Happy Zach

Generalized Crap

Not much going on here except work, work, work, pump, work, nurse, pump, yell at Evan to do his homework, then repeat. I pretty much hate my new work schedule, even though it is what I asked for. After being off of work for over 5 months, thought I would need to get my chops back, and so I have tried to avoid signing up for several 12-hr. shifts in a row. Plus, with me waking every few hours to nurse a baby or pump, it makes it easier when there are days off in between. But.....I feel like I never have time off because the days don't come in stretches. That was, they didn't until this week. I am off until Friday night, with the exception of an 8-hour computer class on Wednesday for the new software the hospital is getting. Holy crap! So what's new?



Well, in my quest to turn myself into a one-woman dairy farm, I broke down and called our area La Leche League leader. She was wonderful, and we talked about what I could expect at the meetings and more. I gave her a brief synopsis of my breastfeeding woes and she advised me to start taking blessed thistle with my fenugreek. Ok. Done. I missed the month's meeting by 2 days, but found out they meet in my hospital! So I will be going to try it out for September's meeting. Yay! Maybe I'll meet others in the same boat.



Other than that, there is one more development. I've gone Bat-Shit Crazy! Yep, you read that correctly. As if I wasn't already an emotional minefield, I now have something new to add to the mix: I have started having nightmares. Crazy ones, too. And some that aren't terrible but just seem so....real. Yesterday I swore I woke up to the feeling of one of my progesterone injections. (This is where I admit that they hurt like HELL!) In my dream, Evan was the one giving me the shot instead of my RN, and I just kept thrashing, saying, "But I've already had my baby!" And when I awakened, I was crying. So yeah, I'm going to seek out somene to talk to. I'm starting with our hospital's EAP in the hopes that just a few sessions will be adequate, and in the event that it isn't, they can then refer me. I definitely want someone experienced in this sort of thing.


Other than this stuff, my days and nights blur together to where they are almost unrecognizable. I blame night shift. And my pump. I blame that too. It is the bane of my existence these days, especially since Iave realized that Ido not have the luxury of slacking off on this. My milk supply is too fragile. Very little increases it, but if I so much as skip one pumping or nursing session, it decreases. Unfair. But I have come to realize, with the help of Zach's weight gain and level on contentment, that each ounce of breastmilk I give him is a sort of gift. So for now, in light of all of the work it has taken, I am choosing to focus on the fact that I have been breastfeeding him for almost 4 months. One third of my goal of one year! Go Me!

On that note, I am going to pump! Ha!

A Touch of Love

I don't know who wrote this, but as I was sitting awake last night, thinking of how quickly my babies are growing, I vaguely recalled it, and searched and searched until I found it.

You were six months old and full of fun,
With a blink of my eye, you were suddenly one.
There were so many things we were going to do,
But I turned my head and you turned two.
At two you were very dependent on me,
But independence took over when you turned three.
Your third birthday, another year I tried to ignore,
But when I lit the candles, there weren't three but four.
Four was the year that you really strived,
Why look at you now, you're already five.
Now you are ready for books and for rules.
This is the year that you go to school.
The big day came, you were anxious to go.
We walked to the bus going oh so slow.
As you climbed aboard and waved good-bye,
I felt a lump in my throat and tears stung my eyes.
Time goes so fast.
It's hard to believe,
That just yesterday you were home with me.
And tomorrow when the bus brings you home and you jump to the ground,
You'll be wearing your cap and graduation gown.
So I'm holding to these moments as hard as I can,
Because the next time I look, I'll be seeing a man.

Poop Enigma

Zach only poops every other day, which turns out to be perfectly normal for him. Its color and consistency vary based on the amount of formula and breastmilk he gets the day before the Big Poop. And I mean BIG POOP. As in he needs an entire wardrobe change and sometimes even a bath afterwards. With my work schedule lately, these Big Poops usually happen to John. Tonight I just happened to be home, which means it was my turn to deal with it by default.

Nothing could have prepared me for it. Nothing.

