Friday, August 16, 2013

Day 30 - a picture explaining the lines and tubes on a preemie

A year ago I made this helpful diagram, to show what each of JAM's lines meant



I got some things wrong.  Like it's not a PIC line it's a PICC line. It was about the thickness of four strands of thread used for cross-stitching, and about that flexibility too (only a little tougher).  It somehow had a hole through the middle of it so that liquids could be administered.

He also had a IV for a blood transfusion a year ago today, because the platelets in the blood wouldn't be able to get through that tiny hole through the PICC line.  The duck was sanitized before it was ever put in his isolette.

After seeing him in the NICU, Jonathan's sisters came home impressed.  Their conversation went like this:
Mimi (3): Jonathan sure is good at sleeping.
Ella (5): We didn't even teach him how to do that.
Mimi: He is even much better that us. He's an expert at having closed eyes.
Ella: He sure is.

Leave it to kids to find the positive to talk about. They were becoming used to having their brother in the NICU. Ella had attended a family support program for siblings and, in addition to coming home with preemie diapers, a stuffed animal, coloring book and belly full of pizza, she came home an expert in all things little Jonathan. Like me, when Ella knew things it gave her the illusion of control, and that helped her cope better.
Both girls were starting to fall a little more in love with their little guy.  They still call him that today, "our little guy."  I hope, for his sake, that doesn't continue forever.  Perhaps some day he'll be taller than them. Then he won't be their "little" brother any more.

Some pictures from a year ago:

Ella at Jonathan's bedside

Ella and Grandma making
a frame for a picture for her locker

Ella at the NICU learning to wear
a mask and hair net like the doctors

Ella showing off the stuffed animal and shirt she got from the
NICU family support people at the siblings dinner.
She got one for Mimi, too.




Thursday, August 15, 2013

Day 29 -- Stuck between a rock (creatinine) and a hard place (PDA)

A year ago today we found ourselves a bit stuck. Jonathan's kidneys were starting to fail. I learned that a nephrologist was a kidney specialist. He'd come to see us a few times. He'd told us that JAM was too small for kidney dialsys, whatever that was.  Basically, he said, if Jonathan's creatinine levels in his blood didn't come down on their own, this would be a deal breaker. Creatinine was another word I'd learned. I could now sound more like a medical professional than most of the general population, and we were only one month in to this experience.

By the way, a "deal breaker" was my word.  It what I called anything that would cause his death. I couldn't bring myself to say "death," especially when people asked for updates. So I said "deal breaker" instead.  I also would say "take home baby" instead of "survivor."  I wanted to know if he would become a "take home baby." I didn't dare ask if he'd survive. I wanted to throw the grim into the shadows as much as possible.

If we could get his levels normal, they could close his open valve near his heart that was causing the murmur.  That would cause his heart to beat more effectively and might help keep the kidneys functioning properly.

But we had to get his kidney levels there first.

He was retaining fluid. While I rejoiced at his weight gain, I knew not all of it was good weight gain.

Here's what I wrote on our care page.  I am amazed at how optimistic I sounded. Here we were in a catch-22: can't fix the kidneys until the heart is fixed, can't fix the heart until the kidneys are working well enough to bring down the creatinine levels. And yet I don't acknowledge how dire it was. Instead I'm rejoicing that he's taking my own milk and may get his IV out soon. Was I ignorant or just trying to keep a brave face? I think perhaps it was a bit of both.

2 lbs 2, eyes of blue, (gootchie gootchie and all that)

Written August 15, 2012 1:04pm
SUMMARY:
  • Heart surgery for the PDA vessel, but not yet (waiting for kidneys to improve).
  • Neat stuff I: Jonathan's weight statistics
  • Neat stuff II: On full feeds from Mom's milk with very little medical intervention needed for nutrition.
  • Today's experiences with holding and looking

---------------------------------------------------------------
Take Heart
Doctors decided on Monday to do surgery on Jonathan's PDA (vessel near the heart) as soon as his kidney function returned to normal.  They feel that closing the PDA now is the best option for him, but they want him as healthy as possible before they do surgery.

