Monday, October 17, 2011
Thursday, October 13, 2011
Tuesday, October 11, 2011
Monday, October 10, 2011
Sunday, October 9, 2011
Saturday, October 8, 2011
I tried so hard to prepare myself for what labor and birth would be like, but could never find a good answer to my eternal question, "How will I know I am in labor?" The answer I found in every source, including communication with friends who were moms, was exactly the same: "You'll just know." I spent all manner of time worrying about this. What does that mean? HOW will I know? Can't anyone tell me? Hubby told me, sounding very doula-like, to trust my body and my instincts.
When anyone tells me to trust my gut, I like to reply with my favorite line from the movie High Fidelity: I don't trust my gut. My gut's got shit for brains!
Never has that line been so well-deserved.
On November 30, I worked my last full day at the hospital. On December 1, I had a routine weekly check-up with Dr. Teddy Bear's nurse practitioner. Even though I was just 7 days from my due date, she had not actually checked me for dilation/effacement up to that point. My co-workers at the hospital were actually pretty shocked, but I hadn't reported any contractions. This time, she decided to have the nurse check me anyway. The nurse asked me if this was really my first baby, because it seemed like I had had one before. Then she announced that I was already between 4-5 cm dilated!
I burst into tears at the thought of them putting me in a wheelchair and rolling me down to L&D right then and there. Neither she nor Hubby really understood what that was about. I don't understand their surprise.
I thought I had another week. I was not ready for this. The bags were packed, but at home. I was dressed and ready to go to work in my office at the college next door. NOT ready to go have a baby. And I was SO EMBARRASSED that despite my best efforts to educate myself, I had no frickin' clue I had progressed that far. She called me the "Mack Momma" for not even noticing that I was halfway dilated already. (This made me laugh as I usually curse in pain when I stub my toe.) As it turned out, L&D was full, so they sent me home with a plan to go back in at midnight. Since I was already dressed, we left the appointment and went to work. I got nothing done, but I showed up, so I didn't have to waste a day of FMLA.
Hubby and I went home that evening and packed up the last minute stuff. We let our parents and close friends know we were headed to the hospital. We called Fr. Charlie, who said he would come to the hospital and baptize Sam right away if we needed him to before surgery. I packed a pure white blanket to wrap Sam up with in case of a hospital baptism.
I checked in, disappointed that Hubby wasn't allowed in the room right away, and that the carefully selected clothing I had chosen for labor comfort were quickly set aside in favor of a backless hospital gown. They hooked me up to the monitor, and asked me if I wanted an epidural when the time came. The "early and often" approach to epidurals was my mantra. I am a pharmacist, after all...I believe in the healing power of drugs.
The OBGYN resident on that evening checked on me periodically, but explained that her goal was actually to "keep me pregnant" for as long as possible, to avoid a NICU transfer and neonatal echo during off-hours. Hubby got some rest, and I watched silly movies to pass the time. For a while I listened to the iPod playlist I had painstakingly put together for relaxation, but not as much as I thought. I still wasn't in any pain. When I progressed to about 6 or 7, and things started picking up again in L&D, my nurse came in and said "If you still want an epidural, I think we should consult the anesthesiologist now. He is going to get busy here in a bit." The anesthesiologist was actually a resident, a smallish guy with dark hair and blue eyes. After he left, Hubby and I laughed and laughed because his name, like his face, was strikingly similar to the character Zach Braff played on Scrubs.
At about 8 in the morning, the overnight OBGYN resident thanked me for staying pregnant all night, and turned on Pitocin to move things along before leaving. My husband saw Dr. Teddy Bear out in the hall when I was about 9 cm, and as Dr. Teddy ran by he just waved and said, "It's baby time in Tennessee!" I languished at 10 cm and fully effaced for a while because he was off delivering another baby. As long as I felt no pressing need to push, they were going to let me wait as long as possible.
At around 12:45, they came to tell me they were taking me to the OR to deliver. They weren't expecting to do any surgery, but they would have all sorts of staff and equipment on hand in case Sam needed it, and the OR would accommodate it better than the L&D room. They gave Hubby scrubs to put on and away we went. When we got to the OR there were not many people around. An OBGYN resident who goes to our church walked in (!) then realized he was in the wrong room and walked out (whew!). Nurses started filing in from what seemed like everywhere...Sam was going to get quite the hero's welcome!
