the moment we were working for.  Today we were having a baby. 

We got to about 7-8 cm dilated and then the next check, still 7-8 cm dilated, and same for the check after that.  The news was that our daughter's head was not positioned correctly in the birth canal which meant that progress had, well, stopped progressing.  Vitals continued to be fine, which was the important thing, but our exciting morning had turned into an afternoon of patience and waiting, followed by an evening of patience and waiting.  The OB to perform the delivery had a very hands-off approach as long as the vitals remained well.  Thus, waiting begat more waiting.  Waiting can be exhausting.  I cat napped through the evening, but without fail, every time I would doze off, that is the very moment the OB would choose to visit.  My wife felt quite certain that the OB thought that I had slept through the entire evening.  Needless to say, we didn't have a child that day.

Early the next morning, after my wife had been in labor for just over 24 hours, things progressed.  "You're doing well.  Just breathe. Breathe...in....out.....in....out.  OK, push...PUSH....PUSH....PUSH.  Honey, she's starting to crown.  She's got some hair.  Breathe...push."  In and of itself, it is a prelude to the climax, but that moment, the crowning, that's the first time I saw any part of my child...my own offspring....something, someone that I had a part in making.  It's a tearful moment as there's nothing to hold back the wellspring of emotion.  That's the moment that you know the reality of becoming a parent.  Everything up to that moment is just pregame warmup.  All of that was the pregnancy, but this moment, this is birth.  There's a child about to take her first breath.  "Push, push, push, push, PUSH.  OK, breathe and relax.  This is so beautiful honey,  I wish you could see it.  I can almost see her whole head.  Push, push, push, push, PUSH."  And there she was, my daughter Madison. 

While she was misaligned in the birth canal, Madison had her head lodged for hours in that position poking at the beginning of the birth canal.  So when she was born, her head had taken on some shape from being in that position such that one could call it cone shaped.  That coupled with the fact that babies come out of the womb from which they spend nine months in a sack of fluid, not the pink smooth skinned baby we all see on television, but with wrinkles and pasty gray.  At that point, we're a spaceship and Sigourney Weaver away from a classic blockbuster. 

I know, I know.  That's awful.  Mom is thinking beautiful hair and who's eyes she has, and I'm in utter shock thinking that something has gone awfully wrong.  It was a relative eternity before she took her first breath.  Why hasn't she taken her first breath?  So, she's a pasty prune skinned conehead and isn't breathing, something is terribly wrong......oh, there's the first breath.  Now I can breathe.  Oh, OK, cut the umbilical cord?  Sure, the new-dad rite of passage.  Great, severing flesh so Captain APGAR over there can go to work.  Who's going to catch me?

And then a few moments later, mom gets a newborn, with all the pasty stuff wiped off.  And thus the bonding begins.  That's the way it should be.  It was the same for our second child, Kaitlyn.  There was still tears when she crowned.  And a not so long while later, mom and dad were bonding with her.

But when your child (or children) are whisked off to the NICU, that's just unnatural.  The interaction, the imprinting, all that which jump starts the maternal instincts is completely cut off.  As necessary as it is, it is still an entity of being a parent that is missing from the process.  Instead, your child(ren) begin a journey in which they start off relying wholly on medicine and machines to survive from one breath to the next.

Revisiting October 17, 2009, A Birthday Celebration

Our first two children have birthdays in November. Madison was born 11/13/2003, and Kaitlyn was born 11/2/2005. As our triplet pregnancy progressed, even though the due date was in January, we realized that the date of delivery would likely be prior to November. Because we knew that our lives would be changed dramatically after we delivered, we made it a goal to have a grand birthday bash for the girls and schedule it early in hopes that we would be able to share the moment with them.

