Saturday, January 30, 2010

Michael and Oregano

Michael and Oregano

* * * The twins are fine * * *

When Chiara went back to school after the Christmas break, she was SOOOOO ready for Show-and-Tell.  One of the nurses in the NICU had made her a little care package: a hospital band that reads “Big Sister,” a preemie diaper, a preemie shirt, a preemie pacifier and stickers of the boys’ footprints and she was ready to show them off.

“I have twoooo brudders!” she announced to her teachers.  “Mi-call anda Wag-ah-nah.”

The teachers were puzzled.  “Michael,” they understood.  But what was that second name?  Oregano? 

“No!  Ah Wag-ah-nah.”

It really sounded like “Oregano.”  A name like that, paired with the name “Michael” was an unlikely combination, the teachers thought, but they didn’t want to pass judgment.  After all, we do live in Berkeley, where half the parents get their names from The Silmarillion and the other half pretend that’s completely normal.

As open minded as the teachers are, they were quite relieved to hear that Baby B’s name was “Wagner,” Matt’s mother’s maiden name, and not some pizza topping.  (When Matt’s five-year old niece heard that one of the twins was named “Wagner” she gasped and exclaimed to her mother, “They named him after your computer password!”)

The twins’ full names are Michael George Ordonez Kovac and Wagner Lee Bryan Kovac.  “Michael George” is Matt’s dad.  “George” is also my stepdad’s given name, the father of my stepmom, Matt’s middle name, and Matt’s grandfather’s name.  “Ordonez” is my mother’s maiden name.  “Lee” is my dad’s middle name and “Bryan” is my maiden name.  Which means that we have completely exhausted our pool of family names.  If we have a fourth kid, we just might have to turn to the genealogy of Gimli.  So if you get a birth announcement four years from now for “Dothlorian Kovac,” don’t laugh and don’t judge.

* * * * *

Mikey & Wagner are a month old today (Saturday, Jan 30) but their age is still counted in gestational weeks.  Right now we are at the end of week 29.  I think of it as T minus 11.  So it’s funny for me to see that they have little personalities and peculiarities, since, under “normal” circumstances, they’d still be in the womb with nearly three more months to cook.

For your amusement, some Michael and Ore . . . uh, Wagner fun facts:

Michael was born at 1 pound, 12 ounces.  He is about two and a half pounds or about a kilo and some change.  Or, for those of you doing the conversion in methamphetamine, about $70,000 street value.  In other words, if Michael were all meth instead of all baby, he wouldn’t even come close to paying his hospital bills.

Wagner was a little scrappier, born at 1 pound, 9 ounces.  Now he is hovering right around two and a half pounds, depending on if he gets weighed before or after the diaper change.

Michael has an outie belly button; Wagner has an innie.

Sometimes I look at them and think, “Wow.  They look just like Kovacs.”

Today they both had the hiccups AT THE SAME TIME.

Michael likes to suck his thumb and when the nurse delivers “oral care” (a swab with a few drops of breast milk to clean out the mouth), he always opens his eyes.  They both like to suck on the swab.  (Michael and Wagner, not Michael and the nurse).

Wagner is often found with a hand down his diaper.

Both boys prefer to be on their bellies.  They get turned every few hours and their heads get turned, too—to prevent what the nurses call “Toaster Head .” 

Michael will often hold on to a finger or thumb when you “hold” him (compassionate touch holding).

Wagner will often put his arm over your hand.

Now that they have a new breathing system (nose pressure—SiPap for you NICU know-hows—rather than tubes down the throat) we can hear them cry a little bit.  They sound like that penguin from Toy Story who swallows his squeaker.

Yesterday Wagner had tears when he cried.  Actual tears.

They have strawberry blond hair.  And, sadly, a little bit of Toaster Head.

Both LOVE to be held and both hate diaper changes.

They are funny little guys.  The nurses like to tuck the babies’ arms and legs in when they are on their backs (the babies, not the nurses).  Then they (the nurses, not the babies) stuff little blankets to make sure they stay that way (the babies, not the nurses).  One day—and just this one day, as far as I know—the nurses would tuck the twins’ arms and legs in and two seconds later BOTH kids would have their arms and legs draped over their blanket bumpers like little old men in inner tubes, sunning themselves in their little isolettes.  The nurses would tuck the limbs back in and within seconds, both kids would be stretched out again.

The day nurses always say, “Wagner’s so fidgety.  Michael’s the calm one.”

The night nurses say, “Michael’s a feisty one!  Not like his brother.”

Sometimes I look at them and think, “Wow.  They look just like Dr. Zaius.”

