Resurfacing

April 24, 2014 § 43 Comments

I have nine week old twins.

This will be brief, but I need something to break the silence. I do this weird thing where I insist on putting things in order. If I haven’t told you about the birth story yet, I can’t possibly tell you about the NICU. Or having two newborns at home. Or postpartum anxiety. Or tandem breastfeeding woes. Or August’s birth anomalies. Or all of the tears of fatigue, worry, overwhelmed-ness, loss, and bliss that I have cried over the last two months. Or my incredible, chest-wrenching, throat closing love for these two tiny humans.

I need to break the silence, though, because if I don’t, things will just keep adding up, and I’ll feel so far behind that I will never write again. So that is what this post is. And nothing else (I’m sorry.. it seems I’m always sorry these days). I simply don’t have the time at the moment. In the brief periods they are both asleep, I have a dissertation to work on, a move (in five short OMFG weeks) to prepare for, lunch to eat, a shower to run, a million loads of tiny, spit-up soaked clothes to wash.

The birth story is about 7 pages long and currently unfinished. I will need to edit like mad before any of you might show any interest in reading it. It will come in time.

For now I will say that things are really tough. Really really tough. Everyone is healthy, and we are surviving, and I feel so blessed and full of bright blinding joy. But. That joy is accompanied by many other things.

Remember that post about how people with twins keep saying they wouldn’t choose twins if they had a say in the matter?

Yeah. I get it now. I think I would prefer to have my children one at a time.

So here I am. Back. Alive. In love. Thankful beyond belief. Sputtering and coughing and choking as I resurface.

Escape!

February 26, 2014 § 72 Comments

On Wednesday, February 19th after learning that our boy had not grown at all in the past two weeks, I had the most amazing cesarean birth experience I could have imagined.

And at 4:21 and 4:22 PM, our sweet babies were born.

World, meet Etta and August.

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These photos are from just after birth, so they look a little different already. Many more pictures to come.

I am home. Home after a month in the hospital. The emotional confusion of that transition deserves a post itself. Neither baby was able to be in the room with us after they were born, and they were in different places, so we had to run back and forth to see them. Doing that while having to pump and eat and sleep was really, really hard. Recovering from major abdominal surgery has been cake compared to having a sick child (and a well child) who are separated from you.

Guys, they are tiny. But so mighty. Etta needed no NICU time. She spent her hospital stay in the special care nursery, away from me and hooked to monitors, but was able to come home with me on Monday. She’s now weighing in at around 4 lbs 12 oz. August, who has dropped to 3 lbs and it’s hovering right around there, will be in longer. He’s in the NICU, but he’s doing well. He’s just very skinny. All limbs, that kid. From the start, he was eating breast milk by bottle and breathing without issue, but they’re increasing his feeds a lot, so he’s getting fatigued trying to keep up, and they ended up having to drop a feeding tube Sunday night.

His bilirubin  has also been a bit high, so he has to be under the lights and can’t be held that often. He gets upset and there is no way to comfort him. He also startles a lot because he can’t be swaddled and because he’s blindfolded by his hip baby shades. It’s heartbreaking. He’s coming off today, though, so you better believe that little man will get all the loving he wants over the next few days.

Packing up the fam and heading to the NICU now. Much love to you all. Your support and encouragement have meant the world.

33 weeks, 6 days: Close calls, interdoctor discord, and THE PLAN

February 13, 2014 § 34 Comments

Still pregnant! But holy, cow.

Crazy days, my friends.

Last Wednesday, I got my rankings submitted for the next phase in my clinical training. In 9 short days, on Match Day, we’ll know where our little (all of the sudden not so little) family is going to be living next year.

And then on Friday, we very nearly met the new members of that not so little family.

Friday was one of the most stressful days of my life. It was the first day I have had to make a serious decision for these children. My children. It was the first time I felt the weight of that – of being someone’s mother. The mother to two particular someones. Two small humans who have only me and The Artsy Engineer and who need us to make the right choices. It was so heavy. My throat closes up a bit thinking of it.

