Today was not a good day. Jeff and I went to my OB this morning for my final check-up. Both he and his nurse (who doesn't know how to take blood pressure) further demonstrated incompetence. The nurse didn't realize that I had had the baby (either it wasn't marked in my file or she can't read). My doctor gave me the "This was probably just a random occurence. There's nothing in your history to suggest that you'd have these problems again. My gut says that you could have a normal pregnancy." At which point, I asked him what he thought about the pathology report on the placenta. He never sought it, received it, nor read it. What a fraud. Dispensing medical advice based on his "gut" rather than looking at evidence.
Joyce, Henry's nurse today, called us at home. Henry had a lot of As & Bs (apnea and brady spells) last night, so the staff did a septic workup on him. One of the tests suggested that Henry has an infection.
Dr. Cahan ordered an x-ray of his abdomen. The x-ray showed that there are little air bubbles in the lining of the intestines. So far, none of them has ruptured. His feeds have been stopped. Carrie, the nurse practitioner, put a PIC line in Henry's leg for the TPN. And, Henry is being given antibiotics, plus some sodium and potassium.
Other than surfing and having As & Bs, Henry hasn't displayed symptoms. If the bubbles burst, that would be incredibly problematic because that would allow bacteria from the intestines to seep into his entire body. Such breaking or tearing of the intestinal lining would require surgery. The surgeon, Dr. O'Connor, stopped by to get to know Henry just in case surgery is needed. The surgeon told me that most preemies Henry's size do not do well with surgery.
If you are inclined toward prayer, now would be a good time to send them Henry's way.
Monday, June 11, 2007
Surfing and a Blood Transfusion
On Saturday night (6/9), Melissa J. was his nurse. She was excited to be assigned to Henry. She signed up as one of his primary nurses but hasn't had him in a couple weeks. Henry's weight was down to 810 grams. When Melissa checked his stomach, the residuals looked slightly green, but not enough to discontinue the feeds. I did skin-to-skin with Henry, and it went well. It was quite relaxing; I even drifted off to sleep for a bit. Jeff said that Henry's sats and heart rate looked good during it. At one point, Henry had a small desat when the nurses' chit-chatting got a little loud. He recovered quickly, but he's clearly still noise sensitive.On Sunday (6/10), Mary was his day nurse. I wanted to do skin-to-skin, but the recliner was being used. The nurses often offer to get a rocking chair when the recliner isn't available, but holding Henry in an upright position isn't that good for him (according to some people). One nurse had told me that the upright position puts some strain on his lungs. Seems rather odd that they only have one recliner in the entire NICU; apparently, they have others "on order," but they have been "on order" for months.
While I was there, Henry had an apnea/bradycardia that lasted about a minute. As near as Mary could tell, he had been bearing down to produce a stool, and he must have held his breath during it, which resulted in the episode.
Mary checked Henry's stomach for residuals. She found just a little bit. It didn't look green. Mary said that they have started adding calories to the breast milk to help Henry gain weight. And, they gave him some vitamins. One problem with the vitamins is that it can turn stomach contents green, which makes it difficult to analyze the stomach contents. You don't know if the stomach residuals are green from bile traveling in the wrong direction or from the vitamins.
In the evening, Marcie was Henry's nurse. Jeff and I hadn't met her before. Henry weighed 820 grams. Jeff did skin-to-skin with him, and it went well for a while. Then, Henry had several desat episodes that required Marcie to bring out the oxygen mask used during blow-bys. Marcie suctioned out Henry's mouth and got some goop out, but that didn't prevent further desats. At one point, it seemed like something wasn't quite right with the fit of the cannula; we heard something that sounded like a leak. So we decided to put Henry back in his isolette. Marcie tried to rearrange his cannula tube and feeding tube. Henry had a rather big desat in his isolette where his saturation levels at one point went down to 45%; even though it only lasted a second, it was still disconcerting.Because Henry was already agitated (more agitated than we'd seen him in a long time), Marcie decided to do his cares and take his blood tests for the evening. While Marcie was doing the blood work, Jeff and I went downstairs for a snack (around 11:20PM). When we came back about 20 minutes later, we found Michelle helping Marcie put in an IV into Henry. Jeff asked what was going on. Marcie said that Henry's crit levels were 26.5. His crit levels had been low for a while, so I can't say that I'm surprised. They started up a blood transfusion. Mary Ann, the nurse practitioner, talked with us. They are hoping that with the added red blood cells, Henry's body should have an easier time carrying the oxygen. When we left around 12:45AM, he looked OK. He is going to be closely monitored this evening. We very much hope that they won't have to put him back on the CPAP.
Saturday, June 9, 2007
Clever Boy at Almost Minus 9 Weeks
I went to visit Henry around 12:30PM. After getting off the elevator, I ran into my parents who were walking down the hall with nurse Holly. There was a surgerical procedure taking place in Henry's pod (one of the babies transported to the NICU a couple days ago), so the staff was blocking off the pod for the next hour. My parents did get a chance to visit him for a little while and, all was well. I went to lunch with them and then returned afterward.
Henry was doing well. His oxygen was a little higher than before, because he had been sat surfing. It was set around 45%. My sister Carolyn visited. And then, Jeff came. We thought that Henry's breathing was beginning to look a little labored and he did a dip into the 70s on saturation, so Beth, his day nurse, turned up his oxygen to 50%. I had planned to do some skin-to-skin, but the pod was noisy, so I decided to wait until tonight. It was one of those very noisy days in the pod where it wasn't anyone's fault; a lot was going on. One baby just had some kind of procedure done to him/her; it looked serious (the father has been standing watch over the baby for a couple days now). One baby was moving to another pod. And a third baby, Bryanna, from the far side of the pod was being moved to slot right across from Henry. It was best for Henry to stay in his isolette, which supposedly blocks out some of the sound, but not enough in my opinion. At one point when the staff was moving Bryanna, Henry grabbed his ear and folded it over to block out the noise. What can I say...Henry is a clever boy. Excellent hand to ear coordination at age just about minus 9 weeks!
Lisa McCoskey, the nurse practitioner, came by and said that Henry was doing well. They are pleased with his progress. She thinks that the next step will be to add extra calories to the breast milk to help him grow. A few days ago, one of the nurses mentioned that there has been nothing typical about Henry's case. I got some clarification how "normal" Henry's situation has been. Most preemies stay on the ventilator a lot longer than Henry did. Henry's move to CPAP was very fast. So the staff has impressed with Henry's respirator performance so far.
Henry was doing well. His oxygen was a little higher than before, because he had been sat surfing. It was set around 45%. My sister Carolyn visited. And then, Jeff came. We thought that Henry's breathing was beginning to look a little labored and he did a dip into the 70s on saturation, so Beth, his day nurse, turned up his oxygen to 50%. I had planned to do some skin-to-skin, but the pod was noisy, so I decided to wait until tonight. It was one of those very noisy days in the pod where it wasn't anyone's fault; a lot was going on. One baby just had some kind of procedure done to him/her; it looked serious (the father has been standing watch over the baby for a couple days now). One baby was moving to another pod. And a third baby, Bryanna, from the far side of the pod was being moved to slot right across from Henry. It was best for Henry to stay in his isolette, which supposedly blocks out some of the sound, but not enough in my opinion. At one point when the staff was moving Bryanna, Henry grabbed his ear and folded it over to block out the noise. What can I say...Henry is a clever boy. Excellent hand to ear coordination at age just about minus 9 weeks!