On Monday I got to hold Wagner and Matt got to hold Michael for the first time.  Really hold them—skin to skin on our chests—not just one hand on the head and the other on the feet.  It’s a dramatic endeavor: the babies still have tubes and wires and IVs and it takes two nurses to take each baby out of his isolette.  But it’s so good for the babies.  And the parents.  True, I did cry on my son’s head.  But it was amazing.  We held them for over an hour.  (Michael cried when they put him back).  It was like being parents. 

Sleep tight, my little Toaster Head monkeys (the babies, not you blog readers).

© 2010 Janine Kovac 

Sunday, January 24, 2010

Ligation Wednesday!

I have decided to do what the NICU does when they call us on our cell phones:  begin each post with “The twins are doing fine.”  (Which hopefully reads better in a blog post than in a phone call.  After all, dear readers, by now you must be accustomed to reading all kinds of things from placenta recipes —who could forget that one—to obscure movie quotes.  In a phone call, one thinks, “If everything is fine, then why are you calling me?”)

So—the twins are fine.  Now for more stuff you never wanted to know about really tiny babies.  Ligation.

Ligation is one of those words that get tossed around frequently and carelessly (in our circles at the NICU, anyway) as if everyone knows what it means and no explanation is necessary and after it gets used in context often enough you figure it out.  Like the word “escrow.”  Or maybe it’s one of those words that everyone but me knows the definition of.  Like the word “escrow.”

In our context, ligation means baby heart surgery.  Which is probably why they call it “ligation” instead. 

It turns out that our babies, like ALL babies, have a PDA.  No, not one of THOSE; it’s a Patent Duct Arteriosus, meaning that the valve of the pulmonary artery (from the heart to the lungs) is open and flapping.  And it’s important to have a closed PDA because then blood from the heart goes to where it should, like to other blood vessels instead of where it shouldn’t, like to the lungs. 

Usually, this valve closes shortly after birth.  But in preemies, often it doesn’t.  The PDA is diagnosed by an echocardiogram (or simply “echo” for the cool kids) and is treated by either a) waiting; b) ibuprofen or c) baby heart surgery.  We tried some of a) and some of b) and I kept thinking, well, at least we can always try this ligation thing instead of baby heart surgery.  Then I found out that ligation IS baby heart surgery.  And I burst into tears and fled from the hospital. 

After Tuesday’s echo confirmed what the doctor’s stethoscopes had detected—that the boys’ PDA’s were still open—the surgery was scheduled for the next day.  The head nurse practitioner described the surgery and even offered to show us pictures, to which I said, “You know, I’m cool, but I’m not that cool.”

Now, ligation surgery in the scheme of baby surgeries, is really no big deal.  But it does involve a lot of “-tion” words and “-sion” words that you didn’t want to associate with your newborns, such as “sedation,” “incision,” and “morphine drip.”

On Wednesday morning, the surgeon, Dr. Olaf GuutDoktor (mostly not his real name), imposing in stature and nearly albino, explained the procedure in a very calm and reassuring manner.  But all I could think was, “Where are his eyebrows?”

For the curious, the procedure starts with a small half-moon shaped incision under the left shoulder blade.  Then they spread the ribs a little, gently push the lungs out of the way and with the help of sci-fi binoculars to navigate through teeny tiny vital organs, clamp a teeny weeny metal clip to close the PDA.  And then they attach Steri-strips, which is basically just tape.  It’s done bedside at the isolette by expert doctors like Dr. Olaf and takes about fifteen minutes.  It takes longer to set up the surgery than it does to perform the surgery. 

On Tuesday night, the boys were moved from the room they shared to individual rooms for Wednesday’s surgery.  The only reason they had to move at all is to adhere to state regulations: the babies in the most precarious condition have to be closest to the exit.  So Michael moved 12 feet from Room 3 to Room 1 and Wagner moved 6 feet from Room 3 to Room 2.  After the surgery Wagner moved to Room 1 to be with his brother.

The doors to all the NICU rooms are big, sliding patio-like doors with a second set of glass doors that adjoin to other rooms (so each room has at least two “exits”).  Parents aren’t allowed to watch the procedure (whew), and to prevent this, the curtains are drawn and paper is taped over the windows.  Which didn’t prevent us from trying to peek over the paper nor did it prevent us from hearing the doctor, anesthesiologist and nurse crack jokes.  We don’t know what they were laughing at.  We can only guess that it was our terribly funny ligation clearance sale joke.

