Tuesday, February 23, 2010

A Night at the Ballet

* * * Twins are doing really great.  Mike the Cow, not so much * * *

A Night at the Ballet

“How is your daughter handling this?” I am often asked.

Great, I say.  I reply that she’s at the perfect age, old enough that we can explain [some] things to her, but not old enough to be worried.  For all she knows, it’s perfectly normal to have a baby and leave him at the hospital.  And for all we know, it’s perfectly normal for all her dolls to be sick and need medical attention.  This morning she was lining them up for vaccines.

“And how did she do with you in the hospital for so long?” (I was in Ante-partum for eight days before the twins were born and in post-partum for five).

She did great.  Just great.  Don’t all three year olds scream, “DON’T LEAVE ME, MAMA!!!” when their mommies go take a shower?

But just in case, I thought we’d have a little mother-daughter time.  We went to see the ballet, Coppelia last Friday night.

“It’s like a night adventure, Mama!”  “Adventures” are what we do on non-daycare days.  Some people run errands.  We have “adventures.”

Coppelia is a full-length ballet from the late 19th century.  Like Giselle, it’s one of those “My man done me wrong” ballets.  You know, boy and girl are engaged.  Boy falls for someone else.  Girl gets upset.  In Giselle, the other woman is a rich aristocrat.  Girl goes crazy and dies.  Boy is wracked with guilt and tormented for all eternity by a herd of undead jilted ladies.  I’m not kidding.  In Coppelia, the other woman is a doll.  So Girl triumphs, Boy feels dumb that he fell for a doll.  They get married and she probably holds it over his head for the rest of his natural born life.

Coppelia does have an additional creep factor—Dr. Coppelius, the eccentric old maker of life size dolls, has been studying magic in hopes that he can bring his doll, Coppelia, to life.  When Boy (“Franz”) sneaks into the toy factory to make overtures to this hot doll, Dr. C gets him drunk and tries to steal his life essence for his doll.   “Swanhilda,” the Girl (again, not kidding) is dressed in the doll’s clothing (oh!  What would 19th century comedy be without the ol’ dress up in someone else’s clothes bit), and pretends to come to life.  Franz sobers up and Swanhilda says, “Ha!  I tricked both y’all!”  To which Franz says, “Oh, you!  I guess we might as well get married, then,” all in ballet pantomime, of course.  Then Dr. C. crumples to the floor, broken hearted.  

I thought it would be a good ballet to see because I thought I could explain the story to Chiara.  (Turns out I was wrong; it’s harder than you think.  “See, the girl pretends to be a doll who pretends not to be a doll anymore.”)

She loved it anyway. 

And now we get to the part of the story that makes it blog worthy.  Apologies for sounding trite, but I learned something on Friday night.  Not only is the whole greater than the sum of its parts, but you get to cherry pick your parts and that makes it even better. 

For example, this was not a convenient show to see.  There was one show only: Friday night at 8 p.m. in Marin County, 45 to 60 minutes away when there’s traffic.  On a Friday night before a three-day weekend, there’s traffic.  It was raining to boot.  I knew beforehand that the quality of the dancing would not match the price of the tickets.  Lastly, I have a lot of negative memories associated with performing Coppelia. 

In the end, none of these details mattered.  Chiara and I shared a magical night at the ballet in a way I would have never anticipated.  Here are details that made it memorable.

Chiara insisted on wearing her “fancy dress” (blue velvet with a layer of tulle underneath), her hair in a bun, and sequined Mary Jane’s (thanks to Cousin Maria).  Chiara was by far the smallest audience member and several people commented on her get-up.

“Are you a dancer?” she was asked over and over.

“Sometimes,” she would shyly answer.

I had gotten seats on the far edge of house right, in case we needed to beat a hasty retreat.  In the row in front of us sat a white haired couple.  Judging from her cane and his agility, I think it was a son accompanying his elderly mother to the ballet.  It was hard to say who was more excited, his mother or my daughter.

“We aren’t going to have a sing-along, now, are we?” he preemptively reprimanded her.  She didn’t answer, hands clasped at her chest, watching the curtain in anxious anticipation.

The lights dimmed and the overture played over the loudspeakers.  The old woman’s head bobbled in time with the music and her hand involuntarily waved to and fro as if she was conducting an imaginary orchestra.

The score to Coppelia was composed by Leo Deliebes specifically for ballet.  If this woman knows the music, chances are she danced this ballet.  How beautifully poetic it is.  Here we are, three generations of dancers.  Past, present and future.  Will I one day be like this old woman, escorted by Chiara to a B-list production, with nothing to hint at my past life but knowledge of the music?

The performance was pretty much what I expected it to be: the occasional dancer out of line, a sickled foot here and there but what I will remember is Chiara, sinking into my lap, leaning against me, occasionally whispering, What happens next?

I had planned to leave after the second act (the third act is the wedding—always a bore), but Chiara wouldn’t let me.  “NO!  We have to stay for the next act!”  (How did she know there was another act?).  She bargained with me: “Let’s stay for one more dance.”

