11 Months

Here we are. The last month of Zach's first year. It's hard to imagine that in just a year, we went from the wrinkly preemie who would occasionally forget to breathe to the chubby, robust baby who cruises and babbles. Mama. Dada. Bababa. I love hearing him "talk" in his lilting little voice. It truly is music to my ears. And the teeth have finally come, as well. He has 2 now, both on the bottom. They aren't even all the way in, but two tiny little buds of teeth that show only when he gives us the biggest of Zachy smiles. This week, we are going to be making the trip to see John's parents, and Zach is going to celebrate his first birthday with family. We'll come home and celebrate his actual birthday here, with just the four of us. The way it all started a year ago. It seems appropriate. Fitting. After all, when we were going through the hell of his pregnancy, it was just John, Evan, and I, clinging to each other, just trying to get through. And after all of it, it will be Zachary with the 3 of us, celebrating his presence here in our lives.

I still swear he is an angel.

As far as Zach this month goes, he loves being outside. He loves the sun and the trees. It really is his first spring, and he is starting to absorb all that is around him. The chirp of a bird. The breeze on his cheek. 2 days ago, he went outside and we actually let him go in the yard, with close supervision of course. It was so fun to see him explore and learn. I didn't even care about the dirty knees. I even sat down in the grass with him, watching him go.

He's really starting to enjoy toys as well, and it is hilarious to hear him giggle at a noise one makes. His favorite is the baby laptop we bought him when he insisted on trying to get at mine everytime I would attempt homework.

On the food front: we went ahead and, after the last drop of my milk was gone, made the switch to cow's milk this past week. He is doing great with it. No problems whatsoever. He feeds himself more and more. I only spoon-feed him the really messy stuff: yogurt, applesauce. He handles the rest. Most of the time, he eats in the buff because he has decided he hates all bibs except for the Bebe auLait reversible bib. If they have a velcro closure, they are coming off, and that is that as far as he is concerned.

He laughs and coos at Evan to no end.

He steals our hearts again every day.

He's everything.

Ending for the Third Time

I am finished with breastfeeding/ exclusively pumping. It was great. It was real. We did it. I'm glad we did and despite all of the trouble, there is no doubt in my mind that I would do it all over again. I love him that much. But it's really over. I finally got myself down to where I can quit pumping. Yesterday, I pumped twice and only produced 1 ounce total, on both sides, for the day. Yes, I'm really done this time. And to tell you how really done I am.....(Erm, I should say "finished", because the mix-up of finished/ done, as well as the exchange of good/well are just two of my pet peeves.)

So anyway, I was about to explain how finished I am.

I am so finished that I made a phone call to a local breastfeeding boutique tonight to see how I could go about selling my pump. The big MamaJamma. The Symphony. The one that retails for $2K. And at first the woman didn't really believe that I bought one. She said that most people who have brought them in have stolen them, that they only own one themselves and the rest of theirs that they rent out are actually leases from Medela, etc. I gave her the serial number and she called Medela and discovered that it was indeed sold to a buyer by the name of Andrea XXXXX, that it is available for resale. And she offered me $1K (and another $200 in merchandise was thrown in), which I thought was pretty damned good considering I have used it for the better part of a year. And with my employee discount at the hospital, I only ended up paying $1600. So if you do the math, it cost me $400 to use my own Rolls Royce of breastpumps for 8 months. And so I met her this afternoon and sold my pump.

I sold it.

John couldn't understand why I teared up as I was packing it up. Because he is a man and just doesn't get it. I did everything. I really did. And we had a good run, Zach and I. I remember when he stopped nursing altogether and I thought it was over. And then the pride I felt when he drank a full bottle of my milk and seemed to prefer it to formula. When Zach was about 4 months old, I dropped down to where I was getting 1/2 an ounce total output for both sides and I thought it was over. And I kept on. We have toured every nook and cranny of Cincinnati in order to find obscure herbs recommended online by sites advising on increasing milk supply: teas and tinctures and capsules. I remember the day John went to run errands and came back to find me completely topless with Zach in just a diaper in his Moby Wrap while I was doing the dishes. Desperate for time to do Kangaroo Care in between my crazy pumping schedule, this was the only way I could manage to do it. He really did think I had lost my mind at that point. But if it was supposed to increase supply, I was going to do it. I didn't care what it was.