Lisa McCoskey, the nurse practitioner, came by and said that Henry was doing well. They are pleased with his progress. She thinks that the next step will be to add extra calories to the breast milk to help him grow. A few days ago, one of the nurses mentioned that there has been nothing typical about Henry's case. I got some clarification how "normal" Henry's situation has been. Most preemies stay on the ventilator a lot longer than Henry did. Henry's move to CPAP was very fast. So the staff has impressed with Henry's respirator performance so far.
Wet and Wild
Henry is doing well. The big news is that he is still on the cannula!
I was incredibly surprised to find that Henry was still on the cannula when we visited him in the evening on Wednesday (6/6). His weight was 880 grams. We were pleased to find that Kathy and Holly were his evening nurses. They had taken care of him during his first few weeks in the NICU, but they'd been assigned to the triplets in his pod, so they hadn't had him in awhile. Kathy, Holly, and Joyce make up a trio of nurses who often work together switching off on "8 hour" shifts instead of the usual "12 hour" shifts. 8 and 12 hours are in quotation marks because, as near as I can tell, an 8 hour shift is really 9 hours (at least) and a 12 hour shift is really 13 hours (at least) because of the time spent relaying information about the patients during shift changes. Kathy, Holly, and Joyce are excellent nurses and have a lot of NICU experience.
I was even more surprised to find that Henry was still on the cannula Thursday. Henry's bedding had been changed. The full drape on his isolette was changed to a cute yellow blanket that comes down halfway along the side of the isolette. This allows the nurses to better keep their sights on Henry (which is important with the continous feeding). And, Henry got his first teddy bear (it's a blue beanie bear that Holly chose for him).
Joyce was his day nurse. Joyce has been working in the NICU at UMC for 36 years. That means that she was working there when I was in the same NICU 34 years ago. I was a preemie, a 33-weeker born 3 lbs 13 ounces. Alas, Joyce doesn't remember me (I'm a bit heavier than I was back then), but she feels a strong bond with Henry. When she saw me enter the NICU, she said to me, "I get to take care of Henry today!" It was nice to see such enthusiasm over my son.
Henry was given a dose of Lasix again. They switched him to a different diuretic after the Lasix dose. Other than that, he was doing well. They must have felt confident in his cannula experience because they took the CPAP machine away from his bedside. Joyce said that Henry had good muscle tone. His color was still rather pale, and his hematocrit was somewhat low...suggesting a blood tranfusion in his future. Basically, as I understand it, the hematocrit is a determination of the red blood cell count. However, they aren't inclined to do blood tranfusions just based on the labs because they want Henry's body to learn to make the red blood cells on his own. If Henry shows problematic symptoms (e.g., sats continuously low), then they'll proceed with the transfusion.
My mom arrived just as I was leaving. Henry put on quite the show during her visit. Henry managed to pull out his feeding tube. Because Henry was on the continous feed, this made a mess. So, they ended up putting the feeding tube through his nose (something they couldn't do when he was on CPAP), which should make it much harder for his to pull out and a bit more comfortable for him.
In the evening, Kathy was his nurse. The Lasix did its job. Henry had a 20 gram diaper and a 30 gram diaper during his first two cares on Kathy's shift. When Henry was weighed, he was 860 grams. Jeff did skin-to-skin with Henry, which Henry enjoyed. Holly took over the second half of the evening. Henry continued to do well.
Today (6/8), Joyce was his nurse again. When I arrived, he was wrapped up like a burrito in his blankets. Holly left a book for Henry entitled "Everything I Know I Learned from My Grandpa." Holly often talks to my dad when my dad comes in the morning.
I did skin-to-skin for about two hours with him. He did very well (high sats, often at 100%). My mom visited and watched his monitors while I held Henry. The big "wet and wild" event of the afternoon was that Henry peed on me. When I mentioned it to my mom, she said that it wouldn't be the only time. Kathy (who had just taken over for Joyce) said the same thing as she helped get Henry settled back into his isolette.
Jeff and I arrived later than usual in the evenings (arriving around 10:45PM). Kathy was still his nurse. She reported that Henry's PIC line had to be removed because it was clogged with a small clot. They decided not to replace it because he just started full feeds, and if they take, he won't need a PIC line. As of 10PM, his continuous feeds were up to 5ml per hour (his current feeding goal). He had lost some weight (probably fluid) and was down to 830 grams.
Things continue to go well, but he did a little sat surfing (not enough to make the alarms go off, but sat surfing nonetheless). Jeff did the skin-to-skin again, which went well. Henry looked relaxed. Because heat is often lost through one's head, Henry usually wears a hat when he's taken out of the isolette. Tonight was exciting because Henry got to wear the first article of clothing that he actually owns (not borrowed from the NICU). It's a red knit hat with a blue letter H on it. Our good friend Jamie is an expert knitter and made it for him.
During the skin-to-skin, a nurse came by and wrote some things in one of Henry's charts. She mentioned that Henry had been switched to the blue color on the patients board. I don't know what the full color range is, but Henry started off at red color, then went to green, and now he's at blue. We'll mark this as a step forward.
Michelle took over for Kathy when Kathy went off shift. Jeff and I helped with cares before we left.
I was incredibly surprised to find that Henry was still on the cannula when we visited him in the evening on Wednesday (6/6). His weight was 880 grams. We were pleased to find that Kathy and Holly were his evening nurses. They had taken care of him during his first few weeks in the NICU, but they'd been assigned to the triplets in his pod, so they hadn't had him in awhile. Kathy, Holly, and Joyce make up a trio of nurses who often work together switching off on "8 hour" shifts instead of the usual "12 hour" shifts. 8 and 12 hours are in quotation marks because, as near as I can tell, an 8 hour shift is really 9 hours (at least) and a 12 hour shift is really 13 hours (at least) because of the time spent relaying information about the patients during shift changes. Kathy, Holly, and Joyce are excellent nurses and have a lot of NICU experience.
I was even more surprised to find that Henry was still on the cannula Thursday. Henry's bedding had been changed. The full drape on his isolette was changed to a cute yellow blanket that comes down halfway along the side of the isolette. This allows the nurses to better keep their sights on Henry (which is important with the continous feeding). And, Henry got his first teddy bear (it's a blue beanie bear that Holly chose for him).
Joyce was his day nurse. Joyce has been working in the NICU at UMC for 36 years. That means that she was working there when I was in the same NICU 34 years ago. I was a preemie, a 33-weeker born 3 lbs 13 ounces. Alas, Joyce doesn't remember me (I'm a bit heavier than I was back then), but she feels a strong bond with Henry. When she saw me enter the NICU, she said to me, "I get to take care of Henry today!" It was nice to see such enthusiasm over my son.
Henry was given a dose of Lasix again. They switched him to a different diuretic after the Lasix dose. Other than that, he was doing well. They must have felt confident in his cannula experience because they took the CPAP machine away from his bedside. Joyce said that Henry had good muscle tone. His color was still rather pale, and his hematocrit was somewhat low...suggesting a blood tranfusion in his future. Basically, as I understand it, the hematocrit is a determination of the red blood cell count. However, they aren't inclined to do blood tranfusions just based on the labs because they want Henry's body to learn to make the red blood cells on his own. If Henry shows problematic symptoms (e.g., sats continuously low), then they'll proceed with the transfusion.
