Four Weeks Old and TWO POUNDS!

My little man is doing a great job growing!  He finally hit two pounds today, and his nutritionist, who left a bit of a bitter taste in my mouth with the twins, even said she's proud of Lincoln and Mommy!  He's staying on his curve of about 35% for his gestational age (28 weeks tomorrow).  He was born at 95% in height and weight, but both are around 35% now.  That number is just fine as long as he continues to stay at or above that percentage.

Link was started on hydrocortisone last night, a steroid that doctors are using to bring his cell receptors to the cell's surface so when the dopa floats by, the cells grab hold.  He's had three doses so far and the results are really showing.  He's been able to come down on his dopa dose to 5 so far with a goal of 3 for today.  His blood pressure, temperature, and heart rate were all increased which is a sign that the dopa dose is too strong.

Link's also gone up to 8 cc's on his feeds.  David says one of the doctors said that 15 cc's would be considered a full feed at this age/size, so we're halfway there.

I headed up to the Ronald McDonald Room for coffee and a bagel a bit ago.  We've got a rough road ahead with lots of ups and downs, but being on the Ped's floor is still difficult.  As I walked down the hallway into the room (NICU is floor 5, Ped's and PICU is floor 11 along with RMR) there were parents on the phone discussing insurance, discussing their child's change in stool, one woman crying on her husband's shoulder.  The world seems to zoom by outside of the windows, but it is a completely different world inside this hospital.

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Here we are again, David and I, back at the hospital for the evening.  Lincoln is doing great on his hydrocortisone steroid treatment.  His dopamine is down to just 1.67 mcg!  They've weaned him as low as he can go and now we watch his blood pressure readings for a while.  Dr. DeCristafaro was just here and I said, "He looks good.  He's doing well, yes?" And Dr. D nodded and then knocked on wood.  LOL - none of the docs or nurses will say it out loud for fear of jinxing it!  We asked Dr. D what happens after Link's five days on the steroid.  He said if the cell receptors continue responding well, then great.  If not, they can do a maintenance round of the steroid.  Today is a good day, folks!

Busy Day

I can't go to work tomorrow.  I'm only now finally having a moment to breathe today.

I went to work this morning.  I left when I was done teaching and headed to the hospital.  I got a pump and start pumping.  Then I fell asleep. Pumping.  And our male nurse came into the room and I woke up.  Then I went to Miss Ronnie's to get the girls (it was their first day there!) and bring them home.  Then to pump.  Then made dinner, which we didn't get to eat because it took too long to cook, then scooped up all the girls and Dave and the girls dropped me at Back To School Night.  Then back home to pump and now to bed!

I'm going to sleep in tomorrow until the girls get me up.  And then maybe take a nap.

Tomorrow Link could hit two pounds.  He's at 900g today, 907g = 2lbs.

Blood pressure still a major issue.

Day 25

As of right now, Lincoln is backsliding a bit.  He's had residuals at a couple of his last feeds (milk that hasn't fully been digested and processed), so now they're giving him the balance of 6 cc's.  In other words, when they go to feed Lincoln the nurse sucks out of his belly what is left in there to see how it looks - lately it's looking okay, but is not gone.  It's a good color, it's partially digested, but only about 3 cc's are gone and 3 are left.  So at his next feeds, he'll get his 3 cc's back that are partially digested, then he'll get 3 cc's more instead of 6 more.  Heather says this is likely due to him needing to poop.  I got to hang out while she did an "anal stim," and I joked that the best part of my job is that I never have to anally stimulate any of my students.  Hopefully the stim will help Link poop, and then he'll be able to tolerate his feeds better.

He's a little more dependent on his vent today, and his dopamine dose is back up to five.  Neither of those things are great.  His weight is 885g, just a few shy of 907 which gets him to 2 pounds.

A Surprise Visit from Nana & PopPop

I was excited to be home this morning around 10 AM, because my parents were coming and we hadn't told the girls.  Elliot had her well-visit this morning at 9.  We got to tell our pediatrician all about Lincoln.  He also told us that a foot thing we've been worried about with Elle is simply flat feet, and a good (expensive) pair of sneakers with arch support.

After the appointment, we came home and hung out in the family room until we heard the doorbell.  I told the girls to answer the door, and there were squeals of delight that Nana & PopPop were here!  Then Dave and I took off for the hospital.

Lincoln is staying on the same track.  Nearly nothing has changed, which in some ways a good thing.  His weight has gone to 815g today, and his feeds are now 5cc's every 3 hours.  Still has the blood pressure issues going on, still going up and down on the vent.

Dave and I are actually going on a much needed date night to our favorite restaurant tonight.  Since we have 24 hour babysitting right now, we're taking advantage and going out to dinner then to the hospital to see little man.

27 Weeks Gestation

Lincoln would have been 27 weeks today in my belly, so he's now referred to as a 27-weeker.  He's still staying the course with everything.  Nothing really new to report.  Link got a smaller amount of blood today in a transfusion - he didn't need a full ?dose? - and after that was done, he was going to 4 cc's of breastmilk at each feed.  He's still handling feeds well with no residuals so they're upping him a bit more.  Weight is down to 795, but likely due to get ?lasics? which helps to drain extra fluids from him.  Slow and steady hopefully wins this race!

Three Weeks Old - Oh, Lincoln...

News isn't as exceptional today.  Here's the good stuff - he has stayed stable and his weight is up to 810g - our first trip into the 800's.  He's grown half an inch in the last three weeks as well, making him a long 13.5 inches.  Also his feeds have gone up again to 3 cc's every three hours.  Each day of the last three, he has gone up one cc every 3 hours, which is progress that I like.  No residuals mean that his body is processing the food, and poopy diapers mean it's making it's way through his little body.

His blood pressure is still a major issue and cannot seem to be explained yet.  The doctors had his cortisol levels checked and the results came back normal.  Endocrine has been called to do a consult next to see if they know why he's fighting to keep a normal blood pressure.  The dopamine is still at 8 mcg, but his blood pressure is falling again.  Mommy is concerned.

A chest x-ray was done last night and Lincoln's lungs look "hazy."  He was given medication, but his blood pressure is still dropping, so we have to wait and see.  When I got here they were performing a kidney ultrasound.

At three weeks old, Daddy has still not held Lincoln.  My heart breaks for that.  I've held him, only twice.  Just want to scoop up my boy and love on him...

My Son is a Rockstar

Link's doing well again today.  His sodium levels are dropping which are a concern, but perhaps related to his low blood pressure issues.  He's on 6mcg of Dopamine to help his blood pressure, but he should really be weaning off of it.  Other than that, he start at noon yesterday 1 cc of breastmilk every 3 three hours.  He had no residuals and he pooped twice :)  It's amazing how happy poop can make you!  Today, since he's tolerating it so well, he'll be upped to 2 cc's every three hours. Dr. Pynn, the attending on with us for the next two weeks and the doctor the twins had most in their stay, said 2 cc's is still very little, but good for priming his gut for real feeds.  Link also gained 60g over the last 24 hours, getting him to 790g.  His O2 has been consistently 30-40% over the last 24 hours, down from 50-60%.  Room air is 21%, so we're working our way to his being able to tolerate that.

When I arrived this morning, his group of doctors, NPs, and RNs were outside the next babies' room for rounds - we were next - I snuck in just in the nick of time.  But then it turned out that a baby was being delivered, and suddenly the hallway just filled with six or eight people was empty, but their rolling desks with binders, papers, laptops and calculators were there, deserted.  About 20 minutes later everyone was back.  Heather had Lincoln's bed open because she was prepping to put a new IV in.  He needed to add phosphate into fluids, but since he's on dopa they can't do a swing line.  While she was prepping him and then again after the IV was in, I got some good face time with my little man.  We were hanging and chatting (okay, I was chatting, he was looking at me - good enough!).  That time with him today will likely be my highlight for today.

Daddy went up to the hospital this evening to see Lincoln.  He also got some good face time while Lincoln's dipe was being changed.  Dopa is up to 8mcgs, and now Mommy is getting quite nervous about his blood pressure.  Doctors are trying to get to the bottom of why it is so low and needing so much dopa to keep it up.

Also, the highlight of my day may actually have been all 3 girls being really well-behaved and good listeners while they got their hair cut one at a time.  The woman cutting their hair was impressed by their behavior!  Mommy enjoys good listeners and a good compliment.

19 Days Old - Day 20

The NICU counts day of birth to be day 1 since it's their first day of life.  So where we say Lincoln is 19 days old, the NICU staff calls him 20 days.  Day 20 is looking good for Link.  He dropped a bit of weight again at 730g, but we know that is related to being bloated, urine output, etc.  His dopamine dose is up to five after easing yesterday down to three, then up to four. But his oxygen is down to 30-40% from 50-60% yesterday.  He's comfy hanging out on his belly right now, easily his preferred method of relaxation.

