Wednesday, February 6, 2013

Andrew's Birth Story

Well, here it is, better late than never!  I have been writing this in bits and pieces in stolen moments over the course of the last four months.  There are a lot of details here and it is probably a rather boring read for pretty much anyone other than me!  But I love having all of these tiny little moments captured in print for the days when all of this has faded into the foggy recesses of my mind.  I treasure each moment of their birthdays and hope someday they will love hearing about every moment of the best days of my life.

The morning of Andrew's birth, I was up at 5:20 AM to shower and get dressed.  I was really nervous; anticipating the surgery, of course, but also not really knowing what to expect as far as my platelet counts and what that would mean as far as the anesthesia method that would be used.  I knew it would all depend on what the counts were that morning and whether or not the anesthesiologist would be willing to go against the hospital's rule of not doing a spinal if the count had been under 100k in the past month.

We were supposed to leave for the hospital at 6:30 AM, as I was to report to the lab at 7:00 AM.  Dr. S felt that if I had my labs drawn at the hospital lab, they would get the results back faster than having me go through admissions at 7:30 AM and not probably get my blood drawn until 8:00 AM.  This would have been great, but for various and sundry reasons, we ended up leaving later than expected and then getting stuck in traffic.  It is less than fifteen minutes to the hospital, so the 6:30 time I had planned would have had us there early, even with traffic.  But we left too late to account for traffic and I didn't get to the lab until 7:15 AM and there was a long wait. 

So, I was pretty stressed out, wondering if I should just bag it and head over to get checked in, or follow Dr. S's original advice.  I had sent M over to let L&D know where we were and all of a sudden, two nurses appeared in the lab waiting room to escort me over to L&D.  They didn't want to wait for the lab and just wanted to get me started in L&D, so we headed back over that direction.

A memory that stands out starkly from the day of Andrew's birth is taking that walk from the lab to LD for check in.  It was less than a five minute walk, with two nurses as my escort, but it seemed far more momentous that a simple stroll.  Me, nine months HEAVILY pregnant, M, the nurses, all on a "final walk", if you will.  I remember, as each foot went in front of the other, feeling so nervous, so scared, and so excited to meet my newest kiddo.  I tried to commit those last moments to my memory and it worked.  It was "a walk to remember", pun so intended.

We arrived in L&D and were introduced to our nurse, who happened to have a student with her that day.  He was really nice and expecting his own first baby in January.  Dr. S came in while I was getting my blood drawn and he also had a student with him.   They were putting in my IV and also taking blood from the same port.  It burned a lot, but I was just worried about the results and whether or not I would be awake for my upcoming surgery.

Our anesthesiologist (Dr. Wonderful) came in after that.  I have to be completely honest when I tell you:  I fell in LOVE with that man.  He introduced himself and reviewed my history.  In addition to my platelet issues, he also raised concerns about my previous history notes, where I had vomited during both sections.  I thought, as my last anesthesiologist had told me, that it was simply par for the course and couldn't be avoided, but he said that it COULD.  I was skeptical, but when he said he would do a spinal if my counts were above 90k, I didn't care what he said, he was my new BFF.  If he could also keep me from throwing up, well, I would have to seriously consider naming Andrew after him.

We had to wait about a (nervous) half hour for the platelet results.  M took some pictures, we listened to the gentle beat of our son's heart, and chatted with the nursing student.  Eventually, our nurse came back in with a huge smile on her face.  My platelets were at 90k EXACTLY.  I told everyone that I had willed them to be that level and they all laughed.

Dr. Wonderful stuck his head in a few minutes later and flashed us the thumb's up sign.  "See you in the OR!" he said.

Dr. S came in shortly after that.  He also had a student doctor with him.  He reviewed my history and the student asked some questions about thrombocytopenia.  And then. . . it was time to go.

I hugged M and then it was time for another walk; this one to the OR.  This is another stark memory.  I remember the same feeling walking into the room when I had Emma.  The air is cold, the lights are bright, everyone is bustling around.  It's just another day "in the office" for them, and yet your life is about to change so drastically, it is anything but just another day for you.  As I walked through the door into that operating room, I started to cry. 

"Please tell me I am not the only one who cries when they walk in here!"  I said to my nurse in a shaky voice.  She smiled and said, "No, pretty much everyone cries.  It's a big moment for you."