The nephrologists dropped by Monday afternoon and explained to me how they measure his kidney function (blood tests, urine output, etc).  They showed me two graph that show the results of the two blood tests they do for kidney function.  These graphs showed how his kidney function got worse on Saturday and Sunday but appeared to be resolving on its own.  Since he wasn't on any meds or feedings that might irritate the kidneys, they decided to wait for the levels to normalize on their own.

Tuesday his urine output was very low and these kidney numbers started to climb again (this is bad).  So they put him on a diuretic.  That seemed to be successful (at least according to the weight of his diapers -- they weigh his diapers every time he's changed).  According to this morning's blood test, those kidney-function numbers are coming back down, so we're back to wait for things to resolve themselves.

The doctors don't think those numbers will come down to a normal level again before the weekend, so the PDA surgery won't happen until next Monday or later.  Another scan on his heart has been scheduled for Monday to take one more look at the PDA before this surgery happens.

----------------------
Neat stuff
Jonathan now weighs over 2 lbs. Monday night he was around 2 lbs 3.5 oz, Tuesday he (thankfully!) lost some water weight (remember, he was retaining water because of the kidneys) and so he was down to 2 lbs 2 oz.  He might take off a little more tonight, but should probably still stay above 2 lbs.  That's nice!  (He was looking pretty puffy yesterday with all that extra water.  Looked good on him, except that that is not the way we want him to gain weight.)

Jonathan outgrew his PIC line yesterday, so they turned it in to an IV line.  Then that leaked, so they pulled it out altogether and overnight they gave him his required IV liquids through the IV line they'd given him a few days ago for a blood transfusion (blood platelets and stuff are too large to go through the pic line - they get stuck, so they always had to stick him again to give him blood). Then this morning the doctors put him on full feeds and gave the order to take him off IV liquids.  So, as soon as the IV line from the blood transfusion closes, they'll remove it and he'll be free of those pesky IVs until the day of his surgery (assuming he doesn't need any more blood).

And, in case you missed it, yes, that's right, my milk (plus a little human milk fortifier mixed in) is now alone sustaining my child's nutritional needs. Woot.  Grow baby grow!

He's off most of his medications now.  He's just getting a little bit of saline solution twice a day because the sodium levels in his blood are still a little low.

So, let me get this straight -- he needs lots of calories and fat to grow and he needs more salt for his blood levels, right?  And he's getting nearly all his nutrients from me?   Correct me if I'm wrong (actually, no, don't), but doesn't that make it sound like what I REALLY should be doing for my child is going out and eating more french fries?  Because that's what I'm hearing.

-------------------------------------------------------
Today with Jonathan
I held J today.  He wasn't comfy for most of the time because of a wet diaper and possibly his foot IV. (Note: next time change before the holding.)  He tried to find a sweet spot (which included trying to turn his head to the other side by swinging it down to my skin and trying to swing the head around - something he's both not strong enough to do AND that really messes with his vent).  He never quite found that spot, but he became VERY calm when I prayed over him. Very sweet.  Maybe he could sense when momma was calm and that calmed him.

Afterward when I (finally) changed his diaper he was alert and looking around.  It was cool to see that his eyes were both looking in the same direction at the same time and moving together (not always a given for him).  He also seemed to be responding to light.  A few times he seemed to be opening his eyes to look at me as I spoke.  It will be a bit yet before we're able to tell if he will have eye damage as a result of severe prematurity, things are still developing after all, but it was fun to see this step in the right direction.


Tuesday, August 13, 2013

Day 27 - Hearts and Kidneys

A year ago I was so worn.
I'd stopped updating people on Jonathan's daily progress.  It was too hard. Too hard to write, too much to process. I was so tired.  We all were.