I dropped off Elle's birth certificate and arranged "babysitter busing" for when I work and she needs to go to our Miss Ronnie's house.  The stop by district office on the way to the hospital was nice - I was greeted by lots of concerned and caring people who wanted to know how little Lincoln was doing.  It also wrapped up a couple more things I needed to scratch off the to-do list.

And as far as the twins: This morning Charlie was at her worst. She had been up in the middle of the night and girl needs her sleep! She was throwing tantrums from the moment she woke up. Char was particularly mad at me for giving her an orange cup when blue is her favorite color. Addie had been given a pink cup, which is HER favorite color, and she sweetly offered it to and fed Charlie from it while she took the orange cup for herself. Addie, for all her faults (like exhausting her parents with her endless wants and whining), is such a little mommy to her sister 
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Balancing Act

Lincoln's doctors and nurses often refer to the balancing act - if we lower the dopamine, he can take feeds, but then his blood pressure is at risk.  If we give him something to fix his kidneys, it could put a strain on his heart.  Everything seems to balance on a thread as thin as a hair.

I'm feeling the same way. I am healthy enough and physically fine to be back at work. Being at work could be good for me because it may take my mind off things and save my sick time for when Link comes home.  But I'm so distracted at work thinking of how he's doing and feeling extreme guilt for not being there, particularly during rounds.  I seem to have some fantasy in my head where my attendance at rounds affects his treatment.  If I'm back at work I miss morning rounds, spend two (just two) hours at the hospital with him after work, and don't return at night because my alarm is set for 5AM for work days.  When I'm at work, I think I do a pretty good job of plowing through, but then all my energy is gone for the much longer portion of the day when I'm a Mommy of four.  I didn't go to work today, and I still feel like I am half-assing everything I'm doing.  I just literally cannot decide whether it is beneficial for me to be at work.  Am I doing my students a service or dis-service by being there?  I guess I'll keep taking it day by day until I figure that out.

I did manage to get Elle signed up for religion classes today.  She will get her first communion this year, one year behind her classmates, as Mommy messed up and missed a year.  She's required to go to church 12 times - something Mommy may just enjoy doing with her.  We've gone to our new church one time, right after Lincoln was born.  Elliot was excited that the priest was talking about welcoming people into the church.  I had a hard time as he talked about praying for pregnant women and women who have lost their babies.  I'm neither of those things, yet I still feel incredibly raw.

18 Days Old

I can hardly believe we've been at this for 18 days.  Little Man is doing well today.  His weight today is 750g, which is what his birth weight was.  He's been all over the map the last few days with his weight, as kidney issues are causing bloating and affecting his urine output.  If you could just see him move and groove and squirm all the time, you'd see that he looks good for a 26-weeker.  Hopefully the kidney and blood pressure issues we're seeing get better so he can go back to feeds again.  He's still getting colostrum care - rubbing the inside of his mouth with a swab of colostrum.  But Mommy & Daddy want him eating, because the nutrition in the colostrum and breastmilk will do wonders for him.

Our nurse today, Heather, realized that whoever hung his dopamine line did so with a line with a filter.  She is now changing it out for a line without a filter.  She said the filter can catch molecules of the medication and keep it from getting to him.  This could be the reason that 1 unit was working a few days ago and 7.5 doesn't seem to be working as well as it should today.  Lincoln's blood pressure is okay, but on the very low end of okay.  They will monitor closely with blood pressure readings every 30 minutes to be sure it is making a difference.

I Was Robbed

Today I am feeling a lot of anger. I was robbed.  My pregnancy with Lincoln was my last.  I knew it was my last, David and I feel our family is complete.  My pregnancy was going well.  Then something f*cked that up, and my baby came at 23 weeks, 6 days.  And now I'm not pregnant.  I miss feeling him move and kick.  And I miss being pregnant.  I even suck at being pregnant - I have gestational diabetes that diet alone can't control and I have to be on insulin.  I have to check my blood sugar four times a day and shoot insulin four times a day (though I was only up to 2 times so far this pregnancy).  I shouldn't want to be pregnant.  But I do.

Yesterday I was pumping gas and there was a pregnant woman a couple of pumps over.  I was angry with her for getting to be pregnant and I don't.  Dave and I went to a consignment sale on Thursday and it was "special entrance" for women in their third trimester.  I had to listen to women talking about how cute this outfit was and what do we still need for the nursery, while what I thought was if I buy Lincoln a bunch of cute clothes with money we don't really have to spare and then he doesn't make it, what do I do with all of these clothes?  So we bought four or five little outfits.

I'm supposed to be pregnant and my baby is supposed to be growing and thriving.  Instead, I'm not pregnant and my baby is fighting every day for his life.  He's stable and doing pretty well today.  I'm not.

Why I Hate the Number Eleven

Ask anyone who knows me well, I was certain Lincoln would be born on November 11.  The number eleven kept showing up in my life - mainly when I looked at the clock.  There were days I'd look at the clock at 7:11 then 8:11 then 9:11 then 10:11 then 11:11.  I figured this was a sign from my grandmother again.  That number was going to play into Lincoln's birthday for sure.  11/11 would be a little earlier than I would have liked him to show up, but far better than his actual birthday.

Link was born on 9/3 at 7:53 PM.  Weighing 1 lb, 10 oz.  13 inches long.

I still see the number 11 everywhere.  What does it mean?


In other news, Link dropped quite a bit of weight today.  It could be anything - likely his urine output.  And urine output is a good thing.  His weight went from 769g to 685g today.  When I asked his nurse, we'll call her CA, she said, "He's just so small.  When babies get bigger, they weigh more."  Profound.  Haha!

Other than that, he looks good.  Moving around a like a champ.  That's my boy.

"Our Little Miracle Boy is Having a Great Day"

I headed into the NICU around 1PM.  I dropped my stuff in Lincoln's room, and headed off to the pumping room to find a pump to take back.  On my way to the pumping room (on the opposite end of the NICU from Link's pod), I saw Dr. Eche sitting at the desk.  I stopped to say hello, and he greeted me with, "Our little miracle boy is having a great day!"  Now that's what I call a greeting!

Lincoln's infection had Dr. Eche concerned that the PDA would re-open, so he ordered another echo.  Today's echo showed that the PDA had remained closed and Link's heart looked good.  They also discovered that yesterday's pneumothorax (a pocket of air outside of the lungs, perhaps a small tear in his lung had leaked some air out) was gone.

Lincoln is on two antibiotics to get rid of his infection.  He apparently does not respond well enough to a two-day antibiotic, so he's on a seven-day antibiotic treatment.  That's fine, so long as he keeps getting healthier and growing to be big and strong.

It's amazing to me how down and scared and worried we were yesterday, and then today is such a great day.  It's so trite to say that the NICU experience is a roller-coaster, but I can't think of another way to describe it.  There is a little hesitation in the celebration, though, as I know tomorrow can be different.  We'll keep up our "cautious optimism" for now.

*Someone at work today was telling me about their experience with their preemie today.  I hear "other preemie" stories all the time now.  This one ended differently, however, and tragically.  This person's child was born at 25 weeks and after 13 weeks in the NICU, the baby didn't survive, nor did their marriage.  It definitely adds to the "cautious" part of cautious optimism.  I know there are dozens of success stories, but it is quite a reminder that no matter how confident and excited we get, the possibility is still there.  I just keep praying for my baby boy and hope our story is success.

Link's Future

David and I have been getting little tidbits about Lincoln all day.  Mostly little things that just seem to be adding up and weighing us down.  Tonight we had tickets to attend a consignment sale pre-sale.  We knew we needed a new high chair as I had sold our other two.  We wanted to buy him some cute little outfits and take a look around at what else they had.

We were discussing Lincoln in the car on the way there, and both getting quite upset about all the little things going on today - infection, air outside his lungs, low blood pressure, etc.  Everything adding up.  And as we went in to look at clothes, I wasn't feeling it.  Dave was half-hearted about it, too.  I said, "Is it bad that I'm scared to buy him things, in case..." And Dave understood and agreed.  I don't want to have to think that way.  I'm his Mommy.  I want to protect him.  *sigh*  Now I'm back at the hospital because I want to be with him.  Screw sleep - I'll nap on Saturday.

I'm no Superman!

(Title is a Scrubs reference for Dave)

I went back to work today.