My mom arrived just as I was leaving. Henry put on quite the show during her visit. Henry managed to pull out his feeding tube. Because Henry was on the continous feed, this made a mess. So, they ended up putting the feeding tube through his nose (something they couldn't do when he was on CPAP), which should make it much harder for his to pull out and a bit more comfortable for him.
In the evening, Kathy was his nurse. The Lasix did its job. Henry had a 20 gram diaper and a 30 gram diaper during his first two cares on Kathy's shift. When Henry was weighed, he was 860 grams. Jeff did skin-to-skin with Henry, which Henry enjoyed. Holly took over the second half of the evening. Henry continued to do well.
Today (6/8), Joyce was his nurse again. When I arrived, he was wrapped up like a burrito in his blankets. Holly left a book for Henry entitled "Everything I Know I Learned from My Grandpa." Holly often talks to my dad when my dad comes in the morning.
I did skin-to-skin for about two hours with him. He did very well (high sats, often at 100%). My mom visited and watched his monitors while I held Henry. The big "wet and wild" event of the afternoon was that Henry peed on me. When I mentioned it to my mom, she said that it wouldn't be the only time. Kathy (who had just taken over for Joyce) said the same thing as she helped get Henry settled back into his isolette.
Jeff and I arrived later than usual in the evenings (arriving around 10:45PM). Kathy was still his nurse. She reported that Henry's PIC line had to be removed because it was clogged with a small clot. They decided not to replace it because he just started full feeds, and if they take, he won't need a PIC line. As of 10PM, his continuous feeds were up to 5ml per hour (his current feeding goal). He had lost some weight (probably fluid) and was down to 830 grams.
Things continue to go well, but he did a little sat surfing (not enough to make the alarms go off, but sat surfing nonetheless). Jeff did the skin-to-skin again, which went well. Henry looked relaxed. Because heat is often lost through one's head, Henry usually wears a hat when he's taken out of the isolette. Tonight was exciting because Henry got to wear the first article of clothing that he actually owns (not borrowed from the NICU). It's a red knit hat with a blue letter H on it. Our good friend Jamie is an expert knitter and made it for him.
During the skin-to-skin, a nurse came by and wrote some things in one of Henry's charts. She mentioned that Henry had been switched to the blue color on the patients board. I don't know what the full color range is, but Henry started off at red color, then went to green, and now he's at blue. We'll mark this as a step forward.
Michelle took over for Kathy when Kathy went off shift. Jeff and I helped with cares before we left.
Wednesday, June 6, 2007
One Step Forward
Jeff and I had a frustrating experience last night (6/5). Kim was his nurse again. Melissa J., who is one of Henry's primary caregivers, was on duty and wanted Henry, but Kim had him the night before and didn't want to switch. Melissa really likes Henry and got him a 5-week birthday present (a cute blanket and an adorable small bull blanket).
When we arrived, Kim mentioned that Henry had been so quiet that she didn't want to disturb him to change his diaper. That was OK, I suppose...although he had had quiet day yesterday and his diaper had to be changed some time. Jeff and I let him sleep for a half an hour longer and then said we were going to change him.
He started spitting up during the changing. Kim told us to suction it out, which we don't mind doing, but she didn't seem to pay attention to how much he was spitting up. This bothered me because spitting up is obviously an indicant of feeding intolerance (hence you'd want to track how much there is).
While changing him, we noticed that his mottled color looked worse. The previous evening (6/4) when Henry looked mottled, I was very concerned. Jeff couldn't see the mottling. Well, last night, Jeff became a bit concerned because he could definitely see it. Henry's stomach had a gray tinge, distinguishable from his chest color.
When Kim comes over to inspect Henry's stomach, she told us how preemies can make it. She once took care of a baby that was very small, and the baby made it. Of course, her twin brother died (who happened to be named Henry). You are probaly wondering why anyone would tell this to the parents of a 25-weeker named Henry. I was wondering the same thing. Rather absurd.
Kim didn't seem to think that there was anything unusual in Henry's state. She thought his color looked better than the previous evening. It wasn't. Jeff and I asked her to get one of the nurse practitioners. We wouldn't have been able to sleep without making sure that everything was OK before we left.
Mary Ann Roberts came over to look at Henry. I explained my concerns to Mary Ann. I told her about how his color seemed worse to me than the before. Kim interjected that she had noticed the night before how he looked mottled and how that was bad (mind you, that's a bit different than how I remembered the evening's events; I seem to recall that I had raised the concerns, not Kim). Mary Ann did a thorough inspection of his stomach. She could feel some air in one of his digestive loops but said the stomach was soft. That was a relief. We really like Mary Ann. We talked with her for about half an hour about various microbiology issues (including the biology behind handwashing). We left feeling comfortable, knowing that Mary Ann was keeping watch.
Jean was Henry's nurse this morning. She told my dad that Henry had been restful. She said that his weight was 840 grams. They do the weighings in the evenings. I thought that his weight had been 860 grams, but perhaps he had been weighed again after we left last night. Or perhaps last evening's nurse had entered his weight incorrectly.
When I arrived at the hospital in the early afternoon, Sherry had taken over for Jean. The big news was that they decided to try him on the cannula again. They had put him on it at 10AM. He wasn't quite as steady with it as with the CPAP, but he was doing OK. His sats stayed in the 90s for the most part, but he did do a little surfing. He had a few apnea and brady episodes, but he got out of them himself. Sherry was on top of the situation. Anytime the alarms went off, she was there in an instant.
Sherry had him swaddled, which seemed to keep him relaxed. He got un-swaddled during 3PM cares and was active. His sats were great during cares. My mom arrived during cares and stayed for about an hour after I left. Sherry told her that she thought that they were experimenting with the cannula, but that given the bradys and apnea, she thought they'd switch him back to CPAP. I'm not surprised. I am glad that his face was getting a bit of a break from the CPAP at least.
He's still on continuous feeds (3ml per hour). They are talking about having him go back to regular feeds soon. Don't know when this will happen. And, they decided to give him one dose of Lasix while I was visiting.
So all in all, things look OK. The move to the cannula is one step forward, but realistically, we might move one step back by this evening.
When we arrived, Kim mentioned that Henry had been so quiet that she didn't want to disturb him to change his diaper. That was OK, I suppose...although he had had quiet day yesterday and his diaper had to be changed some time. Jeff and I let him sleep for a half an hour longer and then said we were going to change him.
He started spitting up during the changing. Kim told us to suction it out, which we don't mind doing, but she didn't seem to pay attention to how much he was spitting up. This bothered me because spitting up is obviously an indicant of feeding intolerance (hence you'd want to track how much there is).
While changing him, we noticed that his mottled color looked worse. The previous evening (6/4) when Henry looked mottled, I was very concerned. Jeff couldn't see the mottling. Well, last night, Jeff became a bit concerned because he could definitely see it. Henry's stomach had a gray tinge, distinguishable from his chest color.
