Sunday, September 30, 2012

The Calm and Then The Storm

NOTE: The first 5 days and stories can be read HERE.

NICU Day 5 (Friday, September 28):
Oliver and I finally decided on a name.  It was really hard to do because when you have a baby without complication you spend your days in your recovery room relaxing and holding and observing and watching your new baby.  It took us just over a day to name Addison - and we were able to spend every minute with her.  When Baby Hansen #2 ended up in the NICU just 5 hours after birth - there were all kinds of restrictions and limitations and I wasn't even able to see her for the first several hours - let alone hold her.  Our lacking ability to really observe her and hold her and feel connected to her made choosing a name very difficult.  But after 5 days we finally decided to name her Claire Whitney Hansen.  She is named after Oliver's paternal grandpa,  Farr Whitney Hansen.  He is a wonderful example to us of family devotion and love and we are honored for her to have such a legacy in her name.  
Here's her dad consulting one last time to ensure she's okay with the choice.  
Oliver and I spent most of our day feeling great about being in the NICU and feeling like everything was coming closer to an end.  The standard antibiotic treatment for pneumonia runs 7 days and so we had been talking to the nurses about what we need to do to be discharged.  Things like CPR training, a 2 hour car seat check, Claire gaining weight for 48 hours, etc were the hurdles we felt were the last as part of this journey.  Because Claire received a PIC line we were transferred to the care of the Neonatologist.  Unlike the pediatric rounding that occurs in the NICU, the neonatologist rounds on the sickest babies first and then visits with the parents of the more well babies later in the day.

We weren't surprised the lunch had past and we still hadn't seen the doctor because the NICU was buzzing with complications that day.  At about 3 pm Dr. Ellen A. Liu came to meet with us.  Oliver asked if we were still on track to head home on Monday and it seems that things just got difficult from there.

Dr. Liu expressed that she has some very uneasy feelings about the test results from early in the week.  She explained that she was impressed by Claire's test results - to which I inquired - impressed because they have come down so well?  Nope - impressed because the .8 I/T ratio score is extraordinarily high.  With below .2 being normal, .25 being maybe okay, .5 being WOW, and .8 being impressive. Claire had just been transferred the previous day to the care of the neonatology staff and Dr. Liu was spending time reviewing her charts and labs from the week.  They had been making her feel uneasy and uncomfortable all day and so she would read them, walk away, go back to them, then call her partners in practice.  She explained that she realized that coming in to speak to us about her concerns was going to terrify us and that we had already spent 5 days in the NICU and were thinking that things were close to being finalized. She also expressed that she just didn't feel right about not sharing her concerns or all the information with us and couldn't, in good conscience, send us home after only 7 days since she didn't feel we had all the facts.  She had consulted with her partners throughout the day and none felt she was overreacting.

The thing with labs/test results in newborns is they don't definitively answer what is wrong they just show that something is wrong.  The I/T ratio is comparing the immature white blood cells to her total blood cells and the high number is showing that she has some type of infection - but exactly what is unclear.  The original review could pinpoint that she suffers from pneumonia and decided to treat for that.  However, behavioral observations of Claire being crabby and irritable - combined with such extraordinary test results - left Dr. Liu feeling like Claire may have had meningitis.  The problem with such a late review is that no baseline testing could be established to give a for sure answer of what was in Claire's body 5 days previously. 

Oliver and I were left with several options.  One, we could treat Claire for 14-21 days of antibiotics which is the standard course for meningitis, because we don't know what was originally in her labs because, while they were ordered, they weren't ever run.  Two, we could take her home after 7 days, which is the standard course for pneumonia and believe that is all that was ever wrong.  Three, we could consent to have a spinal tap performed and see what her while blood count is after 5 days of antibiotics - knowing that it won't replace not having earlier test results but that it might provide another piece to the puzzle.