We closed on our house yesterday, we now own only one home again.  It's a good thing - mortgage prices where we live are insane.  And the taxes are worse.  So at 4:00 Dave and I headed off to our lawyer's office for the closing.  It went well.  Then we went to Panera to pick up dinner (thanks to our friends who have sent restaurant cards, they've been very helpful!) and headed home to eat quickly with the girls and Grampy.  As soon as we swallowed our last bite, we went to Back-To-School night at Elliot's school. It was nice being a parent instead of a teacher there.  We were given lots of hugs and well-wishes from my former colleagues.

After being at Elle's school, Dave dropped me at home and went to see Lincoln.  We like to go together for evening rounds and speak to the doctors.  But I begged out because I went back to work today.  That means an alarm goes off at 5 AM.  Five AM.  Five.  A.  M.  I couldn't stay out until 11PM for rounds, because of 5AM.  Then I realized that I would be missing morning rounds which seems to be where we really get most of our info on Lincoln.  But they're from 9-11AM (evening rounds are 9-11PM).  I work from 6-12:30, so no morning rounds.  And no evening rounds.  No rounds.  We can call, ask our doctors while we're here, ask our nurse anytime.  But at rounds, everyone is sharing all their info about him, questions are asked, treatments are planned.

Also, my breastpump hasn't arrived.  I am renting a monstrosity of a pump, a hospital grade, with no carrying case, and there is no way I'm toting it back and forth to work.  I get one free from insurance, but hadn't ordered yet as Lincoln was not supposed to have arrived yet.  So I'm now at the hospital pumping, but it's been over 7 hours.  And I'm sore.

Also, during zero period, my first class of the day, my phone rang.  Actually it rang at 6:30 and I missed it.  Then it rang during my class and I missed it again.  Then Dave tried to call three times.  I still couldn't answer but assumed something was wrong.  Sure enough, the hospital had called.  That's how to stop a Mama's heartbeat.  The hospital, where your sick baby is and you are not, called.  Lincoln has developed an infection.  His urine output dropped yesterday afternoon and stopped overnight.  His white cell count was low.  His hematocrit was low.  They are starting antibiotics.  This is the first time they have called us.  

Great, everyone at work is asking me how he is.  It's all I can think about.  I'm finally here at 1 PM, and he's recovering well - once he peed, he peed 34 mg(?), instead of 3-6 like his normal output.  The flood gates had opened.  He had to go on dopamine again for his blood pressure tanking, but an hour later he was taken off because it bounced right back up.  His coloring is good, he's getting a blood transfusion, he's stable again.

Last night I posted on fb that I was returning to work today.  My friend Kelly, a psychologist, texted me to remind me that no one expects me to be SuperWoman.  I forget that sometimes.  I know now, after a year in therapy, that I am an OCD perfectionist.  I'm really battling with whether or not to work right now.  I miss my students, and today I was able to jump right in and get them going. It was like I hadn't been gone a day.  But there is a lot of catch-up to do.  And I use A LOT of energy when I teach, I come home exhausted.  Now, sitting in Link's room, I just want to sleep.  My students are my students for three years, so I'm really invested in them.  We have a great relationship by year three.  I don't really want to leave them.  We're right in the meaty part of Drama Club and that's MY Drama Club now.  It's hard not to be there for that.

And I'm worried about money.  Who isn't?  I was supposed to work for most of 2015.  Not stop in the beginning of September!  And with a new house, we can't predict bills yet.  And Dave changed his pay option so his checks are smaller now, but come year-round.  But now one check does not even cover the mortgage.  Ugh.

I should be with my son, but I can't do anything for him so I should be teaching where I can make a difference and make some money.  But while I am work I'm so worried about him that I'm not giving my students 100% of me.  And this doesn't even begin thoughts of going home to my three healthy girls who want Mommy's attention, too.  I'm no Superman, but I wish I had more to give everyone.  Including myself.

*Dr. Eche says we have to be careful with infection, especially because it can reopen the PDA.  There is a small pocket of air in each side of his chest that is being watched, too.

One Step Forward, One-Half Step Back

Yesterday was thrilling.  Lincoln is rocking these last couple of days.  He began feeds yesterday, a little Mama milk to get him going.  Unfortunately, he's having a bit of a rough go with it.  Granted when your first meal isn't until you are 12 days old, I guess it's a shock to your system.  He's gotten .5mL which is 1/10 of a teaspoon - about 3 or 4 drops of milk.  He started at noon yesterday, so noon, 4 PM, 8 PM, 12 AM, 4 AM, and then at 8 AM they realized he's not digesting it well enough.  He has "residuals" in his line.  Each time they feed him, the nurses suck his belly dry through his feeding tube to see how much he has digested.  Then, they send that back to his belly to continue digesting and put in his new food as well.  Our nurse today, Jessie, said he had residuals and they are dark in color, so feeds have been postponed.

He is, however, pooping.  He's getting rid of the meconium - the black tar that they have in their little baby intestines while in Mommy's belly.  The first few days of poop are meconium - hard to clean up from what I understand.  All four of my babies have been in the NICU during the meconium stage so I've never had to change those diapers!  Jessie also said his belly is soft, which means there shouldn't be painful gas building up in his belly.

I anticipate a lot of poop and putt jokes (we call farts 'putts' in our house) as we now have a son.  I'm embarrassed to say that Miss Adeline will be the one teaching Link how funny potty humor jokes are! LOL!

Link is up to 720g this morning from 650g, so big growth since he started feeds.

Mommy's Milk!

Today at Noon, Lincoln will get his first shot of Mommy's milk!  David and I couldn't be happier, as we know the nutritional and health benefits that this addition can make.  He will be getting milk from his third day of life, though he is 12 days old.  Each time I pump, the bottles are labeled with the date and time so that Link gets the milk in the order I made it.  The female body is brilliant in that it makes milk for the baby's needs.  The first week of life it makes colostrum, which is a gold colored milk very high in fat and calories that preps his little tiny tummy for milk.  Lincoln will be given all colostrum until it is gone.  After that, my body says, 'okay, he's ready for regular Mommy milk now,' and it adapts my milk for his needs.  Because he is so young and a preemie, my body will make milk catered to that - probably high fat, high caloric milk.  In fact, once pumping further on in the pregnancy, when it is refrigerated, the milk separates into blue-ish watery milk and fat.  When that happens, you have to shake or stir the milk to mix it back up to give to him.  My milk now (again, he's 12 days old and that should have probably started by now) is so fatty that there is no separation.  I've had offers by two fellow pumping Moms (Aunt Lisa and a dear friend Kelly (not nurse Kelly)) have offered milk.  Had I needed it, I would have absolutely taken it.  But I am a milk machine - a cow, if you will, and happy to be it.  But their milk would not have been specialized for Lincoln's needs.  Glad my baby boy gets his Mommy's milk.

His nurse Joanne (who has requested Link every time she's been in and gotten him - she's very sweet and I can tell how much she loves him by how excited she is by his progress) just came in to give him caffeine.  We joked that we both could use a cup of coffee but Link literally gets his in an IV.  The caffeine does what you would expect - increases his heart rate - to give him an extra boost.  Starbucks, anyone?  (And just so I remember when I return and read this someday - the lines at Starbucks here are amazingly long!  I've only partaken once so in 12 days (which I consider impressive) because I've mostly gotten my cup o' Joe in the Ronald McDonald room.)

At IHI Rounds, which I made it in just in time for today, everything sounded very positive for the moment.  IHI Rounds are the rounds done by doctors and nurse practitioners (NPs) from each specialty.  Dr. Eche is on Lincoln's case for another week, and he said his goal is to grow this baby.  When all was said and done as is done each time, they asked if I had any questions.  I said, 'Not really, but do we know how and/or why the PDA closed on it's own?"  We know the indocin didn't work and maybe is the cause of the kidney issues, so what did it?  Dr. Eche said that the PDA is like a faucet that has a leaky hole in the side.  By limiting Lincoln's fluid intake, they starved some of his blood from rushing through that hole.  That it in itself could have made the PDA start to shrink.  Then the dopamine he was on to raise his blood pressure was causing the blood to flow faster through his heart and pump it down to where he needed it in his kidneys, gut, and lower extremities.  That would keep more blood from being able to pass through the PDA.  With both of things taking place at the same time, the stress on the PDA was lessened, and it was able to close.  Dr. Eche said, "That is what I told you I was hopeful would happen."  But when he told us that, it was with the reservation that they tell us everything.  We had it in our heads that we were going for surgery, so we didn't anticipate that this could actually happen for our tiny boy.

While Daddy & I are at the hospital, the girls are playing at Aunt Laurie and Uncle Mark's today.  They love their cousins Sara, Stephen, and Emma, and rarely see them other than holidays, so this is a real treat!

