Monday, May 28, 2012

Act Two




If every day in the NICU passed like a week, since Asher's been home, the week has flown like a day.

Did you know babies are a lot of work? It's something I knew and accepted before Asher, but didn't fully understand why it was so. Now that we, not a team of nurses, are in charge of his round the clock care, he fills our entire day.  Especially with Marissa still pumping, even the times he's sleeping are spent cleaning the house, scrubbing his bottles and pumping gear, and trying to fit in all the old household jobs on top of that.

Asher's naps are also spent by us in a combination of relief and terror. We slink around the house like we're trying to evade a deranged murderer, knowing that one creaky floorboard, one stub of the toe could mean our demise.  Decisions to risk picking up his sleeping body make me feel like Indiana Jones stealing treasure at the risk of being crushed by a boulder.

He likes being outside.  We spent hours outside at a party for our friends Will and Katy, who are due in July, and Asher was calm and happy the entire time.  It helped that there was a deck full of people wanting to hold and talk to him (though this picture somehow makes it look like we ditched him).


He's a popular dude, and had a few visitors this week, including a turkey sandwich from Katy that apparently saved Marissa's life.




Asher had a few medical appointments this week.  We met with the feeding team, and were able to tell them about some small successes with breastfeeding.  He'll latch on and suck at times, once taking most of a feeding that way with the help of our childbirth educator, the "Queen of Latch".  That's been an up and down struggle, but feeding has not been a problem, as the team observed.

We also met with his pediatrician, three days after coming home. This is the family doctor we feel very grateful for, who attended a meeting that nurses said they'd never seen a family doctor attend.  Not having seen Asher in two weeks, he looked at Asher and us with a real happiness for what he saw.  We'll treat him like the normal baby he's behaving like until he gives us reason not to, said the doctor.

This was the first of multiple times this week when the "m" word was offered up.  I can't think of anything I'd experienced in my life that qualifies as miraculous.  We've all heard stories of people beating long odds, but I've never had long odds to beat.  To tell the truth, my life has been pretty easy up until now.  I'm a white, middle class male in the US of A.  Miracles have not been required.  In his short life, Asher has done something most will never have the need - or the opportunity - to do.  It seems like he's fought back from the dead.

At the same time, that fight has begun to fade from my consciousness, stored away as something irrelevant to our lives now.  In just a week, it's become so distant.  Did that really happen?  Looking at Asher today, you'd never know what he's been through.  His doctor told us that any differences in him from other babies were so minimal they weren't worth mentioning. 

Though this feels and sounds like a happy ending to Asher's story, that's not exactly the case.  This week marks the beginning of the second act, one that will play out on a timeline much longer than the first.  We won't know what, if any, consequences he'll have from the hypoxia until he begins to pass developmental milestones like walking and talking.  Coming home is not a happy ending, but it is happy.

Tuesday, May 22, 2012

Homecoming

Time has moved at a glacial pace since Asher was born.  Days have been weeks in this world, and our time in transition was no exception.  After only 24 hours, it felt as if we were never going home.  The spot on our room's whiteboard for "Possible discharge date" remained blank.

On Saturday, one of our favorite nurses who knows us well, came to our room and gently kicked us out.  She reasoned that Asher was ready to go home, has been ready for days, and only needed to hear that his parents were ready.

I felt very ready, but Marissa was understandably nervous at the thought of having him home by ourselves.  We'd become accustomed to the safety of the hospital, knowing that if anything went wrong, he would be taken care of.  Chances are slim that anything like that would happen, but they were slim the day he was born, too.

Still, as our nurse put it, it was finally time for us to go start our family.  In transition, we got in the rhythm of feeding, pumping, changing and sleeping.  We worked on breastfeeding, which was difficult and still needs a lot of work, but we made some small steps in the right direction.  Before we left, we watched a few NICU videos on topics like baby CPR, which didn't help Marissa's anxiety on Sunday.  I thought she might hyperventilate as we loaded him into his car seat, but we all made it into the driveway in one piece.

Coming home seems to have brought Asher out of his shell.  Maybe in NICU he was just shy, but no longer.


At least he feels comfortable telling us how he really feels.  I think he also feels more comfortable in his own clothes.

"Baby, I got your money"

The last day has felt oddly normal.  Asher cries when he's hungry, messy, or gassy.  He makes cute little noises and faces.  I change diapers, I clean, I warm bottles, and I do it all over again like so many other parents.  Life has been so abnormal for the past four weeks that now, with things the way they should be, I feel a little out of place.  Being calm and stationary have become foreign to me.

At the beginning, I remember feeling like I was living someone else's bad dream of a life.  The first days were an out-of-body experience.  Slowly, I came back into my body, and began to live that dream.  It became lucid.  Yesterday, when we pulled in the driveway after four weeks, I woke up, though once again not to the life I remember.  It's been a strange start to parenthood, one that at times has left me feeling robbed of the experience.  At least now, it feels like we've truly started.


Saturday, May 19, 2012

"Dramatic improvement"

A lot has happened in the last few days, so much that it's become harder to post regular updates.

On Thursday morning, we spoke to Asher's neurologist for the first time over the phone.  He'd been on vacation and hadn't seen Asher in the last week.  Visiting the NICU after his return, the doctor told Marissa that, at first, he thought he had the wrong baby.  Asher was unrecognizable to him.  He shared that he was glad he didn't attend the meeting that had been so difficult for us, since he was very pessimistic at the time and would have only added to the already overwhelming negativity.