So we did.  We stayed for the opening of the third act—the pas de trois—the part I danced in Iceland.  And this is what makes life so extraordinary.  I haven’t heard this music in seventeen years.  But as I listened to it, I felt a surge of joy.  “Wow.”  I thought.  “I must have really enjoyed dancing this.”

It may sound silly, but this was a surprise to me.  Unlike other parts of the ballet that evoked memories of the choreography or the political back story that unfolded behind the scenes (literally!), the music to the pas de trois just brought back blissful feelings of pure joy, one of those moments where you feel that to live life is to soar above it.  And now I was simultaneously remembering, experiencing and sharing that feeling with my daughter. 

We stayed for one more dance, the doll dance (the Russians had taken liberty with the story) after which Chiara whispered, “Now we can go.”

© 2010 Janine Kovac 

Wednesday, February 17, 2010

Happy Birthday

Happy Birthday

*** The twins are doing great. ***

Today is Chiara’s birthday.  Saturday is her party.  She has been to two birthday parties this year and has specific ideas about what her party should have.  For one, it should have balloons and party hats and a piñata.  And the piñata should be cow-shaped.

I have no idea where she got this, (since neither of the previous piñatas were cows), but she was very firm.  Had to be a cow.  As luck would have it, they do make cow piñatas and we found one at the second store we went to.

Chiara loves her cow.  It’s almost as big as she is, but that didn’t stop her from dragging it from room to room as soon as we got home.  She introduced it to her other—much smaller—farm animals.  She read it a story.  She named it Mike.  Mike the Cow.

Uh-oh.  What was going to happen on Saturday Mike the Cow gets strung up by the ears and has her udder bashed in with a baseball bat by nine screaming three year olds?

“Honey, do you know what will happen to Mike the Cow at your party?”

Chiara knit her eyebrows, made a frowny face and a stabbing motion. 

“WE’RE GONNA HIT, HIT, HIT MIKE THE COW!” she exclaimed.  And then she turned to Mike the Cow and starting reading Harold and Purple Crayon to it/him/her.

Well.  At least she’s clear on the concept.

Sunday, February 14, 2010

My God, It's Full of Stars

My God, It’s Full of Stars

Today when I got to the NICU and checked on Michael, he had his mouth open (as he often does), his eyes open (as he has started to do right before feedings) and his hands on his cheeks.  Although he looked like something between Macaulay Culkin  and Edvard Munch’s Scream, I like to think he was looking up at his isolette in with the same awe of Dave in 2001. 

After all, he and his brother have something no other preemie in the NICU has had before (besides blond hair): a nasal cannula with a ventilator.

[Preemies don’t have blond hair.  They just don’t.  Even those who end up blond later don’t have blond hair.  So it’s really weird that ours do.  Esp. since one of us has brown hair and one of us has black hair.]

A nasal cannula is just fancy hospital talk for “tubes up your nose.”  But these tubes are different.  Not only do they deliver oxygen, but the ventilator means that they give pressure, too.  This is good because if the twins stop breathing, as they are wont to do from time to time, the ventilator gives ‘em some extra breaths. 

It’s the first time they’ve combined the nose tubes and the ventilator for a preemie at this hospital.  Apparently the technology was conceived at USC’s L.A. Children’s Hospital (O.K., Louise, you win this round), but for us, it’s new.  The nurses are all very impressed with it.

The twins like it, too.  It means that they can touch their faces, as Michael has discovered, and tug on them without disconnecting terribly important breathing implements, such as the old nasal prongs (which scrunched up their faces) and the breathing mask (which covered their mouths and nose), both of which have to be secured with elastics (which leave indentations on their starting-to-get-chubby cheeks) and little do-rags (which leave their heads just the slightest bit smaller than if they didn’t have the hats).  Prior to nasal cannula insertion, the boys would, from time to time, pull their prongs out and their masks off, which is Not Good.  (Note: they CAN breathe on their own, just not for extended periods of time—say, longer than twenty minutes—and their lungs don’t always inflate fully).

The new get-up is also much quieter than the old get-up, which is nice because our boys do not like noise AT ALL. 

The new get-up also means that in addition to “kangaroo care” (where we hold the boys on our chests bare skin to bare skin), they can start “recreational breastfeeding.”

Now don’t laugh, but when I first saw “recreational breastfeeding” at week 31 on our “Care Chart” under “Parental Awareness,” I worried that it might mean something between the parents rather than something for the babies.  And I didn’t want to ask about it because I didn’t want my fears confirmed.  Hey!  I asked you not to laugh.

Turns out it just means that babies nurse without really feeding, as the whole “suck, swallow AND breathe” thing involves a lot of coordination.  For the babies, anyway.  So the recreational breastfeeding is like an intermediate step.

And they are so ready for it.  Last night, Wagner was in “kangaroo care” and starting to root, inching his way toward the nipple, licking his lips, so intent on his goal that he didn’t even notice the hairy chest.  How was he supposed to know that recreational breastfeeding doesn’t work on Dads?

Oh – and we’re now at week 32 with both boys over 3 pounds.  Yippee!  All of this means progress.  Which is probably why Michael had his hands on his face; not just because he can, but because he can’t believe we’ve come so far in just six weeks.