What?! Wait?! Really?! YAY!!!

So we got the results of the echocardiogram.  Dave was on his way to the hospital to visit our little man as well as find out the results of the morning's test.  But he was stopping at a couple of stores first.  I was pumping and the phone was sitting next to me.  I've memorized the NICU number, so I went ahead and called.  The echo showed that Lincoln's PDA had healed!!!  NO SURGERY NEEDED!!  I cannot even believe the wave of relief that washed over me.  All the concern about where to stay while he was there so I could be by his side but still get a decent night sleep, about how I could get my Mom here in time to be with the girls so I know they'd have someone 24/7, about the closing on our house in two days, about missing Elliot's Back-to-School night, and mostly about my baby who was less than two weeks old and under a pound and a half and how we would do in surgery.

We were reminded that this does not mean we don't have to worry about the PDA anymore, it could still reopen.  It doesn't mean we're free and clear and Link's just all better.  The battle is still long and still uphill.  But this is one MAJOR victory!

I bet I sleep better tonight!

Waiting...

Today Lincoln will get a head sono and an echo. His blood results in addition to the results of these two tests will tell us if/when Lincoln's surgery will be taking place.  Sitting around and waiting to hear is difficult.

Last night while lying in bed, I started to think of my little guy being moved to a different hospital.  One where we don't know ANYONE.  Here at SBUH, we know doctors, nurses, security guards, everyone, it seems.  Whether we're off to Cohen's, Mt. Sinai, NYU, or Columbia, we don't know anyone.  No one has an extra vested interest in our son.  I know he will still get incredible care.  But when your doctors and nurses know they'll be seeing you for months or even that you live in their neighborhood, I think there is an extra care there.  And I picture him being moved into an ambulance.  And heading into a new hospital.  And having surgery!  Surgery.  He's 10 days old.  He's one pound.  I'm having trouble with this.  I know it's what is best, so we're obviously going for it.  But yikes.

I came into the hospital this morning with Brian, our across the street neighbor.  Brian and Sue have been so good to us.  Until I can drive, Brian has been taking me to the hospital since he works here anyway.  And when I arrived, Kelly had made two more blankets for Lincoln.  She had made one a year ago for another friend - a boy blankie and a girl blankie - the friends needed a girl blankie, so the boy one had been living here awhile.  It has Batman comic sayings on it like "Pow! Super! Wow!"  We get compliments on it all the time.  Now, Kelly had found Superman material and animals dressed as superheroes and made more blankets for Lincoln. SO CUTE!

Kelly went to suction him, he builds up mucus and saliva from having a tube down his throat.  As she did, his jet vent began alarming.  She listened to his heart/lungs, and she couldn't hear the puffs that the jet gives him.  She asked another nurse to call respiratory, and within 30 seconds, there were 6 people in the room solving his issue.  Luckily, his heart rate was fine and they upped his oxygen to 100 as a precaution.  Within two minutes, everything was calm again and working as it should.  Because his numbers were fine, I didn't panic too much, and it was incredible to watch this team work together to very quickly resolve the issue.

Will post more after rounds when I know more what the track for treatment is.

*Okay, Dr. Eche says if the PDA seems to be flowing with restriction into his lungs, we will wait and give him more time.  If it is wide open (unrestricted), ligation it is.  The echo was just completed.  We wait now for the results of that to come through.

Also weight is down today - 680 to 665g.

Keeping Up with the...Jaks

One of the many hard parts of having Lincoln live in the hospital while the rest of the family is home is keeping up at home.  When David and I have been home for the last week, we have concentrated on the girls and spending quality time with them.  Things like laundry, dishes, unpacking, cleaning become second priority.
This morning, though, I busted ass.  I rocked it out.  I'm pleased with how much I got done.  Dishes, laundry, unpacking boxes, taping the twins' room with the hope of painting it soon, pumping (always pumping!), putting away the twins' summer clothes, sorting all the "girl" diapers from our stash to sell.  David, too, was able to get a little done - practicing cello with Elle, unpacking and moving boxes from the garage to the basement.  One of these days we'll be able to park our cars in the garage I insisted upon having.
People have dropped off meals, muffins, groceries, or sent gift cards - if you're reading this, and you've helped in any way, we cannot thank you enough.  There is so very much to juggle between home, hospital, work, etc. that every small assist is a major major assist.  Thank you!!!

The Month Prior

We closed on August 6th on our new home.  It's beautiful and huge upgrade from our old house.  Our old house was wonderful, but we were quickly outgrowing it.  On August 9, we left for vacation in Williamsburg, VA.  We returned home on August 17, but had less than a week until Dave returned to camp and then back to school on August 31. 
I began work on September 1 with Superintendent's Conference Day.  It was great to see my teacher friends again.  I was feeling great and having fun socializing.  I left a little for a doctor appointment at my endocrinologist.  They were adjusting my medication - I had been taking 20 units of NPH insulin at bedtime, and we upped that to 30 with 5 of fast-acting before breakfast.  My morning numbers have given me trouble with every pregnancy.  
The following day the alarm went off at 5 AM.  I know, right?  In the old house I would put my clothes out on the couch in the living room the night before so that when I woke up, I could sneak out of the room and David could sleep without interruption. That's not to say that I didn't frequently sneak back in the room to get jewelry, shoes, or something else I had forgotten to lay out the night before.  
In the new house it's different.  We have a en suite bathroom, so I put my clothes in there.  I showered and got dressed.  I went downstairs, tested my number, made my two eggs with one piece of toast with margarine and cup of coffee with a splash of milk.  That was my breakfast every day now, as I knew my glucose numbers were controlled with that breakfast.  I had to go back upstairs to do my hair.  But then I came back downstairs and relaxed with my coffee and morning news.  Then I went back upstairs for shoes and jewelry.  This new routine would take me a bit of time perfect so David could sleep without me coming in and out, over and over.
I left for work and stopped at Dunkin' Donuts.  I picked up munchkins for my eighth graders - they have to be at school at 6:45 voluntarily - I spoil them the first and last day with donuts.  It was rather challenging to walk into DD and not get coffee or a muffin or a breakfast sandwich or a donut or...  And I was even good once I got to work - I didn't have even one munchkin when my kids were eating them - I had a baby to protect and I was doing well on my diabetic diet.  I knew they would have lots of questions, so on my chalkboard I wrote, "My name is Mrs. Jaklitsch, you can call me Mrs. Jak.  His name is Mr Heller (my co-teacher), you can call him Mr. Heller.  Yes, I am going to have a baby.  No, you may not babysit."  I didn't want to announce to each class that I was having a baby.  And I didn't want my students trying to decide if I had eaten too many hamburgers over the summer or if perhaps I was pregnant again.  
The kids wanted to know everything.  When is the baby coming? How long will you be here? Who will our sub be? Is it a boy or a girl?  What about the musical?  I answered the questions as they came in as politically as I could.  They baby was due Christmas Day, but we were expecting more like Thanksgiving.  Your sub will likely be Mr. Heller, my new co-teacher.  It's a boy this time - yes, after 3 girls we're excited to have a boy.  I will be here for the musical, no worries.
The rest of my classes continued along the same track.  I answered questions, talked about rules, we sang, I joked, they giggled.  Lunch duty was fine - I spent time hanging out and talking with my kids. 
I went home from school around 1:00 and then you know happened.  If not, read further down the blog.

I do know that some people are asking how we could have possibly not known that Lincoln was making his way that night.  I can honestly say that there were no warning signs.  I felt great at school.  Doctors had no signs, I felt no different until labor started.  We knew the baby would be early, but we thought 35 weeks or so, not 23 weeks.  I have thought every what if that could be thought.  What if I hadn't gone back to work? What if I had had more water? What if I had sat down more? What if I had eaten something different or thought something different or was on bedrest or sneezed to hard or or or...  The doctors assure me that it was nothing I had done.  And they also tell me that it doesn't matter.  He is here, they are doing the best they can for him.  Wondering what if isn't helping me or anyone else.  So for the little bit of blame I hear coming my way, please keep things positive for us in this challenge. Thank you.

Holding Lincoln for the First Time

Last night, Mommy got her first cuddles with Lincoln.  Daddy gave him his first kiss.  All was right in the world.  It was quite a production to get Link out of his incubator and into Mommy's arms.  I will forever be grateful to AnneMarie, our nurse who was willing to do a lot of work to make this a possibility.  (I still remember nurse Kelly who offered to let me hold one of the twins for the first time.  Kelly was also the first who let me hold both together first!)  It took about 10 minutes for Lincoln to be settled.  Not only did HE have to be moved, but so did wires, tubing, a small box that delivers his puffs of air from the jet ventilator, his infusion machine, and so on.  I wore a hospital gown over my tank top to bundle him in, and a blanket folded four times was placed on top of him to keep him warm.  He got a handsome little hat so he wouldn't lose heat through his noggin.

