Thursday, September 18, 2008

Baby Story, Part 2: Delivery

Soon after Eric relayed the news to our family, he had a voicemail from his parents -- if we wanted to get ahold of them, we should try the cell phone. It was no mystery to us that they were on their way to Indiana. My older sister would fly in that night as well.

I don't remember if Eric had called them or whether they had arrived unawares (I suspect the former), but the couple in charge of the high-school group at church where we volunteer showed up. The neonatalogist had stopped by again, this time to spin the positives of a 24-week-old baby; the day before had been more gloom. As he prepared to head to surgery and await the arrival of our child, he asked if he could pray with us, so the five of us had a short prayer.

I was prepped for surgery and taken to the operating room.

The anesthesiologist was prepared to give me my spinal. Apparently it was difficult for him to find the exact center of my spine where he needed to inject, so for each of the four shots, he would press the needle tip to my back and ask, "Do you think this is in the middle, left, or right?" Only if I answered middle would he proceed with the injection. I must have done okay, since I was appropriately numb for surgery, although the last one was so incredibly painful. I don't think it came to tears, but there was much grimacing taking place.

Eric was then brought into the room, and the surgery began. We knew this was a tenuous time. She was so small at this stage, the brink of viability. The doctor had said depending on our daughter's condition, they may have to rush her to the NICU, so we shouldn't be concerned if we didn't get to see her. Also, with the likelihood that she would need assistance breathing, he also informed us that we may not hear a cry because of the obstruction, so we shouldn't be concerned.

Our little daughter was born at nineteen ounces and 11 3/4 inches long at 10:06 AM. The sound of her newborn cries was one of the most welcoming sounds I've ever heard, and I promptly dissolved into tears. For me, even as I had begun showing and feeling little slight movements, there was much that still felt surreal and none of this was supposed to happen until December, so the frail sounds of our daughter, while proving that she had some developed lungs, also reinforced the fact that life would now be different since we were suddenly parents, an event we had been anticipating.

Apgar scores were 6 for the one-minute check and 8 for the five-minute one. Eric had the camera ready and spent his time taking pictures of our little girl and watching over me. I had to laugh when on one of his returns, he caught a glimpse of the other side of the sheet as they were stitching me up, and only with some deep breaths was he able to regain composure.

Our daughter was doing well enough that when it was time to head to the NICU, they took the time to wheel her next to me and pause for a couple minutes. She was so tiny but entirely whole. I was even amazed to see some black hair already on her tiny head. There was no extra flesh on her, as that was to have come in the remaining weeks, but every little bit of her was perfect.

We didn't have a girl's name selected yet, but as I wheeled to surgery, in my mind I knew we would have to name our little girl Grace, although I hadn't yet shared my decision with Eric yet; after her birth, Eric himself would volunteer that same name. We would later learn that more than one relative was thinking of and praying for our daughter, even before she was formally named, as Baby Grace. We felt we really had no option -- when a baby is given a chance at life at only 24 weeks and at such a tiny size, every minute we had with her was due to the grace of God.

One of the nurses shared with me that the surgery was done at the right time; our daughter had expelled meconium in the womb, which meant she was beginning to show signs of stress. With everything that would happen later, this was a consolation to remember. Had the surgery been delayed, the outcome could have been more sobering, and although I certainly wouldn't have wished for her to come so early, I needn't spend energy blaming a doctor for rushing me to surgery unnecessarily or prematurely, as it was done at the proper time.

Over the next few days, doctors and nurses alike encouraged us by repeatedly stating we had one leg up because we had a girl; apparently girls in the NICU fare better than boys. I had no idea what to expect or when to be optimistic. I didn't have the heart to ask the size of the smallest baby in the NICU in recent history (or the outcome), but Eric's parents did ask the first part, and the answer was nine ounces. At 24 weeks, she was at the cusp of viability, so we tried not to think too far ahead and take each day as it arrived.

I think I'll include some of Eric's updates from time to time, since my memory is faulty due to the painkillers I was on and just the monotony of the days following, so his timeline can help ground these posts. Any indented text on these posts can be credited to him:

We've been out of the operating room for about an hour. Faith is doing very well; her blood pressure started dropping (plummeting, really) during surgery and is now about down to normal. Her pulse has also stabilized, and the nurses think that her swelling is starting to go down as well. The only symptom that hasn't gone away yet is her blurred vision; she's still not seeing clearly out of her left eye. The nurses hope that will recede shortly.