The neurologist discussed with us Asher's second EEG.  Results from the first of these tests had created the sense of pessimism in that team meeting.  That EEG had been taken with Asher's phenobarbital levels very high, probably around fifty, whereas this test was taken with a level of seven.  In the neurologists' words, Asher's new EEG showed a "dramatic improvement".  While it was not completely normal, the doctor sounded very pleased with the results and optimistic for his future.  He made us no promises, and emphasized that only time will tell how things such as Asher's IQ will develop, but he confirmed what we were already starting to believe.  The worst case scenario for Asher is very unlikely.

Clearly, this was wonderful for us to hear from the closest thing we have to a crystal ball.  At the same time, anyone who's seen Asher in the last few days could have seen how much he's improved, so the doctor's words felt more like an official validation of what we already knew.  Later that day, we went back and looked at some of the videos from Asher's first week.



At the time, we were just thrilled to touch and hold him.  I remember enjoying the feeling of his limp arms draped across my stomach, even as I knew it was a symptom of his problems.  Today, I watch these videos and my heart sinks.  They sadden me, though they might not if Asher wasn't now behaving like this:


Our doctor from the palliative care team, the one who'd made sure to inject some optimism in that otherwise awful meeting, left a voicemail for Marissa today.  He described what he's observed in Asher as "incredible", and offered him as an example of the importance of maintaining hope in the face of odds that seem hopeless.

*****
On Thursday, the NICU called to say they had a room available for us to start the process Asher has been healthy enough to start for days now - transition.  As I write, we're starting our second night staying in a hospital room, the three of us together, with the goal of having us finally take the lead in his care.  As of now, we haven't been given a discharge date.  A few days ago, Asher's nurse thought we'd only be in transition a day or two, though given that we've been here now for 24 hours with no word, that seems unlikely.

Transition had seemed a good opportunity to work on moving Asher away from the bottle and toward nursing.  I figured we'd have the time and resources, like lactation consultants, available to us to allow us to hit this goal hard.  This was my thinking before I'd seen Asher try to breastfeed.  He's turned, thankfully, into a very squirmy baby, which makes nursing difficult.  Feeding from a bottle is also much easier, and is the only thing he knows.

Really, breastfeeding would benefit Marissa more than Asher.  She pumping every two hours, and because of the the engorgement, sometimes for an hour at a time.  That doesn't leave much time for everything else in her life, including sleep.  With that and everything else she's been through, she's physically and emotionally frayed.  If she were able to breastfeed, she could cut out the pumping, the labeling, the cleaning, the massaging, the hot cloths, the cold cloths, and probably the pain, plus get more time with her son.

At the same time, she's not the first person to go through this.  Painful as it is, it's a normal problem, and in that way a welcome change from the abnormal problems we'd grown used to.




Tuesday, May 15, 2012

Face

We are the proud parents of one hungry boy.  Yesterday, Asher took 95ml from a bottle from Marissa during the day.  Today, he got as high up to 120.  The feeding team monitored him with a stethoscope and said he sounded great.  Things were going so well that the feeding tube was removed, and he is eating completely on his own.  When I arrived yesterday, he was sleeping, and I saw him for the first time without obstruction from tubes, tape, or wires attached.  Just his beautiful face.


Religion is mostly foreign to me.  After my grandpa died when I was about nine, I stopped going to church.  My dad describes himself as a recovering Catholic, and to this day I can't tell you much about my mom's beliefs beyond the fact that she believes in God.   The idea of God as portrayed in most religious texts has never been one that computes in my mind.

Yet I know what I feel.   A couple of years ago, I was waiting out a heavy downpour in a shelter on the Appalachian Trail, talking to a group of backpackers and trying to keep my dogs from making trouble.  Once the rain dispersed, I left the shelter and hiked to steep section of trail called the Jump Up.  My favorite time to be in the mountains is right after a hard rain, as the humidity clears and collects into fingerling clouds that nestle into the crevices of the land.   Such was the scene as I arrived at the Jump Up that day.


That had been the last time I saw God. A power far greater than me surrounded and enveloped my being on that mountain. Parts of myself that I'd never met before came to the surface. The Earth was giving me a big ole bear hug, and I could have spent the rest of that day in its embrace. I felt whole.

Then, last week, my son looked into my eyes, and it happened all over again.


Contained in that face is the power of something far great than me.  It surrounds me and fills in the gaps.  Like a campfire, I could stare into it for hours, not fully understanding why, watching as it flickers and dances.  Maybe it's love, but it feels like God.

*****

The wires came completely off today, along with diaper and clothes for Asher's first bathing by his dad.  I couldn't resist a picture.


Poor kid got his dad's gut. 

The good news of the day was that Asher can certainly cry.  Unfortunately, discovering this came at the expense of an unsuccessful first attempt at breastfeeding.  I wasn't there, but according to Riss, he wanted to latch on but couldn't quite do it, hence his frustration.  Given that his initial attempt at bottle feeding was also tough, I don't think this should be too surprising.  He may just need practice.  Riss took it hard though. Between the illness, hormones, and desire to get him home, she's been strapped into an emotional roller coaster lately.

Hopefully, starting transition will help her.  We're now on the waiting list, and we've been told that from there it should only be a day or two until we're home.  I hope when transition starts, being together all day for the first time will really help her feel like Asher is hers.  Motherhood came with a beginning that was unfair to her.  Pretty soon, I think we'll get to make up for some of that lost time.

