36 Weeker ≠ 26 Weeker

One does not want to brag about how long their baby was in the NICU, although many do (see this earlier post on NICU bragging).

However, not all who mention how long their baby was in the NICU for are bragging about the experience. I would say a decent number of parents are simply stating that information up front as a desperate attempt to find someone else out there who has gone through exactly what they have gone through. I can relate to their desire because parents who have had a 26-weeker are not going to have much in common with parents of a 36-weeker.

What Kate and I know about prematurity is based on our own experience of having a 26-weeker. So, if you can, imagine our reaction when we read something like this, “My baby was born at 36 weeks. It was so horrible. We had to stay in the NICU for two weeks.” Parents of a 26-weeker are just going to laugh at that. In a similar fashion, so different our experience could be from a 24-weeker that parents of such a preemie might rightly scoff at our daughter’s 109 days in the NICU. I would not hold that against them because 24-weekers are at a higher risk of having longterm side effects from their prematurity than 26-weekers.

The earlier your child is born, the more you will hear stories from parents of preemies that will sound “easy” or “absurd.” The more they are going to sound like the person is NICU bragging, when, in fact, they might not be at all. Perhaps they just want to share their story. 32-weekers are fairly rare, right? Yes.

As you might be able to tell from reading the earlier post about NICU bragging, my views on this phenomenon have slightly evolved. For parents of preemies, a good rule of thumb is this:

Next time you are talking to someone who has also had a preemie, do not assume that their child’s time in the NICU was harder, easier, shorter, or longer than your child’s stay there. There are ways to find parents who have gone through the same experience as you have, but starting off with woe is me, is likely going to isolate you rather than find you the support you desire.

The Redefining

I wanted to share something short today.

At some point during London’s NICU stay I was shuffling through some words in my head. The words were not new words to me, but rather old ones with new, real-life experience meaning.

Selfless.

Difficult.

Scary.

Challenging.

Beautiful.

Enduring.

Love.

The meaning of these words most often change with a full-term baby, but when you have a super early preemie almost no word or perspective is left unchanged. The story of London’s birth is many things to us, but to boil it down to a few sentences is this…

A shift of everything into high gear and high limits. Your life and your cares as you knew them were wiped away in an instant. It is the redefining moment of your lives. What you thought would break you passed and you emerged from it whole.

Remade.

And redefined.

Free Of It

I was filling up a growler at the Bull and Bush when I received word that London no longer needed oxygen support. Tears immediately filled my eyes as I stared at the text message from Kate that delivered the news. I tried to compose myself as I signed the bill and took my growler, noticing a woman next to me at the bar. The woman’s prolonged stares told me that she knew I was trying hard not to cry.

Back in my car, I was able to share the news with my parents who were visiting us for Thanksgiving. After that I wept. I was overcome with pride in my daughter’s strength and attitude. It was the happiest cry I can remember having.

Here, on this blog, I have tried to convey to you what this journey has been like for our little family. However, there are some emotions that are so hard for me to put into words that I know I cannot give you the depth of feeling I felt at this news or that news, nor should I really expect to be able to do that because my feelings as London’s dad are obviously not going to be the same for you. Nevertheless, I wanted to try.

If you have read this blog from the start, you know just how far London has come since birth. I have reminded you enough. But her finally shedding oxygen support was a landmark event in her story, unlike any that she or heFullSizeRender-2r parents have lived through.

From January 30, 2014, we have treated London like a normal baby, sort of convincing ourselves that this is how all lives start. This is a coping mechanism and I suspect parents of babies and children with physical or mental setbacks have often treated their child as completely normal. This has served us well and I am sure it has served countless other parents well.

Now, I can only speak for myself, but no matter how much I thought of London as normal, I knew of her unique health risks and the challenges she had faced, so I never forgot that this was all quite far from normal. For all of her life up until last Tuesday, London had external, let’s call them accent pieces, on her face that clued everyone else into her prematurity or special needs. As a parent of a preemie, you get used to this, but from that first moment when you see your baby in that Isolette with tubes coming out of her mouth, nose, and belly, you yearn for the day when she can rid herself of it all, when she can be free of it.

Just shy of her ten-month birthday, that day arrived and I will remember for the rest of my life where I was when it did.

Pictures: Leaving the NICU

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The day of London’s discharge from the NICU I brought the Nikon to take some higher res photos of her room and its surroundings. Although we never wanted a baby in the NICU, it did become a home for us after three and a half months. I suppose anywhere your baby has to stay will inevitably feel like a second home. I wanted to capture even the mundane things of the room, like the chairs we sat in everyday, or the closet doors displaying her footprints and growth progress. So, some of these shots will just not have much appeal to you, but I thought I would share them anyway because they mean so much to our little family.

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London resting in her NICU bed. For her, the day was not so monumental as it was for us. She had no idea what was in store. We did, and we could hardly contain our excitement and nervousness.

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This is one of those pictures that is more for our benefit than for yours. I wanted to capture what I saw from this side of the bed, where I actually rarely stood. I stood on the other side all the time. But at least from this angle you get a feel for what was in the rest of the room and the amazing windows we had in the room.

