I have always thought that choosing a name for a baby is a difficult task that carries a lot of parental pressure; it is the one thing you give them that stays with them for their entire life, right? We had Vivian’s name on our “list” for a while, it kept floating to the top partly because we liked it and partly because it has special meaning for me. It was my paternal Grandmother’s name and she was a really good person. I have many fond memories of my time with her as a child: walking with her through the woods at my grandparent’s ranch picking wildflowers, sitting in her kitchen watching her cook up delicious things without a recipe in sight, and admiring her seemingly untiring strength as she did chores around the ranch. I hope my Vivian can embody the kindness, caring and strength that I saw in my grandmother. Secondly the meaning of Vivian is derived from the Latin word for “alive” which has personal meaning to me because of the 4 consecutive miscarriages I had before I became pregnant with her. She is the one, who despite the odds, lived. And now her name has continued meaning for that same reason; she made it through this ordeal, she is strong, and she is alive.
You may also wonder about her middle name, Grace. Well, honestly, we let Avery choose. We didn’t even give her a list, she just told us she wanted her name to be Grace and we said, “ok, how about that for her middle name?” and the deal was done.
I know there are at least some of you out there that want the details of how it all happened, so here they are. This is really the first opportunity I have had to come up for air in what, for the most part, has felt like a week of drowning. But now that things are going well we just feel so lucky to have her be with us and I “think” I can write this without crying but we’ll see.
On Tuesday 11/15/11 Andy and I arrived at St. Als hospital at 7 am for my scheduled induction, I was one day past my due date and feeling very done with being pregnant. I was lucky right off the bat because there had been an error at L&D and 2 of the people originally on the induction list had accidentally been crossed off as having delivered when they hadn’t! So several of us had all shown up pregnant and ready for inductions but there wasn’t room for everyone and so a couple of people had to get sent home (whew! Glad it wasn’t me!). At 8 am my doctor broke my water (I didn’t ask if I could write about her publicly so I’ll leave her as anonymous, but she is a fellow Family Physician who I trained with and consider a friend as well as a really good doctor) and we decided to wait and see if I went into labor spontaneously. I sat around for a few hours and not much happened so by 11 I was ready to get things going and so we started pitocin. As the pitocin was being increased the contractions got predictably more intense. I was trying the hypnobirthing/relaxation method (see previous blog entry) and at first, when the contractions were 4-5 minutes apart it was really helping. But as they got closer together and a lot more intense to where they felt like they were almost on top of each other (really they were 2 minutes apart but it felt closer than that!) I got really irritated with the hypnobirthing lady telling me to relax and sort of lost it. I think Andy wrote on facebook that I was swearing, I might have been, I don’t remember because I was in a lot of pain at that point. It was midafternoon by that time and I thought I could tough it out for a while, and so I had the nurse recheck where I was at, hoping I was 9 cm, but no, I was still just 5 cm! That is when I asked for the epidural and was pleased with how rapidly they arrived to place it. It was really wonderful, I had forgotten how great it is to be in such tremendous pain and have it completely relieved. The only down side was that Andy almost passed out while I was getting it, and then I got hypotensive afterwards (70/30) and almost passed out too but was brought back with a little ephedrine. Vivian did fine through all of that and overall appeared well throughout labor. In retrospect, she did have some times where her heart rate went up a little bit (180’s) but they looked more like big accelerations than a baseline change. I asked the nurse at one point what she thought about her heart rate and she said, “you just ate popsicle, she probably liked it,” and that also reassured me everything was fine. I never had a fever or any other signs of chorioamnionitis, I had no risk factors for GBS and my screening test had been negative. Everything was really going quite smoothly. At around 6:45 pm we were joking around with my nurse that she was going to miss the delivery since she went off shift at 7 and I was going to be sad about that because I had really liked her when I suddenly felt some pressure (not always easy when you have an epidural) and sure enough I was complete and ready to push! So my doctor came and we all got ready. I pushed with a couple of contractions and it was that “I hope I’m doing the right thing because I really can’t feel anything at all” sort of pushing (they said I was doing ok). Then around the 3rd push her heart rate dropped to the 60’s and stayed there after the contraction was over and through into the next one. They did the oxygen thing and I asked my doctor if she was low enough for a vacuum and she said she thought she was and I said that would be fine. My nurse said that she was calling the NICU team to come and I said that would also be fine. We were all pretty calm about the whole thing. So the vacuum was placed and I pushed as much as I possibly could given I was totally numb from the ribcage down and she was born at 7:10 pm! She had one of those nuchal/body cords where the cord was wrapped around her neck, one arm, and her whole body and once she was untangled from the thing she started crying vigorously and pinking up right away which was great. As I looked down at her on my chest I almost couldn’t believe it, that she had finally arrived! Andy and I were both crying and from the moment I looked into her eyes I instantly fell in love with her. We spent the next hour just gazing at her. She was breathing a little fast and so the nurses wanted me to let her transition a little bit before I nursed her but after an hour she seemed a little better and she nursed