Sunday, May 13, 2012

Mother's Day

Marissa hasn't gotten what she really wanted for Mother's Day - relief from her mastitis and thrush.  Nerves have worn thin between us in the last couple days, due in large part to the frustration this is causing.  The impatience to get him home is also building, and Marissa's problems are only slowing this down.  He looks so normal now, it makes me feel like a horse at the end of a ride.  I can see the barn, and I want to run for it.

I'm not the only one who thinks he looks like a changed baby.  His new neonatologist stopped by to echo that view, saying the early reports and what he sees now seem pleasantly incongruent.  Another EEG would be done next week, he said, once Asher's phenobarbital level gets below 10.

The one thing we're still hoping for is crying. Yes, crying.  Find me the parent of another two-week old who wants that.  Today's neonatologist, the nurses, and Asher's grandparents all seem to be less worried about this than me.  He's making other noises, so it's not as if he doesn't have a voice.  We know he feels pain, as in the circumcision, by the look on his face.  He could just be a mellow like we're told his mom was as a baby, or like our dog Jhana, who Riss pointed out barks about twice a year.

If he were going to cry, it seems his circumcision yesterday would have been the best opportunity he's had.  Instead, his mom did all the crying.  Perhaps to help her through, the doctor, who's also Jewish, began humming a song I've heard in synagogues before.  As he hummed and worked, Marissa joined in.  The comfort and the connection between two near-strangers provided by their faith made the event feel like more than a simple medical procedure.

*****

Though Marissa didn't get what she wanted for Mother's Day, my mom got the only thing she hoped for.


She's the last of the grandparents to meet him, which I think was quietly killing her.  However, she's also the first person outside his parents and the nurses to hold him.  It seems like she's been waiting to be a grandma since I made her a mom back in 1982. As a child, I remember her being very protective over my reproductive parts. Her fear of having no grandchildren was apparent every time I got unspeakable poison ivy or was hit in the groin with a soccer ball.  That fear must have felt like it was nearly realized the day Asher was born.  She admitted she was nervous to meet him, not knowing entirely what to expect when she saw him.  By the time she left, I think she felt very happy and as hopeful as Asher's parents are.


Saturday, May 12, 2012

Fending off the paparazzi

Asher hit the big time today.  I woke up to find this on the front page of Haywood County's newspaper:








One of our co-workers entered Marissa in a Mother's Day contest on Facebook.  For having the most likes of her pictures, she won the grand prize of an article about her and Asher in today's paper.  Other than the ironically placed article about child hunger (see below) next to Asher, it was a really nice, well written and aptly titled article.

We've had two very important days to finish out this week. During the day yesterday, Asher took five, then ten, then fifteen milliliters of milk from a bottle. The last of these was the first chance I've had to feed him:



After we left yesterday, he decided to blow those numbers out of the water, taking 70 milliliters - an entire feeding. This morning, he first managed thirty, then seventy, then another thirty milliliters for his mom this evening. It seems that Asher likes to eat about as much as his dad does.




I haven't heard this from anyone at the hospital, but at the rate Asher's going, I would not be surprised if he were home toward the end of next week. Maybe that's wishful thinking, but we have been told that the main thing keeping us from beginning our transition is Marissa's pumping pains.  Once that clears up, we'll be able to try moving from the bottle to the real thing.

*****

My sister left last night after spending two days slaving in our kitchen, packing our freezer with squash and sage lasagna, stuffed peppers, and sweet potato shepherd's pie. She also took great care of Marissa, who's been miserable at certain points with mastitis and thrush. At the same time, my dad unexpectedly popped in for a visit yesterday to meet his first grandson. Every now and then, I'll get a call from him that starts something like, "Hey, what are you doing in a couple hours? I'll be flying through Asheville." He's a pilot, so that's a very literal statement, and his job enables him to pop in from all the way from Ohio every so often.

Marlin White is not an emotional creature. I inherited many things from him, but my empathic and emotionally therapeutic abilities were not among of them. He's old school in many ways, whether he's exercising his second amendment rights or sitting at home watching the History Channel in his underwear.

Given this persona, his reaction to Asher's situation has been perhaps the most interesting of anyone in our family. Praise from him needs to be earned, and, like many, he doesn't always know how to approach others going through tough feelings.  This makes messages he's been sending, like the one below, all the more notable:




An experience like this could cause people to grow and change, to do things they hadn't been able to do before. Or, maybe it provides people an opportunity to show sides of themselves that had been there all along.


Thursday, May 10, 2012

Hungry man

In the middle of last night, I woke to find Marissa trembling and crying in pain. She's been fighting a case of clogged ducts in her breasts which led to a mastitis infection. If you've never seen seen this, like I hadn't, imagine a really bad bout of the flu or heroin withdrawal, only it doesn't last quite as long. She was hot and cold, soaking our sheets, without much that could help her.

Since we were both up much of the night, I'm drained and can't muster up the energy for a post worthy of how good our day was. In short, I don't think anyone doubts now that Asher will be feeding on his own very soon. He drank from a bottle four times today, including once with me, and took a little more each time. My dad and sister were in town to see all this. Dad also modeled a nipple-less sports bra for us - tune in tomorrow for pictures.