I was grateful for her compassion.  And as I climbed up on the table, I started to feel like I was going to throw up, and was grateful that she was right there with a bed pan.  I didn't throw up, but I felt close.  Dr. Wonderful came over and noticed my watery eyes and asked if I was okay.  I told him that I was, but I joked that they should start the morphine in the pre-op room so moms weren't so nervous when they came in.  He smiled and handed a syringe over to the nurse, "That's your morphine, right there.  You'll get it in just a few minutes!"  Then he noticed the bed pan and said, "Put that away, we aren't going to need it!"  I was still skeptical, but eager to see him prove his boast.

Getting the epidural was a bit tricky.  It was by far the longest epidural I have had inserted.  I began to lose confidence in Dr. Wonderful.  I was hunched over for quite some time while he poked around looking for a good spot.  He found one, but seemed to have trouble with it, and then I got a weird, painful shocking feeling in my left leg.  I asked if that was normal and he said an abrupt no before pulling out of the insertion and having me reposition.  After I was positioned correctly, it didn't take long and soon I felt the familiar pins and needles feeling down both legs.  I was quickly rolled onto my back and the prep work began.

It was then that I realized how FULL the room was.  In addition to the normal team, there was the student nurse and the student doctor, and also a big GROUP of very official looking people in suits at  the back of the room.  A woman wearing scrubs came to my head on the table and introduced herself.  She explained that she was with the "visitors" in the back, which included the hospital's CEO, medical director, CFO, and the risk management director.  They were there to observe my c-section for process and procedure standardization.  I was a bit overwhelmed by this, as I was. . . well, spread-eagled on an operating table and about to have a baby and there were going to be about a dozen EXTRA people watching.  In suits.  While I was NAKED.  I mean, in one sense, it was comforting, because you just know everyone in there was on their best behavior and I wasn't likely to have a random piece of surgical equipment left in me with that many people observing.  In another sense. . . have I mentioned how NAKED I was?  I just felt really vulnerable. 

And here is where Dr. Wonderful earned his name.  That man was my guardian angel.  He asked if I wanted them to leave.  I said it was okay if they stayed and he leaned down and said, "If you change your mind, let me know.  I'll kick 'em out."  I got the sense that he was only half joking and if I had said the word, he would have asked them to leave.  I felt as if I had a protector, which was a very nice feeling.

He watched my blood pressure like a hawk.  He told me that low blood pressure was usually the culprit when someone gets very nauseous with a spinal (this makes sense, because when I was having my iron infusions, my blood pressure dropped dramatically and I ended up vomiting).  So anytime my blood pressure started to drop, he gave me some wonder drug through the IV.  He also watched the color of my face and he could tell instantly when I was getting nauseous and he was right there.  He held small alcohol pads under my nose and talked to me in a gentle tone.  He made eye contact with me and didn't look away.  He took my pinned down hand and rubbed my thumb and forefinger. 

They finally brought M in and it was Baby Time.  Even with M there, however, Dr. Wonderful was 100% focused on me.  I truly felt like the only person in the world.  In my past two c-sections, the anesthesiologists were just kind of "there".  They were fine and did their jobs, but this man?  IN-FREAKING-CREDIBLE.  He kept me posted on what they were doing (without getting too graphic) and talked to me about my stats.  He kept me very grounded and also distracted from what was going on behind the curtain.  This time, I felt the same tugging and pulling as last time, but it seemed a bit more abstract, almost like it was happening to someone else. 

And before I even knew it, I felt a POP and this release of pressure and Dr. Wonderful said, "Here comes your baby, guys!"

Dr. S shouted out, "We've got a ten pounder here, M!"  And Andrew came out peeing, just like his older brother had.

There was a lot of exclamations about his size.  As with our other two babies, M got up immediately to go to the warmer.  This is where Dr. Wonderful stepped up even more.  He continued to watch my vitals, held the alcohol wipes under my nose, and told me how enormous and gorgeous the baby was.  I kept asking if he was okay (he wasn't crying very much) and Dr. Wonderful assured me he was just perfect, with an APGAR of 8/9. 

M was standing between where I was and the warmer where they had Andrew, so Dr. Wonderful politely asked him to move so I could see him.  And I could finally see his chubby legs and arms (oh, the chub!).  Then he started crying and I started crying.  M cut the cord and I laid there, watching and drinking in the glimpses of my boy.