Oliver and I sat and listened in shock.  We had been in the NICU for five days and it felt like a bomb was dropping on us.  How could we just now be hearing about meningitis - the only thing we knew about the disease is people die or suffer horrible brain damage - it wasn't very comforting.  We asked if we could have some time to talk and called Oliver's mom - who is a nurse - and asked that she come meet with us and the neonatologist again to hear the same information and listen with a more clinical perspective.

We met up again about an hour later and talked about the risks of a spinal tap, the effects to meningitis, the frustration of things being non-definitive in newborns, and Heidi (Oliver's mom) and Dr. Liu reviewed Claire's chart in more medical detail.  Oliver's mom was also blown away by the band count numbers from early on testing.

The thing about a spinal tap in a newborn is that you can get a clear result looking like there are no white blood cells in the sample which is what you would like to see, you can get a cloudy result showing white blood cells which you don't want to see, or you can get a messy result which means that a vein was struck in the effort to put the needle in and has contaminated the sample leaving you with inconclusive results.  We elected to have the spinal tap performed nad see if we could get more information.

Oliver and his dad anointed and blessed Claire and then I went back to my room and Oliver opted to stay and witness the procedure and be a comfort to her.  He blessed her to be calm and peaceful and for the doctors to be able to get a clean test result and be inspired and guided in her behalf.  He also blessed that she wouldn't feel much pain and not fuss and squirm through the procedure.  I couldn't stand the thought of them holding her in the shape of a "C" with her back exposed and sticking a needle in to draw out vials of fluid.  It took less than 10 minutes and the priesthood power was realized in just that short number of minutes.  Oliver said that other than a cry when they actually put the needle in she was cooperative and didn't fuss or fidget.  Dr. Liu was able to get three clean sample vials of fluid for testing and they appeared clear to the naked eye - just what we wanted.

I returned to the NICU after the procedure to nurse and comfort her and we spent the evening just being with her and holding her and thanking God for all the blessings of the week and His constant attention to our needs and desires.

While the vials appeared clear to the naked eye - meaning no white blood cells present - they still are sent to the lab for testing.  We would have to wait for the definitive results until the following day.  We went to sleep feeling confident and at peace.

How could a baby as beautiful as this, and only 5 days old, have meningitis?  We would know for sure tomorrow.

Saturday, September 29, 2012

The First Five Days

Day 0 (Sunday, September 23):
I was scheduled to be induced to have our daughter on Sunday, September 23rd at 6 am.  Some other medical complications during my pregnancy necessitated our need to be induced at 38 weeks.  This is what I looked like checking into the hospital.   
I got all dressed and ready to go - and like good hospital swiftness it took more than an hour before we really got anything started.  If only that was the longest part of our adventure that would have been a wonderful story.  
Unfortunately this is me in labor, having contraction 2-3 minutes apart, after 12 hours.  I might still look happy for the camera - but I was anything but still happy.  My blood pressure was crashing, I was puking and feeling faint, and running a fever.  AWESOME!
NICU Day 1 (Monday, September 24):
So, 19 hours after we were admitted to the hospital here we are dressed for a C-section because the babies heart rate, on top of all of my complications, was now at too high a rate and there were concerns about her running the risk of fever.   If fever had been her only problem that would have been wonderful but nothing was seeming to go right.  Yes - I am just uptight enough about photography/proper documentation that I put down my barf bag long enough to smile for a picture right before my C-section and make sure that I documented Oliver's garb. 
At 1:47 am this beautiful tiny child was yanked out of my body.  Oliver watched the whole thing and they told me I didn't want to watch - but actually I did.  I watched as best a could from a reflection in the ceiling.