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The closet in London’s room with several footprints, a growth chart, a physical therapy schedule, a note from Kate, and the top of a bag holding London’s dirty clothes. Again, just trying to capture it like it was before all this stuff came home with us.

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The million-dollar view. It doesn’t look like it, but it’s the only window this size in any of the NICU’s pods. We scored in a major way.

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I took all the stickers we had placed on things around the room and put them on the iPad. The outcast Leprechaun was a treat from our Irish primary nurse. When he was on the lamp for months, I had placed a Union Jack flag in his hand. Eileen was not amused.

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Dear Megan, London’s primary, on the last day she was responsible for taking care of London.

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Spent a lot of days in both of those chairs, usually with coffee on the side table and always with my Timbuk2 bag filled with magazines or books to read when, or if, I could get some time to do so.

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Megan and Kate going over some paperwork before we finish packing the room up and carry London out of there once and for all. There’s no way to explain just how nervous you feel about taking your daughter home from the hospital after she has been there for almost four months. You absolutely need to get everything right and you also need to know again and again what exactly needs to be done if there is a problem with something once you are home. In less than an hour there is not going to be a team of nurses and doctors on the other side of the curtain able to answer your every question.

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Moments after all three of us stepped outside the hospital, 109 days after we frantically arrived, thinking we’d spend just a few hours there.

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Home. The adventure begins anew.

World Prematurity Day

Right before falling asleep last night I was scanning Twitter and I learned that yesterday was World Prematurity Day. The March of Dimes Twitter account, which I follow, had shared images of city landmarks all across the world that were lit up purple, the color of support for preemies.

I don’t know how I missed this day, but today I read some articles about prematurity and found this one on NPR, the most interesting. Money quote:

Premature birth is now the single largest cause of death among babies and young children. Every year, 1.09 million children under age 5 die due to health complications that stem from being born before week 37 of pregnancy (a 40-week pregnancy is considered full-term).

I recommend reading  the whole article at NPR. It’s quite short. The editorial, titled “Preterm Birth: Now the Leading Cause of Child Death Worldwide,” mentioned in the NPR piece can be found here.

After reading the article and seeing the picture at the top of the NPR page, I am, again, so thankful for the treatment available to us here in Denver and that we were not traveling when London suddenly decided she wanted out.

To the Internet, Not So Fast

Back in 2007 I had a troubling sickness. It started with migraines, then it transitioned to the frightening Bell’s Palsy, and whatever I had did not stop there. I developed iritis (inflammation of the iris, which makes the whites of your eyes blood red and the photophobia can be unforgiving). I had partial hearing loss in one ear. Doctors ran me through a battery of tests. In a few months I had a CT, blood draws, many eye exams, an MRI with and without contrast, X-rays, and a flexibility test, where the doctor looked for signs of Ankylosing Spondylitis, a symptom of which can be stiffness and pain in the spine and neck.

The tests turned up nothing of concern, but the symptoms continued to give me plenty of reasons to worry. In between visits to the doctor I would sometimes have a lapse of judgment during which I logged onto the internet and did some self-diagnosing. What I found was terrifying. There was an encyclopedia of diseases and unheard of (to me) maladies that could, in theory, give me some of the symptoms I had. Brain tumors. Cancers. Crohn’s disease. Thinking about it all scared me. The doctors, I knew, were doing their best to give me an answer. For a time, I thought that their lack of explanation was a bad sign. When I was firmly convinced of this I went to the internet. Ultimately, what I found led to prolonged worry and who knows, maybe some of the symptoms would have gone away sooner if I was not giving them their unwarranted attention.

By 2008, all of my aches, pains, and inflammation were gone. Most likely a virus had attacked me and, my body, with some hiccups along the way, crushed it. However, if any of the symptoms had returned in the seven years since I would not have consulted the internet. I would have gone to a doctor.

To have this lesson in my back pocket heading into London’s bumpy start to life was an unexpected blessing. London’s actual and possible complications from prematurity were a tsunami of information compared to my sickness years ago. The first wave of preemie particulars and statistics hit even before London was born. While I was waiting outside the operating room a doctor came by and ran down a random list of possible complications. She told me 26-weekers have an 85% survival rate. This brief conversation introducing me to the challenges preemies face was similar to seeing the tip of an iceberg above water. The other 90% was below the surface, or in our case, through the OR’s double doors and on into the NICU. To borrow from The Lord of the Rings, it was “the deep breath before the plunge.”

*          *          *

Upon your family’s arrival in the NICU, you might feel like you’re drowning. There are more people taking care of your baby than you can keep track of. There is a new procedure every day. Thus, there are results every day, results that must be explained to you, sometimes three or four times. In addition to that, there are a lot of unknowns and, regardless of how talented the NICU staff may be, no one can accurately foresee the obstacles ahead for your baby. The internet is not going to be any different. There, you will find many question marks and new and more dangerous preemie complications to worry about, even if your baby is not suffering from them.

As parents with a baby in the NICU, Kate and I felt like there needed to be a sacred part of the day, during which we would try to not worry about the next results from London’s latest blood draw or echocardiogram. Of course, to not worry is impossible. It is more accurate to say we carved out time in each day during which we would purposefully not heighten our worry. This time became essential to getting us through every month our daughter was in the NICU.