Since the last time I updated, things have fluctuated considerably. A few days after I wrote that post, they sent me home to continue bed rest there, because baby boy’s cord blood flow was consistently showing continuous (but still reduced) end diastolic flow. That lasted for under 36 hours. I got home on Monday evening and was readmitted a week ago today on a Wednesday morning after they saw intermittently absent flow again on the Doppler ultrasound. We were disappointed, but I knew the respite from the hospital would be temporary. I was just really really hoping for another couple of nights of dog snuggles and home cooked meals that my husband doesn’t have to unpack from a cooler. The good news about that Wednesday (32+5 weeks) was that we had the growth measurements taken again (as they only do it every two weeks to minimize error), and both babies had pretty solid growth estimates. Baby girl had gained a full pound and was estimated to be 4lbs 4oz and baby boy had gained 3/4 of a pound and was estimated to be 3lbs 6oz.

Then on Friday, my friends, it got real. The flow went back to absent end diastolic flow and the proverbial shit hit the proverbial fan. If you peek back at that last update, absent end diastolic flow is what was going on when I was admitted in the first place. The exact same issue. I was only 31 weeks then, but the data was the same. I had a particular protocol that the perinatologist (MFM doc) recommended and that my OB implemented. It involved 3x/day NSTs and 3x/week ultrasounds, bed rest, and steroid injections. However, I am situated at a major academic medical center, which has a lot of really excellent benefits but which also means that there are LOTS of people involved on my team. It’s a big freaking hospital with the highest ranked NICU and perinatology program in the state. But on Friday, the perinatologist who I had been seeing all along was out for medical treatments and that meant that I would be passed along to the others, depending on who could squeeze an inpatient into their schedule. There are 7 of them. This is apparently how it typically goes for people, but my OB had arranged it so that this particular perinatologist  would see me whenever he could. With him out of commission for 2 weeks, I saw this new guy. This new guy was described as “excitable” by several people before I met him, and I wasn’t sure what they meant. It could be demonstrative excitable, which is not a bad thing at all and was frankly what I was picturing, but it turned out that they meant more of the high-strung, impulsive, temperamental flavor of excitable. Bummer for me, apparently. Because he walks in, and with no further ado, he says, your baby has absent flow and you’re past 32 weeks and so there is no sense of waiting around until reversed flow because of risk of stillbirth so I am recommending that we deliver your babies today. BAM. Just like that. I’m all alone, sitting in his outpatient clinic office on the exam table, and I can’t walk anywhere or escape (which is strangely what I wanted to do) because if I look like I’m going to pass on the wheelchair, people get all concerned like.

By the time I got back to my room, my OB was there waiting for me, and he was not pleased. Pacing, fired up. He had to lecture to medical students, so he said that he was going to leave but that he’d be back 2 hours later to have a conversation about what we wanted to do. He had me call Bryan in and stop eating and drinking in case we decided that we wanted to proceed with the c-section that afternoon. Apparently, he had asked the perinatologists to speak with him before speaking with me and especially before making any specific recommendations to me, because he knew how different their opinions regarding what to do with absent end diastolic flow at 32, 33, 34, etc weeks.

When he came back, the three of us talked it out and decided to wait and try to squeeze out a little more time. We just felt as though this was the SAME DATA we’d had when I was initially admitted. Babies continued to look great on monitoring, BPPs were excellent, and there was absent flow. The only difference was that I was now past 32 weeks, so this doctor decided he thought the risk of leaving him in was now greater than the risk of taking them out. To appease this doctor, we’d increase monitoring to daily ultrasounds to look for reversed flow and do continuous fetal monitoring except when sleeping and eating (although I was woken up between 1-2 in the morning for a briefer monitoring session). The trickiest part was that my OB was leaving town for the weekend and was unreachable until Monday night and thus could not act as an advocate. He left saying that he’d tried to tie down all of the loose ends he could, but that he couldn’t control it once away. If whatever perinatologist did my scan on Saturday or Sunday or Monday suggested delivery and the OB on call agreed, we’d be delivering. He spoke with all of the OBs who were on call over the weekend to try to tell them the situation, but he wasn’t sure it would be enough.