I was handed a mirror to get to see his beautiful face while I held him.  I wasn't able to move much or get too comfy because I was literally taped to most of his equipment.  That didn't matter at all.  I was downright blissful.  Daddy was thrilled to give him his first kiss.  And his second and third.  Once we finally had him all settled in, I used my mirror to see him as I talked to him.  He kept his eyes open most of the time - likely curious about the new world he was "seeing."  David and I sang the ABC's to him, Daddy singing the harmony part, because when you have music teachers as parents that's how it goes down.  I read Link his first book - The Little Engine That Could - a gift from March of Dimes and also Grandma.

I talked to Lincoln a lot.  I told him about his sisters. First Elliot who doesn't break the rules (please follow in her footsteps), who plans on making Lincoln HER buddy because Mommy and Daddy are a pair and Addie and Charlie are a pair and Elliot needs her pair.  Then Adeline who has claimed Lincoln as HER baby, and she just wants to HOLD him, and how she's the IMP of the family with no one even coming close.  And finally Charlotte who will dress him in tutus, show him how to be animals (Charlie's partial to turning into a frog or dog at any given moment - I'm sorry - PRINCESS frog or PRINCESS dog or PRINCESS baby!), and probably teach him how to climb things.

After an hour, I was quite uncomfortable and it was getting quite late.  We prepared for Link to go back to his isolette.  So much easier for him to cuddle in than to come out!  It took only about two minutes to get him back and settled in.  For all the effort it took to bring him out to "play," I am so grateful that at nine days old I finally got to hold my son.  And I snuck in one sweet little (okay, big) kiss to his sweet little (no seriously, very little) head.

Day Nine - Doing Fine

(I can't rhyme every title of a post.  But the last two days lent themselves well to it.)

Lincoln could pretty much only go up today.  Thank God he did.

He is far more stable now than he was 24 hours ago.  Twenty-four hours ago I was praying my son would live.  Today, he is pink, he moving more (he was listless and grey yesterday - bad signs...). Again, I lifted the blanket over his incubator and he was sleeping, but as I spoke to him, he opened his eyes.  I know he doesn't understand a word I say, and I'm not even sure how much he can hear me through all the plastic, with the hum of all the machines, the beeping of the alarms.  But he knows I'm there.  He looks in my direction (he can't see me, but perhaps sees a blur that in his mind is his Mommy).

We're not out of the woods - Link's kidney function is still an issue.  They stopped the dopamine because his blood pressure is looking better.  His blood pressure is a major issue because of his PDA.  The PDA is a major issue, but we cannot even address it until his kidneys are functioning better.  Of course, they aren't going to function as well without the PDA being repaired.

There are so many vicious cycles here - until Link gets bigger, he can't be transported for the ligation.  Without the ligation, he can't eat and therefore won't grow quickly at all.  If his kidneys aren't functioning well, he can't be given much in terms of medication and antibiotics, but without the medications and antibiotics, his kidneys won't function well.  *sigh*  The doctors, NP's, and nurses keep referring to the balancing act.  And each act affects everything else.  So while we're working on his kidneys, which is the main focus right now, other things are changing and being ignored and thrown out of balance and then checked again and adjusted and...

But the news for now is that he's pink (what a beautiful color on a baby), he gained 20mg since yesterday (690 to 710), he's off the dopamine, he's moving around a bit.  He's going back on bili lights as I type, and he's on two antibiotics (Seph(?) and V-something).  And for now he's stable.  And he is under Mommy's strict orders to continue improving.  Because I love him so much.  I know you know that.  But I love to say that I love my son.

Day Eight - Not Great

I came in this morning, after leaving in tears last night, hoping for a good report.  Sadly, none was to be had.  Lincoln looked grey lying in his incubator.  I was told he'll be receiving another blood transfusion - his fifth in eight days.  We're perfectly fine with that, we see what a difference it makes when he has one; he perks up, moves around, his coloring improves.  He's started dopamine, a drug to help his disastrously low blood pressure.  Blood tests revealed low white cell counts, so as a precaution he has begun a round of antibiotics to ward off possible infection.  His potassium levels are too high - a sign of kidney issues.  To remedy that, they've changed what he receives as IV fluids.

Lincoln, in his stubbornness (he gets that honestly from Mom AND Dad), extubated himself last night.  That means that he pulled out his breathing tube.  His lungs collapsed, and he really stressed out his tiny little body.  He was re-intubated, but has now been set back quite a bit.  We're not nearly doing as well as we were even days ago.

And all of these updates mean no second round of indomethacin to try to fix his PDA.  I'm guessing, and I will get this clarified during rounds, that that means we're looking to stabilize enough to be transferred for the ligation.  I could be wrong - they could be working to stabilize him with the plan to start the indomethacin (indocin) in a couple of days.

In all honesty - they're working to make him stable so that he lives.


*A couple of hours later, Lincoln is looking pink again - the blood transfusion helps that.  Also, his incubator was open and I was talking to him when his nurse Kelly A stepped out of the room for a moment.  He opened his eyes very sleepily.  As I talked more, he fought to keep them open and kept eye contact with me (I was about 6 inches from his face).  The more I talked, the longer he kept his beautiful eyes open.  When I stopped talking, he settled back in for a nap.  It was a beautiful moment in a difficult day.

**Before leaving the hospital to come home to the twins, lunch, and a nap, some of Link's blood work came in and numbers were headed in the right direction.  He also had a head and kidney sono as I was leaving.  We'll hear those results tonight at rounds.

***We're back tonight for rounds.  Link's eyes are open, he's a little squirmy.  I'm going to hold onto that as a hopeful sign.  I really do feel like right now he's on the brink of life and...not.  I can't even bring myself to say it or type it.  The main focus of his care right now is his kidneys.  Our nurse tonight, Annemarie, asked if I want to kangaroo him, but I really feel it would hurt more than it helped.  Perhaps I'll ask the doctors.  If I thought he'd improve as a result, I would do it in a heartbeat.  But he's so unstable today, I can't imagine moving him and all his leads and tubes would actually be good for him.

This is Where it Gets Hard - Updated *again*

I have a reputation in the NICU.  I'm the girl from whom the milk flows.  Everyone is always commenting on what a good "stash" of milk I have.  I know how important it is - better than most medicine, and I'm super dedicated to pumping it for all my preemie babies.

I'm also the Calm Mom.  Doctors and nurses alike comment on how well Dave and I keep it together.  We remind everyone that our previous experience in the NICU has given us an education about what to expect.  Alarms and beeps don't scare us like they did when the twins were there.  When Adeline & Charlotte were in the NICU, I was super woman for like five weeks.  Then one day I broke down.  Everything had gone wrong - Charlie lost weight, Addie had to be stim'ed.  I thought they were ready to come home and they needed at least another week (it ended up being two more weeks).  I lost it.  I cried.  A lot.  The spectacular care of the doctors and nurses in the NICU shifted from the twins to the Mommy.  Everyone worried about me.  They knew I would crack.  I didn't.

This time is different.  This is really hard.  Like really really hard.  Lincoln is SO tiny.  I told my Mom that this time I'm not nearly so worried about how his early arrival will affect his development, I'm worried that it affects whether he comes someday or not.  23 weeks is not nearly the same as 31 weeks.  Link was born at 23 weeks, 6 days.  When I told a nurse today that he was practically 24 weeks, she said, "He's considered 23 weeks because that early, EVERY. DAY. MATTERS." He is a 23-weeker.

I was feeling excited today.  We were getting his echo results.  His umbilical line was being removed and replaced with a picc line.  (At one point it was mentioned that once that happens, he could be held. It feels like a dream.)  He was taken off the jet ventilator and put on the conventional ventilator.  They mentioned him starting feeds today.  (Another dream - all this milk that I know can make a huge difference for him - he's about to get some!)  He even gained a little weight today.

But the echo results came back.  The medication didn't work.  We will try another round, and then it will be surgery if it doesn't work again.  Also, because it didn't work, he cannot eat.  He can't get this amazing milk yet that everyone says will work wonders.  His heart can't pump enough blood to his gut to let him digest the food.

I keep saying I'm being "cautiously optimistic."  And I am.  But tonight I feel broken.

Tomorrow is a new day.  And I'll reset my mood and try to be Calm Mom again.

***UPDATE***
David and I just arrived at the hospital.  Lincoln has been taken off the conventional ventilator and put back on the jet ventilator.  Another step back.  Damn.