Andrew was swaddled and M brought him over for my first up close look.  I touched his soft cheek the best I could with my shaking fingers and whispered, "Hello, sweet boy.  Happy birthday." 

The rest of the surgery was a blur and soon.  Dr. Wonderful continued to give me status updates ("Just putting your uterus back in.") along the way and soon I heard the ca-chunk of the staple gun.  Dr. S came to take another look at Andrew, declaring him "perfect".

They had a new device for lifting me from the OR table to a gurney to transport me to my post-op room.  It was this blow up inflatable mattress and it was pretty neat.  It did feel a bit scary, almost like I might fall off of it while it was blown up, but the nurses assured me I wouldn't and kept their hands on me.  They then slid the mattress over to the gurney.  Andrew was placed in my waiting arms.  Dr. Wonderful congratulated us and then had to brag a bit, "You didn't throw up, did you?"

I realized that I hadn't.  If we hadn't already named the baby Andrew, I might have changed it right then and there to Dr. Wonderful's first name.  Seriously, that man was wonderful at his job and made this c-section the best experience of all of them.  (I sent a long letter to his medical group and to the hospital director singing his praises.  I hope he gets the recognition he deserves.)

We were then brought to post-op, where I definitely started feeling the effects of the surgery and medications I had been given.  The room was spinning and I felt very tired.  The nurse took my vitals and Dr. S came in with some specific things he wanted to be watching for in my immediate post-op phase as well as labwork while I was at the hospital.  He then told me he would check in with me later on during the day.

The nurse asked if I was feeling well enough to attempt to nurse Andrew.  I honestly wasn't feeling that great, but I wanted that post-op nursing session, so I nodded yes.  He was brought to me, my gown was pulled down, and that little boy latched on like it was his job.  There was no hesitation; he was a nursing champ from moment one! 

It was in post-op that we first noticed his rapid respirations.  Actually, the student nurse noted it first.  He pointed it out to our actual nurse, who then double checked it and raised her eyebrows at how fast it was.  I asked what they do with rapid breathing and she said they would just monitor it.  She mentioned that larger babies sometimes have a harder time acclimating to life outside of the womb.  One of the major concerns is a baby's ability to regulate their blood sugars, so we had to do a pre and post glucose reading to make sure he was processing them adequately. 

I also noticed that he seemed to be shuddering a bit here and there.  Our nurse called this the "sugar shakes" and said it was completely normal.  His little feet and hands kept turning blue off and on. I pointed this out to M and he reminded me that Emma had done the same thing when she was a newborn.  I noticed the blue crept up to his knees and elbows and mentioned it to the nurse who also declared it normal.  They did place him on the warmer to observe him a bit, but other than his rapid respirations, everything seemed A-okay.  He LOVED the warmer, making us all laugh at how he lay there, with his arms spread out over his head, perfectly content.

We were in post-op for a little over two hours.  It was truly a wonderful and special time.  I knew that this was truly it; my final time experiencing this miracle.  I soaked up every second of it, reveling in his perfection and the sweet gift we had been blessed with.  He nursed for quite a bit of that time, snuggled up perfectly next to me, his fingers splayed out across my breast.  His little shudders the only thing that kept concerning me as I could not remember either Will or Emma making those noises before. 

His post meal glucose number came back in the normal range and my vitals were stable, so it was time to head to our official hospital room.  Andrew was reswaddled, given to me for the ride to our room, and we were on our way.

We got to our room and I was transferred to my bed.  I was in a lot of pain by this point, as the nurse in post-op had meant to give me another dose of morphine before I left, but got distracted with checking Andrew's sugars.  The trip to my room and shifting around had me more than a bit uncomfortable.  My new nurse was getting aquainted with me and the first words out of my mouth were, "When can I have something for the pain."  She seemed a little taken aback by this, as they usually have pain pretty well controlled before discharging you from post-op, so she had to figure out what I was due to have.  Since I hadn't had anything in post-op, I was eligible for a lovely shot of morphine and two precious pain pills.  She went to get those and I got down to the business of examining my beautiful son.

I unwrapped him and both of legs were entirely blue, from toe to diaper.  I showed M who again wasn't concerned.  I shifted his position and the legs pinked up a bit, so I decided I was just overreacting.  I put Andrew on my left breast and he latched eagerly.  He was making that strange noise again, though, and I watched him nurse with mild concern.