When Kim comes over to inspect Henry's stomach, she told us how preemies can make it. She once took care of a baby that was very small, and the baby made it. Of course, her twin brother died (who happened to be named Henry). You are probaly wondering why anyone would tell this to the parents of a 25-weeker named Henry. I was wondering the same thing. Rather absurd.
Kim didn't seem to think that there was anything unusual in Henry's state. She thought his color looked better than the previous evening. It wasn't. Jeff and I asked her to get one of the nurse practitioners. We wouldn't have been able to sleep without making sure that everything was OK before we left.
Mary Ann Roberts came over to look at Henry. I explained my concerns to Mary Ann. I told her about how his color seemed worse to me than the before. Kim interjected that she had noticed the night before how he looked mottled and how that was bad (mind you, that's a bit different than how I remembered the evening's events; I seem to recall that I had raised the concerns, not Kim). Mary Ann did a thorough inspection of his stomach. She could feel some air in one of his digestive loops but said the stomach was soft. That was a relief. We really like Mary Ann. We talked with her for about half an hour about various microbiology issues (including the biology behind handwashing). We left feeling comfortable, knowing that Mary Ann was keeping watch.
Jean was Henry's nurse this morning. She told my dad that Henry had been restful. She said that his weight was 840 grams. They do the weighings in the evenings. I thought that his weight had been 860 grams, but perhaps he had been weighed again after we left last night. Or perhaps last evening's nurse had entered his weight incorrectly.
When I arrived at the hospital in the early afternoon, Sherry had taken over for Jean. The big news was that they decided to try him on the cannula again. They had put him on it at 10AM. He wasn't quite as steady with it as with the CPAP, but he was doing OK. His sats stayed in the 90s for the most part, but he did do a little surfing. He had a few apnea and brady episodes, but he got out of them himself. Sherry was on top of the situation. Anytime the alarms went off, she was there in an instant.
Sherry had him swaddled, which seemed to keep him relaxed. He got un-swaddled during 3PM cares and was active. His sats were great during cares. My mom arrived during cares and stayed for about an hour after I left. Sherry told her that she thought that they were experimenting with the cannula, but that given the bradys and apnea, she thought they'd switch him back to CPAP. I'm not surprised. I am glad that his face was getting a bit of a break from the CPAP at least.
He's still on continuous feeds (3ml per hour). They are talking about having him go back to regular feeds soon. Don't know when this will happen. And, they decided to give him one dose of Lasix while I was visiting.
So all in all, things look OK. The move to the cannula is one step forward, but realistically, we might move one step back by this evening.
Tuesday, June 5, 2007
A Lazy Afternoon
Henry's nurse today was Jean. They stopped the feeds last night but resumed them today around 11AM. His blood tests from last night all came back negative. Jean was able to get some residual from his stomach, but it was a tan color, not nasty green. Rather than being done every three hours, the new feeds are being done continously at a very slow rate. His skin is still mottled-looking.
His oxygen was set at 30% when I arrived a little after 12PM. Jean asked me if I wanted to hold him. I asked her if she thought it was a good idea given last night's episode. She thought it was, so I ended up doing skin-to-skin. I asked if we could do it with the cannula, but she said he needed to wear his CPAP. I don't know if Jean wasn't aware that Dr. Cahan said cannula was OK for 1 hr kangaroo care sessions or whether Dr. Cahan has changed that decision after last night. I decided to go ahead with the CPAP, and things went well.
Henry cried for a little bit as he was getting positioned onto my chest. I was in the recliner. While Jean was trying to sort out all of the wires, Henry squirmed and lifted his head up like he was about to do a push up. Jean helped me get him settled down with his head to the side. We ended up doing the skin-to-skin for two hours. He was relaxed the entire time with sats ranging from 92% to 100%. Most of the time, they were around 97%. His heart rate and respiration looked good.
My sister Erin stopped by for a little while during the kangaroo care. She said Henry furrows his eyebrows just like I do. Shortly after she left, my mom visited. After two hours of skin-to-skin, Jean put Henry back into the isolette. He settled down pretty quickly. My mom stayed and watched over him after I left. She said that he kept his sats up and was restful the entire time. It's nice to have a day where Henry isn't sat surfing.
His oxygen was set at 30% when I arrived a little after 12PM. Jean asked me if I wanted to hold him. I asked her if she thought it was a good idea given last night's episode. She thought it was, so I ended up doing skin-to-skin. I asked if we could do it with the cannula, but she said he needed to wear his CPAP. I don't know if Jean wasn't aware that Dr. Cahan said cannula was OK for 1 hr kangaroo care sessions or whether Dr. Cahan has changed that decision after last night. I decided to go ahead with the CPAP, and things went well.
Henry cried for a little bit as he was getting positioned onto my chest. I was in the recliner. While Jean was trying to sort out all of the wires, Henry squirmed and lifted his head up like he was about to do a push up. Jean helped me get him settled down with his head to the side. We ended up doing the skin-to-skin for two hours. He was relaxed the entire time with sats ranging from 92% to 100%. Most of the time, they were around 97%. His heart rate and respiration looked good.
My sister Erin stopped by for a little while during the kangaroo care. She said Henry furrows his eyebrows just like I do. Shortly after she left, my mom visited. After two hours of skin-to-skin, Jean put Henry back into the isolette. He settled down pretty quickly. My mom stayed and watched over him after I left. She said that he kept his sats up and was restful the entire time. It's nice to have a day where Henry isn't sat surfing.
Henry's New Clothes
The good news first, Henry got to wear his first shirt today. It was a bit big for him but it was kind of cute. Of course he spit up on it within about 10 minutes and Janice had to take it off. He's back to just the tiny little diaper.I don't know why I found that so exciting. Probably the commercial society we live in pressuring me toward conspicuous consumption in an attempt purchase approval from others as well as my child. Hello, Baby Gap, I'd like to find a shirt that has long sleeves and provokes feelings of envy from other parents as well as shoes that have good arch support while simultaneously evoking feelings of joy from my child that I can misinterpret as love.
Now for the not so good news. The plans for the week Kate mentioned in the previous post look to be on hold. Tonight Henry went backward a little bit. He had green colored residual in his stomach from his previous feeding which isn't good. His color looked mottled, at least that is what I'm told. For some reason I just can't see it.
Dr. Cahan and Moe Kane both took a look at him. Dr. Cahan ordered an xray of his stomach and intestines as well as several different blood tests. The xray showed a lot of air in his intestines. There was no air in the walls of the intestines which was good. Air inside the walls of the intestines is one of the signs of NEC (Necrotizing Endo Colitis, sp?) which is very bad and one of the things they are constantly checking for.
Apparently air in the intestines is not uncommon for babies on the cpap because it is forcing air down their throat which can go down the wrong way. Kate just called and the results of the blood tests don't show any major problems. Dr. Cahan has ordered the feeding to resume in the morning. Hopefully the air will be gone by then.
My theory is that this is the result of his feeding tube. A few days ago Gene had taped it to his upper lip and had it coming straight into the mouth. He explained that this way it goes down the throat in a way that doesn't make as much contact and causes less irritation. This morning they removed Gene's tube job and replaced it with the typical taped to the side of the face style. Henry pulled the tube out several times today. Every time I saw him he was trying to work it out with his tongue. I believe the attempts to work it out with his tongue are causing him to swallow even more air than normal. Maybe I'll fly this up the flag pole tomorrow.