She came out not really screaming - but crying.  Oliver watched as the nurses sucked several vials of fluid from her lungs and then he was able to hold her and weigh her and bring her over to me so I could see her too. She weighed 7 pounds .02 ounces and was 20 inches long. 
She was tired after her long arrival into the world.  Here is our first partial-family picture right after she was born. 
We went then went to our postpartum room and she nursed for about 20 minutes and then the nurse came in and said that she needed to go to the nursery for her shots and eye goop.  Oliver accompanied her to the nursery and the staff were a little concerned that she was grunting.  They asked Oliver if they could keep her under observation for awhile and he admitted (now at 3:45 am) that we had been up almost 24 hours and would like to try to get a few minutes rest.  He asked that we please be notified if anything changed or if they noticed anything and then came back to our room.  He returned to the nursery to take a photo of our delivery nurse and expressed his same feelings that we please be notified if anything changed - our room was literally directly across the hall from the well-baby nursery.  They said they would bring her to our room at 6 am.  After I was finished getting checked out - Oliver and I went to sleep for two short hours.

At 6 am, the NICU charge nurse came into our room.  She informed us that our daughter had been moved to the NICU, started on oxygen, had a chest x-ray, had an IV started, and had blood drawn to run some labs.  Pissed does not even begin to explain our surprise and frustration about the lack of communication.   By all means - please do whatever is necessary to take care of her life - but please keep us in the loop!  Oh, and by the way, the nurse explained, the NICU is closed from 6-7 and we could get more information at that time.

We spent the next hour fuming and talking to several higher ups on our floor and then I decided to try to get up and go with Oliver to the NICU at 7.  Having just had a c-section 5 hours earlier made for a near impossible trip for me to accompany his to the NICU and so Oliver went off to get more information and I lay in bed wondering what was happening.  Just what every barely-not pregnant, emotional mom wants to do all by herself at the hospital.  After several hours and consultations later it was shown that her I/T test resulted in a result of .86 (.2 being normal) and her chest x-rays showed she had pneumonia.  She was having trouble breathing and so she was being supplemented by 30% oxygen and had an IV so that she could start a 7 day course of antibiotics to treat her pneumonia.

This is Oliver at 3 pm the day she was born getting to hold her for the first time after all the drama of the  morning.  We could only hold her for moments at a time because she needed to be in her heat controlled home because she wasn't maintaining her body temperature.
This is Addison at 4:30 pm that same day getting to meet her for the first time through the doors of the NICU.  The nursing staff was wonderful and accommodating and rounded up all her equipment so that she could be wheeled down the hall for a few minutes of sister time (and the first time for mom to hold her).  She could only stay for a minute, not that Addison has an attention span that's any longer, because she had to get back to her temperature controlled home.  
Oliver and our NICU nurse gave her the first bath at 4:50 pm while I sat in a wheelchair and watched.  It was a little different than Addison's first bath and a little complicated around all her cords - but we made do.  
Just after her bath.
My mom had brought Addison to the hospital and so when Oliver was done bathing her - my mom came in for a few minutes to at least get to look at her and meet her for the first time.
By 6 pm we were all back in my hospital room and Addison got to open her present from her sister.  She also had brought her sister a present - and she opened that too!  
With all the picture taking going on in our family - Addison was ecstatic that her sister bought her a camera - and like her shirt says - Addison is the best sister ever!
Just before 8 pm Oliver's mom came up to the hospital and by then Baby Hansen could come out of the heat environment for a few moments and so Grandma was the first to get to hold her (after mom and dad).   There is little in life that can't be fixed by holding a new born baby. 
NICU Day 2 (Tuesday, September 25):
Our pediatrician rounded in the morning and more tests had been run showing that her body was reacting well to the antibiotics and her chest x-ray showed that her pneumonia was starting to clear.  Similarly, her I/T test ratio was not .41 so she was also making progress fighting her infection.  She wasn't showing any signs of jaundice and her test results indicated that she was doing fine.  The day seemed to be looking fairly positive - too bad we had no idea that the whole world can change after 15 minutes in the NICU.