When a baby gets ready to leave the NICU, mom and baby will spend time together in the transition unit getting ready to go home. These are rooms that help moms learn about any special needs the baby might have and to see how the baby responds to a less medical environment. Asher has been doing so well that transitioning was mentioned for the first time today. We might be doing that in the next few days if it weren't for Marissa's infection, but it sounds like this is coming soon regardless.

More to come tomorrow, including pictures and video of Asher taking down a big gulp of milk with me, then begging for more.

Wednesday, May 9, 2012

Teacher

As the days go by, it's become easy to forget that there are questions about Asher's future abilities.  He looks and acts more normal each day, even with a phenobarbital level that's fifty percent above what's therapeutic.

 Today, he didn't just make eye contact - we practically had a staring contest.   His deep blue eyes opened as wide as ever, and it seemed he was scanning my face as intently as I was scanning his. He would also take time to look around and absorb his environment. As he did, I could see his mind, supposedly damaged beyond repair, processing.

From the department of feeding, Marissa reports Asher showed a gag reflex today. For much of the time I was there, his nasal cannula, already flowing low, was out of his nose because Asher had knocked it out (a good sign in itself). He was breathing just fine without it, and we didn't even bother to fix it while we held him. The IV going into his belly button was taken out last night, and he's now being fed completely by his mom's milk. We were given no word on when a bottle would be tried again, but I'm guessing it will be soon.

Since none of Asher's doctors could attend, the meeting on Friday was postponed. That's fine by me.

I've written before about the sense of community that we've developed and strengthened over the past week and a half. The response of everyone, young and old, with and without kids, has left us speechless. One of the great surprises in this regard has been the sub-community of NICU parents that has come forward to share their stories with us.  Some of the most heartfelt words and kindest offers have come from these parents.   People I've never met have written at length to share their stories.  It's apparent that learning about Asher often takes these parents back to that time in their lives, a time like we're going through now.

No two situations are exactly the same, so these parents are often careful not to compare.  But we all seem to have shared a similar pain and fear.  It's a pain and a fear that I didn't know possible prior to Asher's birth.  One of these fathers, a person I respect a great deal and whose family has been very supportive of us, echoed some of my earliest feelings from this ordeal.  Like me, the father said he initially felt sorry for himself.   I remember in those first days, as I clutched to preconceived notions of what my family should be, among the forest of emotions, I pitied myself.

This father also helped me recall and solidify a thought we had in common, one that signaled the beginning of our recoveries from self-pity.  In his words, he began to believe that his child would be his teacher.  For me, should Asher have special needs, being so close, so inside of this would be completely novel to me.  It would be a completely new way of looking at life, one that scares me less each time my son looks into my eyes.

Tuesday, May 8, 2012

Power or bliss

Asher was surrounded by a group of very happy nurses when I walked into the NICU this morning.  They informed me I just missed a very exciting 15 minutes.  Two of the women were from the unit's feeding team, and had been testing his ability to suck and swallow.  Not only had they gotten Asher to give a good suck on a finger, but, more importantly, they could hear swallowing both through a stethoscope and with Asher simply laying there in front of them.  When I told them he'd already taken some milk from a bottle, they advised we slow that down, not wanting to make the experience unpleasant for him or risk getting milk in his lungs.

His nurse today worked with him on his second and fourth days on the unit.  She hasn't seen him since then, and seemed pretty amazed at his progress in that time.  I loved listening to her talk about him.  Professionally and personally, she seemed so hopeful for him and so invested in his care.  The look of excitement on her face was one I've seen more and more from the nurses in recent days.  It tells me the progress I'm seeing in Asher isn't just the product of my parental pride.  Others are seeing the same thing.  It's real.

He continued taking small steps in other areas today outside the sucking and swallowing.  He's a little more able to hold his hands up by his face like babies do.  He's tracking things with his eyes and looking when someone says his name (he already knows his name!).  He pooped mustard.

Marissa called me in the afternoon when I'd gone back to work.  Our case manager was asking her about scheduling another team meeting like the one we had last week.  About half way through this conversation, I became aware of how much the idea of this meeting scared me.  The last one, when I was told Asher would likely be "moderately to severely disabled", was the hardest thing I've done in the past week.

Since that point, I've seen nothing but progress, been given nothing but hope.  It's no wonder I found myself saying I didn't see the point in such a meeting.  Part of me would rather live only with the hope of what's in front of me rather than understanding the facts of our situation.  Knowledge is power, but ignorance is bliss.

We're meeting Friday morning.


Monday, May 7, 2012

A Letter

Dear Asher,

First, let me say I'm very happy for you and all the progress you're making. No one can deny that you're a fighter. You're cute, charming, and an inspiration to hundreds of people. Everyone's pulling for you, including me (just don't tell my boss).

However, I must say that you're making my job quite difficult. Your consistent, daily progress, giving nothing but hope to those around you, makes it very hard for me to argue my case. For example: who would believe that there is reason for pessimism when, just this morning, you drank FROM A BOTTLE nearly two days ahead of schedule.

I don't think I'm asking for much, only that people consider all sides of the argument. Even if you don't regress, just slow down a bit. Take a break. You've earned it. Plus, it just might save my job.

Regards,
The Devil's Advocate

Sunday, May 6, 2012

"Gale?... He smiled at me."

I think I fell in love with my son today.

I've loved him since before he was born, or at least the idea of him.   Today, though, he really became a person to me when he laid on my chest and looked up at me.  I wanted to crawl inside of him.  Everything about that face - the innocent eyes, soft cheeks, the lips that I will claim with pride, thank you very much - is perfect.