The nicu seemed rather chaotic tonight. His nurse was Kim and she seemed to be overwhelmed so Jenny, who took care of him before, helped out a lot. Henry was very active and his cpap was not sitting well tonight so he required a lot of attention to try to get it on right. By the time we left he was steady but they had turned up his oxygen to 40. His reported weight was 840 grams. That is up 30 from yesterday. I'm kind of suspect of this number because that is a rather big gain. We'll see what they say tomorrow.
Monday, June 4, 2007
The Plan for the Week
As I was washing up to enter the NICU this morning, my dad was coming out. He found out some information on how decisions are made in the NICU. Each baby is assigned to a resident. The residents are assigned to the NICU for one month. A doctor is assigned to supervise the residents on a three week cycle. The residents make recommendations that the doctors either approve or disapprove.
Dr. Cahan is currently supervising the residents. Each morning from 9AM to 12PM, the residents have rounds with the doctor in charge. The NICU handbook that they give parents suggests that parents and guests should not visit at that time. But Jeff and I quickly figured out that they don't pay attention to this policy. The only time that parents really can't visit is between 6:45-7:45 in the morning and evening when the nursing staff does its shift change.
During 9AM to 12PM rounds, the residents and doctor begin in pod 1, discuss the patients in that pod, and then move onto the next one. Today, I was in our pod (pod 2) before they started discussing the pod 2 babies. I was hidden in the corner behind Henry's isolette, so I got to hear the discussion about him. Nothing that we didn't already know. Dr. Cahan referred to Henry as a "trooper" and said that he was doing "awesome." That's nice to hear.
Someone had questions about his ultrasounds. Dr. Cahan didn't say anything we didn't already know. She's seen babies where the slight bleed (if it is a bleed) resolved itself, and she's seen babies where the bleed worsens and becomes hydrocephalus. They are monitoring his head circumference each week. I found out from Janice, his nurse today, that his head circumference (taken last night) was a little smaller than last week's measurement, but is essentially unchanged. Some of the head measurements are a little different because the nurses have probably measured it from slightly different spots.
As the residents gathered their things to move onto the next pod, Dr. Cahan stopped by and gave me their plan for the week. Dr. Cahan reiterated that she measures progress by week to week changes (something she told us on the first night that Henry entered the NICU). By this time next week, she'd like to see the following: (1) Henry off the Lasix, (2) Henry's weight increased, and (3) Henry on nasal cannula. She is quite methodical in her approach to achieve these goals. She doesn't believe in making all three changes at once, because if something goes wrong, she wouldn't be able to tell what triggered the reaction. So, today Henry's Lasix dose will be reduced by half. Tomorrow, they will begin adding calories to the breast milk to help him gain weight. His weight, taken last night, was 810 grams (same as the day before). If all goes well, then on Thursday, they will try him on the nasal cannula.
Since we have used the cannula during kangaroo care the last two times, I asked Dr. Cahan if it was OK to continue to do so. She said that we could do 1 hr of kangaroo care with the cannula twice a day if we wanted. I gather from talking to my dad who talks with the nurses that the 3-4 hour mark is when Henry's system is probably most tired out by the cannula. So 1 hr on the cannula should be just fine. And, it gives his nose and face a break from the CPAP.
I had missed his 9AM cares by a couple minutes this morning, so I decided to stay past noon, so I could do his 12PM cares. They went well. He had very little residual in his stomach before the feeding. When I left the NICU around 12:45PM, his oxygen set at 30% and his sats were in the 90s.
I'm happy that his feedings are going well. He has had a little reflux, but I heard Dr. Cahan say something about the vitamins being the suspected culprit in causing him to urp. He did have one questionable bout of throw up that had some green color in it on Beth's shift yesterday. But the rest of his residuals have looked OK, and his stomach is still soft. They will continue to monitor it closely.
Dr. Cahan is currently supervising the residents. Each morning from 9AM to 12PM, the residents have rounds with the doctor in charge. The NICU handbook that they give parents suggests that parents and guests should not visit at that time. But Jeff and I quickly figured out that they don't pay attention to this policy. The only time that parents really can't visit is between 6:45-7:45 in the morning and evening when the nursing staff does its shift change.
During 9AM to 12PM rounds, the residents and doctor begin in pod 1, discuss the patients in that pod, and then move onto the next one. Today, I was in our pod (pod 2) before they started discussing the pod 2 babies. I was hidden in the corner behind Henry's isolette, so I got to hear the discussion about him. Nothing that we didn't already know. Dr. Cahan referred to Henry as a "trooper" and said that he was doing "awesome." That's nice to hear.
Someone had questions about his ultrasounds. Dr. Cahan didn't say anything we didn't already know. She's seen babies where the slight bleed (if it is a bleed) resolved itself, and she's seen babies where the bleed worsens and becomes hydrocephalus. They are monitoring his head circumference each week. I found out from Janice, his nurse today, that his head circumference (taken last night) was a little smaller than last week's measurement, but is essentially unchanged. Some of the head measurements are a little different because the nurses have probably measured it from slightly different spots.
As the residents gathered their things to move onto the next pod, Dr. Cahan stopped by and gave me their plan for the week. Dr. Cahan reiterated that she measures progress by week to week changes (something she told us on the first night that Henry entered the NICU). By this time next week, she'd like to see the following: (1) Henry off the Lasix, (2) Henry's weight increased, and (3) Henry on nasal cannula. She is quite methodical in her approach to achieve these goals. She doesn't believe in making all three changes at once, because if something goes wrong, she wouldn't be able to tell what triggered the reaction. So, today Henry's Lasix dose will be reduced by half. Tomorrow, they will begin adding calories to the breast milk to help him gain weight. His weight, taken last night, was 810 grams (same as the day before). If all goes well, then on Thursday, they will try him on the nasal cannula.
Since we have used the cannula during kangaroo care the last two times, I asked Dr. Cahan if it was OK to continue to do so. She said that we could do 1 hr of kangaroo care with the cannula twice a day if we wanted. I gather from talking to my dad who talks with the nurses that the 3-4 hour mark is when Henry's system is probably most tired out by the cannula. So 1 hr on the cannula should be just fine. And, it gives his nose and face a break from the CPAP.
I had missed his 9AM cares by a couple minutes this morning, so I decided to stay past noon, so I could do his 12PM cares. They went well. He had very little residual in his stomach before the feeding. When I left the NICU around 12:45PM, his oxygen set at 30% and his sats were in the 90s.
I'm happy that his feedings are going well. He has had a little reflux, but I heard Dr. Cahan say something about the vitamins being the suspected culprit in causing him to urp. He did have one questionable bout of throw up that had some green color in it on Beth's shift yesterday. But the rest of his residuals have looked OK, and his stomach is still soft. They will continue to monitor it closely.
A Happy Henry
My parents visited Henry in the afternoon (6/3). My dad got to hold the feeding bottle during Henry's cares.
Jeff visited Henry shortly after my parents left. Henry continued to do well. His oxygen was set at 37% and his sats were around 99%, so Beth turned the oxygen down to 31%. Jeff read "Sam and the Firefly" to him.
