Showing posts with label guilt. Show all posts
Showing posts with label guilt. Show all posts

Wednesday, January 8, 2014

Guilt, Part II -- Survivor guilt

“How old is he?”

Oh, the dreaded question. I was at a church potluck. We hadn’t been at church much over the winter months, so I didn’t really know many of the new members. Now it was early summer, risk of RSV and colds were diminished, and we were finally taking our baby out in public.

And I was sensitive.  He was 9 months old, but he looked like a newborn. He was still wearing 0-3 month clothing.

“He’s nine months, but he was born four months early.” My quick standard line.

The middle age gentleman that asked the question became very still.

“Oh.” He said, “What’s that for gestational age? Like, 25 weeks?”

Oh-oh. He knew something. Middle aged men don’t typically do gestational age math that fast.

“23 weeks,” I said.

“Oh, wow,” he said, “How did they do that? I mean, how was that possible?”

I said something light-hearted about how it was pretty amazing, and then hinted at the difficulties by saying something like “it was a pretty near thing,”

And then he shared. His son – born at 29 weeks – a full month and a half further into the pregnancy than my son – had only lasted until his second night. Then his heart and lungs gave out.

This was over 30 years ago, but as he spoke, he was transported to that NICU of that past, to the bedside of that baby, to his boy Samuel, and to the few moments they’d had together.

“They didn’t tell us that anything like that could happen. It was so sudden,” he said, “I thought he would be okay. I’d gone back to work that day. When I left him in the NICU, it looked like he was fine.”

Sam had lived less than two days, over three decades ago. But he wasn’t just this man’s son-that-had-died. As he spoke of Sammy, Sam’s name was used over and over again. His baby boy Sammy, forever a baby, but never forgotten.

I cried with him. Me and this stranger. We cried over Samuel. We cried over the tragedy that babies die. And when he asked again how it was possible that my son survived, I still didn’t have an answer.

“By God’s grace and a great medical team,” I said, feeling very insufficient. The truth is, JAM hit some of the worst preemie ailments at a very low birth weight, and he was born the wrong gender (preemie girls fare better than boys) and yet he’d squeaked through. He shouldn't have made it, and yet he did. I had no answer.

I don’t know! - my heart screamed – I don’t know why my son lived and your son died.

In the book of Job all these wise friends try so hard to explain all that had come of Job’s life. And their wisdom was nothing. It was them, trying to explain an unexplainable God. In the end, God has choice words for these friends (Job 42:7). Sometimes there are no answers.

So this middle aged father and I cried for his son, raw emotions of a pain that will never fully heal. Jonathan looked up at us from his car seat carrier. I didn’t get it.

NICU survivor guilt.
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There are other types of survivor guilt, too. There’s comparison guilt.

Comparison guilt (my term) is when I feel guilty that my child is doing better than someone else’s child. Since you don’t get much earlier than 23 weeks, most of these other children were born later and had more time in the womb. So they should be doing better.

And then there’s the flip-side of the comparison guilt coin: comparing my child to the micro-preemies who ARE doing better. These are the babies born around my son’s birth weight and gestational age who fared so very well. These are micro-preemies who left the NICU prior to the babies’ due dates. At a year and a half or two years old, they are basically entirely caught up. They’ve graduated from early intervention services. They have perhaps some signs of prematurity (like a head shaped like a toaster – yes, that’s a thing) but they’re the sorts of signs most people won’t notice much. It's so easy to see that and have a pang of regret when I know I should rejoice with them. Most of the time I DON'T mind that they're doing so much better. Most of the time I rejoice with them. But then there are moments when they get unexpectedly quiet or awkward, as they realize I still have to battle to get where they are. I don't want them to feel guilty, I don't want to feel pained. I want their support and friendship, because they do understand so much of what I have been through.

So how do you fight these guilts?

First, recognize that every premature baby is different. If I sat down and went point-by-point over what my premature baby was doing compared to someone else’s, and at what ages, we both would leave feeling kind of down. And what would it help? Feeling guilty about how well my child was or was not doing compared to other preemies was not going to equalize things. You can’t make a preemie get better by pointing to another preemie who did better. So don’t compare.

Second, recognize all that you share in common with those around you. Share. When I say don’t compare, I don’t mean don’t talk about how things are going. DO find good friends with similar experiences. DO share. But shift the focus. Instead of focusing on keeping score or tallying up a report card on your kid (I love lists, so it is WAY too easy for me to make mental lists on my kids), instead of this sort of comparison, focus on hearing each other’s story. Talk honestly about how things are going. In other words, do empathize.

Cindy, one of my NICU friends, taught me this. She shines better in this than I ever could. She naturally empathizes with others’ situations. She did this even when she was worn by months and months living at her daughter’s bedside. I admired her strength.