A friend (Thanks, T-dawg!) had sent us a pair of monogrammed backpacks, one for each of the girls.  I was so grateful, as Ella was starting kindergarten and I had not had time to buy her much of anything. My mom had driven me and Ella out to the store (remember, I still couldn't drive at this point) so that we could buy her a first day of school outfit. Mom had asked over and over if it was really all that necessary for me to be there, saying she'd be happy to do the shopping with Ella herself. I had put my foot down, though. I may not be able to walk well, but I WOULD do something right by my girls. I hadn't been much of a mother, and I think I thought that this trip to buy a first day of school dress might make up for it.

A year ago yesterday I broke the few-day silence and wrote this on JAM's care page. It was the beginning of what would be a very bad month, though I didn't know it at the time.

Written August 12, 2012 2:57pm
I'm breaking my promise not to write for a while. Our at-home family has had a good weekend, I'm feeling almost normal, and tomorrow (in addition to it being E's first day of kindergarten), big decisions will be made for Jonathan.  Since this is the easiest way to tell family & friends about Jonathan's care, and since I'm feeling alright, I write.

1. Jonathan's PDA (patent ductus arteriosus) has not closed and seems to have opened more.  If you don't know what that means and want to understand, see a short & sweet explanation here.  (This is his heart vessel thingy.)  The doctors have to make a decision on whether or not to do surgery to clamp the vessel.  They are (at least as of last week) split on this decision.  On the one hand, this could help prevent or make better lots of ills (including issues with his lungs and heart)  On the other hand, it's surgery on a wee little guy, and if closing this PDA isn't going to do much good (if it's a small leak closing it might not help too much) -- if it isn't going to help things significantly -- it should be avoided until a later date.   They are doing several more scans today, and will be reviewing them tomorrow to determine the best course of action.

2. Jonathan's kidneys aren't working so great any more.  He's had lower urine output since getting put on the starter TPN, and they are trying to figure out why.  This may be related to the PDA, may be just because of severe prematurity.  In essence it means that he isn't doing so hot on just my milk after all.  They're increasing the amount of starter TPN that he is receiving in hopes that this will help.  And they are doing scans on his kidneys.

3. Jonathan's blood sugars are not what they should be. There's too much fluctuation.  They are preventing this by slowing his feedings from taking 15 minutes to eat to two hours to eat.  This seems to be helping.

4. Jonathan is still having vent issues. His cuddle time with Steve today (first time) was cut short because after a half hour it was clear that they could not find a sweet spot for his vent and his leak was out of control.

Overall we are amazed at what these doctors can do and how early they can catch things.  It is fascinating to watch (okay, a little scary too, we wish things would always improve -- but it's good to see how well they are caring for him).

Thanks for your prayers,
.


It is so strange to read all that, and then look at pictures from a year ago today.  We were, indeed, living split-lives. While our son was critically ill in the neonatal ICU, we took these pictures of our daughter:
FIRSTDAYOFSCHOOL FIRSTDAYOFSCHOOL!

E next to the apple tree we named after J


Mimi watching from a tree.
Some day I'll get to go to school, too!

Monday, August 12, 2013

Week 3 & 55 of life: Two bridges - the difference a year can make

A year can make a huge difference.
A year ago, still healing, I struggled to walk up this bridge to the NICU



This weekend I ran this bridge.
(Click and check the top of the tree line on the horizon if you can't see it.)





















This is what I earned this year - a metal around my neck.

This is what I earned last year - a child next to my heart.
First time holding my son, at three weeks and two days old.























This is how we did kangaroo care.
A blanket and my heat kept him warm.
Two nurses helped get him on my shoulder so that
he would be safe and not too much disturbed.
We worried that he'd get too cold.









Gratefully, I've held him many times since.
Here are me and he, exactly a year later.









We don't even call this kangaroo care any more.
I'm just holding my baby.
The sun keeps him warm, sometimes too warm,
And I can pick him up whenever I want to.















A year ago when I was done,
we (at least one nurse and me)
would snuggle him back into his isolette.
He had a very hairy blonde back.
He had brown silky hair.









Now when I'm done,
I pass him to an uncle.
He stands and chats at us. Or yells about the weather.
He has a very hairy blonde head.
His uncle has the brown spiky hair.