We went about our morning coming in to nurse her and we weren't really able to hold her except for 30 minutes during feedings so that she could be in her warm bed because she still wasn't holding her own body temperature.  The nurses started weening her from her oxygen and she was now down to 25% oxygen (21% is room air).  The only problem the NICU was having was keeping an IV site.  She was going through them fairly quickly (they really only last 12-24 hours in a newborn) and hers were only lasting 6-8.  Every time they had to stick her I excused myself because it's horrible to watch.  Luckily, Oliver could be with her and talk to her and comfort her.

My sister came up in the morning and was able to come into the NICU to meet her while I fed her, but not yet able to hold her (neither of us got a picture!).  Aunt Holly was able to stand next to her bed and put pressure on her to help calm her down and talk to her which was hugely helpful because I wasn't yet able to stand.  It's pretty depressing to have such a small helpless child and feel, as the mom, that you are just as helpless.  Thank goodness we have so much family that love and support us and have been making this experience a million times easier!

Oliver went home around lunchtime so he could spend some time with Addison and then he decided to stay and get some work done and nap as well.  My mom could come up to the hospital to be with me and was able to hold Baby Hansen at 2 pm for the first time and feed her for part of her feeding.
I finally got a picture of me and her together before we put her back to get her rest and strength and work on healing.  
The day continued to be looking fairly positive - with a continued rotation of IVs - but our family kept coming to welcome her into the world and meet her for the first time.  Aunt Tasha and Uncle Nick came about 8 pm and by then we had a longer window of holding that was available so they both got a chance to snuggle her for just a second.  

NICU Day 3 (Wednesday, September 26):
I went to the NICU about 4 am to do a feeding and just bawl and hold her.  When I went in she was sleeping well and had been eating well.  They had needed to move her IV in the night and it was now in her leg/foot but it was holding up fairly well.  Other than my being emotional - things were looking fine.  We consulted with the pediatrician and she said that her labs looked great her I/T ratio was down to .02 and her oxygen was down to 21%.  She was now being supplemented by room air qulity but just a higher flow.  The goals for the day were to wean her from oxygen and start decreasing her IV fluids.  She continued to nurse well and we were feeling pretty good about everything.

We briefly discussed putting in a pic line - but because she had a good working IV we decided that we would revisit it in the future if needed.   Baby Hansen got to wear an outfit for the first time that day and so here is dad dressing her for the first time. 
Our favorite little visitor came up to see us and we had lunch together (or left over breakfast).   Our friend Meghann came up to see us and brought Kneaders for breakfast and then the nutrition people started calling because I hadn't ordered yet - so I ordered something that Addison would eat for lunch instead.  She loved eating in the bed and thought it was such a treat!
She also worked with daddy while she was here and kept saying "I show you something". 
Between 2 - 6 pm Oliver and I stayed in the NICU to have a family council with Baby Hansen - because the name Baby Hansen just wasn't cutting it for mom anymore!

We had to observe her and get a feel for her personality and then she needed to have a PPI with dad to really discuss it.  

In true Oliver fashion - no decision was made - and she was exclaiming - "Oh dad".  He promised that we would make a decision the next day.  
We then went back to our room and had a celebratory dinner provided by the hospital (the food was gross but the sentiment was nice).  After dinner, Mary came to see us as we spent our night holding Baby Hansen and trying to just be with her.  She held her IV for more than 12 hours. 
NICU Day 4 (Thursday, September 27:
Happy 5 Year Anniversary!  We went to the NICU right after it re-opened at 7 am (it's closed from 6-7 for shift change).  When I went to see her at 4 am she had a new IV line in her head that looked horrible - but they thought it had went in very well and were confident that it would hold.  They gave her antibiotics at 7 and the IV failed - so they moved it down into her arm and by 7:30 that IV had failed as well.  By this point - Oliver had went home about 6 in the morning so he could be home when Addison woke up - shower and have breakfast and spend some time with her.  The pediatricians were rounding about 8 and we were feeling confident from the day before and the progress she had made.  Through the night they were completely able to wean her IV fluids and she was off oxygen.