***UPDATE AGAIN***
We just finished evening rounds.  The PIE is there after all.  Perhaps the first x-ray wasn't clear, perhaps moving him to conventional ventilator caused it to reappear.  In any case, it's back and he's back on the jet.
He will start a new round of indocin tomorrow.  I asked if there was a better chance this time that would work or about the same or worse. No one answered right away and I said, "It's okay. You can tell us it's worse."  It is.  If it didn't work the first time, chances are less that it will work the second time.  But as long as he can tolerate it, it's worth a try before a ligation (surgery).
Because we're full of questions, I probed on.  If he needs the surgery, what kind of time frame are we talking about? Days? Weeks? Months?  Maybe a week, two tops.  The PDA has to be repaired.  But Lincoln has to be bigger and more stable.  He can't eat because of the PDA, but he can't get bigger without eating.
Then they dropped a bomb.  The surgery will be at another hospital.  Cohen's on Long Island, perhaps, or Mt. Sinai in the city.  Maybe Columbia.  That means that our teeny-tiny boy will be put on an ambulance and taken to another hospital.  It's okay, it's quick, they said.  He'd only have to be there for about 3 days.  ONLY?  How are we supposed to do this?  My heart is broken.  I don't know how to handle this.

I had planned to go back to work next week.  The unexpected time off will be a big financial strain that we don't know if we can handle.  But how can I go back when my child is fighting for life?

One Week Old - Big Changes Coming

Lincoln is one week old today.  He seems from Mommy's perspective to be doing pretty well.  I am nervous to get too hopeful.

Link had a bunch of big positive changes today.
*His weight went up a bit, we're hoping it will trend that way now.
*His PIE (a preemie lung condition) is gone. Because of that, he has been moved this morning off the jet ventilator and onto a conventional ventilator.
*He is having an echocardiogram as I type this to see if the indomethicin is working to close his PDA.
*He is having more blood gas tests (they are frequent) and Lincoln is involved in a study about blood draws in premature infants through the umbilical lines.  His last participation in said study just happened, because his umbilical lines are coming out today.
*He's getting a picc line today to replace his umbilical lines. A picc line is a central line that can be in place for a long amount of time.
*Doctors have decided tomorrow is the day for him to start feeds.  Mommy has been pumping colostrum and milk for her sweet baby to help him grow, gain weight, and be protected by her antibodies.

On the downside today, we have one thing:
*His head sonogram last night revealed an area of concern.  Dr. Eche said he believes it could have a been a small bleed (lvl 1) that has already corrected itself.  They will do another head sono soon to keep an eye on it.

I'm waiting now for the results of the echo and for them to do the head sono.

In totally different, unrelated news:
We moved into a new house last month.  We listed our old house after putting an offer in on our new house, and we had an offer in three days.  Our realtor Fran called this morning to say that the buyer is now cleared to close.  We have been ready for this for a couple of weeks now, but most importantly, we want it all wrapped up so we can stop thinking about it.

In more house related news:
We were out for a family walk last night, our first one since moving in one month ago, and as we were walking a car stopped and rolled their window down.  It was Dr. Eche, the doctor with Lincoln for the next two weeks.  Turns out we now live two streets away from him.

Lincoln's Birth Day

I will probably update this post several times as things come back to me.  I was so groggy on the magnesium (David can attest to this!) that a lot of things are foggy.  I remember waking frequently to have to my vitals checked, I don't remember being bothered by this as I was so tired I was able to immediately fall back to sleep.  My doctor, Dr. Davenport, came in at 11 and joked that I had slept from 11P-11A.  That was fine by me; I was so relieved that the extreme pain was over and I could relax enough to sleep.

Dr. Davenport, my favorite doctor at my practice, checked me at 11AM.  She said I was fully effaced, but only 1cm, if that.  She said to expect to live in the antepartum unit at the hospital for several weeks until Baby Boy's arrival.  Dave and I had debated for weeks what we would name our little man.  Every cute name Dave came up with got veto'ed.  Every cute name I came up with got nixed.  We had a couple of names we mutually liked, but neither Dave nor I both loved the same name yet.  Some of the names in the running were Fletcher, Alexander (but call him Xander), & Copland.  We had seen Lincoln and Fletcher on street signs.  I was arguing for the name Lincoln and call him Link (a la the Zelda video games) - I thought for sure that Zelda "link" would win.

Anyway...Dr. Dav checked me and everything seemed to be holding steady.  My contractions had slowed down and held steady at 8-10 minutes.  Dr. Davenport seemed confident that Baby Boy wasn't going anywhere.  She promised to come check in on me later.  She decided to wait until 11 PM for my second steroid shot, because my first had been at 11PM the night previously, and though you can take it at 12 hours, 24 would be better.  Around 1:00, I told David to go home.  I reminded him that the twins should be napping, Elliot wouldn't be off the bus for an hour and a half (and it would make her day for Daddy to get her from the bus), and he could just go home and rest.  Our nanny, Sarah, told me that he came home and threw laundry in, did the dishes, cleaned up the back yard and essentially didn't stop moving.  So much for resting.  David is incredibly hard-working, and I know his concern was keeping up with everything as a single parent while I lounged in the hospital for what we hoped would be more than a month or two.

At 4:30, after more naps, time on FaceBook and updating concerned friends & family, Dr. Davenport came in again to check on me.  She did not do a physical check, as she said that too many could actually force me into labor.  She told me she had already delivered six babies on this shift and she was going home.  I was amazed and didn't blame her for wanting to crash!  I was still feeling perfectly fine and confident that I would be stuck here for weeks.  I was due for my second steroid shot at 11PM.  The steroid shots boost the baby's lung growth, giving them a much needed jumpstart should they enter the world early.

Around 5:00, I used my call button for my nurse to tell her that I was starting to feel pain from my contractions again.  She said she'd call anesthesiology to come in and check - probably the epidural was wearing off.  Around 5:45, I called her in again (no sign of anesthesiology) because not only was the pain quite bad again despite still having the epidural, but I felt a lot of pressure (like an extreme need to poo - sorry).

My nurse sent the on-call doctor in who checked me, and sure enough I was fully dilated.  I couldn't believe it.  The nurse yelled to call Dr. Davenport, I cried and had to ask someone to get my phone which was charging across the room.  This couldn't be happening.  I wasn't even 24 weeks yet.  Chances were not great that this baby would survive.  Doctors and nurses were trying to gently tell me that.  I had to sign a paper that said I wanted doctors to try all measures to keep him alive.  They had discussed that with me the day before.  I tried put it out of my mind.  I talked about it with Dave the day before - I was questioning what I wanted.  Did I want them to try to keep him alive if he would live his life as a "vegetable"?  Was I dooming my sweet boy to life of difficult disabilities?  And why was this happening?  What could I have done differently so that I wouldn't have gone into preterm labor?  I shouldn't have gone back to work.  I should taken the chair that James offered me at lunch duty.  I shouldn't have carried that small load of laundry downstairs.  I shouldn't have helped move a single item this summer for our new house.  I should have stayed off my feet more.

When a nurse handed me my phone, I immediately texted our across the street neighbor and dear friend Sue.  I said, "Can you go to my house until my in-laws get there? I need David now." Then I called David and told him the baby was on the way and I needed him at the hospital immediately.  I knew he would call his parents to watch the girls, but I needed him there more quickly than that.  Sue ran across the street to watch the girls until Bill and Betsy could arrive.  Anesthesiology finally showed up and "topped off" my epidural - I was able to relax a bit more then, the pain had been very intense.  What seemed like a lifetime and yet only seconds later (and was probably 15 minutes later), Dr. Davenport arrived.  In the meantime, nurses were setting me up for delivery, the NICU team was called and was setting up.  (When all was said and done, there were 15 people in the room, other than David and I.)  While everyone was setting up, I told my nurse that something was coming out - she checked and my amniotic sac was delivering.  It burst and it was go time.  David still hadn't arrived, but Dr. Davenport said, "Okay, Stephanie, it's time to push."  I started crying again.  I told her I couldn't because David wasn't there.  She said, "I'm sorry, honey, you have to push.  The baby is coming."  At that moment David ran into the room and for a second all was right in the world.  With Dave at my side, I pushed.  It was incredibly hard.  I couldn't feel much.  The epidural took away my ability to feel what was happening.

