32w1d: Tuesday

September 23, 2009

Tuesdays are the best day of the week: the day the babies’ gestational age turns over. It all started when I had my IUI on a Tuesday, way back when, and since then every Tuesday has been “turnover day.”

On Tuesdays I systematically go through the different online week-by-week fetal development websites, and learn that my babies are now the size of jicamas or that their toenails are fully developed.

On Tuesdays I open the spreadsheet I made to track gestational age and post-birth visitors (which requires all sorts of if/then decision trees). Maybe the best moment of the week is deleting the prior week’s gestational age column — yesterday, goodbye 31w. It simultaneously satisfies my OCD list mentality and also signals that yes, we really have reached a new milestone. The projected NICU stay goes down by one week with each deletion. It’s no longer out of the question that they might have little or no NICU time at all. This little ritual has become even more meaningful since I was hospitalized a month ago for preterm labor. The initial prognosis when I was having contractions 4 minutes apart and dilating quickly was that I might deliver that day (28w0d) but that maximum I’d maybe make it to 31w or 32w. 32 weeks, here I am.

On Tuesdays (and now also Fridays, since I’ve been in the hospital) I have an ultrasound, and every other Tuesday it’s an extended ultrasound to measure their growth. When I’m on the table, I say to myself that this is the best moment of the week. Listening to their heartbeats has lost its novelty after being hooked up to the TOCO and fetal monitors for more than an hour each day (down from over 2 hours per day when I was first hospitalized), but the ultrasound thrills me every time.

Yesterday was an even better every-other-Tuesday than usual, because I came home from the hospital. I was so afraid to leave the hospital a couple of weeks ago, but now it sure is good to be home.

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Thoughtful Thursday: Patient

September 17, 2009

Thoughtful ThursdayInfertility has tried my patience, and it has made me more patient, but that’s not the kind of patient I mean.

What kind of patient are you? How has infertility changed that?

In all realms of life, I straddle a line between following directions and thinking for myself. My rejection of directions is usually based on some combination of logic, my own research, my assessment of the validity of the directions, and doing what I feel like.

This certainly applies to health care. For example, after I had my wisdom teeth removed, I followed all of the instructions for cleaning the extraction sites, but I completely ignored the prescription for narcotics. After the day of surgery, I didn’t even take any Advil.

During infertility treatments, I almost always followed directions to the letter, except when I thought they didn’t matter. For instance, when I was told not to eat after midnight prior to IVF #2 retrieval, I bumped back the time on my own because my retrieval was scheduled for late morning. I know the purpose of being NPO, and I also know that the midnight instruction is the same whether the surgery is at 6 a.m. or 11 a.m. If six hours of fasting is enough for an early morning appointment, then it should be enough for a late morning appointment, in which case eating something at 4 a.m. is fine.

My most egregious case of ignoring doctor’s orders occurred during the infamous IUI #7, in which we didn’t bother to have sex in addition to the IUI because in my mind the whole cycle was pointless anyway. Result: currently 31w2d pregnant with twins.

As a pregnant woman, I have been amazingly dutiful. I have followed doctors’ and books’ recommendations as much as possible (as a vegetarian, 100 grams of protein requires a lot of work but is feasible, but 150 or 200 grams just doesn’t happen no matter how hard I try). When advice has conflicted, I’ve evaluated the relative merits and acted on what seemed to be the most prudent course of action.

And then my cervix started shortening and I was put on bedrest. I followed bedrest instructions to the letter (didn’t go anywhere outside the house except the doctor, didn’t sit up for more than 15 minutes at a time for meals, etc.).

And then I went into preterm labor and I was admitted to the hospital.

This whole time, doctors have remarked on what a “good bedrester” I was and continue to be. They tell me how some other patients interpret bedrest as cutting down on housework or being quicker about grocery shopping. When DH said to the head perinatologist that a high-activity day on bedrest for me meant that I went up the stairs once to go to the kitchen, she laughed.

They’ve been pleased, and a little bewildered, at my openness to staying in the hospital as long as they deem medically necessary. They talk about patients fighting to be discharged — particularly those with other children at home, or those whose husbands are incompetent/unwilling with housework. When I told DH about the latter, he got a little defensive and said, “You told them I’m not like that, right? That I’m not one of those husbands?” I certainly couldn’t manage total inactivity without his constant help.

Doctors and nurses have remarked on my cheerfulness, and one doctor makes fun of me for being so cheerful. They applaud my wisdom when I give them my stock explanation for my compliance and good attitude: Better here than in the NICU.