really well at that point (which in retrospect is a little odd that she could nurse well at all given what her chest x-ray looked like just a couple of hours later). Around 10 pm I was finally able to walk enough that they could move me to a postpartum room. I was holding her while they wheeled me in the wheelchair and I looked down at her and thought, “well that’s funny, her face looks dusky, I wonder if it’s the lighting in this hallway.” We got to my new room and as I was getting in the bed I asked the nurse to unwrap her and assess her because I thought her color wasn’t right. As soon as they unwrapped her I was like, “that is NOT how she was before” because there was a clear line right at the nipple line and above it she was pale and below it she was almost purple. I watched her chest and estimated her respiratory rate was around 80. The nurse confirmed it was. They started giving her blow by oxygen and called the NICU to bring down a pulse ox. The NICU charge nurse came down and checked her pulse ox, it was 97%, even on room air, but she agreed, her color was very strange. At this point there were now 3 nurses in the room: my labor nurse, my postpartum nurse and the NICU charge nurse and no one really seemed to know what to do. The NICU charge nurse mentioned that the neonatologist happened to be coming in to see another baby and maybe he could come take a look. I said yes, please call him and have him come, and also call my doctor (since I happened to know she was on call) and if she is in the hospital maybe she can come and look too. After a little while the NICU nurse came back in and said that on the phone the neonatologist thought it sounded like harlequin effect (http://www.ehow.com/info_8533538_harlequin-effect-newborns.html) but that he wanted to get blood pressures. After awhile they figured out that they didn’t have a cuff in the postpartum area to take an infant blood pressure and that they would have to take her to the NICU to get the blood pressures. I was relieved she was going to be assessed in the NICU because, while I hoped it was something benign like a harlequin effect, I was still really worried about her breathing so fast even with a normal O2 saturation. From experience I know that when babies crump, they crump very quickly and so I was nervous that she had been breathing so fast for 3 hours now and that she could get tired out at any moment.
Around 11 she went up to the NICU with Andy and I was still in my room since at that time it was busy on the floor and no one could take me up to the NICU in a wheelchair (and I couldn’t really walk well yet from the epidural still wearing off). I wasn’t there to see how it all played out but the doctor told me later that he really became concerned when he looked at her and couldn’t feel any peripheral pulses and also noticed she was getting hypothermic. She also had an episode where her O2 saturation went down into the 80’s and that clinched the deal that she would get an IV and a blood draw. Finally someone was able to come and get me and take me up to the NICU and it was around midnight when I arrived to see them trying (and failing repeatedly) to get an IV. The neonatologist was truly concerned at this point because he had done a capillary blood gas and her CO2 was 90 and he felt she needed a fluid bolus right away and so she would need umbilical lines. So just after I got up there we turned around and went back to our room so they could work on her, feeling very scared not knowing what was going on. That’s when I started crying, and that didn’t really stop for the next few hours. After the lines were in we went back up to see her and her color looked slightly better after the fluid she had been given but she still looked really pale (which was better than purple I thought). The neonatologist showed us her x-ray which looked like pneumonia and he felt very confident this was some combination of pneumonia and sepsis and that it was likely her blood cultures would be positive with some sort of bacteria. He warned us he might need to intubate her but that for now she was doing ok with nasal CPAP and so he would keep her on that. We were sent back to our room so he could do the LP and some other things and sat there and cried some more and watched the seconds ticking by on the clock. After another hour we called up to see if we could come back up and see her and they weren’t quite ready yet so we waited some more. The neonatologist came down after that and let us know that the LP was negative for signs of infection which was reassuring (because meningitis carries a higher morbidity) and also to gather more history. He was very kind and nice; I was so appreciative of his good bedside manner at that point because I was barely holding it together. He also told us that she had an elevated CRP and neutropenia (an ANC of 900), which were both likely related to sepsis. Also she was DAT positive for anti-D (long explanation required here if you don’t know what that means, but basically it’s a blood type incompatibility thing between her and me). The risk for that is mostly related to jaundice, which was not our primary concern at that moment so we just shrugged that one off. And then I asked the “what is the mortality rate in this scenario” question and he said given all the factors 20-30% in the next 24 hours but after that if she was getting better it would drop to much lower. So after he left the room I fully broke down; the thought of her dying was more than I could take after such an already emotional day. It was like falling off of an emotional cliff where the pure joy of meeting your baby for the first time quickly plummets while the fear of her precious life being taken away escalates into panic and horror. I hope no one reading this ever has to experience it. The next 24 hours after that are a blur, partly because we hadn’t slept and also because there were just so many trips up and down from our postpartum room to the NICU and back again. We found out that she did have group B streptococcus in her bloodstream, which, while awful, was also reassuring because we knew that it was sepsis and we knew that it was being treated appropriately. She was a fighter that first 24 hours and thankfully never had to be intubated or require blood pressure support with medication.