We sit and stare at my favorite river.I think about the race we ran.
"See little buddy?" I whisper to JAM,
"I told you it would get better."




Scars - they fade.

Remaining only as pillars, reminders
of our struggles
and of God's faithfulness.

Pain - it disappears.

Except for on those days
when the weather changes
and the ache reminds you of what you've lost
A lot. A lot was removed.


But
A year ago, a year
was all the further ahead I dared to dream.

The most important bridge was a half a block long.
Now the bridge is longer.
We see farther.
A year - can make a difference.















Thursday, August 8, 2013

Day 22 - NICU Support

About two or three weeks after Jonathan's birth, I was talking to Cindy about support in the neonatal intensive care unit (NICU). You'll remember she had had a micro-preemie born just a few days after Jonathan. We hadn't met before our babies were born, but our husbands had become friends, or at least acquaintances, in the family room of the high risk pregnancy floor while she and I were stuck in our respective rooms hoping to stay pregnant a day or a week or a month or three longer.

When we did finally meet, it was at a "Lunch with Lactation" meeting at the NICU. Both of us were still sore from our c-sections and couldn't stand for long or walk too far.

I have to admit, the name of the meeting was unfortunate and confusing.  "Lunch with Lactation." Thankfully within a month or so they'd changed it to "Lunch with Lactation Consultants" or something of the sort and the purpose of the meeting became a lot clearer.

The meetings happened about once every other week, and we NICU moms (dad never attended for some reason) got free sandwiches and salads and huge chocolate chip cookies from Panera Bread and an opportunity to ask questions to the lactation consultants.

Since nearly all of us were pumping with a dream of someday nursing, it was hugely helpful.

Except that that first session it wasn't so much.

The first thing we did was go around the table and introduced ourselves. Sometimes birth stories came with the introductions (how often does that happen with complete strangers?) and at the very least we learned a bit more about the other infants in the intensive care unit. 

I felt a little alone, as we went around the table. I was one of the first to introduce myself, and I didn't get a lot of nods or knowing looks. There weren't too many micro preemie moms there. Each time someone mentioned a baby that was born before 28 weeks or under 2.5 pounds, I tried hard to remember who they were. It was increasingly hard to remember anything these days, so I made a point of trying to put those faces in my brain, so I could ask how things were going the next time I saw them on the elevator or in the family room. Maybe I should have made a point of remembering everyone, but I didn't have the brain cells for that.

J was the earliest birth. Only two or three others had introduced themselves as parents of babies born younger than 28 week.  As parents introduced themselves, I realized that weight at birth did not equal health at birth. One mom of a full term baby was in the room, and I think, being the only parent of a 8 pound or larger baby, she felt just as out of place as I did with my one pound baby. Her baby, her daughter, too, was struggling for life and trying hard to beat the odds. Before she was born her mother had already had to fight with doctors and transfer hospitals just to get someone to agree to give her daughter a chance, despite the odds, despite the potentially inevitable disability. It was humbling.

Cindy was one of the last ones to introduce herself. As she did, I though, "OH, THAT'S the Cindy I've heard so much about. I wondered if she'd be here. I was hoping she would. I wonder if she'll be my friend? I've assumed so, but she's sort of pretty and looks so well-put-together, and I'm a mess."  I realized it was awfully presumptuous to have assumed she'd be my friend, just because we shared the same floor of the hospital for a month. And then came the problem: How do I introduce myself to someone whom I've heard so much about, without seeming strange or awkward or overly enthused?

But she cut through all that with a look at me and a "I think our husbands have met. You're Jonathan's mom, right?"

Sure, she was put-together, but she was also warm.

The rest of the meeting was above both our heads.  The floor was left open for the moms to ask any question they had. Most of the questions were about nipple shields or HMF (human milk fortifier) and prolacta. These last two were things added to breast milk to up the nutritional content and calories for preemies. I had only barely heard of prolacta, and had no clue what HMF was. I was concerned about the 2 mls my son was getting. And how to keep up pumping.  I wasn't concerned about my supply, I made too much. I wanted to know how much I should be making so that when he DID reach a full-term weight, I'd still be making enough?  How long did I have to wake up every three hours every night to establish a milk supply? When could I start sleeping through the night?

