Friday, September 23, 2011

There is no place like home!






As you can see from the pictures we are home! Brynn was discharged from the hospital last Monday, exactly one month from the day she was born and one day after my original due date. As you might remember, the two hurdles we had to jump over were three days of consecutive weight gain and placement of the feeding tube. Brynn had the three consecutive days of weight gain and after much fuss and worry Tony and I sucked it up and learned how to place the feeding tube.

We were very blessed to have the nurse we both trusted and adored show us how to place the tube. This nurse was kind and patient but very firm with us and knowledgeable about what had to be done. I held Brynn's head while the nurse helped Tony insert the tube and tape it down. She talked us through the whole process and gave us lots of encouragement and moral support. Thankfully, she also replaced the tube which all along I had thought was too big with a much smaller tube. Overall the experience was much less traumatic than I had anticipated, and I think Brynn ended up being more comfortable with the smaller tube. I went home for the night to get some sleep and was on my way back to the hospital in the late morning when Tony called to say the doctors had rounded and agreed that we could be discharged that afternoon.

I could hardly believe it! We had hoped and prayed that they would let us go home but nothing is set in stone until they doctors say so. I spent a few minutes running around trying to figure out what our next steps were. We had accumulated quite the collection of clothes, paperwork, baby gifts, toiletries, and personal items (hello, breast pump!) at my parents place. In addition, we had piles of baby clothes, blankets, and medical supplies at the hospital. Luckily, my mom hadn't left for work yet and she agreed to take the day off to get us packed up and bring all of our stuff over the the apartment. I left for the hospital where Tony and I spent the next few hours reviewing the discharge paperwork, setting up follow-up appointments, and getting Brynn prepared to leave the hospital walls for the first time.

It was an unbelievable and surreal experience when we finally had all the paperwork signed, bags packed, and appointments made and were able to pick up our daughter and walk outside. I kept thinking someone was going to stop us or tell us they had made a mistake and that we weren't really allowed to leave. Thankfully, we had an uneventful trip home (Brynn was apparently unimpressed with the great outdoors since she slept the whole way home) and were greeted by my mother who had cleaned up our apartment and stocked the kitchen with groceries.

Since we've been home it has been a period of adjustment, joy, amazement, and of course more exhaustion. I might have said this before but I'm not sure I ever fully prepared myself for actually having a A BABY! I prayed and hoped and wished with everything I had that we would bring her home safely but I didn't dare spend a lot of time thinking about what life would be like with an infant. I guess I was taking things day by day. This worked well for me during the months of uncertainty and fear but perhaps did not prepare me physically, mentally, and emotionally to actually bring home an infant with unique and demanding needs. The last two weeks have been a crash course in baby.

Brynn's needs and the requirements to care for her did not magically disappear just because we left the hospital walls. Tackling her feeding tube and administering medications has been a process. Monitoring her calorie intake and volume can be tedious. Weighing her and tracking her 02 stats and heart rate is burdensome. And doing all of this while being more sleep deprived then I have ever been in my life is a challenge all on its own. Thankfully, we have had wonderful and amazing support from friends and family. Frozen meals have been especially helpful. My mother coming over every day for the last week to do laundry and dishes and sit with Brynn while I catch up on sleep has been my saving grace. I'm not sure how I am going to cope when she goes back to work next week.

There have been times during the week that I have felt so overwhelmed and exhausted I'm not sure I'm physically capable of mixing another bottle or drawing up more medication. In these moments I feel disappointed in myself for feeling even a little bit resentful. I go back to reminding myself how lucky we are that Brynn is here and that we have her at home. I dig a little a deeper inside myself than I have ever had to before and make sure I hum to her while I fix her bottle, and sing to her while I put meds in her tube, and rock her while trying to get her to go back to sleep. Truly, we are blessed beyond even what we could have imagined. I think of people with multiple babies, or the woman we shared a room with at the hospital who had six other children waiting at home for her. I was chosen by God to have this baby, and that means He gave me the strength to take care of her. Even at three in the morning.

Brynn's progress has been amazing. She has continued to gain weight daily and her stats have been perfect since we've been home. We have been to the pediatrician and back to the cardiologist and both of them were very impressed with how well she is doing and how good she looks. So much so that they agreed on Wednesday that we could take out her feeding tube and do all of the feeds by mouth! Brynn has been much more comfortable without that tube to choke and make her gag throughout the night. She is eating better and sleeping for longer periods. Everyday she becomes more alert, grows stronger, and gets cuter.

Our return date for her next surgery is November 7th. Until then, our goals are continued weight gain, not getting sick, and lots of snuggling. Thank you to everyone for your prayers, support, and understanding. We are so grateful for this time together as a family and hopeful that the next six weeks will continued to be blessed with good health and the wonder that is this little life.

Saturday, September 10, 2011

48 hours and a tube is the only thing that stands in our way...