Some days her child was more stable than mine, other days less. It was clear from a few months in that our preemies would be walking very different paths. My son was on a volatile up-and-down path that wove this way and that with rapidly shrinking and growing shoulders; her daughter was walking on a narrow, slow going, and steep climb. Her situation was no less scary than Jonathan’s, it was just different. And yet on her daughter’s bad days, Cindy rejoiced with me that my son’s days were good. On her daughter’s good days, she mourned with me that my son’s were bad. In this way she taught me empathy and true friendship.

I’ve found another hidden gem in all this. I’ve found that when I listen to other people, JAM’s past helps me listen well. I know how to hear their pain and what sorts of questions to ask because I can empathize, because I’ve been somewhere similar, even if their stories are vastly better or worse than ours.

The shoulders I leaned hardest on when JAM was in the NICU were the shoulders of parents who have experienced similar things. Sometimes their preemies weren’t always “micro-preemies” like mine. In one instance the son wasn’t a preemie at all, but a grade school boy with cancer. Yet both boys were admitted to the hospital on the same day, and both of us mothers learned to navigate that building like it was the back of our hands. One day part way through our saga we met at her house, grabbed a bottle of wine and five of her closest friends and just shared, and laughed, and absorbed it all.  It was just the sort of therapy we both needed.

“You’ve been through the valley of the shadow of death with your son,” one micro-preemie parent said, “You understand us better than most people do." I wasn't sure I did. They had dealt with bereavement, a place I hadn't been. But I guess I'd done the right sort of relating, the right sort of listening, so I had begun to understand. I hadn't been where they were, but in some senses, I'd been terribly close.

To summarize: don’t compare, just relate. Throw off the shackles of guilt, and instead use the good and bad of life experiences to better empathize with those around you. Mourn with those who mourn, rejoice with those who rejoice.

I can do this.

Wednesday, January 1, 2014

Guilt, Part I- NICU parent guilt, a how-to

I should have felt parent guilt a long time ago. It was hinted at by side comments from people when they found out that I, a mother of two, was not a stay-at-home mom. Pitied looks. Side comments about how they grew up so fast, and didn't I want to cherish this time with them? And here I thought I was cherishing my time with them.

My dear friend had an MA and two (and now four) kids. She also got a pitied look from people when they asked what she was doing with her degree and she responded that she was a stay at home mom for her adorable boys. Wouldn't they be too sheltered? Wouldn't they like to be in a preschool environment?

Seems you can't win. There's plenty of reason to feel guilty.

Steve (my spouse) told me to tell those that asked that we'd talked about the work thing a lot, and we'd decided that since my girls enjoyed daycare and Steve enjoyed his job so much, we felt it was really best for family dynamics if he continue to be a working parent rather than a stay-at-home dad. "Why does it always have to be you they ask?" he said.  I love my partner.

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But NICU guilt is different. It's harder to brush off, harder to fight, harder to grasp.

Picture this: your baby is sick, maybe dying. Your children at home have had their world turned upside down - first by their mom being suddenly put on hospitalized bedrest, and then a few weeks later just as things settled down, by a rush back  in to the hospital in the middle of a mommy-daughter craft time. Now all of a sudden they have a baby brother, but they can't see him because he's too fragile. They're worried.

Things are so uncertain. You are sick with two forms of sepsis. (Er - if you're a guy, just pretend you're a woman here.) Your c-section scars mean you can't pick up your older children. [guilt] Your child in the NICU can't be touched because his paper-thin skin is so underdeveloped it would hurt him. His eyes are fused shut. You don't know why, but your body failed him. [guilt] He should still be in your womb, he should still be there for three to four more months.  But he's a week old and weak. You can't drive to the hospital on your own. [guilt] You can't take your older children with you. [more guilt] This means that you and your partner can't spend much time together. One of you is always with the children at home, the other at the hospital. 

You make things work for a while. Then work starts up again - for both of you. There's no choice. Your household depends on two incomes - or at least an income and a half - but going to half time means that you lose your paid maternity leave, that you have to pay it back. So you put your older kids on the school bus and trudge back in to work. You wait until after the girls have had the supper your spouse cooked before you head back in to the NICU. You spend your weekends there to make up for the missed weekdays.

You miss a surgery to stay at work. It seems odd in retrospect, but if it fails, you'll have to send your son to Detroit so they can reattach his retina. Hours away, and you'll have to go with him. You don't have enough time off for that. Your partner attends the surgery so that your son is not alone. You should both be there, but really, it's only his eyes. You couldn't do anything to help anyway. It's not like the last time, this is a minor surgery, he's not going to die. Just his vision.

NICU nurses explain to each other during shift change why you're not there - why neither of you are ever there during the day, except for the two hours twice a week that your husband can get in to be around when doctors round. [guilt.]

It's okay at first, your baby is still unaware of his world. The NICU nurses take good care of him, and you are banking your last three weeks of maternity leave for the day he's released.

But then he grows up in the NICU. He knows you - the sound of your voice and your smell. You're his mom, and you're one of his favorites. He is stable and wants to be held and played with. [guilt] He misses you when you're gone. [guilt] He has learned to cry. [heart-pang]

You want to spend every moment you can with him.