Dr. Teddy Bear and his intern, Dr. O came in to deliver Sam. I started pushing a few minutes after 1pm. I thought to myself, maybe he will be born at 1:31 pm, like I was. Not even close.
Samuel Alexander drew his first breath of fresh air at 1:13 pm on December 2, 2010. He weighed 7 pounds and 10 ounces, and was 21 inches long. They called Hubby to cut the cord, and then Dr. O announced that Sam had cut his own cord (we still don't know what that meant exactly). I stayed pretty calm, just trying to get a look at him. They took him away to clean him up. I asked Hubby, "Ten and ten?" which he confirmed, telling me his feet looked comically big, but that he was beautiful. I remember everyone telling me that, but wanting to see it for myself. By the time I got to see him, he was already cleaned up and swaddled, with a hat on. I got to hold him for just a minute, crying the whole time of course, so relieved to see his beautiful face. Before I knew it, they were taking him away to the NICU, and I was crying even more. I held him for 39 weeks, that moment just didn't seem the right time to let him go.
Friday, October 7, 2011
In my world, Dr. Liske is a rock star. He is an absolute sweetheart, well-trained and published. He used to work at Vanderbilt, one of the premier pediatric heart centers in the Southeast, but is as humble about it as they come.
At our first visit, Dr. Liske explained that he would be performing an echocardiogram on Sam, to try to get a clearer picture of his heart than a typical ultrasound. He also explained that he doesn't talk much during the echo...he needs to think and he doesn't talk or think well when he's trying to do both simultaneously. (I immediately felt more comfortable with him...he warned me in advance because he knew it would make me nervous that he wasn't saying anything! He also said he liked to think, which put him above at least one doctor we had seen recently.) There I was again, "jelly belly," lying down while he zeroed in on Sam, and then on Sam's tiny little heart. This echo felt like it took forever, made worse by the fact that my leg kept going numb and I had to move, messing up his view. After what seemed like a million years, he announced that Sam had been a very good boy for his "closeup" and we were all done. Here we go...
Dr. Liske pulled out a photocopied diagram of the human heart, and started drawing and writing on it. I love that he gave us a picture so we would know exactly what he was talking about. He told us there were some things that he just couldn't see, that it was hard to get every possible angle. Sam had one side of the heart that was larger than the other, a possible narrowing of the aorta (CoA), and some smaller than average heart valves. Dr. Liske explained that this could be due to a few different causes, including a hole in his heart between the atria (ASD) or between the ventricles (VSD). He wanted to see us back in a month (which would be in October), and then would not see us in November before Sam's birth in early December.
He told us he loved Sam's name because his son is also named Sam! This is just meant to be. :-)
At our October visit, what he saw was more or less the same. It was at this point that he told us the news I was hoping not to hear: Sam would need to go to the NICU immediately after birth. So we would not be able to deliver at the hospital we had planned on, 5 minutes from the house with the original OB group and beautiful new birthing suites. We would have to deliver at the teaching hospital. With residents and potentially students present. Lots of people, some of whom my husband works with, looking at my hoo-hah. Fabulous. (And in case you missed it with all my petty whining about my hoo-hah on display, the baby being rushed to intensive care immediately after birth.)
Dr. Liske said they might have to give medication to keep Sam's PDA (a hole in the heart present in babies until shortly after birth) open until he could have surgery. I am a pharmacist; those drugs do not scare me. He also told us he didn't think anyone here did the surgery with enough regularity to be excellent at it, so we would have to transfer to Vanderbilt. This scared me more. I could not imagine traveling to Nashville emergently in an ambulance with my brand new little guy strapped to a board, potentially only hours after giving birth. What about the bonding time? What about the healing process? How would we figure out nursing? In the end of course, this paled in comparison to the notion of my Sam having surgery by someone who wasn't an "old pro" at it. We were sent on our way with a whole new set of preparations to make; preparations that involved at least one new hospital, and perhaps a new city, in Sam's first few days of life.
Thursday, October 6, 2011
The truth is that I don’t love anything about DS, except for my child, and the other people in this world who have been inextricably linked to it by their extra chromosome. Maybe someday I will be happy that Sam has DS, but I’m not there yet.