I sold my pump.

I hated the damned thing. Waking me up every 2 hours. Sucking the life out of me in more ways than one. Making it so my life was consumed with pumping schedules and ounces produced and ways to get more, more, more. But I loved the thing. Because you cannot convince me that it would not have been over when Zach was just 2 months old if I hadn't bought it. And I am so connected to this baby, and I believe this is why. Because while my body wasn't tough enough to maintain him during the pregnancy, damnit I was strong enough to feed us both.

I sold it because I knew that I would always try to do better, try to do more. That so long as my body kept making mere drops of milk, I would try to make ounces. I had to close this chapter.

I sold my pump. This chapter is closed. I love you, Zachary.

10

Ten. 10 months. This week, I had to fill out my schedule request for the next 6-week schedule to come out, and I had to remember to mark myself off for the big day: Zachary's first birthday is that soon. And then, as if I wasn't already feeling that, today I got an email from the photography studio we use to recieve some discounts for his first birthday photos. And yesterday in Target, I saw all of the Birthday Boy stuff they have. And I started bawling in the middle of the store when I saw the little tee with a big blue 1 on the chest.

It was just yesterday.

It seems as if Zach's first year is flying by even quicker than Evan's did. As a matter of fact, next month, because of the way everyone's work schedule is falling, we are going to be making the trip down to John's parents' to celebrate Zach's birthday with them. There'll be cake and ice cream, and of course presents. And we'll sing "Happy Birthday" to him. And I will cry. Just like I cry every year with Evan. But Zach? This is hitting me even harder. Maybe it is because I'm getting older. Maybe it is because we always assumed Evan was to be the only child and Zach seems even more of a gift because of it. And more than anything, I don't ever want that gift to leave me. Having an older child has shown me just how quickly it all goes by. And so while this is the first birthday of many, I know that 2/3/4/5/6/7/8/9.....that they will all whirr by me in rapid succession. The tee with the blue one on it for that day and then the next day he is wearing a cap and gown, or a tux for his wedding. And even then, it will still have been just yesterday.

Just yesterday that I felt the last of those horrendous contractions and I begged the NICU staff to bring him to me. Just yesterday that the days of new babyhood flashed in a blur of home and togetherness and cuddles. Just yesterday that I held him on my chest and cried from his beauty.

So today, Zach is 10 months old. For 10 months, my very soul has existed outside of my body. For ten months, I have witnessed a miracle daily. And I won't bore you with milestones reached or new things he is doing, other than to tell you that we swear he said "Bubby" the other day, which is what we call Evan. This was the first time he made a consonant sound, and so now we know he is okay. Everything has fallen into place. He has escaped the debaucle of his pregnancy and premature birth literally unscathed, making him even more of a miracle.

2 months left of his first year...

I have loved being this little boy's mother. I cannot believe that he was not always a part of the plan. John is my heart. Evan has been my life and my breath. But Zach? Zach is my soul.

Another Chapter Ends

Where to start?

I remember when I started to get into the throes of my pregnancy with Zachary, and John and I started to make lists of the things we needed. And we got to feeding supplies, and we started to discuss whether we were going to go with breastfeeding. I wanted to with Evan, but his prematurity got in the way and neither of us ended up interested at all. Did I want to try it again? Not really, because I was kind of afraid to get myself invested in the idea. I had breastfed Ben for a couple of months, and when it didn’t work out, I remember crying the first time I gave him a bottle of formula. And with Evan, I just felt guilty that we didn’t give it more of an effort. But knowing how breastmilk is the best for the baby, and seriously thinking Zach was to be my last chance to do so successfully, I decided to give it a go. One more try.

Wow.

You start off with the idea of breastfeeding as being this remarkably bonding experience. With a mind full of rosy images of a tiny baby nuzzling at a mother’s chest. Of cuddling and warmth and a bond that can only be shared between mother and child. A bond that cannot be broken. And I think after the pregnancy horrors I faced, I really needed that. And then Zach was born.