We returned to the NICU in the evening and decided to do some kangaroo care. Jeff and I trade off on the holding. Tonight it was my turn. Emily set me up on the recliner. It was my first time holding Henry while he was on the cannula. His sats, respiration, and heart rate were excellent during skin-to-skin. He rested on my chest and was quiet once he got settled. Jeff said that he had his eye brows up, which means he was happy. He also openned his eyes to look around.
After an hour, we decided that it was time for him to go back into his isolette. I would have loved to hold him longer, but we wanted to make sure he stayed warm. Emily had given us plenty of warmed blankets during the kangaroo care, but I tend to run a little cold on average. One study that I read on kangaroo care claimed that mothers raise their body temperatures when babies start getting cold, so I was probably worryi
ng for nothing. Before he was put back into the isolette, Emily took his temperature and it remained in normal range (37 degrees Celsius), which was great.
Emily did a nice job getting him back into his isolette. He was of course cranky when she put the CPAP back on him. But he eventually settled down. All looked well when we left.
Jeff visited Henry shortly after my parents left. Henry continued to do well. His oxygen was set at 37% and his sats were around 99%, so Beth turned the oxygen down to 31%. Jeff read "Sam and the Firefly" to him.
We returned to the NICU in the evening and decided to do some kangaroo care. Jeff and I trade off on the holding. Tonight it was my turn. Emily set me up on the recliner. It was my first time holding Henry while he was on the cannula. His sats, respiration, and heart rate were excellent during skin-to-skin. He rested on my chest and was quiet once he got settled. Jeff said that he had his eye brows up, which means he was happy. He also openned his eyes to look around.
After an hour, we decided that it was time for him to go back into his isolette. I would have loved to hold him longer, but we wanted to make sure he stayed warm. Emily had given us plenty of warmed blankets during the kangaroo care, but I tend to run a little cold on average. One study that I read on kangaroo care claimed that mothers raise their body temperatures when babies start getting cold, so I was probably worryi
ng for nothing. Before he was put back into the isolette, Emily took his temperature and it remained in normal range (37 degrees Celsius), which was great.Emily did a nice job getting him back into his isolette. He was of course cranky when she put the CPAP back on him. But he eventually settled down. All looked well when we left.
Sunday, June 3, 2007
The Theater of the Absurd
Beth was Henry's nurse today. He was doing well. He did a little sat surfing while I was there. I became frustrated, however, by some of the nurses and parents in the pod.
The pod had been relatively quiet since the move to the corner of the room. We had hit a snag a couple days ago when someone activated the very loud ringer on the telephone at the end of the pod, about five feet from Henry's isolette. But Gene deactivated it for me yesterday.
Several nurses once again forgot that they should keep their voices low. I sometimes feel like I'm a character in the theater of the absurd and can't change the script. Here today's events in this theater of the absurd...
(1) Intercultural Miscommunication
Henry's pod holds ten babies. As near as I can tell, at least five babies belong to parents whose english language skills can only be described as limited at best. It appears that very few nurses are bilingual, which causes communication problems. Unfortunately, some nurses simply raise their voices at the parents when the parents do not understand instructions. It hasn't occurred to them that if a person doesn't speak english, speaking loudly isn't going to help them comprehend the words better.
The parents of the triplets (who are stationed close to Henry's isolette) do not speak english well. Two of the triplets are scheduled to go home today. All three have different prescriptions that they need to take. And one of the prescriptions got changed since yesterday, meaning that new medication bottles are needed. But the parents were given one of the bottles yesterday with the wrong dosing on it. The pharmacist did not want to issue a new bottle when the old bottle is somewhere out there. The nurse assigned to the triplets today does not speak spanish. So she was trying to convey this information to the parents and decided that speaking english as loudly as possible was the best way to do this. In the meantime, another nurse came in to help. She gets on the telephone next Henry's isolette to call the pharmacist and all but yells at him to get the prescription.
This puts me in a difficult position. I don't want to offend these nurses, one who has been Henry's nurse before. But I can't have them upsetting my child. And frankly, it isn't good for the other preemies in the pod either. So I talked with Beth and asked her if she could talk with her colleagues and have them take their prescription escapade somewhere else.
(2) The Coughing Man
At one point during my visit, one of the parents (I assume it was a parent) of a new baby at the other end of the pod gets up, walks to our end of the pod, coughs, then walks back to his end of the pod, and visits with his baby. I kid you not. If it isn't OK to cough on his baby, why would he think that it is OK to cough in the area of other babies? The selfishness and stupidity of people never ceases to amaze me. Beth wiped down Henry's isolette cover with a sanitizing cloth.
These were just today's events in the Theater of the Absurd. We've experienced several other events that warrant mention.
(3) Washing Hands Is Over-Rated
As you enter a room that leads into the NICU, there is a station for washing one's hands. Parents and guests are instructed to wash their hands for three minutes. There are two sinks in this room. You'd think that the rationale behind handwashing is pretty darn obvious. And yet, parents and guests are often seen to skip this step or wash their hands for two seconds and then head into the NICU. The instructions at the sink are clear. Even if you aren't planning to touch a baby, wash your hands! Why? Because even if you don't end up touching a baby, you may end up touching tables or chairs that other people touch. Duh!
Believe it or not, I actually had a grandparent of another kid try to get me to stop washing my hands for the three minutes because he was waiting and wanted to get into the NICU faster. Having not met me before, he thought he could pressure me into leaving the sink. He kept saying, "You aren't performing surgery. You don't need to wash for that long." I feel sorry for his grandchild.
My mom has seen the nurses send a father out of the NICU to wash up. Guess he was about to hold his baby but had dirt on his hands.
(4) A High Patient Is A Happy Patient
When I was admitted to intensive care, they asked me what I was allergic to. I said two things: percocet and aspirin (luckily not ibuprofen). I was questioned by just about every nurse and doctor about my percocet allergy. I said that I taken it before, and it makes me severely nauseous. In fact, both of my sisters have similar problems with the codeine family.
While they were sewing me up during my c-section, the anesthesiologist gave me a morphine dose that was to last 24 hours. After surgery, every few hours, the nurses would ask me to rate my pain on a scale from 0 to 10 where 0 means you do not feel pain and 10 means that bamboo shoots have been shoved up your fingernails. I rated my pain a 2 or 3. I was hurting, but the pain was tolerable if I did not move too much. And bamboo shoots at 10 sounded pretty damn terrifying.
The day after surgery, I continued to rate the pain somewhere between 2 and 4. I was asked by doctors and nurses if I was sure that I didn't want percocet. I said no, I was allergic. Having just had my abdoment sliced the evening before, I really didn't want to spend several hours puking over a toilet. The doctor didn't seem to believe me when I said no and and really wanted me to take it. He said he could give me anti-nausea medication to take with the percocet. I realize that we live in an instant gratification society, but considering that I had explained that the pain was tolerable, why would one try to push drugs on a patient? I didn't feel great when I moved, but that was pretty understandable. I believe that one shouldn't take drugs that one doesn't need. Mind you, there are many occasions when medication is necessary. I did ask for ibuprofen, which took the edge off the pain. Sometimes pain is a healthy indicator. In my case, when I got into a bad position or moved in a way that my body wasn't ready for, the pain told me to change positions or stop moving.