But the women there were wondering about how to get HMF when they were discharged, and whether or not to try to leave the hospital entirely breast feeding their child or if they should try to get out of there bottle feeding (the easier way for preemies to eat) and hope that the breast feeding established itself when they got home. And how to tell how much their preemies had gotten. And if they should have scales at home. And how to get enough HMF into their child's diet if they were breast feeding exclusively -- was it even necessary? And when could they stop using a nipple shield (what the heck was a nipple shield?) and how to up their supply to make up for their baby's increasing demands and needs.

BREAST FEEDING?  That was so far away. It was a dream. I just hoped he'd make it that far. Under supply?  My son took only 1/16th of what I made in a day. He got it through a tube into his stomach.

The rapid fire of questions that were so above anything my son was dealing with left me overwhelmed and isolated.  I mean, they were interesting questions. To be fair, I'm sure if I were in a better and more optimistic state, I'd be storing them away for another day. If I hadn't just had a traumatic birth and wasn't recovering from three (yes, it was up to three now) forms of infection, maybe I'd have had more energy for this.

But moms who just had to teach their preemies how to eat and then they could bring them home?  They were in a different spot than me. I didn't know how to relate. I couldn't even pretend to be in their league. I wished I could, but at this point, I couldn't eve know if I'd ever get there.

Afterward, I met Cindy properly in the hallway. She'd felt the same as I had, which was a bit encouraging in a strange way. She asked if I'd gotten a NICU family support partner yet. I told her I'd heard of the program. It was this neat program in our hospital where other families of NICU graduates support current families of NICU babies and walk along side them, answering questions and being a resource and friend.

I told her I wasn't sure if I should.  "My son was born at 23 weeks. I think I'd feel even more isolated if I was partnered with a family that had a 26 or 28 week baby and thought that was the same thing," had been my gut response. 

"We've already met with our family," she said, "and they are amazing. The mom is so organized. They had this photo album of their daughter where they have a picture for every day of her life while she was in the NICU. Their daughter was born at 23 weeks, two years ago. She's adorable now. It sounds like they're really involved in their church, too. And they were really good about answering our questions. They told us how it was God's grace that had gotten them this far. And we were able to ask questions about what this meant for their faith,."

Suddenly I was interested. There was a family in the program, a family walking beside kids like ours, a family who had had a surviving baby, two years ago, born at 23 weeks.  I really wanted Cindy's support family to be OUR support family. I had a bit of support-family-jealousy.

That afternoon I signed up for the program. Even if I couldn't have Cindy's family, maybe there was another family like that out there.

A week later I got partnered with a family.  They dropped by Jonathan's area of the hospital to see if we were there.  We weren't. So they left a basket full of goodies -- Cookies that were cut into footprints, a sign that said "STOP, wash your hands before touching mine" and a framed image of Jonathan's name down the side, a poem where each letter in his name was the beginning of a promise.

A note inside said that they were excited to meet us, and that the signs would be useful when we took Jonathan out and about after he graduated from the NICU.

They thought he'd graduate from the NICU.  I looked at the signs, and the framed image of his name, and could only hope. Maybe he would.

I was exhausted. Steve was exhausted. Steve looked at me like I was crazy for signing up to meet a family like this. "Why are we meeting them, again?" he asked me, as we walked into the NICU at an appointed time.

"Because I need it." I said. I needed to know I wasn't alone. I hoped that this family had also had a baby as small, as fragile as mine, and that they could show me the way forward through this thick forest.  There had to be a path. Someone must have walked this road - or a road similar to it - before.