Seeking information or support online seemed to only disrupt any sense of peace and hope we had regarding London’s course of treatment. If it was information we sought, then it was to go down the rabbit hole again, entering a world where one complication, like a brain hemorrhage, could lead to hydrocephalus and, almost certainly, cognitive disabilities. At least, that is what the internet would like you to believe at times. And if it was support we queried, we discovered far more troubling accounts than our own, which led to more worry.

Very early on in our NICU adventure we discovered the very poor predictive quality of the internet. Thus, the net never became a source of information for us. We much preferred getting answers straight from the trained professionals who were taking care of our daughter.

I have used the internet for queries about preemies many more times since starting this blog than I did while my daughter was in the NICU. When I am using the internet to find a definition of a certain malady, it can be helpful and I am grateful for that, but the internet will remain a horrible diagnostician and a font of worry for parents with a baby in the NICU.

Double Takes and Long Stares

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On the day we left the NICU for good.

The day after London came home from the NICU we took her on a brief outing, a trip to Target. We were both quite scared. I had hand sanitizer in my pocket, in the diaper bag, and probably in the stroller. As most new parents move about, we were slow, paranoid about every baby carrying tool properly snapping into place, and just a little hesitant about our ability to accomplish an errand with London in tow.

I was scared most by the threat of germs. For over 100 days every single person who came to see London had washed their hands twice, even if they weren’t necessarily touching her. Taking her into a Target, where a nutter could potentially walk up to London and touch her foot freaked me out. Even the idea of her breathing the air in a Target sort of worried me. I know, that’s ridiculous, but that’s the stuff we thought about back then and we prepared for it.

What I did not prepare myself for were the looks we were going to get from people who glanced at our baby. To put it more accurately, the looks our baby would get, the long stares and the double and triple takes. When you take a baby out in public people are inclined to look at him or her. What they do not really expect to see are tender grip cheek stickers holding a nasal cannula in place and an NG tube, held down by an orange strip of tape and wrinkly patches of tegaderm, snaking its way across the baby’s face.

I can still see the first person inside Target who saw all that on London’s face. A nice looking man who was clearly caught off guard by all those sticky accessories. He did a double take and by his second look at London I could see it in his face, he did not have a clue what any of that stuff was. He could very well have thought London’s situation was more serious than it really was. A part of me wanted to stop everything and explain to him what every little tube and piece of tape was doing and that London was a very strong little girl who had been through more scary days than many people my age have endured.

But I could not take the time to tell that man about all that stuff and all those scary days. It would feel like we were back in the NICU explaining to visitors what all the machines around London were doing and why she needed them. It would be an exhaustive way to transition into a life at home with London. So, I just nodded and smiled at the man and kept on walking, his inquisitive stare following us around the store. I had then such an instantaneous and deep appreciation for parents whose kids will never shed their special medical tools and/or physical and mental challenges. We were, for the moment, living that.

But after 109 days in the NICU, I also knew that we had an insanely determined little baby on our hands and, with time, people were going to lean over the stroller and see nothing that might hint at this little girl’s history, enough to fill a book, and that is what has brought a smile to my face every double take since.

Do you remember the show Rescue 911?

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Windy and Rachel on their last night shift with London before she leaves the NICU.

When I was much younger I watched the show Rescue 911. Hosted by William Shatner, the show reenacted real-life emergencies and spliced in interviews from people who were present when the aforementioned emergencies occurred. At the end of the reenactments, the rescuers who saved the individual/s in need of help, were reunited with the people they saved.

The reenactments are so bad they are painful to watch. It was easy to find some old episodes of the show on YouTube. There is even a story about a baby being born “nearly three months early” while on a flight. He weighed in at 4 lbs, 6 oz. (I have to interject here, if the baby was really almost three months early, that’s a huge kid for that gestational age). Here’s the link to the story about the premature birth on the flight. As you might guess, the reenactment is hilariously bad.

What got me thinking about Rescue 911 was seeing some of London’s nurses the other week. I got home and two of her primaries were visiting Kate and London, eating pizza Kate made, and sipping wine. I got a chance to visit with the nurses a little bit before they left and during that time I thought of the reunions at the end of Rescue 911. I always enjoyed these scenes, loving the idea of being able to see and possibly become friends with the people responsible for saving my life or, in this case, my daughter’s life. And now, that was happening right there in my kitchen.

I would never wish what Kate and I went through with London upon anyone. But if it is to happen, this is the happiest ending one could possibly hope for. We were incredibly blessed to have such caring NICU nurses. And now those nurses have become friends. I hope that as long as we are in Denver and as long as they are working nearby, the reunions continue because, for us, they are heroines.

PTSD from the NICU

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Another day down, but one last peek at London before we leave for the night.

When someone first suggested that I am suffering from Post-Traumatic Stress Disorder (PTSD) I stifled my disagreement and listened, doubtfully, to their explanation. A few minutes later, when they were done speaking, I was nearly in agreement with them.

Prior to this conversation, having PTSD was not something I thought I could get. Naively, I associated PTSD with war veterans and not many other people. But this is so wrong. The National Institute of Mental Health (NIMH) defines PTSD this way:

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.

PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

Kate and I were afraid for months while London was in the NICU. We did not always realize it, but we were preparing ourselves for the worst outcomes in the NICU in an attempt to defend against them. Now that London is out, far removed from those most terrifying days, we still occasionally feel frightened and on edge. I first noticed a change when I was performing simple tasks, like preparing some milk for London. On a few occasions I spilled some of that milk and instantly my temper flared. And if anyone was around, I was mean to them. When I am like this I do not want to be near anyone. I was not crying over spilled milk. I was inconsolable over spilled milk. I was not sad. I was irate that something did not go my way. Everything sucked. I consider myself to be a patient person, so this new feeling of anger over something so unimportant was troubling. In fact, that realization made everything worse, bringing a snowball effect to my PTSD.

In addition to losing my temper, I can be anywhere doing anything and if I slip up and think about the scariest moments in the NICU or in the OR the night of London’s birth I am fighting back tears. These are not voluntary recalls. I do not want to think about the scary moments, but the trauma of London’s start is prolonged and fresh in my mind. To think back is to invite some of those moments into the present and once you do that it is hard to stop the flow.

The NIMH definition of PTSD continues:

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

Or as someone recently put it, “You were not just in a single life-threatening accident with London. You were in one week after week after week and the person most precious to you in this world was the one always at the greatest risk.”

Truer words have not been shared with me. Having a baby at 26 weeks is exactly like that. Every time we drove to the hospital we braced ourselves for the accident. For a while, we got bad news every day. Sometimes it was just a trickle. And on the worst days it was a flood.

Even when the bad news did not come, we still braced for it. Do that day after day for 109 days and PTSD becomes a near certainty. For almost four months Kate and I did not just daydream about worst-case scenarios. On top of the worries every parent has concerning their newborn baby, we had to have real, hard discussions about our variety of worries stemming solely from London’s delicate start to life. At the end of most of these discussions one or both of us were crying and holding onto each other.

Until your child comes home from the NICU you live at a heightened state of anxiety. It becomes your new normal and when you plateau for that long coming down can do some really weird things to you. We are still adjusting.

The Fastest Year of My Life

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Taking in the sunrise from our room in Mexico.

Last year, Kate and I were in Playa del Carmen for a wedding during the first weekend in November. I was thinking of this trip just last week and I momentarily refused to believe it had almost been a year since Kate and I strolled along on the beach during a midday thunderstorm. That walk and the rest of that trip are so vivid and crisp in my mind, we could have been there last month. How could those memories be a year old?

Less than two weeks after we returned from Mexico we went under contract on our first home. The next 12 days I was busy with the purchase of the home and making sure we could move out of our apartment before the lease ended. Then we were off to Wyoming for Thanksgiving. Then we drove back. A few days later we flew to Orlando for a week. Then it was a week of last minute Christmas gatherings and preparations before we traveled to New Mexico. There for nearly a week, we drove back and closed on our house that Monday, December 30th. I started painting throughout the house that afternoon. We moved furniture on January 7th. The house was a mess and there was still more painting left to do. We then had a relatively calm three weeks (as calm and restful as settling into your first house can be).

Then the night of January 29th arrived and Kate had painful contractions at 26 weeks. The next significant date in my head is May 19th, the day London came home. And then a summer spent on edge as London slowly strengthened and we traveled to weddings. And then fall arrived. And now we’re almost back where we started.

From January 29th to May 19th, it did not matter what day of the week it was. It did not matter the month, the holiday, the weather, the time. It only mattered that London was doing okay and getting better. These days are curiously recalled in my mind. There is so much held within the borders of them that it will take years to process just how much we changed during that time and how it affected us. Yet, at times, those days seem like one really long fast day. And then it was summer and our girl was home. I recall pausing during my walk out of the hospital one day in April to take in the weather. “My God, it’s spring,” I mumbled to myself. Where had winter gone? I was actually dumbfounded. I can easily remember the cold night we arrived. That was the last day I cared about the weather.

Living on edge makes life go by very quickly. That is one thing I have learned in the last year.

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May 23, 2014. 4th day home.

London is home now. She is strong and happy beyond our wildest hopes and expectations. I do not call her a miracle baby because I never want “miracle” to be a term I casually use. But it is true. She is a miracle. And she is not the only miracle of the last year. It is a miracle all three of us made it through. At times it did not seem possible. It did not seem possible that time would slow. But it did. And I care about the weather once more.

If You’re Just Now Getting Here

I probably should have done this sooner, but if you’re just now finding this blog via a tweet, Facebook share, or web search, then you should know that it all started with a series of posts detailing London’s birth. These posts are the foundation of this blog and, for their author, the hardest to write and the hardest to reread.

Feel free to scroll down through the archives, but if you’re looking for square one, and for getting a better feeling of how this family got its start, follow the links below. A quick word about the original posts, there are thirteen of them, but they aren’t very long posts so reading all parts is not a big ask.

London’s Birth Part I. 

Part II.

Part III.

Part IV.

Part V.

Part VI.

Part VII.

Part VIII. 

Part IX.

Part X.

Part XI.

Part XII.

Part XIII.

The NICU Is A Fortress

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One of my favorites. Her 2-month birthday. “To infinity and beyond.”