It was never supposed to go like it has. I was not supposed to be separated from my baby immediately after his birth after only having a small glimpse of him over a surgical drape. And I remember John bringing pictures of him from the NICU for me to see while we were still separated, and it was so bizarre and surreal. I had endured so much for him and this is what I got? Some blurry images on a digital camera that John barely knew how to use? Was this little  person really my son? How could I be sure when I couldn’t hold him and touch him and smell his newborn scent? They said he was mine. And I could see a family resemblance, so it had to be true. He was beautiful, that was for sure. But really? I begged and begged for them to bring him to me. Everyone said he was doing great and had just needed a little longer to adjust to the outside world. So if he was fine, then he belonged with me. If he is mine, he belongs with me.

And just like that, he was with me. I kicked everyone but John out of the room as I stripped away layers of flannel blanket to look him over. So perfect. So so perfect. And then and there, we nursed. And all was right with the world. Suddenly it all was okay- the pregnancy, the time in the NICU. Suddenly, it was just Zach and I. I loved it. And I hated when the lactation consultant came in and told me he had to have formula and asked me what type I wanted them to give him. I hadn’t planned on that. And so my love/hate relationship with the pump began.

I hated that I had to pump at all. I hated that he got formula. I wanted to cry each time he took a tiny sip of it. 20 mL at a time at first. I gave him every bit of breastmilk I could. I wished they would have told me it was okay to stop the formula when my milk came in, but they didn’t until it was too late. And the supply issues started. I did everything I could and got most of it back. And then the latch issues happened, most likely a result of the bottle feeding he had received. Phrases like “nipple confusion” and “flow preference” entered my vocabulary. Still, I did everything. Always trying trying trying to get him off of the tiny amount of formula he was getting a day. And then when he wouldn’t nurse at all anymore and I learned what it meant to exclusively pump. And my reality became the breastpump, 15 minutes at a time, 8-10 times per day. I’ve kept that up since Zach was 4 months old. I hated it, but Zach was getting breastmilk. That was all that mattered. I still felt a deeper connection to him because of the months we spent together, nursing. That is how I spent the weeks of my maternity leave. And when I first returned to work, I would come home and Zach would nurse with me in the bed as I drifted off to sleep. Zach and Mommy. That’s all there was.

It has been such a difficult road. Difficult but rewarding. Worth it. I honestly can look at the differences in personalities between Evan and Zachary and I think the breastfeeding has something, if not everything, to do with it. Zach seems more content. More secure. I cannot help but think that this is because he had more of a connection to me.

So why am I writing this now? Because this afternoon, John helped me to gather up all of the supplies I have needed to exclusively pump. All of that equipment. And I cried as I made sure all of it was organized and packed away. This week and next, Zach will get what is left of my milk from the refrigerator and freezer, and that will be the end. When I initially started out, I said one year was my goal. In a perfect world, free from latch issues and prematurity, from supply issues and tongue-tie, I would have done one full year. I am pretty proud of myself that I made it this far in the face of all of the difficulties. By the time it is over, Zach will be 10 months old. He is to the point where he is getting more and more food from sources other than a bottle, and I feel like it is time to focus on enjoying the rest of his first year free from the stress of measuring every little ounce, from setting alarms to remind me to pump every 2 hours around the clock. I can spend time enjoying my baby boy and getting some well-deserved rest knowing that I gave him the best for 10 whole months.

So here is a picture for you. This is what thousands of dollars’ worth of breastpumps and equipment looks like. All of my work fits into this tote. Amazing. And the picture wouldn’t be complete without including in it the reason for it all.