I won’t go into all of the details of the weekend, because this is getting long enough (and confusing enough) as it is. But I was essentially told that my plan of care was being changed by every single doctor who came in the room, which amounted to about twice a day. One said that using a different set of norms our boy was actually not growth restricted at all (that he was at the 20th percentile rather than below the 3rd) and put me back to 3x/day monitoring. The next told me that babies were doing great and they’d deliver me at 34 weeks unless something changes before then (this is the first I’d heard of a 34 week cutoff). The next said that she wanted me back on continuous monitoring (even though nothing has changed) and that there was talk again about delivering that day. The next said that there was no way continuous monitoring made sense and that I would also be changed from full bed rest to modified bed rest but that our boy is, in fact, IUGR based on the set of tables that they just switched over to using and that is used in much of the recent research. I did my best to let it go in one ear and out the other and to just hold down the mental fort, so to speak, but it was tough. Without my OB here to be the ringleader (and he is, in fact, the ringleader), I was left to the devices of a group of practitioners who practice as individuals. We didn’t know how to gauge our fear and anxiety. Should we be as concerned as doctor number 1? Did I want continuous monitoring because any minute my baby could die? Or should I be as concerned as doctor number 3, who was clearly confident that there would be indicators of fetal distress leading up to something catastrophic that we could catch using less frequent monitoring. Etc etc. It was a nightmare, my friends, and I think I am just coming down from it.

Nobody signs up for randomized clinical trials and signs on to put their babies at risk, so there isn’t a lot of research for these doctors to go off of. There is no standard of practice for absent end diastolic flow in the umbilical arteries, here at this hospital or anywhere else. My OB pushed the 7 perinatologists to meet and come up with some guidelines that they all agreed on, and yesterday, finally, they did.

So. The plan.

Before 34 weeks: Either absent or intermittent end diastolic flow mean closer monitoring but not delivery. Reverse flow, less that 200g growth in 2 weeks, or indicators of fetal distress on the monitors or on the BPPs mean delivery.

After 34 weeks: Intermittent or forward mean I get to stay pregnant (provided that indicators and growth are okay). Reverse flow OR absent flow mean delivery.

Regardless, delivery no later than 36 weeks. Which means that my OB scheduled our c-section for Friday, 2/28. Two weeks from tomorrow (and one week after Match Day).

So, essentially, if they see absent flow after 34 weeks (which, ahem, is tomorrow), they will choose to deliver me that day. My ultrasounds have gone like this intermittent, absent, intermittent, forward, forward, forward, intermittent, absent, absent, absent, intermittent, intermittent.

Tomorrow I am at 34 weeks. From here on out, every Monday, Wednesday, and Friday are scan days and are going to be the decision points. If you look at the list above, I received a round of betamethasone (the steroids to help with fetal lung development) on the first day there was absent flow. Flow then improved and did not go back to absent for 10 days. If you ask the perinatologists, they’ll tell you that there is no research in support of betamethasone improving flow but that they see it in practice often enough to notice it. They would never give it for that reason alone, but because I was due for a booster (it had been two weeks since the last injection and I was still before 34 weeks), they would be interested to see if it might buy me an extra week or so before I would go back to absent and need to deliver. I got my booster on Tuesday and Wednesday, and baby’s flow was improved to intermittent on Wednesday’s scan. If the steroids are part of what helped the last time and it follows a similar trajectory, perhaps I can make it to the 21st (Match Day and the day I turn 35 weeks) before it turns absent again. I’d love to make it through the weekend and buy just a few more days.

But I could also go in tomorrow and see absent flow and deliver two tiny babies, one estimated to be just under 4 pounds and the other estimated to be just under 5 pounds, within a couple of hours.

I’m on the scan schedule for 7:10 AM. Wish us luck, friends.