I thought I'd need him to say "Hi, dad" to feel like I had a relationship with him, the one thing I wanted more than anything.  Turns out I just needed his eyes.  And for that, all Asher needed was to get his phenobarbital level down to double the therapeutic amount.  Every day, he looks a little less doped, and a little more like your average baby.

Which he's not.  On good days like this, I have to remind myself of that.  I start imagining a life with him like I'd imagined two weeks ago.  It's hard not to when those eyes look into yours.

It's also hard when you see nothing but progress.  Other than the wires, two big things that would tell your average baby ignoramus, like myself, that something's a little off about him.  First, he's floppy and slow moving, even by newborn standards.  He doesn't grab your finger like other babies, and he has a hard time holding his arms up next to himself when he lays on you.  Second, he still doesn't cry.  It will be interesting to see how much these things change as the sedative levels continue to drop.

He's starting to poop after every meal, just like a baby should.  After his tube feeding today, my hand supporting his butt could feel the rumble in his pants.  As exciting as poop can be, there's nothing like baby poop, especially from a baby that hasn't been doing it.

Tuesday might be the start of a big test - feeding orally.  Everyone of us have secretions like saliva and mucus that get into our throats.  A healthy person will simply swallow these secretions without thinking about it.  For most of the past week, those secretions have stayed in Asher's throat, which you could hear when he breathed.  The fear is that this is because the part of the brain responsible for involuntary actions, like swallowing, is damaged.  In the last two days, though, he's been breathing quietly, giving me hope that he's started swallowing.  If he can swallow saliva, maybe he can swallow milk.

In closing tonight, I'd like to acknowledge the prevalence of pictures of my chest on this blog.  It's certainly been prevalent in Asher's short life, as evidenced by the hairs we have to pick off of him every day.  Some have said that they've seen my nipples more than any man outside marriage.  To that, all I can say is, you're welcome.


Saturday, May 5, 2012

Warmth

Today was quiet and relaxing.  There seem to be fewer people in the NICU.  Asher slept most of the day, opening his eyes only a few times briefly.  Some positives of the day include Asher handling increased amounts of milk through the feeding tube, having fewer phlegmy sounds in his chest, yawning, stretching, and all around cuteness.  Much of our time was spent visiting and laughing with friends we feel very grateful for.

As I type with him on my stomach, I feel like he's given me his first, honest-to-goodness eye contact.  We've tried to be quieter and stay out of his face today, and it seems to be working.  At work, I sometimes use an analogy of getting a cat to come to you from under a porch.  The harder you try, the louder and scarier you get, and the further the cat gets from you.  We wanted so badly to interact with Asher this week that at times I think we scared him away.  Backing off by talking to and touching him less feels like it's helped lure him out a bit.

There was no big news on tests or milestones today.  Dr. Allen, Asher's geneticist, stopped by to discuss some things that he'd be looking in his testing, though so far nothing has been found to explain the "why" of Asher's condition.  Genetic testing is improving rapidly, and might someday be able to provide answers, but not now.

This is the most unexpected and important thing that's ever happened to my family.  Yet somehow, a need to explain why or how this happened has escaped me.  I'm glad for that, as it's something we'll likely never know, though that doesn't always keep people from trying to explain the unexplainable.  What's hard for me is not the "why" of the past, but the "what" of the future. Both seem unlikely to be answered.

I wondered today if Asher would ever have a girlfriend.

Our nurse mentioned that she had been in the NICU the day I came upstairs with Asher.  I think I talked to her, but she was only vaguely familiar to me. As she described what I looked like at the time, and I reflected on what those first hours were like.  Devastation.  Dissociation.  Questions to her about that morning that I couldn't quite form went unasked.

I remember I was freezing, and confused as to whether it was the room or me that was cold.  As Brad sat with me, I told him they'd get him a blanket, like they did for me, but he didn't need it.  Tonight, I'm sitting comfortably in nearly the same spot, shirt open, Asher on my chest.  We're both warm.

Yin and Yang


Today started about as rough emotionally as yesterday ended, with lots of thoughts and feelings left over.  I began to question my plan to return to work today, but after saying goodbye to Riss' parents, I decided to give it a shot.  This was my first attempt at trying to integrate my old life into my new identity.

The day went well, thanks in large part to the caring people around me at the high school.  Slowly, I began to feel like a therapist again, and got some good practice at telling kids what had happened.  I didn't feel I could hide it from my kids, many of whom were very excited for the baby, so I decided to be up front.  The day ended with the client who had been very excited and who I knew would take it hard, but who processed it well.  A good day's work was done, and my head had cleared a great deal from the day prior.

On the way to the hospital, I got a list of good news from Riss.  The physical therapist explained why my family and many of you have been saying - not making eye contact is normal.  In fact, in Asher's case, it's probably a sign we're overstimulating him.  I think I'd have a hard time empathizing with any newborn, let alone one who's been though what our son has.  It's easy to forget that just opening his eyes, being stroked, or hearing us talk can be exhausting for him.  Looking away from us might just be his way of saying "Dude, back off."

We're going to lay off the oral feeding for a few days, giving the sedatives more time to work their way out of his system.  Hopefully, he'll be able to latch on better then.  I have to wonder how much of this is a break for Asher, and how much it's a break for his parents.