We are in full-blown hospital mode. Since our transfer up to 3 West things have hardly slowed down. After five days we are finally in a routine that goes a little something like this:

6AM: Brynn’s Food (fortify breast milk with formula, prime pump, attach pump). Try oral feeding to see how much she can take by mouth, put rest through tube (make sure to stop feeding before any air gets in her belly, flush tube with sterile water).

7AM: Nurses change shift. We burp and comfort fussy Brynn.

7:30AM: Nurse checks vitals; we change diapers and get Brynn dressed.

8AM: We administer morning meds through tube (aspirin, laxis, zantac). Brynn is examined by doctor before rounds.

8:30AM: Pump

9AM: See Brynn’s Food

9:30: Rounds.

10AM: Burp and comfort fussy Brynn while trying to pump and change diaper.

10:30AM: Hearting test (or another test)

11AM: Physical therapy

11:30AM: Occupational Therapy

12PM: See Brynn’s Food

12:30PM: Pump

1PM: Burp and comfort fussy Brynn.

2PM: Meet with a specialist (take your pick from Child Life Specialist, Lactation, Pediatric Nutritionist, Social Work, medical supply representative, etc.)

3Pm: See Brynn’s Food

3:30pm Pump

4Pm: Burp and comfort fussy Brynn.

5:00pm: Continue to burp and comfort fussy Brynn who did not tolerate her 3Pm feed. Change diaper, change clothes she just spit up on, possibly give her bath, change her diaper again, and put on more clean clothes.

6:00pm: See Brynn’s Food.

I will spare you the other 12 hours but can assure you they look startlingly similar to first twelve (minus the specialists). If you didn’t see anything about eating or sleeping it’s because we don’t really get much of a chance to do either.

Tony and I have been taking turns staying the night and relieving each other for a few hours during the day when we can (twice I’ve been here for 36 hours in a row and it wasn’t pretty). While we’re here we don’t get to go outside, see sunshine, taste fresh air (or fresh food) or enjoy many of the other comforts of life outside the hospital. We sometimes get cranky or frustrated with one another but try hard not to take out our exhaustion on the other person. As guilty as we feel leaving the other one behind at the hospital we remind each other how important it is to have a break.

On Thursday night we finally switched out of “The Quad”, one big room with 4 (yes, FOUR) babies and two nurses to a double room. After two hellish nights of non-stop babies crying and alarms sounding I put up quite the fight when they told us we might have to spend another night without sleep and sanity. Parents don’t usually spend the night in the quad, which I can understand given the indescribable amount of noise and commotion going on at all hours of the day. However, we were encouraged not to leave due to Brynn’s small size. I was not about to leave Brynn alone for the night without us but there was no feasible way I could tolerate another night in a 4x6 curtained-off personal hell. Luckily, the charge nurse was able to move some things around and we have been in a double since Thursday evening.

These days have been crazy, stressful, exhausting, and frustrating. They have also been invaluable in giving us the knowledge of how to care for Brynn when we get her home. Which is really the whole point of being up here. We have to learn to do everything the nurses do on our own. Both of us are feeling more comfortable every day with the typical baby stuff and are getting more at ease with the medical aspects. One giant hurdle remains: changing out the feeding tube. We are not allowed to leave the hospital until we learn how to put in her feeding tube. I am really struggling with this. When Brynn got her tube changed out in the pod she screamed her head off and was fussy and gaggy for the rest of the day. I can’t stand the thought of having to put her through that kind of pain again unnecessarily. I understand that she might pull out the tube and that we would have to go back to the ER to have it replaced (possibly at 3AM) but honestly I would rather take my chances. I’ve tried negotiating, pleading, and bargaining with the medical team but they are pretty dead set on making us pull out and put back in the tube.

I already have a love hate relationship with this stupid tube. I understand it is keeping my daughter alive. So far she is only able to take in 20-30mls by mouth 2-3x/day (a far cry from the 55 cc’s she needs 8x/day to gain weight). But I hate that she has to have it. I hate that we have to pump her full of calories 8x’s a day to the point where she can become incredibly uncomfortable and vomit from the amount of volume in her tiny tummy. I hate that I can’t just hold her to my breast and enjoy the comforts and bonding that feeding usually allows. I know that Brynn has to gain weight to survive her recovery and her next surgery. I know that the last thing we want is to end up in the hospital with a “failure to thrive” diagnosis due to an inability for her to gain weight. But I still hate the tube.

Please keep us in your prayers as we get closer to the huge and important task of learning to place the tube. We are hoping that it goes smoothly and causes Brynn minimal discomfort.

If Brynn has one more day of weight gain (we need 3 consecutive days to get out of here) we will be discharged on Monday. Ironically, this will be one day after my original due date. And, if she does gain weight again today and we are allowed to go home on Monday I guess I am going to have to thank the tube. J

Wednesday, September 7, 2011

Moving on up...