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* That was going to be an earlier post, because it was a very, VERY upsetting development for me. Apparently our baby girl, who is closest to the cervix, is footling breech, and because of the way our boy’s bag of waters has settled in around her, we have known for about a month that it is highly unlikely that she’ll be able to turn. My doctor will deliver vaginally so long as Baby A is vertex, regardless of the position of Baby B. He will happily do a breech extraction for Baby B. Baby B is moving all around still, flipping vertex to breech to transverse to breech to transverse to vertex daily (I know because I get ultrasounds ALL THE TIME). But it’s Baby A who makes the decisions here, and she’s not turning for us. I cared A LOT about this a month ago. I could care less now. I’d be thrilled if she shocked us and turned after 6 weeks of being in one position, but it ain’t gonna happen. And now, with all of this, I just want some healthy babies to come out of me – through vagina or uterine incision or nostril. I don’t love it. But I have bigger things to fret about.

32 weeks, 3 days: On becoming an inmate

February 3, 2014 § 37 Comments

I’ve written update posts several times, but before I’ve been able to finish any of them and press GO, something changes and makes it no longer relevant.

Let me try to give you all a bit of a timeline. Last Tuesday, when I was 30+4, our baby boy’s growth had majorly slowed. He was sitting somewhere around the 10th percentile after measuring solidly in the average range on previous scans. To try to figure out what was going on, the MFM performed an umbilical artery doppler assessment. The purpose of this is to look at the blood flow through the umbilical artery during peak diastole (when the heart is at its’ most relaxed). Flow in the umbilical arteries ought be in the forward direction. If the placental resistance increased for some reason, the diastolic flow may reduce, then become absent and finally go into reverse. Below is what you might see on the ultrasound screen when there is “healthy” flow. See how the tops of the valleys between the peaks are well above the line? This is essentially what our girl’s looks like.

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My understanding is that toward the end of all of all pregnancies, the placenta matures and doesn’t function as efficiently. This is supposed to happen slowly over time and to not cause problems (and is also one of the reasons they talk of induction post-due date). But our boy’s placenta seems to be deciding to quit early. I grew it wonky, and it’s making its’ displeasure known. The image below will help explain.

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Umbilical artery Doppler velocimetry: (1) normal pattern; (2) reduced end diastolic flow; (3) absent end diastolic flow; (4) reverse end diastolic flow

The top line is normal. A week and a half ago, when we discovered that there was a problem, there was reduced end diastolic flow that was also intermittently absent. So, the space between the valley and the line was small, and every once in awhile, there would be a big gap where there was no valley showing at all. This got me on schedule of biophysical profiles (BPPs) and umbilical artery dopplers twice a week with MFM. Three days later it looked the same. No change was good.

The following Tuesday when I was 31+4, I saw my OB first thing in the morning. This was to be followed by a MFM appointment. I don’t think I had quite wrapped my head around the seriousness of the situation until my OB told me that he was going to do a quick ultrasound even though they were doing one down the hall at the MFM appointment in a couple of hours. I must’ve had a quizzical look on my face, because he then said, I’m doing this because if your baby has died, I want it to be me who tells you, not an ultrasound technician you have never met. I know this probably sounds incredibly insensitive. Heartless even. But I appreciated it. Immensely. He knew that there was no other reason to justify his looking, and he knew that I would know this. But he wanted to look anyway because it was important to him, and so he just decided to go ahead and tell me why instead of just making something up. Or saying nothing and leaving me wonderingknowing.

Incredibly, he later came to my MFM appointment. There we all learned that the flow had changed to continuously absent end diastolic flow (#3 in above image). The two doctors looked at each other, had a brief discussion right there in front of me, and I was admitted to the hospital in order to “tighten the safety net.” I was shocked. My OB had warned the week before that it could happen any time, but it still hit my like a truck. I cannot describe the fear we felt. Not only did it mean very likely early delivery of both babies and all of the risks and complications that come with that, but I also jumped to all of the worst case scenarios for our boy, like death. Or neurological and/or developmental problems from being deprived during such an important stage of growth.

I was allowed to go home and pack my bag and say goodbye to the dogs. And, guys, I cried the entire time.

I won’t be going home again until I am a mother.