As far as our daughter, she entered the world at 10:06, weighing all of 19 ounces. We haven't been able to see her since she left the OR--they're doing a number of procedures on her in the premature baby ward--but I've been told that she is doing very well. It'll be a long road with lots of hills and valleys before she'll be able to leave the hospital, but it appears that the start of that journey has been promising. Right now all we can do is hope and pray that she continues to grow and mature as she should, and that she doesn't fall prey to infection, heart problems, brain problems, or any of the dozens of things that could overcome her this early.

Her name is still forthcoming; we thought we would have a few more weeks to settle on a girl's name.

I was taken back to my room as Eric checked out the NICU, and they placed me on magnesium for 24 hours. This was due to my preeclampsia and to ward off any potential seizures, which is what could happen if my condition worsened to eclampsia.

Unfortunately, this would compound my vision problems, as it caused blurriness in my right eye as well (side effect). I had already been infrequent with wearing my glasses, and this made them useless. My right eye had about half that was blurry, and my left evolved during my time in the hospital. At one point, without my glasses I could see clearly from the middle of my left eye (TV from across the room, for instance), and on the peripheral, it was all blurry, like trying to see in a pool with water swirling across.

Next post: Continued Hospitalization and Saying Goodbye

Monday, September 15, 2008

Baby Story, Part 1: Admittance to Hospital

A lot has happened since I last posted. While I suspect those who read this blog are aware of the changes, I thought I'd use it as catharsis and document the recent events. Since I'm wordy, it may take several installments.

Since I last wrote, Eric and I took a trip to Iowa to visit our families. On Sunday, August 17, Eric's family hosted a baby shower for me. I had been experiencing some swelling in my feet and ankles, and while I had been monitoring the situation, I wasn't too concerned since it seemed to coincide with the humidity, and as the temperatures dropped, the swelling receded. On Monday, however, for our drive back, I did my best to walk at every opportunity.

Tuesday morning, I noticed swelling in my face. I prepared for work, waiting for Eric to say something about it (I'd once warned him about such swelling, to alert me to it if I suddenly swelled up). On our way to work, he still hadn't said anything, so I asked him if my face looked swollen to him. He responded with, "That's it! I knew something was different, but my first thought was that you had put makeup on this morning, so I didn't want to say anything." Eric is adverse to makeup as a general rule, so he thought he'd keep his mouth shut if his hormonal wife needed to put on some for returning to work.

As soon as I arrived at work, I called my doctor's office and explained the situation. It took them two hours to contact the doctor on call and get back to me, but then they asked me to come in. I left my work computer on, hoping I would soon be back at my station, and Eric and I went to the office.

My blood pressure was normal, and the diastolic number was even lower than normal. However, there was protein found in my urine sample, I had started having some white spots in my left eye, and the swelling was a concern as well, so I was going to be in the hospital overnight for observation. Furthermore, since my appointment two weeks earlier, my weight had increased something like sixteen pounds, and I certainly hadn't been eating any more than normal to explain the sudden gain, mostly from water retention. As Eric drove, I called my boss to explain the situation.

At the hospital, I was making a list of what Eric could bring me for the overnight, including my laptop to monitor work email and stay involved in life in general and thank-you cards for the baby shower gifts.

I was to undergo a 24-hour urine collection and have another ultrasound. I felt silly being taken down to the ultrasound in a wheelchair, but I assumed it was regulation. This third abdominal ultrasound did reveal that we would be having a girl. At one point, the blood flow to our daughter was constricted, but later upon a more thorough monitoring, it had regulated, so the assumption was made that she had been laying on the umbilical cord.

Once I arrived at the hospital, my blood pressure soared. I wrote most of it off to nerves, as I felt uneasy being admitted so early. I suspected it would go down once I would be able to get to sleep and my mind stopped racing. I composed a couple messages to work, explaining where I had been in my preparations for the upcoming new-student orientation.

I told Eric there was no need to spend the night with me that first night, as I figured it would be pretty straightforward and uneventful and the chair available to him looked anything but comfortable. I was put on blood pressure medication, and before bed I was given a dose of Ambien. I was told it wouldn't be enough to make me fall asleep, but once out, it would help me have a deep sleep.