Physical therapy went well for him, and the therapist felt Asher was responding to the interventions.  He didn't have a single seizure today that we could see.  The nurse swears that, ever so briefly, she heard him cry.

Best of all, our geneticist had ensured that Marissa and I are not related.  You can imagine my relief.

Small things gave me happiness today.  I took Asher's temperature under his armpit.  He didn't like it, and let me know by fighting it, which I liked.  Asher has poor muscle tone - that is, he's floppy.  Feeling him tense up is a welcome change.  I also felt like there was progress in his sucking response.  Holding a wet cloth in his mouth to wipe of his spit, he quickly began sucking.  While that's good, it's only half of the equation.  He also needs to swallow.


As with the eye contact, we're still learning Asher's language.  While Marissa held him today, he began moving his head around, making us wonder if he was uncomfortable.  I was ready to put him back in the bed, not wanting to overstimulate him.  With our nurse's help, though, we soon figured out he was rooting.  Mom's producing a lot of food, probably enough to feed the entire NICU, and Asher could smell it.  Since it's an involuntary, instinctual response, it gave us hope that this part of his brain is still functioning.

He's very different depending on whether it's Marissa or me holding him.  On her, he's active, and has tended to stay awake the entire time.  Mom's exciting.  With me, though, as long as he's comfortable, he's more relaxed.  Today, he quickly fell asleep on my chest.  I was right there with him.


The last two days have been an exercise in managing expectations.  Hope is so necessary in this journey, yet within it lies the seed of something destructive.  Left to grow out of control, it can come crashing back down on us.  When that happened yesterday, it was hard to see the hopeful things that were still left in front of us.

Our nurse put it best.  Asher didn't have a bad day - we did.  As I felt myself getting too high again today, I asked her to list some things that might happen on a bad day for him.  He might not handle the milk well.  He might not swallow.  Seizures could come back.  He will have bad days, she said.  Today was not one of them.




Thursday, May 3, 2012

Reality check

After two good days, I suppose it was time for a reality check.

The day started well, still riding on the first two days of holding Asher and the hope of continued improvement.  I called Asher's nurse for an update, and was greeting by more hope.  Today, we'd try to start feeding orally.  This is the factor that most affects when we will be able to bring him home.  She said that his oxygen levels had needed to be increased, but she spun this into gold, noting that he seemed to need less oxygen when we're near him.

More encouraging, the nurse reported that Asher had his eyes open most of the morning, looking around.  This being one of the things we'd been hoping for the most, I hung up and got us moving toward the hospital.

After spending time nuzzling and changing Asher's diapers, we left our boy for a conference room filled with doctors, case manager, a chaplain, and our family.  Yesterday, Asher had an EEG, measuring neural activity, and an MRI, which took a picture of his physical brain.  The results would give this team of talented people direction in how to proceed.

While there were some improvements, Asher's brain activity is still much lower than you'd expect in a normal brain.  The somber tone of the doctor told us what this meant in his eyes.  His MRI was better than the EEG, signaling there might still be room for improvement, though this also showed physical damage to Asher's basal ganglia, thalami, and "white matter".  On Sunday, the doctor had said possibilities range from Asher showing few or no effects to being severely physically and mentally disabled.  Today, he narrowed that range to between moderately and severely disabled.

My heart retreated into itself.  It felt like a sentencing.  After a long dialogue of questions and answers, one doctor must have had enough of the cloud opposite of him at the table, and began offering us reasons for hope.  The MRI was better than expected.  There is still sedative in Asher's system that might depress his EEG.  Newborn brains are very plastic, and can recover from things other brains can't.

The wave of the last two days had crested with the morning's hopeful phone call, and by the end of the meeting it had crashed on top of us.  We pulled ourselves back out to Asher's bedside and tried to gather some excitement for a possible feeding.  A bottle of breast milk in hand, Marissa gave Asher his first taste of the best food a mother can give.

Like so many experiences of the past week, though, this ended ambiguously.  Asher tried so hard to suck at times, but couldn't get enough of a latch on the bottle to take in much milk.  We resorted to Plan B - a feeding tube through his nose and into his stomach - and will try the bottle again tomorrow.

Then came time to hold Asher for the third day.  When the nurse picked him up to hand him to Mom, his eyes began to open, and we began to hope for some quality bonding time.  As the holding went on, though, something felt wrong.  Asher wasn't making eye contact with his mom.  He seemed distant, searching with his eyes but unable to connect.

My mind began to slip back into the place that's been so dark for me this past week - the future.  I wrote this week that what I want most is a relationship with my son.  Marissa echoed this.  Eyes open, we had what felt like our first opportunity to connect with our son, and we were denied.

I think I began to lose it first, but really Marissa and I crashed at the same time.  Like most supportive couples, when one of us is shaken, the other is the rock.  Even in the early days of Asher's story, aided by exhaustion, Marissa was my emotional rock.  I don't think we've ever had a harder time finding the rock than we did today.

Then a terrible thought came through my mind.  I didn't want to hold him.  Many things have happened this week that I never thought possible, so in that way this was nothing new.  But it hurt to feel this way.  I knew how it was hurting Marissa, and could see how it felt this was getting us further from what we want most - that relationship.  Marissa and the nurse could see my hesitation when they asked, so they took the pressure off by offering put his head under my chin.

I held him, but I couldn't help but try to engage him.  Somehow, it was less painful for me when I was denied than Marissa.  Still, perhaps because of the emotional exhaustion, the holding today felt awkward, like a middle school dance.  I was worried about him being uncomfortable, and returned him to his bed before I had to.