As badly as I wanted London to leave the NICU I was also terrified of some of the things she would lose when we walked out of that hospital. 24/7 caretakers. A team of RNs, NPs, and MDs just feet away. The opportunity to talk to one of them whenever we wanted to and to ask the dumbest questions of.

As a parent, you do grow accustomed to having your baby in the hospital 24/7. It is comforting to know that your child has the best babysitters in the world.

While London was still in the hospital I wrote:

Right now I feel like taking her home will be bittersweet. I’ll be beside myself, in a good way, when we walk into our house holding London, but it’ll also be frightening to leave our NICU family.

Back then, the approaching discharge date meant exposing an already fragile baby to the terrors of this world like driving home with her! Or contact with the public, those creepy baby oglers who think they have the right to walk up and touch your child just because she is the cutest thing they have ever seen. Can’t stand these people! We would be responsible for a baby, yes, but also all the leashes that come with her: NG tube connected to a feeding pump, an oxygen cord, and a pulse ox connected to her foot. Monitoring all that could be overwhelming on top of normal baby duties.

But a baby has to leave the NICU eventually. We had our gambles and triumphs there in that pod, but the good stuff was to be found in life beyond those hospital walls. It is hard to think of leaving the NICU as anything but a tradeoff. An adventure was before us, filled with successes and failures, loss and gain, losses and victories. But behind us was London’s NICU pod, which, for her parents, became the safest place in the world.

NICU Bragging

I don’t know what else to call it, but NICU bragging. It’s an odd thing, something Kate and I became aware of while London was in the NICU, but something that really reared its ugly head once we were out and could take London to public places.

As emails went out to notify friends and family of London’s emergency birth and her condition, we started to hear back from all sorts of people. Those who had had preemies themselves did share some of the most useful information, but every once in a while there would be a line dropped in an email or spoken in conversation that, while perhaps not ill intentioned, would sound a little like bragging. Typically, these lines would be in response to us sharing London’s gestational age at birth (26 weeks, 4 days, but rounded down in the NICU to 26 weeks) or her birth weight (2 lbs, 6 oz).

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My girls.

In response to the gestational age, people were eager to share if their son or daughter (or relative) was born earlier. In response to the weight, people were eager to share if their son or daughter (or relative) was born weighing less than London. Initially, it was a little bit comforting to know that there are preemies born quite a bit earlier and lighter than London who can turn out fine, but not too long after London was born I had a hard time interpreting these comments as anything but diminishing our particular situation. In some cases, I knew people were trying to comfort us, but with others I said little in response to them about our preemie and NICU experience, hoping they would sort of get the hint and walk away.

I found that the comments in response to London’s birth weight were the most bothersome and they nearly always contained a detested title, micro preemie. If you’re wondering, a micro preemie’s birth weight is less than 800 grams (1 lb, 12 oz) or with a gestational age of less than 26 weeks. More often than not, I felt like micro preemie was shared in conversation with us as if it was the highest commendation a preemie could receive and it was delivered with a tone that implied one thing, our preemie has had it harder than your preemie. Nothing irked me more than someone referring to their preemie as a micro preemie merely because it was born weighing less than London but its gestational age older, like 28 or 29 weeks, or even later. From what I was told in the NICU, from nearly everything I have read, gestational age is more important than weight. Of course, being bigger than average at 26 weeks, like London was, is a huge benefit, but staying in the womb even for just one more week would have been vastly more beneficial for London. So, if someone told me they had a micro preemie, but it was born at 29 weeks, the only thing I cared about was ending our conversation.

Before London left the NICU, we had to attend a discharge class with other parents whose baby or babies were going to get out soon. Naturally, we all sit there and talk a little bit about our circumstances before the nurse shows up to teach the class. Most of the conversation centers around birth weight, gestational age, and length of NICU stay, i.e., the premature baby’s big three. By the time Kate and I sat in on this class, London was the veteran of the NICU, with over 100 days under her belt, and we were very much aware of NICU bragging. Thus, we were sensitive to parents, for example, who spoke about their three-week NICU stay stretching out to what seemed like three months. In our NICU class we did not share one of the big three stats because we did not want to give the impression to anyone that we were diminishing their own private and frightening experience.

Parents of preemies always find one another in public. It’s rather easy for us, we see a baby out and about with oxygen or an NG tube, and we know part of the story even before we talk to the parents. We have been approached by parents of preemies nearly every time we take London out to the mall. The parents approaching us to ask about London are eager to hear a little bit about her story, but mostly they are very eager to share their own. Some of these folks just unload a life history on us even though we met them thirty seconds ago inside a Nordstrom. For Kate and I, with our somewhat introverted personalities, this can be uncomfortable, to say the least.

As you can imagine, such encounters are even harder to avoid when going to a special care clinic at a children’s hospital. Last week, I overheard a conversation that must have started when one parent spotted another baby on oxygen.

“Oh, was he a preemie?”

“Oh yeah, 28 weeks.”

“What’s that, 3 months early?”

“Two and a half.”

“Ours was 3 months early.”

End of conversation. I felt like the parent whose baby was born three months early was just looking for the quickest route through the conversation so he could say, “Ours was 3 months early,” and then walk away. That’s precisely what happened. I’ve seen this a lot. It’s NICU bragging.