Ambien has been known to have some interesting side effects on a small population taking it. Apparently I am one of that number. When I awoke needing to go to the bathroom, I was quite disoriented and it took much internal coaching to remember where to go. I threw up three times, and each time I was so foggy as to how to react. I was able to find my remote for calling the nurses, and I had to stare at it repeatedly before I could decide on the proper button to push (for those of you unfamiliar with them, there are two buttons for turning on lights and another, with the picture of a nurse, for contacting the nurses' station).

Then when the nurses would come and help me get cleaned up, they asked me to stand up and walk to the bathroom. And then, when I seemed unable to respond, they helped me up and said, "Okay, now walk straight." When I would react by walking elsewhere, they came back with, "Here, we'll just push you in the right direction." Once in the bathroom, I knew I needed to wash my hands and somewhere I would find water and soap. I really had to be shown how to do everything. In my mind, I could hear what was being said, or think about what action I wanted to take, but it took such a long time for me to communicate to my hands or legs ("Now I need to dry my hands. Somewhere I should find a towel hanging up. Where is it? What do I do when I find it? I should pick it up. Hands, do you see that towel hanging up right in front of you? You do? Now pick it up. ..go ahead...pick it up, already. Okay, now dry your hands. You know, wipe each hand on the towel until the moisture is gone. Hmm, let's try this again.").

Eric saw me at breakfast the next morning, where I was still groggy. I would try to wipe my mouth after eating, and would promptly drop my napkin directly into my plate of biscuits and gravy, which I was still working on. After repeated bemused suggestions ("No, Faith, don't put the napkin in your food" and the like), he finally took over and fed me.

Several nights after, I would be asked if I wanted Ambien (the first night I wasn't given the option to refuse). I declined every time, explaining that it had made me loopy. The first nurse I told responded with, "That was YOU?! Not that we're gossiping, but it was such an unusual reaction! You only had 5 mg, and we normally give 10 mg without batting an eye!"

So now it was Wednesday, August 20. My blood pressure had lowered, but my left eye had gone from having spots I could blink away to a more constant blurriness. I had some visitors throughout the day -- the knitting crew stopped by, as well as a professor from work who had gone through a similar situation a year earlier with her pregnancy. She was hospitalized the first time at 24 weeks, and finally the third hospitalization around 32 weeks resulted in an early delivery to a healthy baby girl. She brought some resources and answered all of our questions. In my mind, this was what was in store for us, and I figured after everything was regulated, I would be sent home for a time to wait things out.

We were being told our baby would be premature, it was just a matter of how premature she would be. In preparation, a doctor who specialized in high-risk pregnancies ran another, more sensitive ultrasound this day, and we met with a doctor in the neonatal intensive care unit (NICU); he explained what having a baby at 24 weeks would be like. Admittedly I thought this was premature, as I still thought everything would hold off.

I was given another steroid shot to hasten fetal development. Eric read in a preemie book that each shot can be the equivalent of one gestational week of development, and they had given me my first the day before.

After the professor left Wednesday night, my blood pressure was elevated again. I wondered if it was a temporary rise, due to the discussion we had been having, but I did ask Eric to stay with me overnight. Given my first night of confusion, I was pretty tired and slept through most of the night even with the interruptions for medication, but Eric said there were a couple blood-pressure readings that were elevated to a frightening level (one was something like 200 over 140).

Early Thursday, August 21, around 5 AM, I was pretty hungry. I am naturally more of a grazer, and my unfinished meal from the night before at 7 PM seemed far removed. The nurses found me a bowl of cereal since the kitchen wasn't open for room service yet. I had most of it. This morning they also checked my weight again. It had increased around 8 pounds since 48 hours earlier. I saw pictures of myself from this day, and I don't look at all healthy. My face, and presumably the rest of me, was quite swollen.

Around 7:30 AM, my doctor came in to let me know it was time to deliver given the status of my early-onset pre-eclampsia. The results from my urine monitoring had something like 8 grams of protein (a normal level is something like 150 mg/day), and I wasn't expelling as I ought to have been (see: insensible weight gain). He was explaining the surgery I was about to have and the incision. The anesthesiologist also met with me, and here the consumption of cereal was revealed. I wasn't going to have a sedative for the surgery because of it, but I would still have the spinal.

Eric called his parents as well as my dad. My dad had returned from the Czech Republic the night before. He hadn't yet read the email Eric sent to him letting him know of my hospitalization, and due to his jet lag, he was disoriented on the phone. Eric, after relaying his name, even had to tell him who he was ("your son-in-law"). He soon came to when Eric brought him up to date.

Next post: Delivery.