I could say I love his eyes, with their little tiny epicanthal folds. I could say I love his feet, with the sandal gap (even though my hubby wouldn’t let me buy him shib-shib—Arabic for flip-flops--to go in the gaps). I could say I love how sweet and loving and happy he is, how he is so enamored with people and their faces. I could say it was amazing having a baby who would sleep through the night since day one. But I will not say that I love anything about Down syndrome.
Those things are not Down syndrome…they are SAM. Every last one. He comes by them honestly, too…regardless of his chromosome count. Do I love his almond-shaped eyes? They remind me of my own, but with longer eye lashes.
Do I love his sandal gap toes? The gaps that aren’t quite as big as his Daddy’s?
Or his pectus excavatum—the sunken-in chest that he also shares with Daddy (but that Daddy wouldn't let me take a picture of)?
Do I love his sunny disposition, how he rarely cries or fusses? He really is such a happy baby…
Except when he’s not.
Do I love having a baby who sleeps through the night? He gained weight just fine those first five months since we set an alarm to wake him for a 3 am bottle.
Do I love how he engages so readily with people? How he is so loving and “social?”
Of course I do! I love all these things. How could I not love them? They make Sam himself. But, he could have all these traits without having Down syndrome, and I resent the implication that he would be anyone other than himself with only 46 chromosomes.
More than that, I resent the idea that Sam is his Down syndrome, or will ever be defined by it in any way. I patently despise the idea that he is, or will ever be, one-dimensional.
“He’s always so happy” is a dagger to my heart. He loves to flash his “light up the room” smile, but it minimizes Sam’s humanity to think that he never has or will have another emotion.
I love that Sam is so social, highly motivated by faces and the reactions he receives from others. But it would be a lie of omission not to also address my fears about his being used and abused, taken advantage of, or patronized because of his desire to please and gain approval. I want people to know and love Sam for Sam.
The idea that someone might dislike, mock, or devalue Sam because he has Down syndrome is a punch in the gut to me. But at the same time, the idea that someone might be superficially nice to Sam because he has Down syndrome is like a slap in the face. I want people to see him for who he is, just like I do. Who he is, is Samuel Alexander. Down syndrome is only 1/47th of who he is…and he would still be Samuel Alexander without it. So I don’t have to love any part of Down syndrome. Loving the people who have it is enough.
Wednesday, October 5, 2011
Tuesday, October 4, 2011
The week between our U/S and our high risk OB appointment was excruciating for me. I just wanted to know what was happening with the little boy who already meant so much to me. As soon as I got home, I consulted Dr. Google, figuring “I’m an educated health care professional. I can wade through the BS and figure out what is happening with my baby.” WORST IDEA EVER. I woke up in the middle of the night once that week, and went into the nursery, and clutched the glo-worm that a co-worker had bought for us while I lay on the floor wailing. I immediately repented for every time I went out at night as a teenager and didn’t call my mother. I begged God to forgive me for calling my dad crazy when he left me four voicemails to make sure I was okay after a major disaster in the city where I went to college. I knew the anxiety and the love the accompanied being a parent now. I started crying daily in the shower just to let it out, because it was before Hubby woke up for work and I thought he couldn’t hear me. He could, and it even woke him up. But I couldn’t not cry. I was sure my baby had T13 or T18, which had a very low chance of survival to term, and even lower for survival past the 1 year mark. I asked myself which would be worse: a stillbirth, or losing a child in infancy? I never did give myself an answer. I cried instead.
I called the OB office for our quad screen results, and the dingbat medical assistant told me the following: “They’re normal.” And when I asked for specifics, she didn’t even know how to tell me anything else in a meaningful way. She just read out numbers, without units or interpretations. She said they would tell me at high-risk. Awesome, because I can’t think of anything I would rather do than wait to find out the results.
Hubby and I discussed, frequently, what the plan would be if they offered us the amniocentesis. I couldn’t decide if I was one of those moms who would rather be able to plan, or an “ignorance is bliss” type. I couldn’t get the risk of miscarriage with amniocentesis out of my head. I think deep down my husband really preferred to know, but he knew how riddled with guilt I would feel if I were to choose amniocentesis and then have a horrible outcome. So our united front response was, “no, thank you.”