First I opened the crotch snaps of his little jumper. Then the onesie. Of course I could tell from the outside that some had leaked on his side. And I was initially happy. Here lately I have been so fed up with the milk supply battle that I have switched from my regimen of pumping every 2 hours to just nursing Zach. I don't think I am ever going to have a full supply again, so instead I can relax and focus on the bonding with my baby boy that comes with physically nursing him. Of course this means I have very little idea of exactly how much breastmilk he is actually getting with a feeding. But the little bit of leakage I detected was yellow and seedy, telling me he is getting a significant amount. Oh Happy Day!

But then I actually got the clothing pulled up far enough. And I unfastened the front of his diaper. And the look on my face must have been comical because Zach got all giggly and smiley on me. How in the blue hell does a child poop forward????? I mean exactly that. There was absolutely nothing on his bottom. Instead, it was all up his front. And no, he was not laying on his belly when the Big Poop occurred, thus allowing gravity to do the job. He was semi-reclined on his back in his bouncy seat. And there was so much of it that I went through 3/4 of a wipes container to clean it up.

Somehow I managed to get the soiled clothes and onesie over his head without getting it all over his hair. Don't ask me how. I was actually contemplating cutting his clothes off with my trauma shears that I use in codes at work, but he was wearing an expensive outfit, so I resisted the urge. But that is when I did the unthinkable...
Here he is, still all giggly and smiley and kicking his legs with reckless abandon, and I made the mistake only novice mothers make: I left the diaper too close to his kicking legs. So it is no mystery how it ended up all over his be-socked foot, which then contacted his other leg. And before I know it, his entire front side is....well, you get the picture.

Of course by this point, all I can do is take him straight to the bathtub after wiping it all up with wipes. But then I made another novice-mommy mistake. I carried him at arms length, facing toward me, through the house to the bathroom. Weapon cocked and loaded. And I needed a shower afterwards, too, for my sweet little angel hosed me down good with his pee. Of course this provoked more funny looks and strange noises from me, which delighted Zach even further. More giggling and smiling. More leg-kicking. And this time, I even got some little squeals to go along, which made me laugh. Of course I never dreamed there would be a day that I would laugh while being soaked with pee. Evan never did this to me. (He did throw up in my mouth once, and then there was the time he ate his own poop, but that is a story that is just too traumatic to discuss ever again!)

So there it is. We have found Zach's special gift: his shit defies the laws of physics.

Baby Blues

Before I even start to say what is that I want to say, let me start by saying this: I know I should not feel this way. I know I am just about the luckiest new mom on the planet. After a horrible pregnancy, I delivered a premature baby who was the size of a full-term baby. And other than a few mild bumps in the road, he had no physiologic impact of his prematurity. For this I am very thankful.



But...



I do not know what in the hell is wrong with me lately. My baby is 3 months old and I feel horrible emotionally. I burst into tears at the slightest provocation. And I literally feel jealousy toward other pregnant women, which I know is awful. So I have been doing some soul-searching lately to determine the root of my problem, since I am not generally a mean-spirited person.



I feel as if I was robbed. And despite the fact that noone wants me to have another child, my doctors included, I find myself wistfully looking forward to the day when I can have another baby. Because some part of me wants another chance to get things right. And I cannot tolerate the idea that it is all over for me. 2 days ago, I was organizing Zach's clothes in preparation for the coming season change. And I came across a very small amount of things he has recently outgrown. As I folded them and placed them in the storage bin to be packed away, I wanted to scream. Instead, I cried, provoking John to ask me what was wrong. I tried and tried to voice to him how I was feeling, but all he could think was that we have this sweet, perfect baby boy and how could I possibly be sad? H couldn't get that Zach's outgrowing his tiny newborn things (really not even newborn things, but preemie sizes designed for babies up to 7 pounds) is just more evidence that it is all really over before I am ready for it to be.

So yes, that is the perfect statement--that I was robbed. I will never have the pregnancy and childbirth experience a woman should have. And I cannot blame the medical establishment or politics of obstetrics. This is all because of my own body. Hell, I haven't even had the breastfeeding relationship I hoped for. Instead, I have to work for every ounce of breastmilk Zach consumes, and virtually nothing increases my supply while the tiniest little thing will make it drop even further. So yeah, I want to do it all again because I want another chance. Of course I know how illogical this really is. Another chance just means another opportunity for one of my pregnancies. They already told me it will happen with every child I have.