Then the nurse came back into the room and started chatting with us.  She took the two pain pills out of their wrapped and I was reaching up for them when Andrew made a funny cry, almost a choking sound.  I looked down and, to my great horror, he was so blue he was purple.

"Purple!" I screamed. "Really, really PURPLE!"

Andrew was dark purple from head to toe. And he wasn't breathing.

The nurse looked down and dropped the pain pills she was holding.  I can still see those little white pills falling from her cupped hand, how big her eyes got, and how her mouth stretched into a grimace.  She grabbed the baby from me and tilted him on his side.  I could see his face and it was still black-purple and he wasn't making any noise, despite having just been ripped out of my arms.  She rubbed and pounded at his back and still no change of color or noise.

She ripped off his blanket and put him on the isolette.  "Call a code!" she shouted to the student nurse who was just standing there, his mouth open.  He awkwardly picked up the phone and just stood there, holding it with one hand.  "I don't know how to do that!"

She grabbed the phone from his hand and yelled CODE BLUE into the receiver.  My heart stopped beating at that moment.  I forgot that I was literally paralyzed from the chest down and struggled to sit up and get out of bed.  Realizing that was impossible, I urged M to go to our baby.

By this point, the room had quickly filled with the resusciation team.  They shoved M back as they started to work on our son.  Bodies were in the way, and I couldn't see everything they were doing (which is probably a good thing as what I did see haunts me to this day).  I saw tubes and wires being attached to him.  I could also see that he was no longer blue and was returing to a pink color. Even so, I was gasping for air, unable to get a breath myself, and I was so scared.  Even typing this bring back that choking, desperate, terrified feeling.  M was at my side, trying to get me to calm down.  He asked if someone could give me something because I think he really thought I was going to lose it.

Another nurse entered the room and came to my side.  She stroked my arm and said, "It's okay, go ahead and cry all you want, Momma."  I wasn't even crying, really.  I was more or less hyperventilating. Again, M asked if I could get something, and I said, "Don't worry about me, I'm fine if he is fine."  The nurse patted my hand and said, "You'll be okay, he'll be okay" over and over again.

Shortly after that, he was taken to the NICU.  My parents arrived and sat with me while M was in the NICU with Andrew.  I cried and cried, longing to hold my precious boy.  I prayed and prayed for him to be okay.  I guiltily remembered my panic when I found out I was pregnant with him, how the timing had been less than ideal, how overwhelmed I had been at the thought of three.  I whispered my apologies to God for ever being anything less than 150% grateful (I was always grateful, just surpised and worried how we would handle it all.). I called our pediatrician who assured me that he was in the best possible place. They did tests and more tests, ruling out anything serious. M kept me updated via text as one cause after another was eliminated. His heart seemed fine; lungs clear; blood infection unlikely.  The only troubling thing was that as each cause was ruled out, the question loomed: What caused it to happen?  Will it happen again?

(Fifteen weeks later, I can tell you that we never found out what happened that day.  Thankfully, it never happened again.  The cardiologist we saw at Children's does not believe it was related to his heart murmur.)

In any case, my desperate prayers were answered and Andrew was returned to our room.  I eagerly reached for him and started to sob as he was placed in my arms.  I held him so tightly and spilled hot tears onto his sweet head, raining kisses all over his beautiful face.  I rocked him as best as I could from my semi-reclined state, thanking God over and over again for this second miracle.  I vowed to never again take this amazing boy for granted.

I was afraid to nurse him, for fear it would happen again.  I put it off for as long as I could and then rang for the nurse when it was time.  She understood completely and stood guard while he latched on and nursed.  She stayed the whole time, watching for any signs of something going wrong.  Nothing did.  He nursed like a champ and then went to sleep in my arms.  I was then afraid to put him down.  I told the nurse that I would not be able to sleep that night, for fear it would happen again.

She understood, but urged me to get some sleep.  I still couldn't.  One of the nurses finally offered to take him to the nurses station with her for a couple of hours so I could rest.  It was only then, twelve hours after my surgery, that I was finally able to sleep.  Even then, my dreams were filled with images of my blue baby.  I was relieved when the nurse brought him back to be fed.  I made a nest out of pillows and sat up after I was done nursing him, just watching his chest rise up and down. 

Finally, Andrew's birth day drew to a close.  It had been a rollercoaster of a day and one that I will never forget.