There's a Mother Teresa quotation on the wall leading into the Mission NICU:  "Be faithful in small things because it is in them that your strength lies."  A phone call to my family reminded me that there were plenty of good, small things that happened today.  His eyes were open for hours.  There was almost no seizure activity.  The MRI was... not terrible.  But today, one small phrase - "moderate to severe" - started us down a path that negated many small things.  Tomorrow, we'll gather our strength.


Wednesday, May 2, 2012

"My name is Asher..."


"... I come from the future."

(hearing and vision test)

The one where I say thank you

Today feels like it will be the least eventful day yet, though not for Asher.  Another EEG is on the schedule, as well as an MRI, which requires a parade of Asher's cords, tubes, and machinery through the hospital.  The former will get a post-test of Asher's neural activity after the hypothermia treatment.  Sedatives will still interfere with getting a pure reading, but we won't have the cooling pad confounding things.  The MRI will provide a picture of the brain and its structure.  It will also look for signs of a stroke prior to birth, though the neonatologist is not expecting this to be the case.  Damage from a stroke is typically localized in the brain.  It's believed Asher's "insult" caused more widespread damage.

A call to the NICU told us he's tolerating the warming well, with decreased seizure activity from yesterday.  He's also off of his blood pressure medication now, another positive.  He had seemed to be growing rapidly, which we really liked, but it turns out a lot of that was water he's retained.  He was given a diuretic, and I'm happy to report my son took a massive dump.  Four ounces.  For those of you scoring at home, that's a small hamburger in his pants.


For us, it seems there's little to do at the hospital other than the very important job of being and bonding with him.  We're both very excited to hold him again today.  We've spent another morning taking care of business at home like worrying about insurance and cleaning.  One order of business should be something that I don't feel has been done adequately, though that might be because of its impossibility.

Even before Asher's birth, we'd felt so much love and excitement coming in from the world around us.  When our feelings turned to shock, fear, and pain, I felt the world shake with us.

I work a lot of kids and families who've been through traumatic events.  There are three well accepted needs of a person in order to recover from an event like this: safety, mourning, and re-connection.  A person must re-establish a sense that they (and those they love) are safe; they must mentally process the event in their own way; and they must connect with the world around them.

As I watch myself and Marissa go through these stages, I'm struck by how critical others are in the process.  Amid the shock and horror of watching my child swarmed with doctors and nurses, intubated, and rushed to the NICU, I also felt as safe as a person reasonably could.  I mourned with Brad by my side in those first hours.  And I've reconnected with the world through your visits, texts, calls, Facebook messages, and the almost 8000 (!) views of my curiously long blog postings.

Keep clicking refresh everyone, it feels good.

There is no healing without you.  I do feel like we are coping as well as can be expected, and that is a direct reflection of the tsunami of love and support we've been washed in.  I would love to respond to each and everyone one of you individually, but you've been far too loving for that to be possible.  The tsunami has been too big.  Just know that we have read every one of your messages, listened to each voicemail, received every gift, and enjoyed every visit.  Each one has given us what we need most - hope.

From the bottom of my heart and soul, I say thank you, thank you, thank you a million times.


Thank you.



Tuesday, May 1, 2012

A bushel and peck (or, Thawing our babycicle)

Our first night at home went well, and gave us some much needed quality rest.  As good as Mission was to us, there were a lot of things - visits from nurses, social workers, nutritionists, more nurses - that got in the way of being with Asher.  In some ways, even though we're 15 minutes and not one floor away from him, it might be easier to see him.  

We managed to lounge around most of the morning, then made it to Asher in the afternoon.  Brad joined us there, and I'm glad he got to see Asher in a better state than day one.  Asher's nurse told us they'd been slowly warming him since 8am, and that once he got to 36.5 degrees Celsius, we'd be able to hold him for the first time.  

In the meantime, she delivered the day's news, which was small to some but important to us.  The neonatologist had previously told guessed that there was a 50/50 chance Asher would come home with a feeding tube, meaning he would not be able to eat on his own.  Nurse Tacy offered us some hope, saying that when she put her finger in Asher's mouth, she MIGHT have felt the beginning of a swallowing reflex.  Very unscientific, but hopeful nonetheless.

Partly because of all the sedatives to reduce Asher's seizures, he's been mostly silent so far.  It feels like we're the first parents who, days into parenthood, desperately want to hear our baby cry.  The sedatives have also kept him pretty inactive.  The first couple days, we were just happy to see him moving his arms and legs on his own.  He also hasn't shown much movement in his face or mouth.  So today we were very excited by things like this:


Marissa and Asher had a few routines established well before birth.  One was reading Dr. Seuss books, especially The Foot Book.  Babies love hearing anything rhythmic, even before birth, and will sometimes respond to those same rhythms after birth.  I can still hear Marissa reading, "Left foot, right foot, feet feet feet.  How many different feet you'll meet".  But the most consistent rhythm came from a song.  At least once a day during the entire pregnancy, Marissa would sing "A Bushel and a Peck" to Asher.  


Anything can happen once.  Twice can be a coincidence.  But three times is a pattern.  I've seen three times now where Asher has become much more active when Marissa sings their song to him.  This has also happened even through high levels of sedatives.  I'm starting to believe he responds so strongly to the song, he fights through the drugs to connect with his mother.  Yesterday, he opened his eyes for the song.  Today, he practically got up and danced.  