This all makes me wonder if I am suffering from postpartum depression. I don't feel hopeless, can feel joy and enjoy my baby, so I think not. I think it is more just a delayed case of the baby blues. When I start to think that I should maybe find someone to talk with about it, I just feel silly. Regarding the breastfeeding, I keep wanting to seek out a group to join, but I am afraid there will be noone there who can relate to my experiences and it will just leave me feeling more bitter, which is the last thing I want.

Of course the few of you readers who followed my pregnancy blog or read it after the fact are probably disgusted with me right about now. I was so ready back then for it all to be over because I was so miserable. Now that it's all is behind me, I'm complaining. Maybe I just never will be satisfied.

To My Dearest Evan

Here we are, on the eve of your first day of third grade and I cannot sleep. In fact, I cannot quit crying. I wish someone would have told me how quickly time would pass. How looking back, each stage and challenge we have faced would be but a fleeting moment in time.

Raising you has been, so far, the greatest challenge I have faced. You are so bright that you outsmart me on a daily basis. But now, as I reflect on the nine years we have had together, I want it all back. I wish I could bring back the myriad of moments we have shared and relive them together, taking even more time to treasure each and every bit. You don't remember it all, but I do. Perhaps the greatest gift I can give you is the memories of your childhood, so that you can see through my eyes just how amazing and miraculous you truly are.

I remember the troubles we had having you. You saw what we went through to give you a baby brother. It was the same with you. The night a young doctor walked into my hospital room and told your daddy and I that I was having a miscarriage and all they could do was help me be comfortable as your life slipped away from us--that very night is etched into my mind as if it just occurred moments ago. The tears we cried! Already so in love with you that our hearts were breaking. A love so palpable that even the young doctor could feel it and agreed to give me drugs that weren't even indicated that early in pregnancy. But they worked, and I knew then and there that something great was occurring, that your life would somehow and in some way end up being a gift to the world. And we held on because you were so wanted. Through all of the tests and drugs and hospitalizations.

And then you were here with us. You entered the world with the lustiest scream I have ever heard, almost 2 months premature, and yet so ready for the world that you didn't even need to be suctioned. And you were so beautiful. Everyone who had the privilege of gazing upon you saw your beauty. And the miraculous part is that this beauty I am speaking of never faded.

You don't remember colic, but I do. The nights you screamed from some unknown discomfort while Daddy was at work and it was just the two of us. I wished then that it would end. Now, looking back, I realize that those nights gave us some of our most sacred moments. I would clutch you close to my heart and sing songs of love to you to quiet your hurt as best I could while I got to know you in a way nobody else ever will. My baby boy. My angel.

You were just nine months old when you began to walk. In fact, you walked before you talked. I cried when you took your first step because I made it harder for you. My shouts of excitement startled you so much that you lost your balance and plopped down on your diapered bottom. The look of shock on your face! I wish I would have known then that you would start taking baby steps further and further away from me.

And when you first talked! We had been so worried. You were almost two and weren't talking. I worried and worried and took you to specialists because I was fearful that something was wrong. Why weren't you talking? Of course now I know this was just more evidence of how special you are because I had to make you talk. You were too smart and could do for yourself and just had no need. You never did have a real first word like "mommy" or "daddy". Instead, one day out of the blue, you toddled up to me and tugged on my pants and said, "I want a cookie." Just like that. Plain as can be. Not a first word, but rather a first sentence.

Time passed at lightening speed and before I knew it, it was time to send you to school. You were a full year younger than your classmates, and when we took you for pre-kindergarten testing, you looked so small next to the bigger kids. But you were also much smarter than any of them. Your teacher adored you. The sweet innocent little man you were! At recess, all of the little girls would want to play house. And you, so small that the clothes you were wearing came from Baby Gap, would always have to be the baby. And they would push you around in a stroller meant for dolls. But you let them and never complained because that is your nature. And you became even more loved because of it. Anywhere we would go, we would come by people who knew you. "Hi Evan!", they would exclaim, while Daddy and I looked at each other with confusion. Who were these people and how did they know you?