We walked in as stealthily as possible to try to avoid seeing any colleagues. We were called back to an ultrasound room, where the technician squirted me with the wretched jelly and started the scan. She measured size, confirmed that he was a he and started focusing in on the head and neck. For what seemed like forever. Especially the head. When she was done, she printed some pictures for us and said she would send the doctor. A few minutes later, in walked the giant man that I will heretofore refer to as the Giant Tool. He was not alone. He introduced the genetic counselor, and I’m sure my face turned as white as a sheet. I knew it.
They said they did see the thickened nuchal fold again, but didn’t see the choroid plexus cysts that were picked up at the OB’s office. I immediately perked up—This is Good News! My original OB said if they only saw one and not the other, they wouldn’t be particularly concerned! Then I thought, “so why is She here??” The genetic counselor asked for my quad screen results, and read them looking puzzled. She handed them to Giant Tool, who looked quizzically back at her, and then at me. I told him we only just had the screen done the previous week if that made any difference, and he made some surprised comment about not having it done at the first appointment. The conversation went something like this (acting like we weren’t present at all):
Giant Tool (GT): “I think the baby has Down syndrome.”
Genetic Counselor (GC): “But the screen results are 1:4700, less than the general population.”
GT: “It’s just because of her age. Do you see how high that HCG is?”
GC: “You really think so? I don’t know. What about the long bones?”
GT: “Today’s U/S says they’re in the target range.”
GC: “I don’t think it’s Down syndrome.”
**me, in my head, while watching them talk like a cat watches a ping-pong game: why didn’t they have this conversation in his office before walking in here???**
GT started talking to Hubby and me again:
GT: I think you should have an amnio. It is the only way to know for sure, and we can do it today.
Me: No, thank you, we have no intention of terminating regardless of the result.
GT: You’ll have peace of mind, and you’ll be better off with time to prepare.
Me: We don’t feel comfortable with the risk of miscarriage.
GT: Well, the risk you read about is in the general population of providers. I do these every single day, and have for the past 15 years. The risk of miscarriage if I do it is about 1 in 10,000. And with your sac where it is, I would say even less than that. If we don’t do it today, we can’t do it again until 34 weeks. NOW LET’S SEE WHAT’S WRONG WITH YOUR BABY.
**screeeeeeeeeeeeeech…the whole world came to a grinding halt.**
Me: I don’t think so. What are our other options? **internal monologue: and what’s this I hear that you have a partner? Can we see him next time, instead??**
In the end we opted against the amnio, and decided instead to follow the baby with monthly appointments and U/S. We still had to see Giant Tool. The genetic counselor was nice enough. She explained what GT didn’t, including why they disagreed, and tried her best to cover for his rude behavior. She explained that the baby didn’t just have a little extra thickness of the nuchal fold, but actually a cystic hygroma, which could potentially progress to fetal hydrops (fetal heart failure, which could include fluid build-up surrounding the internal organs or other important tissues). She told us that it could get better, or get worse, and that if it got worse then he had an increased risk of dying before or shortly after birth. If it got better, it didn’t necessarily mean that he had a lower chance of having a chromosomal abnormality, just a lower chance of dying from the complication of fetal hydrops.
The one up-side, was that we got to see our baby every month. At the next appointment, the U/S tech was enthused to try a new technique she recently had learned at a conference: 3D U/S of the heart. For being her guinea pig, she gave me some 3D shots of his face. I slept with them under my pillow.
Monday, October 3, 2011
About twelve weeks after our first appointment with the OB, Hubby and I happily made the jaunt to the OB’s office…we were ready to see our baby!! We had been hearing good, strong heartbeats for two months already (I even gave the baby a pep talk before each appointment: “Come on, Baby. Make a big strong heartbeat for Momma”). Almost everything had been going great. There was that one tiny incident at around thirteen weeks…the one when I had a very mild bleeding episode and thought I might be losing the baby. The OB office calmed my fears, but this was a very harrowing experience for me. I have 7 siblings in heaven who never made it to earth, and I am keenly aware of the possibility that something doesn’t reconcile between my mom’s journey and my own “fertile Myrtle” experience. Nonetheless, I prayed and prayed for God to keep my baby healthy and bargained with Him about it, too.