We met them in a private meeting room at the NICU. They brought a photo album. They'd taken their daughter's picture every day of her NICU stay. As I turned the photo album pages, I saw a baby that looked a lot like mine - all skinny with stretched skin -- slowly transform into a round cheeked baby and then the tubes began to be removed, and pretty soon only one thin tube, a nasal cannula, was all that remained on her face. And she looked like a baby. A happy, smiley baby.  And they had taken her home. And she had stayed their baby, their child, for years. Two of them, to be exact. And she had started out as a 23 weeker, too.  It was the same family that had adopted Cindy and her family. They were taking on two families at the same time. I smiled.

As Jonathan was still safe in his plastic bubble, I asked them if they'd like to come meet Jonathan. Tabitha, the mom, said yes. Richard, the father, however, had just come from work, and suggested that he should stay behind with Steve because, even though he didn't have any symptoms, he was feeling a bit under the weather.

Tabatha removed all her jewelry scrubbed her hands at the wash basin, up to her elbows for a full minute, and then walked with me to his room. She squirted hand sanitizer on before walking in, and never once asked to touch him.  Here was a family that understood our concerns about germs!

A few weeks later, I saw their two year old in the waiting room at the NICU. She'd come with her mom as it was her second birthday. She stayed in the front lobby and her old favorite nurses came out to say hello. I said hello to her too. She wasn't amused by me. She gave me a stern look like "whatcha lookin' at lady?  I don't know you, and there's nothing to see here."

I walked away smiling.

Miracles could happen. Thanks to doctors, advances in technology, and God's grace, babies that were all stretched skin and toothpick bones could become stern two-year-olds, scolding strangers with their eyes because, after all, as her eyes said, I don't know you. There's no reason to be looking at me.

You're just a miracle, that's all.

Maybe we weren't so alone after all.  Maybe there was a path through this forest. Maybe it ended in a glade where sun streamed in and grains and wildflowers danced in front of us, where there was a path, a solid stone path to walk on, and a horizon to see. Maybe we someday would be able to see into the distance and dare to dream about tomorrow. For the moment there was only thick undergrowth and a path so dense it felt like every step forward was half a step backward. There was no dreaming, because the next day might bring an abyss.

But maybe it wouldn't always be like this.

Maybe there was hope. Yes, there was hope. A stern and stubborn two year old told me so with dagger eyes. There was hope.

["Tabitha" - I don't know if you are reading this, but THANK YOU. Thank you so much for giving parents like me a bit of hope.  "Cindy" - I know you're reading this. Even though our paths were different -- yours mostly a long steep hill that never seemed to end, and ours full of thorns and pricks and stones to trip on -- even though they were so different, I am so glad that we walked these roads at the same time. Thanks, both of you, for helping us know we were not alone. Thank you so much.]

Wednesday, August 7, 2013

Of "End of Life, at Birth" NYT OpEd by Dr. April Dworetz

I know what you're thinking.  "Goodness, Maikata. Can't you leave well-enough alone?"

That's the problem with reading commentaries to New York Times OpEds right before bed time.

It sticks with you all night, and then in the morning you find you CAN'T leave well-enough alone.

The worst are the comments, really. Lots of people talking about how babies like mine shouldn't be hooked to tubes because it's mean, invasive, selfish and done by optimistic but not realistic parents. You know, the irony of it being, they say, that if God had had his way and medicine hadn't intervened, the baby wouldn't be here.

That seems like a strange God, not wanting us to use the talents we're given to sustain our lives. By the same argument, shouldn't be here. I should have either bled out and died of exhaustion delivering my second child, or died of septic shock with my third. Is my child more unnatural than me, with his ability to live with the aid of modern medicine? I know I'm not the only mom tired of feeling like I must justify my son's existence.

But then there's the OpEd writer's argument. She states that the odds are bleak, that they should be fully explained to parents. I agree with all that. I also acknowledge that there were points where we thought we'd have to say goodbye. Like after his bowels perforated, when we weren't sure how much he had left in him that would work, and we weren't sure if his life could be sustained long-term. So, yes, I get where she's coming from.