I remember the day we found out you were different from other kids. Mommy cried a lot of tears that day and you wanted to know why because you were so concerned. "Gifted", they said. "Freakishly high intellect". I knew then that life would be a little more difficult for you because you just think differently from the rest of us. And the struggles with school started. Do we keep you with your age group or put you where you belong academically? And I began to have fears that I would fail you in some way. That the decisions I would make for you would end up being less than the best. And then I had to learn the hard lesson that I will not always be able to fix everything for you and my heart broke.

I am not the perfect parent. I make mistakes. But I do know that I have done a good job. I know this because I know you. I remember one day we were at the playground and there was a mentally retarded teenager playing on the swings amidst children your age. And those children were making fun of the boy because he had the body of a grown-up but still wanted to play like a young child. You could see the pain and confusion on his face. I felt fear as you started to approach the boy. I didn't want you to add to his hurt. As I made a motion to go a intervene, your dad held out his arm to stop me and told me to watch and see what happened. I did, and my heart swelled with pride as you took that boy by the hand and led him to the sand pit and proceeded to build in the sand with him for over an hour, despite your peers' taunting. And I saw, then and there, the kindness in your heart and knew that I must have been doing something right in the years I have been blessed to have you.

So here we are, and I am sad. Third grade. And your ninth birthday in just a matter of days. It is all going too quickly for me. I know we will build new memories together for me to add to my collection. It's just that those steps you take, Evan! They just keep carrying you closer to the day you will leave me. And I worry that the world will not be ready to see the beauty and wonderment that is you in the same way I have. But at the same time, I cannot wait to see your life unfold, to witness the amazing things I know are in store for you.

I know the past year or so has been difficult for you. First you had to adapt to the idea of a new baby in the house after almost nine years. Then came the medical issues as my body tried to fail Zachary like it tried to fail you. And before we knew it, Zach was here and you had to adapt to having to share us. But you are so tough and strong and resilient that you handled it better than most adults could. I know, with all of the time we have had to devote to Zach, that you question your new place in the family. I am telling you now that it is still, and will always be the same. My baby boy. My angel. The love of my life. One of my greatest miracles. My life. My breath. my heart. My one and only Evan.

With Love,
Mommy

In Pictures

So yesterday, Zach had his first photo shoot to capture him at the ripe ol' age of 3 months. Of course, I am his mom, so it could not have possibly been organized. Actually, I completely forgot to call and make the appointment. So when I called to see if there were any openings, and they asked if I could be there by noon, my reply was "SUREEEEEEEE! No prob!"

Of course this was before I looked at a clock and saw it was 10:59. And so the scramble started. Clothes and shoes and belts and socks were tossed with abandon. Boys were hastily scrubbed clean. And yes, some obscenities were muttered through clenched teeth. How we actually made it to the studio way too early is beyond me at this point.

Of course the shots in the first outfit for each boy went amazingly well. Zach was content and happy, and gave us some great laughs thanks to the photog who was channeling Chewbacca. But after I changed his clothes for the first time in the session, he decided he had had enough. Armed with no tricks other than a bottle of breastmilk, we were out of options as he screamed and wailed. Until I got the bright idea of letting him drink from the bottle in between shots. So it went suck-suck-suck, yank it away, and flash, then repeat. So some of the shots reveal our trick as his mouth is still in bottle formation
Regardless, we did manage to get some great shots to freeze both boys in time for me. The star of the day, of course, was Evan. That kid is so photogenic that it makes me borderline-sick.
Then came the part I hate. Choosing. They take all of these adorable shots of your babies, and unless money is no object, you have to pick. Gah! And I always end up spending way more than planned because I can't narrow it down. So yesterday, I ended up leaving with 5 huge wall prints, 8 8x10's, more 5x7's than I know what to do with, and literally hundreds of wallets all in about 8 different poses. Of course to order less must mean I don't really love my kids, right? Ha!

So here they are. Pictures of Zach so sweet that we personally cannot look at them without smiling. And pictures of Evan that show how much he has grown in a way that breaks my heart. Saved in that moment, just as they are. In case I blinked.

Summer's End

Next week, Evan heads off to the big Third Grade. Our summer vacation is over. The summer that 3 became 4. The Summer of Zachary. Of recovery. Of Evan learning to be a big brother. Wow.