How did I get to the point of winning some sort of Best Patient award? Sure, I try to maintain perspective in everything I do. But in this case, I’m a model preterm labor patient because I dealt with seven years of infertility, and because I read infertility and loss blogs. It took a hell of a lot of time, money, and work to get this far. The stakes are clearly higher for me than they are for the patients down the hall that the nurses roll their eyes about, the ones who are still smoking (WTF?). Because of the heartache of my bloggy friends, I know that not all babies turn out fine, and I know that some babies die. Often there’s nothing that the woman or anyone else could have done — but if there’s anything I can do to help these babies make it into the world safely? You’d better believe I’ll do it.

What kind of patient are you? How has infertility changed that?

29w0d: Omen

September 1, 2009

Still in the hospital, we’re all hanging in there. Mostly uneventful except for a resurgence of contractions over the weekend, now back under control. Cervix has actually grown from .5 cm back to .9 cm! They would let me go soon if I wanted, but I’m not ready to leave just yet.

Now for the omen. I received these chips with my hospital lunch.

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The “guaranteed fresh until” date is my ideal date to finish helping these babies get “baked,” for several reasons.

It would be 36 weeks, an excellent twin gestation. That is too much to hope for me now, as 36 weeks would be well beyond all doctors’ expectations. But, it sure sounds good.

It is the birthday of my late grandfather, the first birthday since his death.

It is even the birthday of another set of twins in my family.

I can’t think that far ahead — it’s one day at at time, one hour at a time right now. But wouldn’t it be nice? Until then, I’ll just be lying here with my little taters.

28w3d: Progress

August 28, 2009

Not the bad kind of progress, as in “labor is progressing.” The good kind of progress, as in “there is some progress toward a positive outcome.” No contractions at all during any TOCO monitoring in the past 2 days. I have only noticed one contraction in the last 24 hours (but I didn’t notice them at all when they were rampant, so I may not be the best judge). The medication seems to be holding.

They’re talking about sending me home early next week.

I don’t know if I want to go.

As long as I’m here, if anything bad starts to happen, I feel like they can make it okay. At home, I’ll go to the doctor once a week and continue with medication and bedrest. I will most likely wonder constantly what symptoms I’m not noticing, and I will dwell on whether I can catch them in time. If I go home, there will almost certainly be another ambulance ride in my future. It could be after one week or one month, and it could result in another stabilization or an emergency C-section, but none of the doctors think I can make it to 34 weeks.

By all accounts, November is now laughably out of the question. Early October seems to be the best case scenario. For now, it seems pretty sure that we will at least get to September, and that is so much more than I had a few days ago.

Thank you to everyone for your kindness and hope. Apparently all of the other patients around here are blaring the TV all day long (I wouldn’t know, since I haven’t left the room), but your comments are way better than TV.

Thoughtful Thursday: Worst

August 27, 2009

Thoughtful Thursday

I have another post in my to-be-written Thoughtful Thursday queue that is perfect for this week’s events. But, emotionally I am not in a place to write that post today. We’ll try again next week.

Instead, I will address a topic that is easier for me but probably harder for you. If this is the easy topic for me, you must be asking yourself, what’s coming next week? First things first.

What was the worst day of your life?

This topic came to me Tuesday night, my first night in the hospital. As my husband, shockingly, got a full night’s sleep on the daybed, I tossed and turned and sobbed in my Kraftmatic adjustable labor putting-off-labor bed.

The worst day? What about that day, so many years ago, when a boyfriend tried to rape me? Naaah, that’s nothing compared to this.

Snapshots of Tuesday that make it a candidate for worst:

  • Being told by MFM at weekly cervical check to drive immediately to the hospital but drop by the house and pack a bag first.
  • I brought the book I happen to be in the middle of reading, Healthy Sleep Habits, Happy Twins. Every few sentences I’d have to put the book down and cry at the thought that I might not have twins, or any babies, to bring home. The Pottery Barn catalog that we grabbed from the mailbox when we went home to pack a bag did not lead to crying, but I couldn’t simultaneously hold it up and turn the pages because of the pain in my hand from my poorly-placed IV. (Fourth IV turned out to be the charm.)
  • Alternating between thinking that the worst part would be losing these babies that I love so much, or that it would be worse to have to go back to fertility treatments after I thought I was done. I don’t know if that makes me a horrible person, or just a battered infertile.
  • Not being able to be alone with my thoughts for more than 60 seconds without crying. Not at all like me, as most of you know.
  • At the first hospital, dealing with the one midwife from my practice that I hate (out of 3 OBs and 6 midwives). She was the one on call two weeks ago at my non-stress test too. DH was out of the room whenever she was there during my first hospital visit, and he hadn’t accompanied to me to the routine appointment a couple of months ago when I met her the first time. At one point when she left the hospital room on Monday, I whispered to DH, “She’s the one I don’t like.” DH said, “I can tell.” I asked, “Because of how she is or because of my reaction to her?” DH said, “Both, but more because of her. Everyone else here is normal.” Another time I’ll tell you why I hate her so much. You will hate her too.
  • Signing consent for emergency delivery in the ambulance.
  • OB’s talk of delivery 3 to 4 weeks from now (31 to 32 weeks) as the unlikely best case scenario.
  • When finally left alone with DH in the first hospital, crying, then pulling myself together halfway. When the lovely, cheerful nurse came to tell me that the ambulance would be ready soon, she asked me how I was doing. I did not give her a pat answer and instead just looked at her teary-eyed and speechless. Her cheerfulness turned to intense sympathy. I don’t know if anyone has ever looked at me quite like that before. I don’t know how I feel about being on the receiving end of a look like that.
  • Ambulance ride was actually kind of fun at times, but needing to be in an ambulance was not. Even worse was that I actually stole it out from under another woman in Labor and Delivery who was supposed to be transported to another hospital, because I was much more urgent.
  • Signing consent for emergency c-section, just in case.
  • Meeting with anesthesiologist to talk about c-section options (she actually was quite pleasant, as almost everyone has been; both hospitals are full of outstanding bedside manner that makes me glad I don’t live in most of the places I used to live where people weren’t nearly so nice).
  • Much talk about delivering imminently.
  • Being told to expect a consult with a neonatologist and a NICU tour the next day.
  • At both hospitals, being asked if I was “prepared” to bring the babies home, with cribs, car seats, etc. Standard labor and delivery question. No, I am not prepared — it is too early. I suggested to DH that we place the orders instead of waiting for people to buy them off our not-really-publicized-because-it-has-been-too-early registry. Then I reconsidered, not wanting to end up with two of everything when I might need only one. Or zero.
  • Lying in bed, unable to shift to get remotely comfortable thanks to my catheter and IV, without any distraction but my almost-out-of-battery iPod. I tried to make myself sleepy with soothing songs, but every soothing song I could find made me burst into tears. Just like I can find infertility content in songs that have nothing to do with infertility, I can find Dead Baby and doom messages in anything, even songs that are supposed to hopeful. To top it off, blowing my nose after crying with every song hurt the catheter site terribly (eventually when I called the nurse to fix it, when I was in constant pain, we figured out why: it seems to have been jostled out of place just a bit, just enough to hurt, during the ambulance transport). Anyway, I didn’t want to listen to happy, upbeat songs that would make me un-sleepy. But, being alone in silence with my thoughts was worse. I tried a creative visualization, the first time I’ve ever tried that particular one, and it was good for 30 seconds at a time until my mind would wander to Dead Baby Thoughts. The only thing that eventually put me to sleep without crying, for a whopping one hour (after caving and agreeing to sleep medication!), was Radiohead. OK Computer is my go-to album when I’m upset. I should have just gone to it automatically at a time like this, but I don’t want it to take on bad connotations by bringing it out every time I am deeply upset. Let’s hope there aren’t too many times like this in the future.

Why the day loses the Worst prize:

  • 24 hours later, my babies are still inside.

Instead, the Worst Day of My Life prize belongs to the day of my first miscarriage because that cloud did not end with a silver lining.

The current cloud has glimmers of silver so far, with potential for a complete lining or even full-blown silver through and through. Still a chance of rain, but I’m trying to keep looking out for the silver.

What was the worst day of your life? If it’s too awful to describe, I suppose you can just say that, but at least tell us whether there was any silver lining.

Show and Tell: Flat

August 27, 2009

Show and Tell

We interrupt this week’s regularly scheduled Show and Tell pottery-themed broadcast to bring you this special report…

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Red and blue babies’ heart rate lines, beautiful as they have been the whole time in the hospital. Black contraction line now wonderfully flat instead of contracting strongly every 4 minutes.

Ignore the “No FM” sign; that means I was not hooked up to the monitor when I took the picture. I can’t very well stand up and take pictures while I’m strapped down to triple monitors.

Magnesium sulfate has stopped the contractions. The cervical shortening continues. Even though there’s almost no cervix left to shorten further (from 2 centimeters last week to .9 centimeters Tuesday to only .5 centimeter Wednesday, consistently 80% effaced Tuesday and Wednesday, 1 centimeter dilated at first on Tuesday then 2-3 centimeters dilated Tuesday night and Wednesday), there is hope that we will make it to September. Maybe even October. These are not supposed to be summer babies. These are autumn babies. Do you hear me, babies? Wait until the leaves start falling, please. The leaves are very pretty around here. Wait and see.

I’ll be in the hospital for at least a few more days, possibly weeks. Every doctor laughs when I say that I’ll stay here for 3 months if they’d like, but I mean it.