Delayed

Evan is recovering nicely from his recent illness, which I'm thinking was viral. Zach ran a temp between 102 and 103.5 all weekend, and although it broke Sunday morning and has not returned, his inbility to tell me what hurts had me taking him to our family doc yesterday to be sure all is well. Yay for Zach! Everything checked out fine, so it was either viral or was caused by teething. (Nope, no teeth yet). While there, with a doctor I work with repeatedly in the ICU's, we went over Zach's milestones again. He's so hard to gauge because I compare him to Evan, who did everything at the speed of light, except for speaking. And I have tried to be laid-back about the whole thing: Zach will do whatever when he's ready to do it.
The moral of the story is that the doctor is worried not about Zach's fine or gross motor development--those have a way of catching themelves up and any mild slowness has mostly been the result of prematurity or simply from baby chunk and resolves itself. But he was worried about the sensory stuff: that Zach still, at 9 months, gags on anything thicker than nectar-thick (the consistency of pudding is too thick for Zachy!), that he isn't babbling mamama/ dadada/ bababa yet. And so the first step is an appointment with an audiologist at my hospital to ensure that there is no hearing impairment. I should mention here that we don't think there is at all, but since it is the number one source of this sort of delay, it has to be ruled out. I can tell you that his newborn hearing screen was perfect, as was the more indepth one they did because he was premature. He has never had problems tracking us by the location of our voices. When we speak to him, he looks and smiles. We are both sure that his hearing is fine. It is more of formality than anything. Something we have to rule out in order to go to the next step.
So what is the next step from there? Well it could be one of two things. Given that Zach has always had green nasal drainage from birth, it is entirely possible, according to our doctor, that there is a pocket of fluid in his ears. It also is unlikely because he has never had a single ear infection, and usually babies with drainage problems will have fequent ear infections. We are really hoping this isn't the case with Zach because it will mean he will need tubes in his ears. Surgery. I don't even want to think about it.
So after both of these are ruled out, Zach will be seeing a developmental specialist at Cincinnati Children's Hospital Medical Center. I have mixed feelings about this. I hate that he has to even go there. This is where the overzealous doctor made the false allegation with Ben, for starters. It is also where Ben was treated by the team of pediatric cardiologists, and thus holds some very painful memories for me. And that place is terribly depressing. Nothing will make you appreciate your healthy children like a stroll through that place,where you are liable to see anyone from newborns to teens with these horrifying medical conditions. And then on the other hand, there is relief. Because while you never want to need them, you feel absolutely grateful that there is a facility a stone's throw from home that breaks ground daily in just about any treatment for children imaginable. They even work in collaboration with Good Sam to do surgery in utero if need be (Yes, it's called The Fetal Surgery Center of Cincinnati or something like that). (Good Sam is the OB Mecca I griped about while on bedrest if you followed my pregnancy blog. Gah! I hated going to that place!) If there is something wrong with Zach or he needs any sort of treatment or therapy, I can trust them not only to find it, but to be completely competent at treating him. And that is about the only ray of sunshine in this whole Godforsaken mess.
Because I cannot get it out of my head that this is my fault. That I should've lied about my contractions while pregnant. Because if I would have done that, there would have been no home uterine monitor. And thus no trips to the hospital. And no drugs. And no early c-section. But my God, the drugs...3 months of the Brethine pump, plus the oral form I took before the pump and the subcutaneous injections I got each time they sent me to the damned hospital. The mag sulfate--evil, evil mag sulfate. The indomethacin. The steroids to speed him up in there. The damned pain meds it took to get me through that last month, which my OB assured me were safe. And the progesterone shots. I keep wondering which one it was, knowing full and well that it is likely none of them that did this. Which brings it back to me. Which takes me back to those last months of my pregnancy and makes me contemplate whether I could've held on longer. It's so easy to speak of this now when I have had nine months with my angel and am free from that pain. But then? If I put myself back in that place, I think I can honestly say that I did the best I could. Me and my uterus of which medical mysteries are made. I have to be nicer to myself about this. I was in an active labor pattern for months--literally--and I effing functioned like that. Yes, I did the best I could. And while I am not trying to stroke my own ego here, I think I would be hard-pressed to find many others who could've endured that for as long as I did. But still...
And John's reaction! Argh! Since he dropped Zach and I off for the appointment that was supposed to be a routine check and ran errands with Ev, I had to explain all of this to him. And his response to all of this still infuriates me: " ARE YOU TELLING MY SON IS GOING TO BE RIDING THE SHORT BUS TO SCHOOL??????" Seriously. And then: "We'll have to get a 'Slow Children Playing' sign for the yard just for Zach." I know he was just trying to make me laugh, but still. I could've killed him, I swear. Completely unhelpful and inappropriate, John.
So anyway...
I have to wait. I have to hope all is well, or that his delays are so mild that minimal therapy will fix it all. I still hate that we are in this place.
The ball starts rolling on February 28th, when Zach sees the audiologist...