[Matt and I made the same joke to different nurses—thankfully—what an embarrassment if we had made the same joke to the same audience!  Me in Michael’s room: “It’s Ligation Wednesday!  Buy two ligations, get one free!“  Matt in Wagner’s: “Today only!  3 ligations for the price of 1!”  It’s like we’re turning into twins, too.]

Laughter is not really something you want to hear during surgery.  You want the surgeons to take this VERY SERIOUSLY; it’s baby heart surgery, for Pete’s sake.  On the other hand, if the surgeons are laughing, they’re not panicking and if they’re not panicking, maybe things are going really well. 

In our case it seems to have meant that the surgeries went really well.  Dr. Olaf seemed really pleased and then he went to the next room to crack more jokes, I mean, perform more baby heart surgery.  Michael’s surgery went first, then Wagner, then a third baby (who had moved from Room 6 to Room 3 the night before and then from Room 3 to Room 2 for the surgery). 

After the surgeries the babies stayed on their morphine drip for 48 hours.  Michael got .188 milliliters of morphine an hour and Wagner got .156 ml per hour (it’s based on weight.)  For those of you who are metric system challenged, a tenth of a milliliter is really just about a drop. 

On the second day they upped Wagner’s dose a smidgen because he seemed to be in pain.  Pain is determined partly by the volatility of their numbers: heart rate, oxygen-saturation rate, amount of oxygen needed, etc. and partly by watching the twins themselves.  Are they really fidgety or are they calm and sleeping soundly?  After they got weaned from the morphine, they got Tylenol suppositories.  Which I’m pretty sure is just as much fun as it sounds.

The twins did better than expected.  Their oxygen needs went down.  They went back on their trophic feedings (they get 2 ml of breast milk injected every 3 hours into tubes to their stomachs).  Their ventilator settings came down in a way that I would explain to you if a) I understood it well enough to repeat it or b) it was remotely interesting.

Today is Sunday.  Each of the boys had a couple of rough patches here and there over the weekend, but nothing a couple of drops of morphine couldn’t cure.  Both were extremely squiggly on their backs (read: lying on their incisions) which is understandable, so they stayed on their tummies (they get turned every three hours).  But today things are good. 

And so ends a big surgery week for the Kovac family: Grandpa on Tuesday, the twins on Wednesday and on Thursday, our poor beloved Jetta had her transmission rebuilt.  I’m happy to say that all are doing well.

© 2010 Janine Kovac 

Sunday, January 17, 2010

The Amusing Post

The Amusing Post

This was supposed to be the amusing post, the one where I describe life with the pump.  The breast pump, that is.  How 8-12 times a day I assemble, attach, pump, disassemble, wash, rinse, sanitize, air dry, and take milk inventory.  Vials of milk that have never been in the freezer get a green sticker.  Vials that have been in the refrigerator for 48 hours have to be put in the freezer, where they can stay for six months.  Unless they have an orange sticker, which means they have already been in the freezer and can’t go back.

But the only vaguely amusing thing about the whole process is the thought that runs through my head as I turn the dial of the pump.  It’s Christopher Guest from the Princess Bride as he tortures dear sweet Westley in the Pit of Despair.

                                            CUT TO:


He switches off The Machine, picks up a large notebook and pen, sits in a chair. The NOISE of The Machine subsides. Rugen opens the book to a blank page.

             As you know, the concept of the
             suction pump is centuries old.
             Well, really, that's all this is.
             Except that instead of sucking
             water, I'm sucking life. I've
             just sucked one year of your life
             away. I might one day go as high
             as five, but I really don't know
             what that would do to you. So,
             let's just start with what we
             have. What did this do to you?
             Tell me. And remember, this is
             for posterity, so be honest --
             how do you feel?


                                            CUT TO:


in anguish so deep it is dizzying. Helpless, he cries.

Count Rugen watches the tears, then starts to write.


The next person who tells me, “If it hurts when you pump, you’re doing it wrong,” is going home with a shoeprint on the forehead.  Seriously.  For those of you who might not know how tender your “mommy parts” get during the early days, even an air current at room temperature is painful.  Life-sucking pumping machines even more so. 

In closing (and with regards to the last post), I’d like to say that I know the image of a mother sobbing over her son’s bed in the intensive care unit as previously depicted was a bit of a downer.  But it’s important to remember that, in addition to the fact that it is a bit of a downer to have your kid in the NICU (FYI, the twins are doing “pretty well, considering”), I also have those raging post-pregnancy hormones that make one cry at everything from crying because you forgot to TIVO Dr. Drew’s Celebrity Rehab to crying because you forgot you don’t have TIVO.