After about 4 pushes, nothing was happening.  Nothing. I wasn't even having contractions.  My epidural being "topped off" had sent everything to a grinding halt.  Everyone stood around wondering what to do next.  Dr. Dav sent the NICU team away, telling them to be ready, but to relax for a bit.  She sat watching my monitor for a contraction, but nothing.  They took me out of the stirrups and put my bed back together.  My nurse laid me back and told me to rest for now.  Dr. Dav went out to sit at the desk where she would monitor my contractions.  After I think 25 minutes, she came back in and said she had consulted with another attending doctor.  Baby Boy had to deliver.  My water had broken and he moved down into the birth canal.  I had two options, neither were good.  I could have an emergency c-section.  I have had two c-sections, but this time was dangerous.  The pregnancy was too early so my uterus was too thick, I had scar tissue from my other sections, baby was so tiny and had already begun moving, the risk of bleeding out was very high.  My other choice was to push without contractions.  Dr. Dav said this would be one of the hardest things I have ever done.  Too hard won out over too risky.  I opted to push.

They took apart my bed again, got everyone all set up, and put me back in the stirrups.  David and my nurse each took one of my knees.  No one remembered to sit me back up.  I pushed, and this time the angle was different - in one push I had nearly delivered my baby.  Halfway through my second push he was out.  The one blessing in delivering a 1 lb, 10 oz baby is that it doesn't damage you too much.  The time was 7:53 PM on September 3, 2015.

I remember saying, "He needs to cry, I need to hear him cry!" The tiniest little kitten's meow came out of his little tiny body.  A wave of relief swept over me.  (A week later, it's still the only sound I've heard him make.)  The NICU team went right to work. I had to stay put, but they were only a few feet away.  The doctors did an APGAR test - I heard Dr. Mintzer, the head NICU doctor there, talk to a student: "What would you give him?" She replied, "I think a six or a seven.  I'm going to with six, because no 23 week baby should be able to get a seven on an APGAR."  He replied, "Okay, that's fine. He's a six." Two minutes later, I believe they repeat the APGAR.  This time he scored an 8.  Those are incredibly high scores for a preemie.  But then again, our family has always been full of overachievers.

A swarm of doctors and nurses were working feverishly on him.  Dr. Mintzer, who was calm and comforting, laughed and told us he had already peed everywhere.  He invited David over to see him.  Daddy took a picture for me.  Everyone asked us his name - Baby Boy Amrine-Jaklitsch.  Dr. Mintzer said, "10 fingers, 10 toes!" We said, "Did you count? Because his sister had 11 fingers, 10 toes!"  After a quick double check, it was confirmed that he had ten and ten.  Baby Boy was taken away to the NICU then and we were told to wait a couple of hours to check on him.  Dr. Mintzer reassured us before leaving that his scores of 6 and 8 were pretty incredible and Baby Boy was off to just about the best start we could ask for of a micro-preemie.

Everyone left.  The room was so quiet.  Only David, Dr. Dav, my nurse and I were left.  I forgot that when you deliver vaginally, you have to deliver the placenta.  Dr. Dav said it doesn't usually take long.  She massaged my belly, hoping to help.  But I still wasn't having contractions.  My body didn't seem to want to make my life easy.  Dr. Dav commented that my uterus was contracting nicely and quickly.  Unfortunately, because I have a bicornuate uterus (a heart-shaped uterus), it was essentially sucking the placenta deeper and deeper back into my body.  After an hour of trying to deliver the placenta, I had to be taken in quickly for a D&C.  An anesthesiologist was brought back in to turn my epidural back on (it was turned off during labor to try to get contractions going again), I was prepped for my procedure.

I started feeling nauseous almost immediately.  I began dry-heaving as I was being prepped.  Then the shakes began.  They were whisking me off to an operating room and I felt worse than I've ever felt.  I could feel myself being moved, tugged, gotten into place.  I couldn't move my legs and could barely move my arms.  They slid me onto the operating table, and I couldn't stay put I was shaking so hard.  I could barely speak.  People kept saying, "Stephanie, are you still with us?" I was, but I was having a hard time responding.  I think I grunted as an answer each time.  I was shaking so badly that my arms were constantly falling off the table.  They had to center me back on the table several times.  My legs were up in stirrups.  My doctor had told David this would be a 20-minute procedure...it took 70 minutes.  Apparently I was a challenge.  I was incredibly nauseous and dry-heaving this entire time.  Nurses were bringing heated blankets in for me and covering me including wrapping my face and head in them so that I could only see and breathe through my nose.  I was still dry-heaving.  I had my eyes closed nearly the entire time - I was so sick and tired, plus all I could see were lights.  By the end, I was in tears and begging to be moved.

I was taken to recovery.  David said that Dr. Dav said the procedure went really well - minimal bleeding and they were confident they had gotten everything.  Dave asked me if he could go to see the baby, and I asked him to stay with me for a few minutes.  Apparently then I fell asleep, snoring, and he went to check on Baby Boy.  I was in recovery for what felt like a lifetime, trying to get warm again and sleep.  We had had to wait for anesthesiology to come remove my epidural.  I peed like crazy while in recovery - I asked for a bed pan at least three, maybe four, times.  I'm told I peed over 1500 cc's - an entire IV bag - while in recovery alone.  I've never been so uncomfortable as I was in that recovery room.  What felt like six or seven hours later, but was only three hours later, I was finally taken to my room.

The nurse took me to the bathroom and got me settled into my bed - far more comfortable than the recovery room bed.  Then she helped David convert the chair in the room to a bed.  We asked for blankets, I was STILL freezing.  There were no blankets on the floor in the unit, so some were requested from upstairs.  They were there within minutes, and Dave and I were grateful to try to sleep.  Dave's head hit the pillow and he started snoring.  That guy, I swear.  This was about 1:00 AM.

My nurse took my vitals.  I asked her to remove my IV's.  After all, I was peeing so much I obviously wasn't dehydrated.  She removed one, but left two in, just in case.  An hour later, I hadn't fallen asleep yet, so I buzzed for the nurse to help me again to go to the bathroom. About 30 minutes later, I still wasn't sleeping, so I crawled out of bed, walked around the room, climbed over Dave in his bed and got my iPad - he slept through all of that.  Another half hour later at 3 AM, I still wasn't asleep.  The adrenaline was obviously still pumping keeping me from settling, so I woke my sweetly sleeping husband (for whom my jealousy over his sleeping abilities was raging) and demanded he take me to see our son.  He pretended to not be annoyed and even laughed at me a little.  I hopped into a wheelchair and off we went to the NICU.

My son was beautiful.  So tiny.  So terrifying.  Baby Boy's nurse, Kayla, assured me that he was doing well for one so tiny.  We didn't stay long.  Dave wheeled me back to my room, and we both fell asleep quickly.

Little Did We Know - Lincoln Eve

This was my easiest pregnancy in terms of feeling well.  We had had a scare at 12 weeks with heavy bleeding.  No cause was found, but when the doctors did a sonogram, my baby was bouncing and kicking and moving as it had been all along.  A wave of relief swept over me.  From that moment on, the baby took it easy on me.  I still had my bicornuate uterus to keep an eye on - the reason for my preterm babies - and I had gestational diabetes once again.  But I felt good.  Like really good.  I couldn't believe the energy I had this time around and how much easier this pregnancy felt.  We had a great (and very busy) summer, and in August we closed on our new house.  We started moving in, and two days later went to Colonial Williamsburg.  After we returned, we jumped right back in to moving and unpacking.  School was approaching quickly, and David worked tirelessly to get moved in and unpacked.  I helped as much as I could with a growing belly and orders to lift nothing.

Back-to-School came, and the night before the first day of school, I packed lunches and snacks and backpacks and bags.  We all headed off to a great first day of school.

It was nice to be back at work.  Don't get me wrong, I'd take a lifetime of summer and how relaxed we get to be.  The new house has a pool, and the joy that my girls get from that pool is so beautiful.  It was nice to be back at school and back into a routine again, though.  It's easy to be back at work when you know you won't really be working later than Thanksgiving.  I had a nice time seeing my students again - this is the first year that my 8th graders are all mine.  I had them in sixth grade, seventh grade, and now they were my elite 8th graders.  I am very proud of the fact that my first year back at JFK I had 14 eighth graders, my second year I had 18, and now this third year I had 67 students signed up for zero period eighth grade chorus.  I was going to spoil the heck out of those kids.  I have lunch duty this semester, and I spent the whole period walking around, catching up with students on how their summers were.  My AP James offered me a chair, but I was truly enjoying my time with the kids, and I felt fine.  I should have taken that damn chair.