It is important for parents of preemies to talk with one another, to share their unique stories, but to share the big three stats and walk away, well, that does no one any good. As Kate and I have grown into being parents of a preemie, we have become increasingly conscious of this truth when talking with other parents of preemies. We would love to share with you London’s gestational age, weight, and number of days in the NICU, but only if you ask. We know there are preemies who were born earlier or later than London, born heavier or lighter than London, and stayed in the NICU longer or shorter than London, but that does not necessarily mean their time in the NICU was automatically easier or harder than London’s. A preemie’s care and progress can be influenced by many factors and is vastly complicated. This truth is never fully borne out by sharing the big three stats. We will do our best to never start a conversation with them.

The Eyes Have It

London’s first ROP (retinopathy of prematurity) exam was around 8 weeks after she was born. From the first time someone mentioned the ROP exam, they made it sound like something that we, as parents, would not want to stick around for. Kate always heeded that advice. I did not.

After London’s eye exams revealed Stage 2 ROP, I knew avoiding them was going to be impossible. They were happening once a week and, as with every other procedure, I decided that I wanted to be with London through it all. I did not want to shield myself from what she was enduring. If I did not watch the exam, I would feel out of touch with her care and progress.

When it was time for London’s next exam, I had just put her back into her isolette. I informed the doctor that I was going to stay. “Okay, stay seated, because I’ve had a dad pass out on me before,” she said.

I stayed in the chair even though I was confident I could stand up and get a better view without passing out and hitting my head on the floor.

The nurse that day gave London some sugar water or “sweeties”, designed to distract London from the imminent eye invasion. When the nurse had an arm on each side of London and her hands holding London’s head firmly in place, the doctor placed the miniature eye speculum. London squirmed right away, but she didn’t start wailing until the doc was looking in her eyes. I had never heard London cry like that.

Now, having watched so many eye exams, the noise London makes when her eyes are being examined is the hardest part of being there. The speculum and the probing with other tools looks quite unpleasant, but I promise you it is the noise that is the worst. It is a traumatic enough burst of screaming that an adult might only make it if they were being slowly stabbed again and again.

It is nearly enough torture for the parent to hear as it is for the baby to endure. Once I heard her scream like that I knew the sound would be with me forever. But, as I sat there and watched eye exam after eye exam, I tried to absorb as much of London’s pain and fright as possible. The eye exams became a unique way for London and I to bond.

As soon as the eye exams were over, the nurse would hand London back to me. She would immediately stop crying, look up at me, and immediately rest her head against my chest.

Last week we endured one last ROP exam together. If London had to have another exam I am not sure how the doc and her assistant would be able to contain London’s thrashing and kicking. One last time I attempted to share in the pain with London by being by her side and one last time I had the privilege of comforting her as soon as the speculum was pulled away.

More Baby Time

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DOL 2: Eyes still fused shut.

How long is a baby considered a baby? Yeah, I just googled that because it feels like London has already been a baby for so long. The Google consensus is that a baby is a baby from one-month old to less than two years. Prior to a month, a baby is a newborn, although I never referred to London as a newborn when she was less than a month. She was a baby. Still is. And, I guess, she will be for quite some time still.

I suppose it feels like she has been a baby for so long because we watched her last three months of in-utero development outside of the uterus. By three-months, most babies are doing something new each week, maybe even rolling over. London was still doing something new each week, but at three-months she was still struggling with eating. Watching that development outside of the uterus is special. Not many parents get to watch their baby struggle as they open their eyes for the first time (which usually happens in the seventh month of pregnancy). But Kate and I were standing right there as the seal broke and London’s eyes flickered to life right in front of us. It is those moments that make London’s seven months of life stretch out to a year in my mind.

I know, among parents of preemies, I cannot be alone in marveling at the changes that can happen in 7 months. But I am also pretty sure most parents of full-term babies are also astonished at the changes 7 months can bring. Naturally, that feeling is more intense when the starting point is three months earlier and seven pounds lighter than you were expecting it to be.

The Header Image

Just a quick story about the header image. It is a panoramic shot of London’s second room in the NICU. This is really the penthouse of the NICU. When we moved from our original pod to this one it felt like going from the ground floor to the fiftieth floor. It’s 1.5 times the size of our first room and it is the only room in the NICU with a whole wall of windows. Our first room had no windows.

I was hesitant when the room opened up and it was first mentioned to us that we could possibly move in there. This was the room that was opposite our first room. I wrote about it in this post. So, you understand my hesitancy.

One of our primary nurses had one stipulation about our move into this room. She said that everyone else that gets that room always ends up pulling the shades and blocking the only flood of natural light the NICU gets. If we were to move in there, we would have to promise her that we would only have the shades down in the morning when the sun is unpleasantly shining straight into the NICU’s eyes. We promised. I got over my initial hesitancy and we made the move, knowing that we had well over a month left in the NICU so why not upgrade for free?

The move was one of the smartest things we did while London was in the NICU. We were there for quite a bit longer than we thought we were going to be. We fell in love with that room, as much as one can fall in love with a hospital room.