8 Months and a Nagging Feeling

Yesterday, Zach turned 8 Months Old. I couldn't blog because I was out and about town. Upon returning home, John and I watched The Social Network, which I had been wanting to see. All of this served as a good way to stall the 8 Months post, which is great, since I have dreaded saying what I am about to say.

I'm worried about Zach. I really am. He is doing nothing new this month. He still just scoots instead of actual crawling. He's gotten better at it. He's quicker, and I can tell he's stronger by the way he reaches and turns. He'll get almost up to where he is on one leg, with the other three appendages up in te air trying to get stuff that has caught his interest. He'll sit unsupported for a couple of minutes before he suddenly faceplants or flops backward, which means I have to worry about him getting hurt and so I always just lay him on his back to play unless I am sitting right there. We aren't making any consonant sounds when we babble. He still has no teeth.

So what is he doing? Well, he's doing everything a little better and more purposefully. When we are out of his sight, he looks for us. The same with toys, which tells me he understands object permanence. When playing with him on the floor, he'll pull you toward him and put his mouth on your face to give a kiss. He's taking solids better. He'll finally hold his own bottle, though we still cuddle with him at feedings. He's very very social and can command the attention of an entire room of people. Yesterday, we were at lunch when his smiles, giggles, squeals and coos had strangers in the restaurant coming up to our table to comment on his cuteness. He can do the whole pincer grasp thing now. And he wants to play. He loves clapping hands. One day, I was trying to teach him to clap his hands by taking his hands with mine and clapping them for him. Instead he learned how to clap my hands and so now he will grab my hands with his and clap them for me. He's still a chubster. He's engaging and happy. He watches everything like a hawk and you can just see him learning!

But the things he isn't doing yet just grabs my attention and induces worry. I keep reminding myself of his prematurity in an effort to quiet the nagging feeling. I'm sure this has a little to do with some of it, as does the fact that every baby is different and that babies don't develop uniformly. They may mature by leaps and bounds in the cognitive arena one month then turn and make strides in the motor skill area the next month. Evan did all of the motor stuff way early and by the time he was a year old, we already had him in a toddler bed because he had learned to escape his crib and I was worried the leap to the floor would hurt him. But then he talked really late, prompting us to hae him evaluated by a developmental interventionalist. Turns out all was fine and when he did finally speak, instead of monosyllable babble, it was in clear and complex sentences. I'm hoping Zach will be the same and will do everything in his own time.

So for now, the plan is to watch and see what happens this month. He goes for another well-child appointment next month, and if I am still so worried, I'll discuss it with the doc and get a referral to have him evaluated. In the meantime, I will stew over every dose of every medication they gave me while I was pregnant and I'll worry about every day that we could have kept him in there and didn't. And I will fret that this is all my fault and if I would have just lied about the contractions, all would be fine right now...