So I thought you might like to know some of the other stuff I have wept about lately:

Rachmaninov’s Piano Concerto #2

Learning that old time radio shows used to ask folks at home to sing along

Not being able to track a UPS package

Forgetting my water bottle at home (Luckily Matt was there to say, “Hey, it’s OK, we can turn the car around and get it.”)

The weirdest one: uncontrollable sobs at hearing Matt describe the ending to a movie that I had seen (and HATED) but have no recollection of. 

And finally, from the inside of a bottle cap of some fancy tea leftover from our Christmas picnic, “We must be willing to let go of the life we’ve planned to have the life that is waiting for us.” (E. M. Forster, sniff, sniff)

© 2010 Janine Kovac 

Friday, January 8, 2010

The Honeymoon Ends

This post was written a few days ago while I was still in the hospital.  It’s what was going on then, which is not necessarily what’s going on now. (In general everything is “fine.”) I promise the next post will be light hearted and amusing. 

The Honeymoon Ends

The doctors had informed us—warned us, really—that many preemies have a “honeymoon period” shortly after they are born.  They take off like gangbusters; everything looks great and then it looks like everything just tanks.  Their weight drops; problems arise.  The honeymoon is over.  At frequent intervals our doctor, Dr. Sandhu, reminds us that the trajectory of progress is never an upward slope, but more like a saw tooth figure: rapid progress and plateau followed by rapid decline and stabilization.  Rinse and repeat. 

Turns out parents experience the same conceptual metaphor as they hope ‘n’ cope. 

The first day the twins were great—better than expected.  So was I.  The morning after the C-section I was up and about and able to walk down the hall on my own for frequent visits to the NICU.  We got a lot of information but none of it particularly scared me.  Yeah, yeah, a blood transfusion consent, the high-fi ventilator for one twin, a respirator for the other, blue light for the blue baby (for bilirubin), little goggles for eye protection from the blue light, tubes in the belly button, extubation, intubation, suctioning, blood gas measurements, RDS, PDA, x-rays, ultrasounds, and of course, the incessant beeping of the monitors.  And none of it bothered me.  I mean, it’s not like I’m the one giving the blood transfusion.  Then I’d be worried, I kept telling the nurses.  It got a big laugh.  Every time.  Oh, you’re doing so well, they all said.

Then on the day three, I’m “holding” Michael.  He looks basically the same as he has the last few days, but whereas before his movements seemed to me to be active and spunky; today the same motions look jittery and frenetic.  The mesmerizing effect of those teeny fingers and toes are just, well, so yesterday.  He doesn’t look like a miracle of nature and science; he looks like E.T. 

I hold him and he feels . . . scared.  I can feel it.  It’s the same body language that Chiara has when she’s scared: slightly rigid, wanting me to hold her and pulling into herself at the same time.  That’s what Michael’s doing.  Rigid, pulling into himself and yet still giving signals that he wants me to be there.

[Preemies, like anyone, have a body language.  They can tell you when they are over stimulated and want you to go away.  (It’s with a big “talk to the hand gesture,” ala the Supremes from “Stop!”  Sometimes outstretched, sometimes in front of their face with their face turned away from the offender.)  Body language to indicate that they like what you’re doing varies from “cuddling” close to where you touch them (Wagner does this a lot) to just feeling heavy in your hands.  The big telltale sign of comfort, however, is the oxygen–saturation rate, a number from 1 – 100.  Right now twins’ rate should sit solidly in the 85 – 93 range.  When the twins are happy, the rate goes up.  (The nurses tell me that Wagner’s oxygen–saturation rate goes up when he hears my voice.)  In the scene I’m describing with Michael, his oxy–saturation rate was rising as I “held” him, but instead of feeling heavy or holding on to my finger (which he does a lot), he was tense.]

With Chiara, I mean it when I say, “It’s OK.  I promise you, you’re going to be just fine.  I’m going to make sure that nothing bad will happen to you.” But I can’t tell Michael that.  I can’t promise him that everything will be OK.  And I can’t do anything to make sure that “nothing bad will happen.”  All I can do is cry on the isolette.  Big, sloppy tears that drop on his little plastic doors.  It occurs to me that my three–day old son is going through more than what I’ve been through in forty years.  It occurs to me that I don’t know if he will be all right.  It occurs to me that I’m scared, too.

“Well, we’ll just have to be scared together,” I tell him.  It’s the most sincere reassurance I can offer.

I stay there, one hand on his head, one hand on the soles of his feet.  I want to try to “think positive” but those feelings just aren’t there today.  Finally, I give up and just feel his head and feet, not trying to do anything.  We’re just going to have to embrace this moment, too, I figure.

It’s going to be a long haul.

© 2010 Janine Kovac