I’ve been in the hospital for 7 days now. I was given the steroid shots on Tuesday and Wednesday to help speed fetal lung development, and I learned that the doctors thought it was likely that I would likely need to deliver within the week. In that picture included above, you deliver when you see #4. Reverse end diastolic flow. Now that I am in the hospital, my two a week BPPs and umbilical artery dopplers get increased to three a week. They also do fetal non-stress tests (NST) three times a day at 6 am, 2pm, and 10pm. For these I get monitors put on that are kind of like our home dopplers, and reactivity of heart rate to movement is measured for 20 minutes. You also deliver if there is a problem seen on one of these tests. So the level of monitoring is outrageous. But it’s allowing me to sleep at night.

It had been pretty quiet around labor and delivery the last few days, then last night and this morning things have really picked up. You could see the stress on the nurses faces. I am one of a number of “ante’s,” who are meant to be here long term. Everyone else rotates. They come in, labor, have their babies, and then move upstairs to the mother and baby unit. They try to stick the ante’s on one hallway so it’s quieter for us. I met one of them yesterday for the first time when we were both getting ourselves some orange juice. She said she’d been here two weeks already. She barely looked pregnant at all and I thought, I hope she has a long, long while left. When I woke up this morning to The Artsy Engineer bringing me blueberry pancakes and tea before heading to work (a variation of which he has done every day to prevent me from eating too much horrible hospital food), he told me that there was a labor bed outside of her door. All morning, doctors’ and nurses’ voices have floated past my door and into hers. And I can hear her crying. And tomorrow she’ll be gone. Hopefully with a small but healthy baby to visit in the NICU.

I’m also on strict bedrest, which is very interesting. I sit. ALL DAY I sit. I can get up for the bathroom and to take a shower. And every once in awhile to walk to the ice machine in the hall right outside my room to fill up my own water because dear god is it hard to let others do things as simple as this for you all day. The nurses come in once an hour to check on me during the day and every two hours at night.

My new digs.

My new digs. See the bassinet? It made me cry every time I looked at it during the first few days, knowing that my babies will not be with me when they first enter the outside world.

But you know what guys? It’s helping.

I had been warned that this sort of issue doesn’t really improve. It just gets worse (slowly or not so slowly) and then you have to deliver. But something is seriously, really really helping. Since I got here, I’ve had two additional ultrasounds. Both have continued to show reduced end diastolic flow (but not continuously absent and not even intermittently absent). This is EXCELLENT. The babies both continue to pass their BPPs (which is where they look at movement and heart rate and attempts at practice breathing using ultrasound). And I’ve been told repeatedly that our babies look great (even for their gestational age!) on the 3x/day non-stress tests. That our boy “does not look like a baby with cord blood problems.” So they both seem to be healthy and doing developmentally appropriate things in there, and no one is distressed. No one is distressed. On Friday, my MFM said that if he were a betting man, all of these things would lead him to place his bet on our being table to talk in weeks until delivery rather than in days until delivery. It still seems doubtful that I will make it much past 34, which is about a week and a half away at this point.

But man. I’m so so close, sisterfriends.

So I will continue to relax my ass off in this hospital bed for as long as I can if it means these babies can use the incubator on the inside of me instead of the incubators on the outside of me.

I can’t wait to meet them, but my body will miss them when they come.

30 weeks 4.5 days: And then just like that things change

January 22, 2014 § 53 Comments

This will be erratic and full of typos. Forgive me. It’s the middle of the night and I’m not so concerned with writing style right now.

My plan was to follow up yesterday’s post with one later this week about the pregnancy itself.

I was going to talk about how the movement is the most amazing thing I’ve ever experienced. I was going to tell you about the weight gain and the roundness and loving my less angular body. About how I’ve somehow miraculously managed to get by with no stretch marks yet. I was going to tell you that we picked out names that we love and that feel right. I was going to comment on all the weird things about being pregnant, like the leaky boobs starting at 20 weeks and the dizziness and low blood pressure and the inability to walk more than a mile during the second trimester (these last two have improved), and the multitude of Braxton Hicks contractions that started around 16 weeks, sent me in for monitoring around 24 weeks, and have since subsided to a “normal” rate. I was going to tell you about all of the things I love about being pregnant. In fact, on Sunday, someone posted a question to a due date group I’m in asking the women what they like about pregnancy. I said the following:

honestly, i am kind of loving almost everything about it. i love the movement. i love thinking of food as baby fuel and trying to squeeze as much of it as humanly possible into my body during the day for them. i am even fine with the insomnia, because i get to lay in bed and feel them move and think of how excited i am to meet them. i’d be lying if i didn’t mention loving all of the positive attention. attention from others usually makes me feel squirmy and uncomfortable, but for some reason now i’m basking in it. i work in a couple of different hospital settings with a lot of women (many of whom are in the child-wanting stage but who are currently focusing on academics and careers) who make me feel like a rockstar and ask me 100000 questions a day. i love the knowing and warm smiles i get from strangers. i love how my coat won’t close in the bottom and my belly sticks out and i’ve overheard two women over the course of the last month stop mid-conversation to comment to whomever they’re talking to on how “cute” i am. i mean, really. talk about making a lady feel special!! i love how peaceful the nursery makes me feel. i love that it has turned my already sweet husband into an even sweeter father over the last couple of months, even though they aren’t here yet. in the evenings, he often sits in the rocker in the nursery with a soft light on and plays his guitar because he “just likes it in there.” ha, oh yeah. and while i do miss working out, i love having the excuse not to, since you really can’t do much besides walk and stretch and squat with a twin pregnancy at this stage of the game.

But then.

Today (yesterday? I don’t know. It’s 3 AM and I slept for an hour between 11 and 12 and then woke and sobbed into the Artsy Engineer’s chest for 2 hours before deciding to get up and make myself a cup of tea to relieve the pressure in my head and to write these words). Today things went not so well all of the sudden.

I went in to maternal fetal medicine for my monthly growth scan. During the growth scan, they measure the femur length, the head circumference, and the abdominal circumference, and they use these measurements to estimate the weight of the baby. She measured Baby A first. Our dear girl looked good. She was right around average for gestational age for twins at 3 lbs 4oz. We weren’t able to get a good image of her face, because she was wedged in and sleeping most of the time, but the sonographer commented that she had really chubby cheeks. And I was able to see that she has quite a bit of hair already.

Then she moved on to Baby B, our boy. And his report is not glowing. Baby B’s growth has fallen off. His estimated weight is 2 lbs 11oz. I didn’t think to ask for his percentile at the time, but from my own Dr. Googling, this puts him below the 10th percentile. This represents only a 450 gram growth over the past 4.5 weeks. They then came back in the room to do all sorts of other measurements, including using the doppler to look at blood flow in the cord as a measure of placental functioning. This was also less than good. 

It is evidently not an emergency situation yet but it could quickly turn into one. The MFM doc has increased the frequency of my appointments. I’ll be going in every Tuesday and Friday for further monitoring. He also said that I will not be making it to 36/37 weeks, as was our goal, but might be able to “coast along” like this for another couple of weeks. Honestly, I didn’t hear many of the details from here on out. I heard the buzz words. Placental insufficiency, poor environment, lack of nutrients, preterm delivery, if we can get there babies born at 32 weeks generally do pretty well, get him out where we can get him what he needs to grow

And this was the first appointment the Artsy Engineer missed, because everything has been going so well and because he’d been out so much around the holidays and to drive me to all of these interviews.

As soon as I left, The MFM called my OB (who I lovelovelove) and my OB called me immediately. He said some additional things, including that he was “a little surprised” that I was not admitted today and that, while I don’t need to have my bags packed before each of these appointments, I should start mentally preparing for the possibility of admission for closer fetal monitoring and eventual preterm delivery.

They were also both careful to say that there is nothing I have done or can do. It’s not the little bit of caffeine I’ve been drinking (one half caff a day). It’s not my vegetarianism or my recent travel. It is most likely due to placement of the placentas and what this placement means for their growth and functioning. I have to believe them right now, because my focus is mostly on my babies alone, but there is a nagging voice of fear somewhere in there that wonders if this is something I have done or (worse, maybe?) my womb is just not good enough to make or carry babies.