Lessons Learned

Somedays, I absolutely love my job. And like most people, there are day where I hate it. And then there are sometimes where the love and the hate are one in the same. Yesterday was one of those days...
A patient who broke my heart into a million little pieces. I was called to intubate this elderly woman who had been discovered down in her home. Without heat. She hadn't had the resources to pay her electric bill and her core body temperature was 74 degrees. She was in that shape for days before she was discovered by a relative. And the family! So guilt-stricken, not only because she had asked to borrow the money and they told her they didn't have it, but because nobody had checked on her in days.
A patient who made it all to real for me. A nice-looking, clean-cut guy. Dressed casually in a fleece and a pair of jeans, much like I do on winter days. I was sitting at a computer in the ER, charting away, when he came up and handed me this folded piece of paper, asking if he could use the phone to call these people. I unfolded the square of paper, soft and worn so that it was about to split where the creases had been, and dialed the number for him. It was for the emegency cold shelter the city sets up for the homeless on freezing nights. My first thought, considering his manner of dress and the way he spoke, was that he was calling for someone else. Since he carried on the conversation right there at my desk, I couldn't help but hear his end of the conversation. He had been carrying the paper around with him, too proud to use it, until it just got too cold and he had no choice. I heard him tell the person on the phone that he hated to take a bed from someone who needed it more, and so he had never used their services. But on that night, he didn't have a coat, either, and so he couldn't sleep on the streets. He even offered to sleep on the floor to take as little space as possible, if he could just sleep indoors that night.
The patient who was a reminder. I got called to the NICU for a preemie. 23 Weeks, 3 days. She or He wasn't delivered yet, but mom was dilated and her membranes had ruptured. They were doing an ultrasound because they suspected placental abruption, in which case an emergency c-section would have to be performed. They were trying to send her across the river to the OB Mecca where I was sent many times during both of my pregnancies. Apparently OB Mecca was full to bursting and so had to triage. This means they were only accepting patients to which they could provide the most help. 23 weeks is on the cusp of viability. 24 is the magic number, and so they turned her away. Her doctor had to explain to her the odds of the baby surviving with any quality of life intact. At a certain point of gestation, we automatically resuscitate, no questions asked. 23 weeks is not that point. And the mom had to make the decision that we were going to let her baby die peacefully in her arms.
People ask me all of the time how it is that I do my job. I usually tell them that for every single one we cannot save, there are several we can, so there is a balance. And for the ones we cannot save? I get to go in that room with that patient who is terrified of death, and I get to do something, anything, to make it a little easier for them. And then there are nights like yesterday.
Heart-breaking, soul-crushing nights. Nights where I take each and every one of them home with me. These happen to be the nights I get something out of my work.
The hypothermic woman reminded me to hold my loved ones closer. To never, ever take them for granted.
The homeless man, at a time when I am financially drained from the year we have had, reminded me that I may not be able to buy myself anything and everything I want right now, but I have a warm home filled with love on these cold, cruel nights of winter.
And the mom. Oh, the mom. She brought every contraction back. Every hospitalization for not one, but two pregnancies. I swear I could feel the needles in my hips. I could feel my belly torque and twist deep down. I was 18, 19, 20, 21, 22 weeks pregnant all over. I was in fear for my babies' lives all over again. But this time, instead of the depression that follows each time I deal with a preemie since my return to work, something very different happened. In the same instant those horrible things were brought into my mind, my head filled with other images. Evan's first cry, first step, first day of kindergarten. Those nights this past summer where the pregnancy was over and I spent five blissful weeks just getting to know Zachary. Zach curled into my chest, deep asleep. His beautiful smiles and giggles. Candles on birthday cakes and tiny baby feet. The smell of baby lotion and the sounds of John playing with our boys. Squeals of delight at a new milestone conquered. I was reminded of what could've happened to us and of what didn't happen. Of what we've survived and what we've escaped. And while I know that my last pregnancy did something to me emotionlly, I am on the way toward healing.

We are, all of us, just minutes from a moment that could destroy us. That family never dreamed they would never speak to their mother again. I'm sure the polite, clean-cut man never dreamed he would be homeless. And I'm sure that mom never dreamed she would have to make the call to allow her baby to die. Any of this could happen to me. Instead of letting this consume me and depress me, I am choosing to let this be a lesson learned: to appreciate everything I have, to love the family I have, and to focus not on the ways in which my children came into this world, but the moments I have had with them since.

On Being Caught Up

The past few weeks have been all about the kids. Zach turning 6 months old, getting Ev started with a therapist...

Zach had his 6-month well-child visit today, during which the entire fam got flu vaccines (yes, even Zach). Except for me: I had to either get mine or sign a waiver the first week of October. Aside from the flu vax, Zach got 3 other immunizations. Poor baby! But we also got the good news--there is not a single bit of evidence of his prematurity. He has surpassed his 4-month developmental milestones and his 6-month ones as well. They still evaluate him based on both gestational age and chronological age. For height and weight, he fell somewhere in between the 50th and 75th percentile, compared to the 25th at last check. I cannot believe this since the kiddo is huge to us: 18 pounds,12 ounces and 25 inches long! But we are comparing him to Evan, who was a very scrawny 15.5 pounds at one year old!