But her data makes it sound more grim than it is. Ninety-two percent chance of death or moderate to severe disability. That's an awful lot thrown into 92%. Odds of death are a little greater than 50%, according to my neonatologist. And disabilities range from nearsightedness and asthma (mild - I don't think she includes this in her data) or speech/eating delays and motor issues (moderate),  to completely non-verbal and non-ambulatory (severe). That's a big range. So, if you're going to inform parents, you need to do it right -- not lumping all that together in a 92% category.

Also, her data is old.  Good preemie studies with large sample sets haven't been done in a decade or more to my knowledge. Okay, I shouldn't say that they haven't been done. It's just that the they are still being done and aren't yet complete. A nation-wide, multi-year longitudinal study is currently underway to give us new data, but it's still only underway. JAM is a part of the study - this is how we know about it.

So, yes, give parents data, but explain that it's incomplete.  Detail it, don't shade it to scare. We can handle the truth all the better if the truth is accurate. And are you doing a poor job explaining?  I'm not sure you are. I had a great pre-birth consult. So have many micro-preemie parents I've "met" (virtually met) since. We know the odds. We make the choice. Most of us don't regret it, even after all the difficulties.

You must also (and here I think about the commentators more than the OpEd writer) see the bigger picture. We are so grateful that we the parents decided. We, the ones who happily and some days begrudgingly bring our micro preemie one year old to PT (physical therapy) and sometimes OT (occupational therapy) appointments. We know the cost goes past the NICU. We search for scholarships and secondary insurance because insurance companies only cover so far, and we don't know how else to pay for what our kids need so that we can fix preemie issues early on, while they're young and malleable.

We get that it's costly. Do we have to defend that cost with raw data of productivity though? (Dagger eyes to the insensitive commentators.) I mean, my son is ONLY one. Does he have to prove that he'll become a neurophysists before you'll agree that he should be treated?  Many many of them DO get on track before two. And those who don't become perfect babies or toddlers, what then? Let's be complete and start judging whether all adults are perfect. Let's place a value on everyone's life, especially right before any major operation is undertaken. [Sorry, over the top. I'm sure later I'll regret typing that, but a bit of anger just flared. Really, one SHOULDN'T read stupid commentators late at night.]

Okay, just so I don't completely lose the point with my brush of anger, let's sum it up. Yes, we get it. We bear the cost. But we also see broader than those initial costs. It's more than the heel pricks in the NICU. Beyond that, if parents are to be fully informed, explain that the data is the best you have, and that things may have changed in recent years as technology improves. Look with great anticipation to new data, to see what the new "average" micropreemie's life looks like. It may be better than years past.

I think I'm done for now.  Jonathan wants to play.

Day 20 - A matter of heart.

A year ago we'd discovered that Jonathan's PDA, which had initially responded well to the drug therapy but not entirely closed, had now reopened.

The doctors were split about what to do. About half the team suggested letting him grow bigger and then assessing the need to repair. Bigger babies have an easier time with surgeries. The other half worried that not repairing it would compromise his blood flow and make it harder to sustain his life.

We were glad for a team approach to medicine. So glad.

Looking back I see that, for one, it meant our doctor would not try to determine Jonathan's worth and pressure us to make decisions we weren't comfortable with. Not that I had that on my mind at the time, nor did he ever pressure us in this way, but I watched this documentary called "Little Man" a long time after J's birth, and the doctor in THAT film was so horrid about what the parents should do (or not do) for their son. I was so glad that my neonatoligsts weren't like that doctor.

A year ago today I didn't really know what Jonathan's primary doctor was like. I had pictures of him resuscitating my son, pictures that Steve had hastily snapped while trying to remain unobtrusive while I was being sewn up after surgery, but I had little data about him. Oh, I knew a little. When the social worker took me to pick out a quilt for Jonathan, donated by sweet sewing souls in our area, she mentioned that he had a sense of humor. And liked trains and cars. I was sure to pick a quilt with trains and cars. But that's about it.