Now we wait and we watch. They are weighing the risk of leaving him in an environment where he is clearly not getting what he needs versus the risk of taking them both out at this level of prematurity. The MFM doc said that had I been 34 weeks today as opposed to 30.5, he would have suggested that we deliver now. But I guess it’s all about balancing risk. The OB told me that he asked the MFM whether I should come in for the steroid shot to help develop their lungs in preparation for delivery, but that the MFM said that he thought that was still premature. So we wait.

Needless to say, I’m not doing super well at the moment. It was shocking. Everything had been going so smoothly. I was just thinking last night that I was pretty sure I could ride this out for another 6+ weeks. In fact, when I laid down on the exam table for the ultrasound today, I remarked to the technician that I felt WAY BETTER than I had expected to feel at this stage in the game. I had started thinking I was going to be one of those to make it to the safe zone.

Tomorrow my dad has arranged for himself a quick phone call with the medical director of the NICU in the hospital where I currently receive obstetric care and where I’ll be delivering (the same hospital my dad recently left for a new position in a new state as resident Bigwig of Pediatrics at Bigwig Hospital). It helps to have family in medicine.

And me. I’m going to go drink my tea (which is now cold and as such will relieve no head pressure after all) and try to put myself to bed.

30 weeks 4 daysareyoukiddingme?!!

January 21, 2014 § 18 Comments

When I was trying to get pregnant and failing miserably and then again during the early months after that miraculous last minute positive beta, I would look at those of you who were 30+ weeks and think of you as already done. Cooked. Finished. Baby is as good as birthed.

I cannot believe I am at this point. I have no clue how I got here. It’s like I hit 20 weeks and blinked and found myself in this space. No joke. I lost time.

In an effort to not sound absolutely ridiculous by updating you on all aspects of my life in the last however many weeks, I decided to break it up. In this particular post, I’m going to try to give you an overview of my work/school life over the past 10 weeks or so. Because, honestly, it has been MAJOR.

After I proposed my dissertation back in mid-October, I had to scramble to get my applications submitted for the next stage in my training. I started thinking about wrapping up my patients. I started climbing out of the cave I’d been living in while preparing for the November 1st application deadline to come around. Then the holidays happened. We traveled to visit the Artsy Engineer’s family for Thanksgiving and then my computer (our one and only computer) broke and then I started getting interviews coming in for said training programs. Lots and lots of interviews (this is good, but maybe less good when you will be 7.5 months pregnant with twins during interview season). Then the holidays kept happening and we drove to visit my family. And then my computer was still broken. And then I came home for three days and then left again to start the interview extravaganza. In the past two and a half weeks, I have attended 10 day-long interview sessions. The Artsy Engineer took time off to drive me around the country. We opted to limit my application to programs east of the Mississippi River in order to remain a reasonable distance from family, but even so, we’ve been in many states and put thousands of miles on the car.

And as an aside. This man deserves a medal. He has taken care of all of the details – driving me around, arranging accommodations, feeding me. He even got up with me each morning and pressed my suit while I was in the shower. He’d help me put on my shoes, grab some breakfast for the road either from the continental breakfast (if we splurged on accommodations for the night) or, more likely, from the shoddy Dunkin Donuts across from the motel (if we didn’t). Then he would drive me to the main entrance of the hospital where I was interviewing and drop me off in front of the main entrance. Hand me my coffee and my fancy portfolio thingy and send me on my way. After kicking around all day in whatever city we were in, either parking and exploring the city on foot (the man visited countless museums and music stores throughout the eastern half of the country) or finding a library or coffee shop where he could eek out a couple of hours of work, he’d pack up the hotel where we stayed the night before and pick me up at the same entrance where he dropped me off. The car would be warmed and ready to go and he’d have the route out of the current city planned so we could start making our way toward the next. We’d get in late, he’d unpack the car, I’d prep for the next interview, we’d go to sleep. Then we’d do it all over again.

I would not have made it through this time without him.

Now it is now and we are finally home. I have been gone for 7 of the last 9 weekends and nearly 4 of the last 8 weeks. I have interviews this week, too, but they will take place in phone or Skype-land. These are ones that would not fit on our route earlier on. And I cannot travel by plane or alone because of low blood pressure issues and dizziness.

What is the point of all of this torture, you ask?

Well.