As a matter of fact, Zach is so caught up and doing so well that we are nixing the RSV vaccination. He met all of the criteria for it, and we were seriously considering it. On one hand, he doesn't go to daycare and thus is not exposed to other kids, is far from being the frail little preemie, and more. On the other hand, in my line of work, I could easily bring it home to him from work, he really is a preemie despite his size, and he has a big bro in school. Of less consequence to me was the cost ($1500 a shot, and a shot monthly during RSV season) of which I had no idea how much insurance would cover) because I really didn't care if he needed it. But the consensuss is that he doesn't!

So anyhow, I can quit the worrying/ guarding/ counting/ adjusting/ blaming myself that comes with being a mom of a preemie. My preemie has surpassed some of his full-term peers!

Lucky Me

Last night, I got the call I have been dreading since my return to work. To the NICU. For a preemie.

I got to work on the baby immediately. A little boy. 3 lbs., 4 oz. Tiny, yet perfectly made. Lungs not wanting to work. I didn't ask questions, other than to make sure we weren't dealing with something that would affect his treatment. No meconium aspiration. C-section delivery. He was obviously a preemie. Gestational age? 35 weeks, 5 days. Delivered after an amniocentesis assured mature lungs, and a long struggle with preterm labor for the mom.

Chills ran up my spine.

Zachary.

Evan.

You know, I try to treat all of my patients the same. I try to treat them as I would want my loved ones to be treated if one of them were to fall ill. But I would be lying if I said anything other than that I treated this baby better than any other patient I have ever had. My touch was more gentle. My dealings with the family more compassionate. How could they not be? I saw Zach's and Evan's angel faces in his eyes. And my heart broke just a bit for the moments where I have allowed myself to forget that both of my boys are true miracles. We are so blessed. We are the lucky ones. How could I ever permit myself to forget that for even a second?

I have made a decision. My hospital is building a state-of-the-art new NICU so we no longer have to ship such high-risk cases out. They are, as we speak, assembling a core team of therapists for the role in the NICU. I didn't think I could stomach it. I thought it would rip my heart out daily. I thought this was a good reason to say no. Now I know that this level of care and understanding makes me tailor-made for the job. When working with adults, one has to be almost heartless to make it through. For this job? One has to be all heart.

Changes

I've been watching Zach, waiting and waiting for that first real social smile, that first baby attempt at talking (coos and other vocalizations) and have been sorely disappointed time and again. In fact I was starting to worry a bit, watching the calendar and realizing he is into his second month of life. They should be occurring anytime. Running into our family doc at work in the wee hours of the morning yesterday did a world of good for me. She reminded me of something.

Zach will be 6 weeks into life here in a couple of days. But truthfully, he is only a week or so old right now. With that being said, he has been making plenty of changes. I was looking at him yesterday, as he was sleeping in his bouncy seat while I cooked dinner. And I noticed these little changes. The soles of his feet, once smooth as glass, have started to develop little creases. The cartilage at the tops of his ears is more formed and less floppy. The lanugo that once covered his entire body is now limited to his upper shoulder area. His skin has has started to lose the looseness as he develops fat stores. He chokes less and less often when feeding as he has learned the suck-swallow-breathe routine. He is more alert for larger periods of time. This is great as his face has lost its puffiness. He opens those huge blue eyes and just looks around, seeming to absorb everything. And his breathing has become much less erratic. This last one was a biggie for me as an RT. In the early days, he was having apnea spells (more so in certain positions). When he would lay flat, it often was bad enough that I would notice a dusky appearance and have to lift him up or nudge him to remind him to breathe. We never got it treated. I knew they would just order an apnea monitor, which can be a great tool, but often just causes more alarm and panic than necessary with false alarms. Or they would keep him in the hospital to monitor him. Why? So they can watch him? He has his own personal respiratory therapist! Even the babies in our NICU don't have this, as they often just call us for problems, and even then we can't possibly be with only one baby all day, everyday. But anyhow, all of these were signs of prematurity that we even use to estimate gestationl age in preemies in a hospital setting.

So Baby Zach has been doing plenty of changing. It's a lot of work for a little guy like him, so I have to be more patient. I have to avoid falling into the trap of being fooled by the fact that he was average full-term size at birth and remind myself that he was still a preemie. Now that his due date has come and gone, I can look forward to the fun changes one expects.