To 3 West! Thats right, folks we are finally here. At this moment it is after 7:00pm and daddy is holding Miss. Brynnie (something we haven't been able to do for weeks now since we had to leave at shift change when we were on the CVICU).

All I can say is THANK GOD we are finally out of there. These last 10 days or so have been some of the most difficult of my life. Brynn was continuing to make steady progress for several days. She got all of her tubes, lines, and IV's out (except for her feeding tube), and her stats were looking great on room air with no support. The only thing she wasn't doing was taking anything by mouth. The doctors told us that she had to work on feeding and gain some weight before she would be allowed to go home but that she should be able to work on those things upstairs in the step-down unit. Then...a new team started and decided that they wanted to be extra conservative with her due to her small size and the type of repair she is recovering from. SO...they decided to keep us in the CVICU for another week. And not just the in CVICU but specifically in "the pod" a seven bed hellhole of beeping, crying, alarming, and nurses 24 hours a day.

This overstimulation really begins to wear you down after the sixth hour of sitting there. Especially when the doctors are telling you that your kid doesn't really need to be there but they are going to keep her in this hellish place just to play it safe. Don't get me wrong, I would never want to jeopardize Brynn's health or recovery in any way but I really felt like my own mental health was deteriorating by the day. Every day I woke up, pumped, and went to the hospital to sit and hold Brynn for approximately 6 hours (except when I would have to put her down to run to the cafeteria and shove food down my throat or sit in a freezing dark room and pump). When I got back Brynn would often be fussing or crying by herself. The nurses still took excellent care of her but they now had other patients as well and you can pretty much guarantee that your kids pacifier falling out of her mouth is not going to take precedence over stabilizing another patient. I would go home around 3:30pm or so and Tony and I would come back together by 6:00pm to kiss her goodnight and then head home to eat dinner and collapse into bed. And then I would do it all over again the next day.

It began to feel sort of like Groundhog Day: a never ending cycle of stress, worry, and exhaustion, with no end in sight. Tony of course had his own difficult days that would begin at 5:30 in the morning and usually end with a tearful and exhausted wife who has been pretty much inconsolable during the most difficult moments. We haven't had to deal with any more surprises from or friends in genetics, and Brynn's progress continues to be excellent, but 90% of our conversations still contain the phrases "try not to worry about it" and/or "I'm just tired".

Our days have also been filled with small victories and pleasures. I changed Brynn's diaper for the first time last week and Tony changed his first diaper EVER on Sunday. We have been able to give her a bath, swaddle her, hand her off to grandparents so we can get a bite to eat, and of course my favorite: dress her up! We survived five days in a row with our least favorite nurse without losing our minds or our tempers. We even began to tackle her taking food by mouth.

Occupational therapy assessed Brynn last week and developed a feeding plan for her to practice taking food orally. They showed me how to position her and how to look out for danger signs that she could be choking (it is very important that we protect her airway and prevent any aspiration). We have run into several problems that relate to her being a preemie and having a heart condition. Brynn had been either totally conked out or super agitated. She rarely had any awake alert time where she would interested in eating. Although she loves her pacifier her latch wasn't strong and she had a very guarded suck. Up until today she was only taking a few milliliters by mouth.

I have continued to pump as often as I can but have found it difficult to keep up with the demanding 8-10 times a day. The most I have gotten in 24 hours is 7 pumps and some days I only get six. As a result I have been able to supply Brynn with most of the milk she needs but the nurses have had to supplement with formula from time to time. Part of the problem has been keeping up my calorie intake to sustain enough milk. My appetite has not been that great and to make matters worse I tend to get a little nauseous or lose my appetite every time I pump. In addition, I rarely have time to sit down and eat anything when I am hungry since I haven't wanted to leave Brynn alone. I spoke with the lactation consultant who has been trying to help and is encouraging me to try and pump more frequently. My hope is that now that I'm allowed to eat in the same room with Brynn and will have food trays brought up to me I'll be less stressed and able to eat better. I've also had some of the other typical problems including blocked milk ducts (ouch!) and sore nipples (super ouch!).

On Sunday we were moved out of the pod and back into a private room in preparation of coming upstairs. It was a huge relief to be out of the chaos and noise. I didn't realize how luck y we were until yesterday afternoon. I went down the hall to the "quiet room" (ironically next to the pod) to pump when I heard a woman sobbing and crying out "my baby, my baby". I got back to our room when the mother next door came in to commiserate about the awful siren that was going off. I asked her what was going on and she looked at me wide eyed "You don't know what that sound means? A baby in the pod is coding. Two babies have died since I've been here.” A giant dose of reality I didn’t need that was enough to send me over the edge. I was in tears the rest of the day. Luckily, I woke up this morning to the phone call that we were moving to 3 West first thing this morning.

My thoughts and prayers continue to be with the families that remain in the CVICU. Our journey to get Brynn well continues upstairs. Thank you for everyone's continued support. We would not be getting through this without your love, support, and prayers.