The pediatrician came to talk to me and suggested that it was time for a PIC line.  She had been through 8 IV sites in the past 3 days and she still had at least 4 more days in the NICU.  He felt they were turning her into a pin cushion and that it would be best to poke her only one more time to insert the PIC line than to keep moving her IV.  The risks of putting in a PIC line no longer out-weighed the risk of putting in multiple IVs.  After much heart-ache and feeling a little alone, not having Oliver there to help me make the decision, I signed a consent form to have the PIC line placed.  This action made it so we were transferred into the neonatologists care instead of the care of our pediatrician.

Since nothing with Baby Hansen had been easy - the PIC line could be no exception.  While poking her was the worst part - getting the line placed in just the right spot proved to be very difficult.  It took four tries and four x-rays before they were satisfied with the placement.  It went not far enough, kinked over on itself, looped under her armpit, and then finally settled where it belonged.  This process took almost 3 hours and was stressful for the mom.  She slept through most of the process and only fussed during the initial insertion of the IV.

With the successful placement of the PIC line - our day resumed to "normal" for the NICU.  Feeding, holding, sleeping, etc.  Papa was able to come up at 4 in the afternoon and hold her for a little while for the first time.
Nana and Addison also visited again which allowed for a quick 5 minute snuggle.  
My anniversary gift to Oliver was to get out of bed and actually get dressed and do my hair (even if it was only a robe).  

His gift to me was to finally settle on a name.  There was a small snafu with the name choosing and it needed to be tabled for one more night.  
More stories and updates will be coming tomorrow of the next day - but thanks for reading our 5 day journey of labor, delivery, and the NICU.

Sunday, September 16, 2012

The State Fair

The State Fair is one of my favorite events of the whole year!  My dad used to take me every year.  With his passing earlier this summer, I have been really looking forward to going and the nostalgia that it is for me.  Well - this bed rest thing really has put a damper on life - and I was especially disappointed that I wouldn't be able to go to the Fair.  Oliver promised to take Addison and they went yesterday.  Oliver is now convinced the best time to go to the Fair is when it opens (at 10).  There weren't any crowds or long lines, it was easy to find FREE parking, they could walk around easily and see everything, and Addison didn't have to wait long for a turn to try different activities.  Plus, as they were leaving about noon, it was starting to get hot and more and more crowded.

In my opinion the best part of the Fair is all the animals up close and personal.  Addison liked some more than others - but mostly she just didn't love the swarming flies around some of the animals. 
Baby cows and big cows.
Freshly washed goats.
They went into the science building and found this huge hands-on bubble activity.  Addison is currently in love with bubbles!  As you can see - she could do it all by herself - which is critical to her loving anything right now.  Oliver said it was so cool that he wanted a turn - but he resisted and let other kids try instead.  She got to play for quite awhile and LOVED it!
Oliver treated Addison to her very first pony ride.  She apparently liked it a little better when he was walking around with her - but he knew how much I would want to see pictures of all their adventures so he did stand to the side for a little while to get pics.  

And - then she was done!  :)  "Daddy off"
This morning she has been telling me all about the cow that she rode yesterday - I guess we'll have to pull up the pictures so she can remember that it was a horse.

In other news - due to all the pregnancy complications - Oliver and I are going to have our newest addition on the 24th - just a few weeks early.  We both think it's weird and wrong to pick your child's due date and we would prefer to leave it to nature - but I would also prefer to get out of bed and get back to normal life (or totally tired, first days of a new baby, adjusting to having two, life).  It won't be the type of delivery we've planned for - but it will bring one healthy baby girl into our family - and ultimately that is the MOST important.  It also allows for my mom to be in town for the birth of one of her grandchildren (living out of state makes predicting such things more complicated and she has never been present for any of her grandkids births yet).  So Nana is coming to take the last week of bed rest duty and then welcome baby Hansen into our family!  Only 8 more days in bed...we probably should discuss narrowing down our list of 41 names...