If you have been around awhile, you may remember that the final step in my doctoral program is to spend a year focusing on clinical training alone. It’s kind of like residency, but it happens before the degree rather than after. For my specialty, there is one of these positions in my entire state. In addition, placement is based on a match system (much like medical school here in the US). I rank sites that asked me to interview, sites rank applicants they asked for an interview, and a computer system spits out our future.

The actual placement will start between July 1 and the end of August, depending on the training site. The inmates will be 3-5 months old when we will likely be moving across the country. The Artsy Engineer will have to leave his wonderful job. We will have to leave the house that we love in the location we love. I will work long hours and get paid pennies that will not be enough to support my family. Thankfully, I’ll still be technically a “student” so we can take out student loans to cover living expenses if the Artsy Engineer does not immediately find work or if we decide it is best for him to stay home with the babies to save on childcare.

So yes. Babies are about to change our lives. But there are all kinds of things up in the air for us right now.

I have to submit site rankings in the next 2.5 weeks and then it is out of our hands entirely. It’s tough, because there are several things pulling us in several different directions. A couple of the sites are close to family, but these may not necessarily be our favorites in terms of program of training. So we have the get-close-to-family pull. And the stay-close-to-AE’s-job pull. And the best-program-to-keep-the-most-doors-open-for-you-in-the-future pull. And the best-fit pull. Taking all of those influences and trying to come up with one final list is really daunting.

In fact, the whole thing is incredibly overwhelming. Two infants. A move. A new job for me. A loss of employment for The Artsy Engineer. A (fingers crossed) new job for him (or a new job as a stay-at-home-dad). Finishing a dissertation. Financial stress.

But.

But. It’s also really exciting.

I love love love what I do. Love. It. I’m really excited to move on to the next step. And I actually like to move around and experience different parts of the country. The US is full of varied cultural experiences by region. And we are people who like varied cultural experiences.

Is it ideal that it’s all happening at once? Ehhh, perhaps not. As every single one of us knows, the luxury of timing is not always on your side. But I think we’ll thrive survive.

There will certainly be plenty to write about.

24 weeks, 3 days: Viability, baby (and other big news)

December 9, 2013 § 49 Comments

My friends!

Where do I start?

I think I’ll start here, with my two little beans. I added a couple of more photos to their page from my most recent scan if this does not satisfy your baby photo desire. I also added approximately a gajillion bump photos. But, anyway, here they are. Baby B reaching back to find and touch Baby A. Incredible.

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These inmates are now technically considered “viable.” I am so so thankful to have made it to this point. However, it is not good enough by any means. My dad, the pediatric intensivist, jokingly (as is his style) tries to make me feel safer by saying things like, “pshhh, 24 weeks? no problem.” But a 40-50% survival rate is still very far from ideal, and my line of work makes me quite familiar with the lasting consequences of extreme prematurity. The consequence of birth at 24 weeks gestation is either death or moderate to severe neurodevelopmental disability for about 70(ish)% of babies. (You’re welcome.) So while I am thrilled that this means that I will, in all likelihood, have two children by mid-March (WHAT. SO WEIRD), I would prefer for them to keep cooking until mid to late February AT LEAST, pleaseandthankyou.

Now. Onto less morbid stuff.

Remember the envelope?

Yup. We looked at it.

We did it on a whim, while riding in the car, when we at last decided we were ready. It was evening. We had spent the afternoon on an impulsive mid-week hike. The drive home from the park was about 2 hours, and halfway back we decided it was time. We pulled off the of the highway and into a well-lit parking lot, set up the video feature on my camera, and placed it on the dash. With the dogs snoozing in the background, I pulled the envelope out of the dashboard, reached in and took out one of the folded peices of paper, and handed it to The Artsy Engineer. The video is hilarious (and so sweet), because apparently when I get nervous, I get bossy. And when AE gets nervous, he makes fun of me. It makes for good viewing. First, he opened his, and then I opened mine, and then we switched. And then we yelled. And high-fived. And cried and kissed. I believe at some point The Artsy Engineer pumped his fists and shouted WE WON!!!

My friends, Baby A is a girl. And Baby B is a boy.

And they are so beautiful.