As he was being warmed, seizure activity increased.  This was always a possibility during the warming process.  There are some points in the videos above where you can see what his small seizures look like - look for the rhythmic chin quiver.  These seizures were bigger,  involving more of his body, so the neonatologist gave the go ahead for another sedative to calm him.

By 5:30, Asher had been thawed, and was ready to meet his parents.  The cords and tubes presented an obstacle, but our nurse did a great job of making this important experience easy and comfortable.  Below is the video of Marissa holding Asher for the first time:



As time goes on in these videos, Asher is receiving more and more sedative.  Still, it feels like Asher fights through the medication to talk to his mom.  Once he changed position, getting more skin to skin contact, he really got vocal:






Today was a special day for us.





After Marissa was done, it was my turn.  We were creeping up on 6:30, which is one of the two times during the day when no visitors are allowed.  But Tracy, knowing how important this was to us, drew the curtains around us and let us stay for some extra time.  

Oxytocin is the body's "love chemical", giving you a warm, fuzzy feeling.  Lots of things get it pumping, but nothing so much as holding a baby.  If I look a little stoned below, I think it's because my Oxytocin levels are near lethal.  This was one of the most relaxing moments of my life, to the point I stopped answering Marissa's questions.





We left lovedrunk.  Gerry and Joel had a wonderful dinner waiting for us.  It felt like a celebration.

Forsythia

A few weeks ago Marissa randomly came home from Aldi with with a forsythia bush.  It was just a tiny little start in a plastic bag, only cost a couple of bucks, and she was excited about how they'd look in the yard.  Problem was, I was busy with other things at the time - the vegetable garden, the patio, the lawn.  So I neglected it.  I think the best use it got was being dragged out into the yard by Buckley and used as a chew toy.  

A week or so passed, and I found the start out in the yard, the victim of Buckley's love.  As the dirt limply fell away from what used to be to roots, the plant looked like little more than a dead stick.  Marissa and I had a "discussion" about when and where to buy plants, having a plan for them, and so on.  Feeling slightly guilty about my neglect, I found an old plastic pot and tossed some dirt in there with the plant, just to see what would happen.  I didn't have much hope for it, though, and didn't give the plant much more thought, let alone water.

Weeks later we're home from the hospital.  I wake up on our first morning here, with Joel and Gerry asleep and Marissa quietly pumping.  There are pepper plants outside that need planting, and that I hope have survived their own neglect over the weekend.  Outside, I find Andrea or Keith had cared for them, so I start working.

When I walk by the left-for-dead forsythia, I stop.  It's mostly still a stick in a pot, a sad sight, looking like it could an artist's commentary on the state of society.  Except for the leaves.  At the top of this stick in a pot, fresh, light green little leaves are sprouting.  Despite the neglect and abuse it had been through, not getting nourished in nearly the way it was meant to, this little guy is growing.

Who knows what this bush will look like in a week, a month, a year?  It might do as I would have predicted weeks ago, dying off.  Maybe it will miraculously bloom into a glorious forsythia, just what we thought we were getting.  Or perhaps it will be somewhere in between.  With some effort, it might grow into something that we weren't expecting but that, because of that effort, I will be so much more proud of.

It's amazing at times like these how the mind finds meaning in the world around us.  I'm going outside now to water the forsythia.

Baby steps

A little more progress today.  As I mentioned before, Asher opened both eyes for the first time, and his eyes continue to show increased responsiveness to light.  Considering this was the first major concern about his neurological function, I really like hearing this.

The doctors will do an MRI later this week to examine his brain.  One thing they'll look for is evidence of a stroke.  Dr. Thingvoll doesn't believe this happened, so we might be scratching off one explanation that I can actually understand.  He also said they'd be looking at his "brain structure", which sounds like it has the potential to hold good or bad news.  One thing we're trying to keep in mind is the resiliency of a baby's brain.  While an adult can take a blow to the head and never be the same, baby's brains have a greater ability to heal.

We met with met with another nice doctor from a palliative care team.  To most people, palliative care means "end of life", but not in this case.  They're trying to approach this as a team, and are going to organize a family meeting with doctors, social workers, and even the rabbi who was going to do Asher's bris.  That doctor, who formerly worked on an ICU, is concerned about the ongoing seizures and is going to talk with the neonatologists about more aggressive treatments.  I'm grateful we have some competing opinions going, and that they're being openly discussed with us.

We sat and talked about what we understand about Asher's situation, and then talked about our hopes for him.  It was a difficult conversation for us both, but an important one.  Marissa talked about wanting as normal a life as possible for him, playing and getting in trouble.  I didn't say much.  At first, I wasn't sure what I was allowed to hope for.  As I thought, I decided my hope is something I would have taken for granted just days ago.  I want a relationship with him.  I want him to understand I love him.  If I can get that, I know I can be happy.

Marissa was discharged tonight, and we're home now.  It feels like we're starting a new phase of this journey, one that might involve wanting to be at the hospital more than we can be.  They offer some twin beds in the NICU for people to sleep in, but it's not a Holiday Inn, let alone home.

Marissa's parents are here with us, thankfully.  Being the generous people they are, they spent the day deep cleaning our home.  We walked in and were greeted by a kitchen we barely recognized.  Like us, her parents are dealing with this in their own way - keeping busy.  Now that we're home, the ways Marissa and I cope will have to change.  I just hope those changes are effective.