Back to the ultrasound appointment. We were so excited to see our baby and find out which room would be the nursery (we have a blue and a green room and would choose which one to set up for baby based on gender…so old-fashioned in that way). I’ve never had an ultrasound before, so it didn’t even cross my mind that anything might be wrong when it went on a long time. Baby was playing a little hard to get, without many good pictures of some key elements. One key element he had no problem showing was that he was a HE. The goods were not in question. The U/S tech printed out a few pictures for us, and told us the OB would be in to the U/S room to speak to us, as she would want to see some things for herself. Great.
When the OB came in she told us about some concerning aspects of the ultrasound. She told us that our precious BOY had a choroid plexus cyst in his brain, and also an abnormally thick nuchal fold. She tried to quell our fears by saying that one or the other of these things might not give her too much pause, but in concert, she felt that I should have another U/S with the high-risk OB group in the area. Their equipment, she said, was first rate and they would be able to see and monitor better than she could. She also asked, since I was still a few days shy of 20 weeks, whether I would like to have the Quad screen now. She made a point of reminding me that I had declined it previously, as though having it at eight weeks would have somehow changed our current circumstance. I wanted to remind her that it was only a screening test which wouldn’t have told us much useful information at eight weeks, and still wouldn’t tell us much of anything. We still were not going to terminate. I decided to go ahead and have it, just in case it could somehow clarify anything when considered in combination with our U/S results. And so, the following week, we were off to the one place I did not want to go for anything related to our son: a high-risk OB office within the walls of the teaching hospital where I worked, and my husband still did.
Sunday, October 2, 2011
Samuel was born to two pharmacist parents. My husband and I are not the most type-A people, but in general, pharmacists are pretty detail-oriented. So when I tell you Sam was planned, you can believe it. Since my husband was in the throes of writing a book chapter about preconception care for women with chronic illnesses, he was well-versed in all that should be done to prepare oneself for having a baby. He harassed me about it regularly. (side note: It’s bad enough feeling stupid about these types of preparations because you read a book or spoke with a girlfriend and found out something you didn’t know. But when you’re getting it from your husband, who doesn’t even have ovaries…you feel extra pathetic not knowing that you should have a dentist appointment before you start trying to conceive, just in case you need any work done that requires anesthesia and can’t wait 10 months or more.) So began my days filled with folic acid, and devoid of Reisling, even though I really wanted it the other way around. Luckily for me, the dentist appointment turned out just fine.
Within a month of our making a plan, I watched the movie “Up” and cried for the first 20 minutes solid. I knew in my heart that our plan had been successful. We confirmed this notion on Easter, a day that is set aside for celebrating new life within. We, of course, were celebrating new life in a spiritual sense, and a physical sense. My husband and I felt so immediately blessed to be entrusted with a life that we were responsible for.
The early days of pregnancy were…just that. I won’t say I had it particularly rough, but for a foodie girl, the bananas and rice cakes diet I ended up on for the first few months was its own special kind of torture. But, having a coworker pregnant at the same time who had hyperemesis gravidarum (extreme nausea and vomiting throughout most of pregnancy), I just ate my rice cakes, lost ten pounds, and counted my blessings. Things were mostly going well, after all. I woke up in the middle of the night pretty early on and couldn’t feel part of my left leg. I could bear weight on it, but couldn’t feel if I touched it. At 3am, I used my iPhone to pull up a dermatome map (a “map” of the human body that shows which areas of skin are affected by which nerves—often used to determine the affected area for shingles), and determined that the baby must be encroaching on one certain nerve. Yes, I am a nerd, even at 3am. I was happy to know these were not problems to be too worried about.
At my first OB appointment, my doctor offered the quad screen. My husband and I had previously decided that as long as the screening couldn’t tell us anything about a situation we could control, that we would decline it. We knew we would not terminate, so in our minds it had no purpose. The OB confirmed what we already knew at the appointment. She had me sign a form acknowledging that I was offered the testing and declined, which I didn’t think too much about at the time. Other than that, I was doing well, with no indication from Sam that there was anything to worry about. Well, other than the fact that the OB’s nurse told me that given my starting weight, they were hoping I would only gain about 15-20 pounds over the course of pregnancy. (Seriously?)