Friday, May 30, 2008

The Tell.

What happened between the time he was born and now? What about that time?

Exactly. That's exactly what I want to know.

It took time for everything that happened to sink in, as I watched my OB sweating and didn't know why. I asked for blankets and saw his brow furrow as he asked me if I was cold or just shaking.

The placenta did not deliver normally. It had to be helped by a shot of pitocin, then another. My doctor had to manually remove a blood clot, then another. There were bimanual compressions, a fist inside and pressing from outside, all as they tried to get my uterus to contract and get me to stop bleeding. For weeks, months, I had contracted and now I wasn't and that was bad, bad news.

It took time for me to realize that the reason my son is covered in blood in the pictures my doula took is not because I tore, though I did, but because I bled everywhere, on everything. I didn't know until much later that the blood bank had already been called because it wasn't stopping, that the reason my doctor seemed surprised I was asking about my son was because he was so worried about me.

We're fighters, my son and me.

Sometimes I wonder now if what happened in the delivery room was the reason my postpartum nurses didn't massage my uterus the way they had after my daughter's birth. I'll never know, nor will I know which glitch along the way was the reason for the complications I've seen after.

We now believe that the reason for my son's grunting after birth, the reason for the bacterial pneumonia that almost took him away for us, was tied to an infection that was most likely brewing in my uterus from before he was born. It would explain a lot of my preterm contractions, how crappy I could even explain why my uterus wouldn't contract after the birth. Hindsight being 20/20, it could explain a lot.

The day after J was hospitalized, I mentioned to our pedi that I'd been running fevers, felt awful and hadn't received a call back from the OB's office the day before. He agreed to talk with the OB office's oncall doctor during rounds to ask if he'd see me so I wouldn't have to leave, but the answer was no, I needed an ultrasound. I said I wasn't leaving my son. He said "if you continue to get sicker and die, you'll be leaving him for a long time. Get your butt into their office." Strong language from a laid-back guy, so I took it.

I'll never know why the OBI saw (not my own) gave me the wrong antibiotic or didn't give me methergine to make me cramp when the ultrasound several things I hadn't yet passed, and an area of my uterus through which there was no blood flow. I'll never know why she didn't seem to connect the dots between my visit and my statement that my son was in the PICU with bacterial pneumonia. Why she didn't realize that I'd pointed out to her I'd stopped bleeding before I left the hospital, when I know that wasn't normal at ALL.

What I do know is that what followed, at least in my own health care, became a comedy of errors. The wrong antibiotics or the right one given too short a time, symptoms that never fully went away, courses that ended with me feeling better but not whole, with raging symptoms to return within days of stopping the meds. Telling doctors that I didn't feel right, my uterus felt like it was burning, telling them I'd been fighting a fever for so long even though it had turned into a low grade fever.

In the midst of this, the little recovered. He came home on oxygen and stayed on it for two weeks. I spent just over three weeks of his life not able to hold him as close as I'd like, not able to just rock him, not able to put him in the sling and place his tiny body over my heart. I felt like I was forced to love him from afar, but I can say that there is no distance between us.

At the end of February, we rescheduled his circumcision. If I had it to over again, knowing what I know now, I don't think I would. Babies are circumcised early because they are too young when tiny to fight much, but I told you...he's a fighter. We didn't have his circ done at the hospital because he was a bit early and we all agreed we'd wait a bit. Then he got sick two days before he was scheduled to have it done. Then we waited for him to recover.

I made arrangments for my daughter to stay longer in school that day, thankfully, as I didn't want to have to bring her with me. My husband was supposed to come to the appointment, but was accidentally double booked and I told him I was ok with him missing it. He finally agreed he was ok with that. So when he started bleeding after and wouldn't stop, my husband wasn't there.

The doctor didn't do anything wrong, we know that from a medical standpoint as well as in general. There was a blood vessel closer to the surface than normal, and for whatever reason (there's no bleeding issue with him, in general) it wouldn't stop. Not even with direct pressure. At one point it looked like a stitch might need to be involved, but in a last ditch effort to avoid that, silver nitrate was used...a tiny, teeny amount. The bleeding stopped, we waited in the office to make sure it was ok, and finally got the all clear to go home.

He slept as I picked up my daughter, as my husband came home and finally woke for a diaper change. When the cool air hit his skin, it stiffened, and that blood vessel reopened. The sight of a soaked diaper is nothing new to a mom, but a diaper soaked with blood, so soaked you can see it from the outside of the diaper, is horrible. My husband got the dr on the phone, we applied direct pressure as instructed...but still we couldn't get the bleeding to stop. I took him to the ER and my husband stayed home to calm our daughter, as that night we had nobody else to watch her.

He lost a lot of blood that night, avoiding a blood transfusion by the smallest of margins. As our doctor sat with us, waiting for the urology consult, he prayed with me. My phone wouldn't work in that part of the hospital so I couldn't even call my husband to update him, the ER staff kept promising they would bring me a phone to use and kept forgetting, and our doctor's phone wasn't working either.

When we finally went home, when he was finally ok, I did not sleep. I not only didn't want him out of my sight, I was terrified that fully clothed and in a diaper he could bleed to death and I'd never even know it. I found a way to swaddle him and put him in his bouncy seat, then open the blanket and the front of his outfit just right so I could see the front of his diaper and open it if I needed to. I sat in the same spot all night, watching him, checking him, praying.

I was amazed at the time how many people kept telling me how well I was holding it together. The same thing was said during his pneumonia. I'm starting to think maybe I should learn to play poker.

We had a lot of follow up appointments after his circ, but everything has healed perfectly. You've never seen a mom so relieved to see her son receive his first stiff breeze, if you get my drift, and the urologist agreed without reservation that everything healed just as it should.

There's a picture of my son and I, asleep on our couch. It looks so innocent, my husband took it because he thought we looked cute. You can't know just by looking at the picture, that I was holding him because I needed to feel his chest rise and fall and just know that he was ok. You can't see that I'd ground my teeth terribly in the preceeding several days or that I'd managed to chew so hard on the insides of my cheeks when I did sleep, that I had sores on the inside of my mouth. You can't know by looking that his blood results from that day had found him just barely on the other side of the level that would require a transfusion. If you look closely, however, you can see that he is pasty pale from all the blood loss. You can see that I don't look well either.

If that picture were any less a badge of courage for both of us, I think I might burn it.

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