I remember when I first found out my due date, when I first discovered Zach was coming. I had all of these rosy visions of my summer off of work, on maternity leave, with nothing to do but hang with my boys. Ha! I should've known that, with my history of my pregnancy with Evan, things would not go as planned. Instead of having 6 weeks of time with just Evan once school let out last year before Zach's arrival, Zach came home from the hospital 2 days before Evan's last day. So the entire summer was spent adapting to having 2 instead of 1. So much for quality me with just Evan. So much for plans.

So now here we are. Ev goes back the 16th of August. We are one year closer to the day when he will be heading off to college. Of course this dreaded day is being rushed as we are trying to make the decision on whether we should send our little angel to the gifted and talented school in 5 th grade like is being reccommended to us. This would mean he would be graduating 3 years early. Right now, I can't even handle the thought. But in the meantime, 3rd grade is.

Customer Service

The latest thing in healthcare (well, over the past few years, anyway) is "customer service". The basic idea is that you have a choice on where you receive health care services, and we want your business. This is great, generally speaking, but it brings with it some problems.

When you are sick, you go to a hospital because we know what we are doing. We can figure out what is wrong with you and know how to fix it. If we cannot fix it, we know ways to at least make you more comfortable. A hospital, however, is not a hamburger joint or a shopping mall. We want you to be involved in your care, to be able to make informed decisions, and more. You have the right to accept or decline any treatment offered. But here is the clencher: You cannot always have it your way. We are not Burger King.

So let's look at our customers. Generally speaking, the "customer" is the patient. The problem is the patient is ill, may be in pain, depressed, irritable, you get the picture. We get drug seekers who want nothing more than their Dilaudid or morphine and get quite disgruntled when their doctor orders them up some Tylenol. We get hypochondriacs who think every twinge indicates the need for horribly invasive procedures. And we get people like my patient the other night.

It was 4 AM, and I was the charge therapist. I was not assigned to this particular unit of the hospital, but I was carrying the ER pager when a very distraught nurse called. Turns out she had an asthmatic patient who said he was having an asthma attack and she was not getting an answer from their therapist. I looked up the man's meds and said I would be up right away. By the time I looked him up, retrieved his ordered medications and made it to his room across the hospital, a measley 4 minutes had passed. To put this time in perspective, we have 20 minutes to respond to a STAT order before anyone asks questions. To make my time even more impressive, we had just had a rapid response call and a code blue.
As soon as I walk into the patient's room (a patient who appeared to be in no respiratory distress, by the way) I was getting screamed at for taking 4 minutes. He accused me of trying to kill him. Seriously? I grabbed his spacer and the inhaler out of my pocket and started to give it to him. A word about the spacer: we use them not only to increase efficacy of medications, but also because they have a one-way valve that means we can use the same inhaler on multiple patients getting that particular drug. This saves money for the hospital and patient because a 200-dose inhaler doesn't go to waste on a 3-day hospitalization. But this guy didn't want to use the spacer and started to argue while I was trying to explain its necessity. He ripped the spacer/ inhaler combo from my hands, took off the spacer and threw it at my face, and continued to take 5 puffs of the inhaler in the most ineffective way imaginable. Since this was a new inhaler, I could not leave it with him. Thinking he was done, I reached out my hand to get the inhaler and this is when he scratched up both of my arms and took a swing. By this time, all of the commotion had aroused a family member of a patient across the hall, and she had emerged from her room to witness the entire ordeal. I ended up having to call security to get the med back--I can't leave it with the guy, even though it is now garbage by that point. I am responsible for its administration. So security gets there, and asks why he is hitting staff members. This is when the patient says I hit him, that I was doing nothing to help him, that he never took any dose off of the inhaler, blah, blah, blah. When security asked him why they should believe him, his response? With and evil smirk, he said "Because I am the patient." Then he proceeded to threaten to call hospital authorities on me.

Of course his plan was foiled. He actually left red welts up my arms and a mark the distinct shape of his closed fist on my upper arm. And there were witnesses. My supervisor and department director saw all of these the following morning before I left for my shift. But this man is still in the hospital and has had security called to his room for one conflict after another nightly for 2 weeks.