Four months in, with no end in sight, means your daughters miss you too. Your oldest starts screaming at the world more, your youngest goes back to bed wetting. [guilt] You rarely talk to your spouse any more. [guilt] You can't even have babysitters over without being embarrassed at the state of the house. Clothes no longer get folded, they're just washed, rifled through, worn wrinkled, and thrown back down the stairs in a heap to be washed. [guilt] Saturdays are mis-matched sock days. Dishes are never done except for pump supplies which seem to take two hours a day to wash. You wonder why you never purchased a dishwasher.

You're failing at this parent thing. There's so much guilt.

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No one told me about NICU guilt. It's hard to manage, hard to have it not consume you. But you can take steps to ease things

How do you fix NICU guilt?

You probably can't. But here are my tips for helping make it a bit easier:
1. Accept a C+ job as good enough. As parents we want to be perfect. When a child is hospitalized, you can't. Perfect is out of the question, so accept good-enough.

I learned this from a wise friend years before our JAM session began. She and her husband were both in grad school getting their PhDs. They were writing dissertations, teaching college courses, homeschooling their ten year old, taking him to swim practice, and had another baby on the way.  By my count they had at least three full-time jobs.

"How do you do it?" I asked her.
"I do a B+ job on everything, and an A+ job on one thing. Each week that one thing changes." 

THIS was the most impressive and refreshing piece of parenting advice I'd ever heard. She went on to say that sometimes she focused on being an amazing home school parent. Other times on getting the kitchen REALLY clean, and other times she sent her son off to his room with a book, ignored the dishes, and spent the day writing her dissertation. She learned to focus. 

As a NICU parent, don't go for B+. Accept C+ in nearly everything. You're going for survive, not thrive. Throw a load of much-needed underwear in the washer, and call it a day. Don't even bother folding.

2. Acknowledge that this isn't forever. I don't know why, but that helps. Eventually your child will be home, there will be no more NICUs. For now, you're growing deep roots. Don't expect fruit

3. Outsource & accept help. In economics they talk about comparitive advantage. YES, you as a parent might be the best person to take your older kids to the park, AND you're also the best person to be at your son's bedside in the NICU. But you can't do both. Someone else can (and is very willing to) take your kids to the park, and they'll only be marginally less good at it than you. (Sometimes, if it's a favorite aunt, they'll actually probably be better at it than you.) Thus, outsource. Let other people bring you meals or watch your other kids. Accept as much help as you can. Free you up to be the mom or dad you need to be for your NICU baby.

4. Focus. This is the hardest bit, but it's also the most helpful. I know so many parents that get consumed by NICU guilt. When they're in the NICU they worry about their kids at home. When they're at home, they worry about their NICU baby. When they're at work, they're really not there at all -- they're just trying to get their head on because life is so fragmented. Their head is always in three spots, sometimes more, always feeling the pressures of the other places.

This all goes back to point one. Know that you will get a chance to be with your baby or your at-home children or at work each day, and spend your time focusing on where you are that moment. If you're with your kids, invest in them. If you're at work, make a check list and work through it. If you're in the NICU, rest in the knowledge that (presumably) someone else has things covered at home/work, and let your attention be focused on your sick child.

5. Create a schedule. This really helps with number four. It was so much easier for me to be at work or with my girls if I knew that there was another time that I'd be at the NICU. My partner and I made a commitment to have one of us parents be at the NICU every day for some amount of time. In the 150 days we were there, we only broke this commitment twice, when we were both too sick to enter the NICU. That's not too bad.

If you're a single parent, get a dear friend or grandparent to help with the NICU duties so that on occasion you can have a night-off. The road is long and occasionally you'll either get sick or just worn, and you'll find yourself having to stay home. Knowing that your baby still is being seen by a care giver will help you rest away from the NICU. (Most NICUs have a program or training an alternate caregiver must go through to be allowed access to the NICU, check with your NICU social worker or the front desk).

If you are living far from the NICU, also make a schedule. It may be a weekly rotation of responsibilities instead of a daily dip into each area, but, again, knowing you're not "abandoning" your baby in the NICU or "neglecting" your family at home (horrible words - strike them from your vocabulary!) will help you be okay with feeling split between two places.

Wow. Doesn't that look marvelous?  Isn't it amazing how easily I've lined up just exactly how to survive NICU guilt?  This woman had it all together!
...
Except I didn't. I don't. It's not that easy. I promise this - if you are a new NICU parent reading this, your heart will be pulled in hundreds of directions and it will hurt, no matter how much you plan to make it work. Maybe this advice will help a little. Maybe not. Know this, though - you're not alone, and you are okay. It will get better.

Hang in there.


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Parents of Preemies / Hospitalized Children -- Please help! Share below what things helped YOU stay sane in the NICU / PICU / hospital. Feel free to link back to your blog.