That afternoon I headed home around 1:00. Addie & Charlie were napping and Elliot was still at school.  I took advantage and laid down for a bit.  I headed out to pick up Elle at the bus stop, eager to hear about her first day of school.  All I knew for sure was that it was hot and I wanted to take my girls in the pool.  Elliot gave me few details about school (as is her way), and started right away on her homework - to read for 20 minutes.  She read to her sisters - she's such a good big sis.  I laid down again, I was starting to feel a little off.  After the 20 minutes, we all got in our bathing suits.  I was excited for how good the cold water would feel and how light I felt in the pool.  We stayed in the pool for a little over an hour.  I always rush my kids on to the next activity, but they were being so good, and it felt good being in the pool.  I was still not feeling great, but the pool definitely helped.

I texted Dave to see if he wanted to go to Friendly's for dinner - it has become a first day of school tradition.  He said it sounded great.  We got ready and off we went.  While there, I was feeling worse and worse, and started to realize that I felt bad, then okay, then bad, then okay.  I started timing the bad periods.  They were coming every 6-8 minutes.  Hmmm.  I drank more water.  I told Dave I wasn't feeling well.  When we got home, he said not even to unbuckle the girls, just go get in bed.  I put the foot of our bed up, drank tons of water, and worried about getting lunches packed.  I was certain it was Braxton Hicks contractions.  I had just gone back for my first day of teaching, I was on my feet too much, I overdid it.  I googled Braxton Hicks.  They shouldn't be painful.  They shouldn't be regular.  Now my contractions were every 5 minutes.  I called the hospital.

The doctor said what I thought - you're tired from your first day back, you did too much, you're dehydrated.  Then he said what I expected - you should probably come in, we'll check you out, we'll hook you up to an IV.  We called our parents and told them it's probably a false alarm, but we were off.  On the way to the hospital, the pain was getting worse.  I must not have looked good, because they sat me down in triage, then got me right back up and into a bed.  David was still parking the car.  They timed the contractions and put me on several monitors.  They started an IV - it took 2 people and four tries - it was the first time I saw David nearly pass out.  I watched the blood drain from his face as nurse #1 tried to get the IV going.  Nurse #2 got it on her first try, thank goodness.

The contractions were now incredibly painful.  And they were coming every 2-3 minutes.  I was given a steroid shot at 11PM to help develop the baby's lungs.  I would receive another in 12 or 24 hours, depending on how imminent the birth was.  The doctors decided to put me on magnesium to slow the contractions.  I was only 23 weeks and 5 days.  This baby simply could not come yet.  I was given an epidural eventually for the pain (thank Heaven for epidurals - I became a much nicer person to be around after that!).  The magnesium made me groggy and cloudy and loopy.  I saw my husband cry for the first time in years.  He is always so strong, he takes care of his four girls so well.  I could tell it was killing him to see me in so much pain.  Once the epidural kicked in, I was a much happier camper.  It was the middle of the night - midnight maybe?  I was exhausted.  One nurse made me take of my rings and remove my earrings.  I remember feeling angry with her - I was feeling better and this baby WAS NOT coming now.  I was told I'd be in antepartum until his arrival.  Dave prepared himself to be a single Dad for several weeks while I lived at the hospital to keep this baby in for every extra hour we could.

Two NICU doctors were sent in to talk to us about what would happen should the baby come that night.  I can only recall Dave sitting on the couch in my room while they talked.  I have no recollection of the conversation or how long they were there.  The rest of the night and the following morning are a a blur.  I slept on and off from 11PM to 11AM.  Several nurses over that time period remarked that I have sleep apnea.  Apparently, as I sleep, my oxygen sats drop to around 90, and they should be at least around 95.  Oh good, something else for me to worry about.  Now I am being told to have a sleep study done.  Because I need one more thing on my list.

Back in Time - Lincoln's Backstory

2015 started out as an awful year.  Things were busy as usual.  That's no different than any other time with three kids, a full-time job, and all the work that is being a Mommy, Wife, and homemaker.  After a panic attack in August of 2014, I had been seeing a therapist and been put on several different anxiety medications.  It was in January of 2015 that we finally found one that made me start to feel like my normal again.

As things leveled out and I began to feel better, I got a call at work from my Dad.  That's never a good sign.  And when you have a grandmother whom you adore who is 94 years young, anytime you receive a call from Dad, you jump to the conclusion that Grandma is not okay.  Well, I was lucky this time that Grandma was okay, but my Uncle John was not.  He had had a heart attack while driving (I believe) and gotten into a single car accident with a tree.  He did not survive.  He was my Dad's brother.  It was quite traumatic.  I remember the phone ringing, I was co-teaching a class, so I took the call.  I went into the AP office and hid in a closet and cried.  My principal sent me home.  The next few days are fuzzy.  That was February 3.

                                                            (My Uncle John is in red.)

My Grandmother's health deteriorated quickly after the funeral.  Everyone had commented how stoic and strong she had been at the funeral.  I think at 94, you probably don't anticipate burying one of your children.  We later found out that Grandma had had two small strokes around the time of my Uncle's death.  She left living with my Aunt Mary to be put into a nursing home.  Sadly, she never returned to Aunt Mary's house - she passed away on April 2.  I had actually taken that day off to drive home to see her.  David had the day off already, so Elliot and I took that day off, packed everyone up a day early and went home to see Grandma. On the way home, Dad called again to say that Grandma hadn't made it.  It's probably a good thing, as everyone said how different she was in the nursing home, and I have beautiful memories of her smile and laughter, which I would not have seen there.

 

        (My beautiful Grandma, Virginia Anne Murray Amrine, at my cousin Allison's wedding.)

I was devastated.  Even as I type this, I still am.  How, just under two months from my uncle's death, could my beautiful grandmother pass away?  My grandma had told me before that she wanted me to have more children.  She often told me that she thought David and I were doing a terrific job with our girls.  That weekend, not necessarily according to our plan, but definitely according to hers, David and I got pregnant.  April 3, in fact.  I only put the date because our beautiful boy came to us exactly 5 months later on September 3.  The sonogram confirmed that his conception was April 3, and his due date? Christmas Day.  If Lincoln was not a gift from my Grandmother...I simply cannot see it as coincidence.  

I honestly did not even recognize that I was pregnant for weeks.  We had tried to get pregnant with the twins for 25 months.  There was no way that one single isolated time without protection could have gotten us pregnant after that ordeal.  It was not on my radar.  I was still on my anxiety medication until I realized.  I was about ten days late when I realized that I may be pregnant.  I had a pregnancy test left over from the twins' days in my bathroom closet.  There was no wait necessary, that line turned blue immediately.  True to our fashion, I went out and got an ice cream cake.  I was pretty dumbfounded.  Shock is a good word.  

                                                                     (Um....what???)

The cake this time, instead of saying, "Congratulations, Daddy!" as it had the two previous times, said 3+1 or 4? Meaning 3 girls + 1 boy or 4 girls?  As soon as David saw the Carvel box, he said, "ARE YOU PREGNANT?"  He was thrilled.  We had debated whether or not we would try for another baby.  The debate was over.  I was super emotional, hormonal, and the anxiety and depression was really feeling out of control.  We eventually told our parents, and I thanked my Grandmother over and over.  

5 Days Old - PDA

I'll go back and tell backstories eventually.

Lincoln "Link" is down to 585 grams.  That's about 1 pound, 4.5 ounces.  In addition to losing weight again today, I was there for rounds.  The doctor hit us with a heart condition today.  Link's blood pressure is about 38/16.  Apparently, his bottom number should be 22 or higher, and definitely over 20.  What that number tells them is that his heart is not pumping as it should.  This told doctors that Link probably has PDA, and they did an echo which confirmed it.

PDA is:
"Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart.

Before birth, the two major arteries—the aorta and the pulmonary (PULL-mun-ary) artery—are connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation.

Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby's circulation.

In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood pressure in the lung arteries."

Essentially, Link's heart cannot efficiently pump blood through his body.  He was receiving his third blood transfusion when I arrived, and once that ended, the doctors will begin a treatment of medicine for the purpose of closing those arteries.

Lincoln's Log

I will begin blogging again, now as a Mom of Four.  When Addie & Charlie were in the NICU, it was the scariest, most exhausting time of my life.  David and I found out in April that we were pregnant again and expecting a child on Christmas Day.  The pregnancy was going very well for months - my easiest of the three pregnancies, and suddenly, our lives changed forever.  Our son, who was to appear around Thanksgiving by most doctors' guesses, arrived a few days shy of Labor Day.  September 3, 2015, Lincoln Alexander forced his way into our world, far before he or we were ready.  Blogging about the twins experience made me feel purposeful in a world where I couldn't do much to help them.  I am hoping that since Lincoln had only made it to 23 weeks, 5 days before labor started, that this will help me again.  I will post almost daily here stories from before his birthday to current day stats and progress.  It isn't really meant for anyone but me, but those who know and love our family will likely find this helpful as well.