On the second day, the morning of the 17th, we got the unfortunate news that my Grandfather had passed away. For those that don’t know the story he was 95 years old and in August, when I was visiting my parents in Montana, he had flown up to Montana from Tucson, where he lived with his wife (also 95) for a visit. He had arrived by himself and my mom and I had been shocked at the airport because he was not in good condition; he could barely walk and seemed severely malnourished and acutely dehydrated. He had been having some swallowing problems and so hadn’t been eating much over the past couple of months and at over 6 feet tall and weighing approximately 115 pounds he looked like a skeleton. That first night he had an episode where he almost lost consciousness and my mom and I had to carry him to the bed. We tried orally rehydrating him at home (per his wishes not to go to the hospital initially) but were not very successful and convinced him to go to the ER. He was admitted for aspiration pneumonia and because of his swallowing problems got a PEG tube almost immediately so he could be fed. He developed some strange neurological signs (leg spasms and the sensation of falling) as well as a rather rapidly progressive weakness so that he couldn’t walk without at least 2 people and a walker to help him. He spent the next 3 months going between the hospital and the skilled rehab facility connected to it for various things (a couple of additional bouts of aspiration pneumonia, anemia requiring transfusion, CHF exacerbation, and just requiring more nursing due to the neurological type symptoms). Three different neurologists consulted on his case and came up with 3 different possible answers for his symptoms, none of which really seemed to explain it fully and none of which were treatable. He had been offered hospice a couple of times but along the entire hospital course had wanted to fight; mentally he was 100% intact and he made it clear he didn’t want to die. It took over a month for them to convince him to change his code status to DNR and he did not want to stop the feeding tube. My mom had been by his bedside every single day over that 3 month period (except 5 days in early October when she had flown down to stay with me while Andy went to a conference out of town). Then, unfortunately (in terms of timing), the day my mom flew down to Boise (the 12th) one of the hospitalists met with him and encouraged him to move to comfort care and he decided to do that and stop the tube feedings. It was the right decision but the timing was just terrible and I still wonder why the hospitalist did that (since my mom had told them repeatedly she was leaving that day). On the 14th they moved him to comfort care and stopped his tube feedings. The last time I talked to him was after Vivian was born on the 15th, he was able to tell me congratulations, he had been waiting all day to hear that she had arrived safe and sound. After that he became less aware of what was going on around him, partly because of his condition and partly from the combination of morphine and benzodiazepine that they kept increasing to keep him comfortable. His passing was hard news to take given everything going on and already feeling emotionally at the end of our rope. I also just felt so bad for my mom, that she wasn’t able to be there for his last few days, and wasn’t really able to have any closure.
That morning that he died Vivian really turned the corner, she seemed to be truly improving and we were so incredibly thankful to have the feeling that hopefully the worst was over. Of course Andy and I both understand that complications can happen and so we were still holding our breath, but overall we were pleased with how rapidly she was getting better. That night we actually got to hold her which was so wonderful. You may be able to see in the picture I was still pretty emotional about the whole thing. I had played out the scenario in my mind of her not making it through and the potential of not ever holding her again and then to actually hold her in my arms that night, even with all of her cords and lines, was the most amazing miraculous thing.
That same day I was discharged from the hospital and I went home and again completely lost it and cried for a long time. Coming home with an empty car seat to an empty crib in an empty nursery is a horrible feeling, even though I knew she would come home eventually, it still just made me feel so forlorn and lost. That day was also the beginning of the most exhausting part of the NICU stay. All of the veteran NICU moms that I know warned me it would be like this (they were right). It is very tiring, even more tiring than the normal postpartum period because you’re never really able to lay down anywhere or take care of yourself very well. Additionally, it starts with sleep deprivation from the beginning (since we hadn’t slept in almost 48 hours). But I think one of the hardest parts is all the pumping. From the beginning I was pumping every 3 hours around the clock, which means setting an alarm at night to get up and pump (which is definitely not the equivalent of a crying baby) which doesn’t sound bad, but pumping is already not as satisfying as feeding your own baby, and to have to wake yourself up to do it is even more painful. Then, early in the morning getting up and getting ready and going into the NICU like you’re going to work. And the daytime is a lot of work, feeding and caring and worrying about your infant, watching vigilantly for any signs of improvement or worsening, pumping even more during the day, and scrubbing in and out all day long. Like I said, it’s exhausting. But, obviously, totally worth it! So it’s strange to have that mix of emotions too, the “I’m so happy she is alive and they saved her!” combined with the “this is a miserable first week of her life for me and it’s so not fair that I can’t be at home with her!” Thankfully there is now an end in sight as we plan to take her home tomorrow night!
So that’s the story. It really has put a lot in perspective for us. I also appreciate the irony of the entire scenario given my previous post from a couple of months ago about the hard process of trying to let go of the feeling that something bad was going to happen and waiting for the other shoe to drop. When she was laying there on my chest right after she was born I had a moment where I finally felt relief and let go of that worry, because finally she was here! And she was fine! And then 3 hours later she wasn’t. Just another good lesson in letting go of things you can’t control and having gratitude for every moment of every day. We are so incredibly thankful that Vivian is alive today and hope she will live up to her name for a long time to come!
I hope everyone is having a Happy Thanksgiving and giving their loved ones an extra squeeze today because each life is so precious!