Toward the end of London’s NICU stay, there was a leak in the ceiling in London’s room and we had to give it up for just one night while it was fixed. The next morning I came back to the NICU and London was in her temporary room, which was much further back in the NICU. No natural light made it there. Everyone was pale and had a depressed look on their face. At least, that’s the way it seemed after living in the penthouse for so long. I only had to sit with London in that room for 40 minutes, but that was more than enough. I pushed her back to her pod with a nurse and it was like stepping out of a tunnel into a glorious sunny day.

We are so thankful for that upgrade.

Blinded By The Light

Last night, Kate and I watched some old videos of London in the NICU as we were falling asleep. We did this every night while she was in the NICU. Now, not so much, because we can get out of bed and walk twenty feet to her crib and there she is, sleeping so peacefully. As we scrolled through old photos and videos on our camera roll, we happened upon this one…

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Kate said, “You should write about this picture and the bili lights.”

“Okay,” I said. But it took me a few more minutes to figure out where I could go with a post about this picture. First, I should just tell you about the picture, it is of a very small stuffed animal (beany baby size) wearing the goggles that London wore while she was under the bili lights. We have a couple of these BluBlockers because the nurses thought London was done with the bili lights and then she went back on them after we had taken the first goggles home.

These goggles were addicting to me once they were home because I could, whenever I would pass them in the living room, pick them up and smell them. Their smell transported me back to London’s room. So when these goggles came home, it felt, for the first time, like we had brought a little bit of London home with us. Before bed I would inhale deeply from the goggles. When I got downstairs in the morning I would take another hit from the goggles. It’s starting to sound like I’m talking about a bong, but that’s entirely appropriate because the smell of these goggles made me relax, they transported me to another place, and I was at peace.

Sadly, the goggles eventually lost their scent of newborn London. Unfortunately, one can’t take that smell and store it away in a NICU keepsakes box where the goggles now rest.

Every one of the fifteen weeks London was in the NICU, I took a load of her laundry home. And every time I was about to put her clothes in the washer I smelled them, although with clothes I had to carefully select where I was going to plunge my nose. Then I threw them into the washer. By the way, do you know how many preemie outfits you can fit in a modern washer? I’ll save you the calculation: a lot.

Smell was and still is an essential way to connect to your baby, especially if they are in an isolette. Even before we were discharged from Kate’s room at the hospital the nurses had us wearing receiving blankets in our shirts as we slept. Whenever we were next at London’s side, the nurses took the blankets from us and placed them near her head or wrapped her up in them. The blankets were supposed to familiarize London with her parents’ smell.

I liked to think of her taking a deep inhale from the receiving blanket before she fell asleep in her hot and humid isolette. And again, in the morning, taking a deep breath and catching a hint of mom or dad in the air so a part of us was always with her.

Mind the Hierarchy

Here’s a pro tip for doctors from someone with no formal medical training:

When you are a resident, regardless of what year you are, introduce yourself as such when you are greeting parents of a 26-week preemie (or any other person in the hospital). Do not say, “Hi, I’m the neonatologist,” as if you are the attending when I can clearly read the giant block letters on your name tag that spell out, “R E S I D E N T.”

Important reasons for identifying yourself as a resident, in no particular order, are:

1. If you’re not a great doctor and you introduce yourself as the neonatologist we are going to assume, at the very least, that you are a fellow or maybe even an attending. And then we will be frightened because if you’re the fellow, then who the hell is the resident and are they next to my baby and, if so, can they please step away from her right now.

2. It’s nice of patients or parents of patients to know your resident status. We will actually give you a little slack (some of us will) because we know you are in an intense three-year period pursuing specialization in your desired field of study.

3. If you say something we disagree with or want to challenge (for example, ordering up another chest X-ray), it’s important for us to know you are the resident so we can communicate to you that we want the fellow’s opinion as well or that we want the attending in on this decision.

4. In rounds, don’t forget that you are the resident. You may be high on your horse, but remember, there are nurses in this circle that have been taking care of preemies since before you were born. There’s also a hierarchy. If a fellow is challenging your idea and nurses are backing up that fellow and the attending is sitting nearby not saying anything, that should really clue you in to the fact that the attending approves of what is happening.

5. You earn your title. Attending. Fellow. Resident. Intern. Clerk. Sub-I. So let us know exactly where in this hierarchy you reside. It’ll be best for all of us.

Daddy Kangaroo Care

The best thing a dad can do for his baby in the NICU is kangaroo care. Mom’s got the breast milk covered, so dad needs to, again, man up, take his shirt off (or unbutton the shirt until it’s open), grab his baby, and sit in a chair for a few hours. When kangaroo care was explained to me, it was emphasized that the most beneficial kangaroo care is skin-t0-skin and that some dads are a little hesitant about taking their shirt off to do this. This was not the only time I heard of machismo getting in the way of taking care of a baby. (That is a whole other topic that I would like to address in later posts.)

After two weeks of London’s life, we were allowed to do kangaroo care with her. Of course, mom got the honors, but I worked my kangaroo care in when Kate had to hook up to the breast pump.

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For the next couple of weeks London was small enough to tuck into Kate’s shirt. I thought that was the cutest. The two of them were so happy together during kangaroo care. I could not stop smiling whenever I would look at them. It was such a peaceful scene that I too could fall asleep even though I had been drinking iced coffee since I got up.