This is what we deal with. This is what happens when some people get too much power. I knew I was in the right, so he didn't get what he wanted from me. But what of the other people he has been terrorizing? People who are afraid to lose their jobs or are afraid of frivolous lawsuits give in to this sort of behavior. (Yeah, he threatened that too, by the way, when in truth, because he was mentally competent, I could've been the one pressing charges on him for assault.) All in the name of customer service. Of keeping the patient happy. Even knowing I did the right thing, I was still a teensy bit worried. Customer service is such a big issue that when the customer complains (i.e. the patient) it is a Big Fricken Deal.

With all of this being said, I usually do what it takes to keep my patients happy. I fetch ice water or snacks when it is not against medical orders. I tuck them in with warm blankies. I leave the door open or shut to their specifications, and much more. None of these fall under the specifications of my job. It's just something I do. Again, customer service.

But....If the mantra of customer service is "the customer's always right", then my experiences have shown me that this has no place in healthcare.

Hey John!

Vacay?

"Nursing Vacation", that is. As in the one Zach and I took all day. Basically, Mommy and Baby hole up in bed all day together and the baby nurses as often and for as long as he likes. It is recommended to increase milk supply. But it is also just what the doctor ordered after a long weekend at work. I now hate doing several days in a row because it means work for 12 hours, sleep all day, then back to work, and so on. I miss my boys too much during these stretches. So Zach and I were due for some quality time together and we got just that today. The photo above is a Happy Zachary after he awakened from one of our many dozes today. Sweet, sweet baby boy!

To My Smallest Patient

To My Smallest Patient,I wish I had a name by which to address you, but to me, you will forever be emblazoned in my mind as Baby Boy. I got the call that you were arriving at 11:30, and made the necessary logistical preparations. Airway equipment ready. Ventilator ready. Suction supplies ready. But the transition from your mom's nine centimeters of dilatation and your arrival into this harsh world took all of 10 minutes. I thought I was ready.

I won't forget how I held your feather-light head in the palm of my hand as your chest fluttered like a baby bird's. How you tried to protest the things we were doing to you but just weren't strong enough to cry. The bones of your tiny face felt so fine as we pried you open to insert tubes to sustain you. My hands shook as I breathed tiny puffs of air into your fragile body. My tears burned the backs of my eyes as I held them in. It is unprofessional to be that affected. Yet I could not help but think that if I did my job correctly, I would never know the outcome. Will you suffer lifelong disabilities because you came into the world so soon? Or would you grow up to lead a normal life? To run the 50 yard dash in gym class and dance with your date at your senior prom?

I will never know. My role is to be anonymous. Your mother never saw me. I was waiting for you in the NICU as she was pushing you into this world, far removed from the drama of her work. And you will never know me for being the one there to take over your vital functions when your own body was unable. You will grow to remember your first date, your first bicycle, your first kiss. I am the one who gave you your first breath. Anonymously.

I did what I had to for you. And then I left you in hands more capable than mine. Hands that do this multiple times a day. I gathered my ventilator and dirtied equipment as they took you away in your plastic box, and it was all high-fives and pats on the back from the team who essentially kept you alive. And I left. And as the elevator doors closed, creating my sanctuary, it was then that I cried.

I cried for you as you endured more pain than anyone should. And I cried for your mom and the tough journey she has ahead of her. I cried for myself and the career I love so much that takes so much out of me. And I cried out of gratitude for the healthy sons I have at home. Either one of them could have been you, as you lay there while people who do not know you fought for your life.

Perhaps the greatest gift is that you will not remember the feel of the endotracheal tube as it slid into place, of the cold blade of the laryngoscope as it pried you open. The needle sticks and chest compressions on still-soft bones. You won't remember my face as you felt these things. And you will never know that we had to keep you from your mother out of medical necessity.

You gave me a great gift last night. You showed me that I can do this. That it is time to shift my career to a different objective, to take on the role of helping other moms and babies who are in the throes of surviving what I did. So thank you, Baby Boy. It is my most sincere hope that I helped you last night instead of hurt.

Lovingly,
Andrea, RRT



Image credit: http://rds.yahoo.com/_ylt=A9G_bF4b8VZMS1oAlLyjzbkF/SIG=1392epco2/EXP=1280852635/**http%3a//babyelandaily.com/2010/04/20/premature-baby-awareness-march-of-dimes-discount/

Obviously, I cannot take a picture of my patient for my blog. He deserves his privacy and so does his mother.