© 2010 Janine Kovac 

Saturday, February 6, 2010

Wagner's Up and Down Day

Wagner’s Up and Down Day

* * * The twins are fine, so fine that I am now writing a post about how fantastic their latest lung x-rays are.  But this is not that post.  * * *

Note: this title was taken from the book Big Brown Bear’s Up and Down Day , which is a GREAT children’s book that everyone should read.  But what happens to Bear is nothing like what happens to Wagner in this post.

* * * * *

“So, Wagner had a bad night.”

Look at the chart.  Cluster of red circles: at 17:30, 23:45, 01:20, 02:40, and again this morning at 10:45.

“Mostly if he de-sats, it’s in the 60’s, but these episodes were apneaic.”

Apneaic.  Not breathing.

Look at the monitor.  Everything’s fine.  Heart rate in the 160’s, breathing in the 50-70 range, Oxygen – saturation rate in the low 90’s.

“Everything’s fine now.  His numbers are good.”

Look at the respirator.  Breaths per minute: still 20.  Oxygen percentage: 25, almost 21%, like the air we breathe.  PEEPs, PAPs, PIPs, all good.

“We have new doctor’s orders.  Limit holding to once a day, no more than an hour.”

Is that the problem?  (Of course, nobody was holding him at night around his cluster of episodes.)

“No.  We want you to hold them, but if they’re having problems . . . “ she trails off.  “Sometimes it’s . . . we just have to see how they handle it.”

Michael’s fine.  Same kind of monitor.  Same kind of respirator.  Same kind of numbers.  Different night.  I take his temperature.  I give him his pacifier.  I change his diaper, put it on the tray so it can be weighed.  I change the oxygen sensor from his foot to his wrist. 

Hey!  The PICC line is out!  (That’s good news.  Really good news.)

“Yes, they took it out last night.  The boys are up on their feedings, down on the TPN.  They don’t need their IV’s anymore.”

So maybe that’s why Wagner had a bad night?

“Could be.”

As I adjust Michael’s pacifier again, I hear it first from Wagner’s monitor, then see it on Michael’s.  The high-pitched alarm of a de-sat beeps from the front monitor.  Wagner’s readings pop up on Michael’s monitor.  48.

48.  Wagner has dropped from a “safe stage” somewhere between 80 and 97, triggered the alarm and in two seconds (literally two seconds), he’s now at 48.  In all of their daily de-sats, I’ve never seen it drop so low so quickly.  The room is dark.  The nurse has stepped out.  I’m alone with the twins.

In another second, a nurse rushes in.  I’m still changing Michael’s bed.  Because I’m at Michael’s isolette, she thinks the problem is with Michael.  I nod toward Wagner to indicate that the problem is with him.  Before she can ask I tell her, “He’s at 48.”

Our primary nurse comes in.  Calm.  Too calm? 

I finish with Michael. 

More flashing numbers: 43.  38.  33. 

“He’s at 9,” says the first nurse.  “Breaths.  He’s at 9 breaths.  25.  He’s back to 25.”

“Give him some more oxygen.  I upped his oxygen but give him some more.”

“Come on, Wagner.  Breathe, honey, you’ve got to breathe.”

“Tap him on his back.”

38.  44.  55.  56.  57. 

“Give him a little more oxygen.”


“Breathe, honey.  Come, on.”

Oh, please, breathe.  Please breathe.

67.  73.  78.  85. 

The monitor stops flashing.

The nurses discuss whether the episode was apnea or not.  His heart rate only dropped to 119.  Technically, an apneaic episode would have had a heart rate of 90s or lower.  But given the cluster of apneas last night, we’ll count it as an apnea.

The monitor beeps again.

97.  98.  99.  100. 

We smile.  He’s fine.  The nurse lowers his oxygen again.

That was the day nurse.

“I think we should do some tests.  There could be an infection from taking the PICC line out.  All it takes is one little germ.”

The doctor agrees, shrugging, “Sure.  You never know.”

Take a blood gas.  The results come back great.

Snap an x-ray.  The lungs look cloudy, but nothing too different from yesterday’s x-ray.

The next step is to take some blood, some for tests, some for a culture.  The artery spasms.  Another nurse is called in to try.  Another spasm.  They try another limb with a tourniquet this time.

Matt and I watch Wagner’s arm, strangely listless.  It doesn’t even react to the needle prick.  Too cautious to pace, we stand there, arms crossed, brows furrowed, lips tense.

Finally, they find an artery.  The blood goes from Wagner’s ankle to a thin tube to a strip of paper.  The results come back picture perfect.  No infection.

And the listless arm?

“Sucrose.  A drop of sucrose on the tongue for infants acts like a pain killer.”

That was the afternoon nurse.

Finally at the end of the day, Wagner’s saturation rate is high and his oxygen percentage rate is low.  (Both very good.)

We still have to wait for the results of the blood culture, but it looks like we’ll never know what caused this cluster of apneas.

“Sometimes that’s just what preemies do.”

That was the night nurse.

A day later, remembering, recording.  Like a balloon letting out air, I finally cry.  Little, simple, relieved tears.  I’m OK.  It’s just what parents of preemies do.

© 2010 Janine Kovac