I was moved down a floor late on the second evening, no longer needing intensive care. Wendy, a nurse from the ICU, helped move me downstairs. She was aware of the situation and informed the nursing staff on the 7th floor that I should be given ibuprofen and then tylenol in three hour cycles. Again, this was to keep the edge off the pain. Basically, the philosophy on the 7th floor during the night shift was to forget giving any medication, if it wasn't percocet. I had to stay on top of the medication schedule because the nurses didn't. My mom once had a doctor tell her (off the record) that she should bring her own ibuprofen to the hospital since you couldn't depend on the staff. I wish I had kept a bottle handy.
Despite one of my many wrist bracelets saying that I was allergic to percocet and a sign on my door saying the same thing, I was offered percocet several times during my stay there. Apparently, no doesn't mean no when it comes to narcotics in the hospital.
My interpretation of the percocet issue is this. The medical staff like giving patients these painkillers whether or not they really need them because a drugged up patient is one who doesn't complain and thus makes their lives easier. There are, of course, a few nurses who don't fit this description. Unfortunately for me, they were only assigned to me about one-third of the time.
As I got ready to check out of the hospital on the fifth day, a nurse came into my room to give me my parting prescriptions. Can you guess what medication the doctor assigned to my case decided to prescribe for me? You've guessed it. Percocet.
(5) Dr. McCreepy
I slept very little while I was in the hospital. Over the five days, I got less than 10 hours of sleep total. The transition from ICU to the seventh floor was hard, owing to my dealings with the night time nurse staff which I won't chronicle here.
Having just dozed off to sleep, I woke up around 5:30AM on the third day to find a doctor hovering over me. He said that he needed to check the incision. While he was doing so, he asked me: "So, have you and your husband discussed what birthcontrol options you plan to use when you leave the hospital?" If there was ever an event that fit the Theater of the Absurd, this was it. Call me crazy, but I had just had a c-section a little over 34 hours previously and had spent those hours wondering if my child was going to live or die. As handsome as my husband is, sex hadn't been on my mind. I calmly replied, "Honestly, my husband and I haven't discussed it." He said, "You two need to discuss it before you leave the hospital." I said, "OK."
Two days later, Dr. McCreepy (as Jeff dubbed him) was back. I was already up when he entered. He again asked the birth control question. "Condoms," I lied. Jeff and I hadn't discussed it, other than to laugh over the situation. Instead, we had spent the time discussing and worrying about our son.
(6) The "Taking Your Baby Home" Video
Before taking babies home from the hospital, there are two videos that mothers are required to watch. One on baby fundamentals. The second on shaken baby syndrome. On days three and four, I was asked every four hours whether or not I had seen the videos. I explained to everyone that I preferred watching the videos shortly before my son was released from the hospital (a best case scenario placing this time at four months from his birth). After I was asked about this for the billionth time, I relented. So, on the Friday morning of my release, Jeff and I watched the "Taking Your Baby Home" video. It would be difficult to imagine a more inappropriate video to show a mother whose baby could very well die. Jeff and I told jokes throughout it. I also occasionally cried as they showed babies being placed in car seats going home or mothers nursing. Just another event in the Theater of the Absurd.
(7) Jeff Has Postpartum Depression?
The day before I checked out of the hospital, I was given a survey to determine whether I had postpartum depression. They give this questionnaire to all women who have had a baby. If you received 10 points on the survey, you are supposed to notify a healthcare professional for psychiatric counseling. And, you are then supposed to recheck yourself on the survey two weeks later. The questionnaire is called the Edinburgh Postnatal Depression Scale. It contains 10 questions, each with four possible response options that you score from 0 to 3. As a teacher of research methods, I couldn't help but critique the questionnaire as I was taking it.
My conclusion: This is a bad questionnaire with highly problematic face validity issues. If you have ever had a bad day, it is easy to score over 10 points. I believe that I scored a 12 on it. And no, I didn't notify a healthcare professional. I did however have Jeff take the questionnaire. If you believe in this scale, then Jeff had postpartum depression as well. He scored a 10.
Items included gems such as:
"I have been so unhappy that I have had difficulty sleeping." Response options were "Yes, most of the time," "Yes, sometimes," "Not very often," and "Not at all."
"I have felt sad or miserable." Response options were "Yes, most of the time," "Yes, quite often," "Not very often," and "Not at all."
"I have been so unhappy that I have been crying." Response options were "Yes, most of the time," "Yes, quite often," "Only occasionally," and "Not at all."
I didn't bother taking the survey at the two week mark. I was going to throw it away, but I have decided to keep it for my research methods class when we have our unit on questionnaire design. Some of the items have weird qualifiers that make the statements difficult to interpret.
Perhaps this is just another example, much like the "Taking Your Baby Home" video, of an inappropriate fit for my needs at the time. Let me say for the record that postpartum depression is a serious issue. I'm not trying to belittle it in anyway, but I am belittling their scale. As a researcher, I can't believe that they can't do better than this to screen for it.
The pod had been relatively quiet since the move to the corner of the room. We had hit a snag a couple days ago when someone activated the very loud ringer on the telephone at the end of the pod, about five feet from Henry's isolette. But Gene deactivated it for me yesterday.
Several nurses once again forgot that they should keep their voices low. I sometimes feel like I'm a character in the theater of the absurd and can't change the script. Here today's events in this theater of the absurd...
(1) Intercultural Miscommunication
Henry's pod holds ten babies. As near as I can tell, at least five babies belong to parents whose english language skills can only be described as limited at best. It appears that very few nurses are bilingual, which causes communication problems. Unfortunately, some nurses simply raise their voices at the parents when the parents do not understand instructions. It hasn't occurred to them that if a person doesn't speak english, speaking loudly isn't going to help them comprehend the words better.
The parents of the triplets (who are stationed close to Henry's isolette) do not speak english well. Two of the triplets are scheduled to go home today. All three have different prescriptions that they need to take. And one of the prescriptions got changed since yesterday, meaning that new medication bottles are needed. But the parents were given one of the bottles yesterday with the wrong dosing on it. The pharmacist did not want to issue a new bottle when the old bottle is somewhere out there. The nurse assigned to the triplets today does not speak spanish. So she was trying to convey this information to the parents and decided that speaking english as loudly as possible was the best way to do this. In the meantime, another nurse came in to help. She gets on the telephone next Henry's isolette to call the pharmacist and all but yells at him to get the prescription.
This puts me in a difficult position. I don't want to offend these nurses, one who has been Henry's nurse before. But I can't have them upsetting my child. And frankly, it isn't good for the other preemies in the pod either. So I talked with Beth and asked her if she could talk with her colleagues and have them take their prescription escapade somewhere else.
(2) The Coughing Man
At one point during my visit, one of the parents (I assume it was a parent) of a new baby at the other end of the pod gets up, walks to our end of the pod, coughs, then walks back to his end of the pod, and visits with his baby. I kid you not. If it isn't OK to cough on his baby, why would he think that it is OK to cough in the area of other babies? The selfishness and stupidity of people never ceases to amaze me. Beth wiped down Henry's isolette cover with a sanitizing cloth.
These were just today's events in the Theater of the Absurd. We've experienced several other events that warrant mention.