He hadn't really been present since Jonathan's birth. It was mostly due to poor timing. He'd gone on vacation three or four days after J's birth, and hadn't returned. We hadn't really seen him before he left, either, though, other than at delivery and a glimpse a day later of him charting outside our room. He never came in. Not while we were there. I wondered at his distance. Did he purposefully remain away those first few days before vacation because he knew the likelihood of J's sustained life after his time away was slim?  He had seen a lot of babies not make it. Did he not want us to ask if our son would live? We knew better. But he didn't know that.

The team approach meant J didn't have one doctor, he had six or seven. And many of them were present (and not on vacation. They made a point to come in and warmly greet us and comment on his size or personality or preferences. They seemed to care.

With a split team, though, we weren't going to do anything about Jonathan's heart. When the situation presented itself better, they would then make a decision about closed heart surgery to fix the PDA. Maybe new information days or weeks later would tip the scale. For the time, though, all we knew was that his heart wasn't working as well as it could. Maybe that's part of why his lungs weren't working as well, too.

But he was still alive.

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Not sure I'm happy with this, mom
TODAY - 2013

J finally got to meet his other male cousin, JB, today.  JB is a four year old who has been praying for him since birth.  Who can blame little JB for praying?  I mean, he has EIGHT other cousins, all girls. In some sense, it probably felt like J was his only chance of playing guy games.  That's at least a year off yet, but it'll come.

J himself was crabby yesterday and today. Unusually so.  He smiled once for his uncle, but then threw up on him a minute later. So I'm not sure what that smile REALLY meant.

This afternoon he cut his first tooth. Teeth, actually.  Two ragged edges poking up from his lower jaw.

No wonder the poor guy was crabby.
Okay, happy now!

After that, he was all smiles and showed off for his grandparents. He rolled all over the floor, grabbed his feet, passed teething biscuits from one hand to the other and then stuffed them in his face (gotta use those teeth after all), and all in all charmed everyone he met.
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Tonight before blogging, I read this article.

I've written about our choice to resuscitate and the difficult decision that can be, so you can probably guess my response.  I thought, "Wow, she makes the temporary seem so grim."

She sees only the smallest part of a portrait. She needs to re-frame the image and see a larger picture. Does she not remember that this is life we are talking about? Potential for life -- good, full life?

Yes, parents must know that there may be disabilities. Yes, we SHOULD be well-informed. But this article is so horrific. It forgets about the hope each day of life brings. It almost makes it sound like parents aren't ready and would make a different decision if they really understood.

We weren't ready. No. Who could be?  But we were well informed. Now, a year later, we would not have changed our minds with any more information. You'll see, if you keep reading or if you know us, it wasn't a walk in a park of a year, either.

J won't remember his pricks or the pain he went through. How much do you remember of your first three to five months of life?  J's dad was a preemie, too (for unrelated reasons) and has some similar scars. He doesn't remember getting any of them. He carried his prematurity through his early childhood (and in some ways into adulthood), but he still enjoyed being a kid. He's a doctor now. Dependent on a med or two as a  yes, but he's had a really good life.
The PT told mommy I had to experience different textures.
I'm like a scientist, figuring out the world.

She forgets that in this article, that the pain is temporary. The disabilities, if they come, may continue for years or a life time, but the pain doesn't usually last. She forgets or doesn't know  that the disabled among us are not without great worth.

If all goes well some day that micro preemie will be a four year old, sitting in the sun on a beach, enjoying the breeze. He might even be doing so with eyes that see and feet that run and arms that swim. But even if not, he'll be alive, and the same breeze that floats across my brow will hit his. And he may giggle. And the fight - it is hard, yes. She describes me and my son perfectly. Brain bleeds (only one, and small), bowel perforation, yep, post traumatic stress, yes. All of that. But the fight - the fight is worth it.

We think this, and we're only 7.5 months out of the NICU. Scars fade. Hope remains.

Thanks, docs, for giving the choice to us.
Chil'axing, with arms flying like only preemies can!
I love having my arms out to the side.
Mr. Jason, the physical therapist, says it's a preemie thing.