As fate would have it, Tiffany was diagnosed as having low amniotic fluid a week prior to the scheduled date of the party and we opted to have her stay in Albuquerque to be closer to the NICU and also hoped that a 2100 ft drop in elevation might have a positive effect on the pregnancy. On Friday October 16, Tiffany was scheduled for a prenatal visit which revealed that Ethan's umbilical cord flow was stagnant during the rest of Tiffany's heartbeat. It is supposed to continue flow during the resting beat, so the condition was very precarious. Tiffany was immediately admitted to the hospital and I was soon packing my bags and headed from Los Alamos, NM to Albuquerque. To be honest, I do not remember any detail from that Friday evening. I do know that I was unwilling to accept that Ethan's condition would worsen and that I fully anticipated Tiffany being in the hospital several weeks before delivery. Saturday October 17 arrived. The day was complicated as I was supposed to be home with Madison and Kaitlyn getting ready for a birthday party. Instead, I was in the hospital soon to find out it would be a birth date indeed. Back to the party, it's a good thing that my mother and brother-in-law were able to be there for the kids. I don't know what we would have done otherwise. As it was though, it was a grand party with inflatables and clowns. Everything was taken care of by a party organizer which made it a lot easier. (I suggest that if you are able to do so, to have one such birthday party for your kids. The memories are well worth it.) We just wanted the kids to have fun, so we invited as many as possible. 

Meanwhile, back at the hospital it was hurry up and wait.  There were lots of nurses and labs drawn and in the midst of it all is the struggle to be calm when there's so much anticipation.  It wasn't until late morning that the prenatal specialist did rounds and checked Ethan's status via ultrasound.  The results were not good and there was indication that his cord flow had indeed started to reverse.  The clock had already started counting down to some point in time that he would essentially suffocate without a blood flow of fresh oxygen.

We were immediately given our options and we chose to go ahead with an emergency c-section that day instead of chancing Ethan passing in utero and the likely damage that would cause Devon.

What followed was a steady stream of doctors and NICU doctors and nurses and paper, lets not forget the paper.  As much as you want to be attentive in such a situation, eventually it becomes a bit overwelming and everything starts to sound like Charlie Brown's teacher.  I caught the parts about needing steroids to help the lungs and first thing first is that each child would have to be successfully intubated which would be challenging with such small infants. 

The period of time that followed seemed like an eternity.  There was some sort of holdup on getting the script for the steroid filled.  I had actually anticipated getting a steroid dose the prior evening, but the prenatal specialist elected a wait and see approach, apparently because it was still a bit early as far as gestational age goes.  Eventually, the dose came and was administered and at some point the anesthesiologist had administered the epidural, and Tiffany was carted off to the OR.  My job was to suit up and wait until called upon, and soon enough I was called upon.  It is difficult to give justice to any description of the moments prior to birth as I waited on one side of the cloth trying to comfort both my wife and myself.  I was very much caught up in consoling her when I was tapped on the shoulder with a "Dad, you don't want to miss this."  As I peered over the cloth the surgical team made quick work as Ethan was born followed quickly by Devon.  Their frail bodies were quickly wisked away and thru a door into the NICU.  Reagan was a bit more difficult to deliver as she was carried much higher in the uterus than the other two.  When she was born, she came out crying.  With the silence experienced during the birth of her brothers, the cry was a welcome sign and Tiffany and I simultaneously gave a sigh of relief and we embraced each other with smiles on our faces.  Ethan was born at 10.6 ounces, Devon at 18 ounces, and Reagan at 23 ounces.

Thus started our experience with the NICU.  Before Tiffany had been stitched up word had came that all three infants were successfully intubated.  Next to Reagan's cry, this was the second best news of the day.

Prenatal Hell, Pt. 2

The interview went well, and surprisingly no questions about what I envision five years from now. Second interview was with the prospective workgroup and found out that one of the members was a grad student at UT same time as me, so maybe there's an inside track. Unfortunately, things won't happen quick and it will be the better part of a month before any decisions are made.