(3) Washing Hands Is Over-Rated
As you enter a room that leads into the NICU, there is a station for washing one's hands. Parents and guests are instructed to wash their hands for three minutes. There are two sinks in this room. You'd think that the rationale behind handwashing is pretty darn obvious. And yet, parents and guests are often seen to skip this step or wash their hands for two seconds and then head into the NICU. The instructions at the sink are clear. Even if you aren't planning to touch a baby, wash your hands! Why? Because even if you don't end up touching a baby, you may end up touching tables or chairs that other people touch. Duh!
Believe it or not, I actually had a grandparent of another kid try to get me to stop washing my hands for the three minutes because he was waiting and wanted to get into the NICU faster. Having not met me before, he thought he could pressure me into leaving the sink. He kept saying, "You aren't performing surgery. You don't need to wash for that long." I feel sorry for his grandchild.
My mom has seen the nurses send a father out of the NICU to wash up. Guess he was about to hold his baby but had dirt on his hands.
(4) A High Patient Is A Happy Patient
When I was admitted to intensive care, they asked me what I was allergic to. I said two things: percocet and aspirin (luckily not ibuprofen). I was questioned by just about every nurse and doctor about my percocet allergy. I said that I taken it before, and it makes me severely nauseous. In fact, both of my sisters have similar problems with the codeine family.
While they were sewing me up during my c-section, the anesthesiologist gave me a morphine dose that was to last 24 hours. After surgery, every few hours, the nurses would ask me to rate my pain on a scale from 0 to 10 where 0 means you do not feel pain and 10 means that bamboo shoots have been shoved up your fingernails. I rated my pain a 2 or 3. I was hurting, but the pain was tolerable if I did not move too much. And bamboo shoots at 10 sounded pretty damn terrifying.
The day after surgery, I continued to rate the pain somewhere between 2 and 4. I was asked by doctors and nurses if I was sure that I didn't want percocet. I said no, I was allergic. Having just had my abdoment sliced the evening before, I really didn't want to spend several hours puking over a toilet. The doctor didn't seem to believe me when I said no and and really wanted me to take it. He said he could give me anti-nausea medication to take with the percocet. I realize that we live in an instant gratification society, but considering that I had explained that the pain was tolerable, why would one try to push drugs on a patient? I didn't feel great when I moved, but that was pretty understandable. I believe that one shouldn't take drugs that one doesn't need. Mind you, there are many occasions when medication is necessary. I did ask for ibuprofen, which took the edge off the pain. Sometimes pain is a healthy indicator. In my case, when I got into a bad position or moved in a way that my body wasn't ready for, the pain told me to change positions or stop moving.
I was moved down a floor late on the second evening, no longer needing intensive care. Wendy, a nurse from the ICU, helped move me downstairs. She was aware of the situation and informed the nursing staff on the 7th floor that I should be given ibuprofen and then tylenol in three hour cycles. Again, this was to keep the edge off the pain. Basically, the philosophy on the 7th floor during the night shift was to forget giving any medication, if it wasn't percocet. I had to stay on top of the medication schedule because the nurses didn't. My mom once had a doctor tell her (off the record) that she should bring her own ibuprofen to the hospital since you couldn't depend on the staff. I wish I had kept a bottle handy.
Despite one of my many wrist bracelets saying that I was allergic to percocet and a sign on my door saying the same thing, I was offered percocet several times during my stay there. Apparently, no doesn't mean no when it comes to narcotics in the hospital.
My interpretation of the percocet issue is this. The medical staff like giving patients these painkillers whether or not they really need them because a drugged up patient is one who doesn't complain and thus makes their lives easier. There are, of course, a few nurses who don't fit this description. Unfortunately for me, they were only assigned to me about one-third of the time.
As I got ready to check out of the hospital on the fifth day, a nurse came into my room to give me my parting prescriptions. Can you guess what medication the doctor assigned to my case decided to prescribe for me? You've guessed it. Percocet.
(5) Dr. McCreepy
I slept very little while I was in the hospital. Over the five days, I got less than 10 hours of sleep total. The transition from ICU to the seventh floor was hard, owing to my dealings with the night time nurse staff which I won't chronicle here.
Having just dozed off to sleep, I woke up around 5:30AM on the third day to find a doctor hovering over me. He said that he needed to check the incision. While he was doing so, he asked me: "So, have you and your husband discussed what birthcontrol options you plan to use when you leave the hospital?" If there was ever an event that fit the Theater of the Absurd, this was it. Call me crazy, but I had just had a c-section a little over 34 hours previously and had spent those hours wondering if my child was going to live or die. As handsome as my husband is, sex hadn't been on my mind. I calmly replied, "Honestly, my husband and I haven't discussed it." He said, "You two need to discuss it before you leave the hospital." I said, "OK."
Two days later, Dr. McCreepy (as Jeff dubbed him) was back. I was already up when he entered. He again asked the birth control question. "Condoms," I lied. Jeff and I hadn't discussed it, other than to laugh over the situation. Instead, we had spent the time discussing and worrying about our son.
(6) The "Taking Your Baby Home" Video
Before taking babies home from the hospital, there are two videos that mothers are required to watch. One on baby fundamentals. The second on shaken baby syndrome. On days three and four, I was asked every four hours whether or not I had seen the videos. I explained to everyone that I preferred watching the videos shortly before my son was released from the hospital (a best case scenario placing this time at four months from his birth). After I was asked about this for the billionth time, I relented. So, on the Friday morning of my release, Jeff and I watched the "Taking Your Baby Home" video. It would be difficult to imagine a more inappropriate video to show a mother whose baby could very well die. Jeff and I told jokes throughout it. I also occasionally cried as they showed babies being placed in car seats going home or mothers nursing. Just another event in the Theater of the Absurd.
(7) Jeff Has Postpartum Depression?
The day before I checked out of the hospital, I was given a survey to determine whether I had postpartum depression. They give this questionnaire to all women who have had a baby. If you received 10 points on the survey, you are supposed to notify a healthcare professional for psychiatric counseling. And, you are then supposed to recheck yourself on the survey two weeks later. The questionnaire is called the Edinburgh Postnatal Depression Scale. It contains 10 questions, each with four possible response options that you score from 0 to 3. As a teacher of research methods, I couldn't help but critique the questionnaire as I was taking it.
My conclusion: This is a bad questionnaire with highly problematic face validity issues. If you have ever had a bad day, it is easy to score over 10 points. I believe that I scored a 12 on it. And no, I didn't notify a healthcare professional. I did however have Jeff take the questionnaire. If you believe in this scale, then Jeff had postpartum depression as well. He scored a 10.
Items included gems such as:
"I have been so unhappy that I have had difficulty sleeping." Response options were "Yes, most of the time," "Yes, sometimes," "Not very often," and "Not at all."
"I have felt sad or miserable." Response options were "Yes, most of the time," "Yes, quite often," "Not very often," and "Not at all."
"I have been so unhappy that I have been crying." Response options were "Yes, most of the time," "Yes, quite often," "Only occasionally," and "Not at all."
I didn't bother taking the survey at the two week mark. I was going to throw it away, but I have decided to keep it for my research methods class when we have our unit on questionnaire design. Some of the items have weird qualifiers that make the statements difficult to interpret.
Perhaps this is just another example, much like the "Taking Your Baby Home" video, of an inappropriate fit for my needs at the time. Let me say for the record that postpartum depression is a serious issue. I'm not trying to belittle it in anyway, but I am belittling their scale. As a researcher, I can't believe that they can't do better than this to screen for it.
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