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The most challenging part about kangaroo care is the management of the tubes and wires when you are moving from isolette to recliner. Once the transfer is complete, you get to enjoy the easiest part about kangaroo care, falling asleep.

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Not the sharpest picture, but look at Kate, my sweet Kate. Whatever was happening that day with London, as soon as she got on mom’s chest she was doing better and every single time Kate looked like she was having the time of her life. Beaming. So proud.

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I did not always take my shirt off when I held London, especially toward the end because we would be switching so often between reading and sleeping on my chest. This was the day of London’s discharge from the NICU. Getting ready that morning at home, I grabbed this purple t-shirt, knowing I had worn it the night London was born, and now the day London came home. I still think of that every time I reach for this shirt in my closet.

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A lot of aspiring writers ask professional writers how they do the work they do? What do you start with? And a common response is, “Butt in chair.” The time to write was not while London was in the NICU, but it was the time to do the most important job I will ever have, which still required my “butt in chair.” This was my view for 109 days, I could not leave it the day of her discharge from the NICU without taking a point-of-view picture. Looking at it now takes me right back to that pod, from where we left the hospital together for the first time.

Not Fun, Placing an NG Tube

Before our NICU discharge, Kate and I both learned how to insert a nas0-gastric (NG) tube into London. NG tubes are necessary when the baby cannot drink enough milk to thrive. When London was discharged, she was only nippling 25% of her daily volume. The rest was pumped through the NG tube.

We needed to learn how to place it because NG tubes can be easily pulled out by the baby. During her NICU stay, London pulled her tube out several times. So, we had seen it put back in place by the nurses. A nursing student did it one day while we were there watching. I would have been extremely nervous if I had been in her shoes with the parents hovering over me, but she did extremely well, threading the tube up one of London’s nostrils and down, down, down to the stomach.

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At home, with that darned tube snaking out of her and all that orange tape on her face.

When it was time for Kate to practice on London they both did pretty well. When the tube first reached London’s nostril Kate stopped because she was already crying. Nurse Megan and I comforted her and told her she could do this. Kate composed herself and went for it, making it look easy, even though inserting an NG tube in your baby is really one of the worst tasks you can have as a parent of a newborn.

I tried the next day and, again, things went pretty well. Of course, by the time I was finishing up with the tube, London was bawling her eyes out, but regardless of who does this to her and how they do it, by the end, London was always screaming. I suspect most babies respond this way. Luckily, London was always easy to calm down afterward.

The success we had placing the NG tube while London was in the NICU did not follow us home. You can nearly cover your baby’s face with tape trying to hold that NG tube in place and attempting to make it impossible for the baby to get a finger around it and pull, but eventually, that thing is coming out. The first time this happened to us it was already late at night. We were so disappointed we had to do this to London. We let her calm down as we readied a new NG tube, tape, and a little sugar water to distract London from the pain. Kate tried first and I held London down on the bed. Things seemed to be going okay until the tube was a couple inches in and it wasn’t going anywhere. London was awake and bearing down so the tube had nowhere to go. It is agonizing to be in this position. We didn’t know if the tube was going somewhere it wasn’t supposed to be going. We didn’t know if we should push with more force. Meanwhile, London sounded like someone was torturing her.

We regrouped before I tried to place the tube. No luck. Same thing happened. London was bearing down and the tube wasn’t going anywhere. We abandoned that attempt. I was distraught, grabbing a pillow and screaming into it because I just couldn’t stand inflicting that much pain on London, twice, and without any reward.

After an hour of talking about our alternatives (try again in the morning or text one of London’s night nurses to see if they can place the tube if we go to the NICU) we decided it would be best to just go to the NICU. London’s nurses had offered to do this before we left. If we had any problems, let them know, come on by, and they will put in the NG tube.

We arrived at midnight and Windy had set up a little operating room in the NICU’s conference room. She placed the tube like it was no big deal and I tried to pay very close attention to how it worked so well in order to avoid doing this again.

A week or two later, London had pulled the tube again. I tried to recall the night at the NICU and I watched a couple of how-to videos on YouTube. The keys to doing this properly, at least on a baby, seemed to be sleepiness and speed. Don’t try this when your baby is wide awake because they are able to quickly bear down and stop the NG tube from going in. Don’t be slow about it either. By the time your baby figures out what is going on, you want the tube to already be in their stomach or damn near close.

I volunteered for the mission. Kate held London’s arms. Then we paused. We said a little prayer over London, attempting to calm ourselves before we do this again, praying that it would not be a repeat of last time. We finished praying. We took some deep breaths and then I plunged the tip of that NG tube into one of London’s nostrils and it curved downward and kept tunneling its way right down to London’s stomach. What a huge relief it was for all three of us to have that done. In this case though, I think Kate and I were the most relieved. No trip to the NICU tonight, baby.

We did not have to place the NG tube again. A little over a week later we pulled the NG tube ourselves because London was due for a photo shoot. That day she took all her milk by bottle. She looked and still does look amazing without that tube coming out of her nose and all that tape on her face. When I look at pictures from the NG days, I cannot get over how crowded her face looks. We are so happy to have put that phase behind us.