So back to catching up, where was I? Oh, triplet pregnancy and prenatal hell. I don't know if it is any easier for those who do not adhere to the acknowledgement and adherence to a greater being, but I ponder how one without an absolute moralistic foundation feels about the tough decisions. For me and my wife, we are Christian and although our actions and/or reactions do not always reflect a conciousness that we are not in control, we simply are not in control. We're not religious, well not overly religious because I suppose you cannot exercise faith in God without some degree of religion. But through all of those episodes of prenatal hell, the professionals that we dealt with seemed perfectly fine to suggest that termination is always a viable option. Even if you put aside all arguments about the morality of choosing to terminate a pregnancy, I hold fast to the notion that we are given every capability to love and care for each child that we bring into this world.

Needless to say, that although my wife and I were shattered visit after visit, our resolve was to make every effort to bring three children into this world. Our next to last prenatal visit morphed from a coctail of probabilistic birth defects to the realistic condition that the amniotic fluid was dangerously low. Our corrective action was to get Tiffany out of the elevation of Los Alamos, NM at 7400 feet above sea level to Albuquerque where the elevation was considerably lower at 5300 feet. To boot, the only NICUs in the state of New Mexico are in Albuquerque. For one week, Tiffany was on complete bed rest and drank fluids like crazy in hopes of increasing the amniotic fluid. On the last prenatal visit, Tiffany was told that Ethan's umbilical cord flow was stagnant between heartbeats. She was immediately admitted to the hospital and I packed bags and left for Albuquerque. The next day, Ethan's cord flow was reversing during the resting beat. This condition was certain to cause mortality and there was an unknown finite window for action.

Our options were to either have emergency c-section or to let Ethan pass in utero. At 24 weeks gestation, the odds were stacked against all three should we choose emergency c-section. Choosing to let Ethan pass in utero would give Devon and Reagan better chances at survival, but since Ethan and Devon shared a placenta, a sudden change in blood pressure could leave Devon seriously brain damaged. Neither option was ideal, but we choose to go ahead with the emergency C-section and give all three children a fighting chance to beat the odds. That afternoon, October 17, 2009, Ethan was born at 10.6 ounces, Devon at 18 ounces, and Reagan at 23 ounces. All three were sucessfully intubated and our NICU experience began.

When she was born, Reagan let out a cry. Given the gravity of the situation, it was one of the most beautiful things I have ever heard.

Father Interrupted (Prenatal Hell, Pt. 1)

I have an interview tomorrow. I am fully anticipating the interview standard, "What do you see yourself doing in five years?"

Five years ago, I had two children, resided in Fairfield, Ohio, had a good job with a solid wage. My five-year answer at that point in time would not have come close to being close to describing where I am now and the path that got me here.

I started this blog a few years ago not really knowing what I wanted to blog about, and you can see that it has been several years since I last posted, so I believe that I got it partly right when I titled the blog Blogger Interrupted, but I should have titled it Father Interrupted. There's a lot of detail to make up, but the triplet pregnancy did not go well. Early on in the pregnancy it was apparent that one of the triplets was not developing according to schedule. Well, none of the triplets was developing according to schedule, but Baby A was even more so than the other two. Babies A and B were identical boys, and C was a singleton girl. We picked out the names Ethan, Devon, and Reagan respectively.

I just realized there is so much to say that bringing everything up to speed in one post could be construed as intolerable cruelty to humans, so I will try to tell our story in several posts.

The remainder of this post will be on prenatal care, or as I have come to know it: prenatal hell. It is my opinion that those who specialize in high risk prenatal care can only reduce their liability by eliminating the risk factors. So as an expecting parent, the cycle is as follows. You love your unborn child, you care for your unborn child (which in the paternal sense means to meet every need of the expectant mother, both physical and emotional), you look forward to prenatal visits with excitement, during the prenatal visits you endure the explainations of how your children are at risk for the assortment of birth defects, you listen to your options as the specialists slant the conversation toward reducing those risks, you leave shattered, you second guess what the right thing to do is, then you embrace each other and pray. You go home with resolve that your decision is the right thing. You love your child, you care for your child, you look forward to the next visit with excitement and anticipation.

Ultimately, we are not in control of the events that shape our lives. However, we are in control of our responses. We can choose to live in fear, or be filled with joy.

Well my 6 month old (yeah, there is a LOT to catch up on) is crying so I had better wrap things up.