Saturday, April 24, 2010

The Wheelock Quads are Born (Part 1)

We thought we were prepared for this.

Saturday was a day that started like so many others since our stay at Woman's Hospital began. I was on my cot and Crissie on her bed. My "uniform" that day was my Mississippi State hooded sweatshirt, my Mississippi State shorts, and my Mississippi State fluffy slippers that look like clown shoes. Something about being in Baton Rouge makes me feel the need to exaggerate my "Maroon-ness." Plus, I'm kinda' known around the hospital for those ridiculous slippers and I have a reputation to uphold. Our plan was to watch movies, Law & Order, and mostly vegetate all day.

Crissie was feeling uncomfortable. Of course, her belly was big, she hadn't had a night of uninterrupted sleep in over a week, and the straps on the uterine and heart monitors were irritating to the point of exhaustion. She'd been off antibiotics since early Friday morning and all indications were that they had done their job. The constant worry about Garrison's leaking amniotic fluid hung like a dark cloud over our situation, but there wasn't much we could do about it beyond hope.

My brother came to visit late in the afternoon because he was in the area and we hung out for about an hour. He left because he could tell Crissie wasn't feeling well. Around 5:00, Crissie started to get really uncomfortable, so we took off the monitors. It was about this point that she started getting the chills. We were still on high-alert for fevers, so we immediately started doing temperature checks. She was running about 99.9 so we called in Rachel, our nurse who was assigned to us for the first time (bless her heart).

Crissie and I immediately assumed the same thing: An infection was taking hold. We'd heard how quickly infections could wipe out a pregnancy if left unchecked, but even we were surprised with the speed and ferocity of this illness. Within two hours of the onset of her symptoms, her fever was 102 degrees. The decision to get the babies out was made quickly. By the time Crissie was on the operating table, she had vomited, was convulsing, and shivering so hard it was painful to watch. I was truly scared for her life at that point. However, they got her on the table a little over 3 hours from the onset of symptoms--pretty impressive considering the complex issues in play.

At 8:38 pm on April 17th, Amelia Frances (Baby B) was born first at 1 pound, 7.5 ounces. At 8:39 came Elena Marie (Baby C) at 1 pound 15.8 ounces, followed by Garrison Thomas (Baby A) at 8:40 also weighing 1 pound 15.8 ounces. At 8:41, Lillian Brooks was born sleeping.

Drs. St. Amant and Diket performed the C-Section and were assisted by a myriad of neonatologists, respiratory therapists, NICU nurses, and surgical assistants. Three of our "Top 4" nurses were able to make it in time for the surgery. Jami, Tanyl, and Tracy raced to the hospital and pitched in on their own time for which we can't thank them enough. We wish that Jennifer J. would have been able to make it too, but she was out of town and couldn't be reached.

A special thank you is reserved for Dr. St. Amant who gave us a 'bat-signal' to be able to reach him in the event of emergency. We found him at the first sign of fever and he was at the hospital within an hour or so--even though he wasn't on call and it was a Saturday night.

Crissie got loaded up with antibiotics and pain meds, while three teams worked on intubating and stabilizing Amelia, Elena, and Garrison. Our families stood by in the waiting room--my dad and brother, and Crissie's parents and sister, along with various other friends and loved ones.

Nurse Tracy took care of Lillian. She had the difficult duty of bathing and dressing her. Once Crissie was stabilized, she and I had an opportunity to hold Lillian's hand and say our good-byes, despite knowing that she was already in heaven. It was an emotional end to an emotional day and we appreciated the nurses who took such loving care of us by looking after her.

We got moved from our room in Labor and Delivery up to the part of the hospital known as "Mother/Baby." It was a much smaller room, and after nearly a month, we'd accumulated a lot of stuff. Most of that stuff got sent home with Crissie's parents. Dr. St. Amant helped us get rid of some of our remaining foodstuffs. Since we deprived him of his dinner, his preoperative meal consisted of peanuts from our "snack table."

Once settled into the new room for the dénouement, we were left with a few visitors, but mostly left to ourselves. It had been a day filled with the most intense emotions we'd ever experienced--fear, love, sadness, hope--we were exhausted. Not long after our last visitor left, we collapsed into what we'd hoped would be long, well-earned sleep...

It was not to be.  

The Wheelock Quads are Born (Part 2)

After falling asleep sometime after midnight, Crissie awoke around 3:30 in the morning with an intuition that something was wrong. Thirty minutes later, we got a phone call from the NICU asking permission to transfuse blood for Garrison. Of course, Crissie granted that permission without hesitation. We really didn't know what was going on with him at that point, and we certainly weren't thinking that a blood transfusion was out of the ordinary, but a 4am phone call from the NICU definitely had our already frazzled nerves on edge.

Thirty minutes later, we got a phone call from Phillip (the charge nurse in the NICU that night and a personal friend) that we needed to come down immediately. Considering that Crissie was eight hours removed from major surgery, still on a catheter, and had yet to be moved post-operatively in a wheelchair--this was a serious request. Though we wouldn't say it aloud, we were pretty sure they wouldn't call us down to the NICU unless there was dire need.

Much of the following was a blur because of our exhaustion, delerium, and (for Crissie) pain medications. But first, I need to back up a little bit...

When Garrison was delivered, he was bruised from head to toe. His membrane had ruptured and he had virtually no fluids in his sac at delivery, so the belief was that he had suffered external bruising as a result of the other membranes crashing down on him. Thus, Garrison's body was darker than we expected--it wasn't quite "black and blue," but it was close.

When we approached Garrison in Pod 8 of the NICU, he was being attended by as many as 6 or 7 different nurses, doctors, and therapists. His incubator was wide open and one nurse was doing chest compressions while another worked a breathing bag. He was being given epinephrine shots at a regular interval. It wasn't good.

The doctor in charge of Garrison explained that the infection that spiked Crissie's fever had attacked Garrison too. Having a ruptured membrane meant that he had very little defence against the infection. It wreaked havoc on his delicate lungs and cardiovascular system. He had crashed once already and they were able to bring him back, but from this last crash, he wasn't recovering. We were asked if we wanted them to continue, but the answer was already clearly written on the faces of everyone working on him. Garrison wasn't going to make it to his first sunrise.

I still don't know how long we stood there in silence watching everyone work. I do know that I felt my heart was literally being ripped in two--so much so that I thought was having a heart attack. Crissie sat and cried while I stood. We were completely devastated.

We continued to wait for a miracle that wouldn't come. They stopped chest compressions and he was shortly thereafter pronounced dead. He lived outside the womb for less than nine hours.

We were given a chance to bathe him. Crissie could only get up close enough in her wheelchair to rub lotion on his left arm and leg and I tried to help, but I was struggling to hold it together so I left it to the nurse. They dressed him and brought him to us so that we could spend a few quiet moments alone with him. We both held him and cried all the tears we had left. A priest came to baptize him. We finally left Garrison to check on Elena and Amelia (more on them later). We were led back to our room to collapse again in utter exhaustion. Heartbroken, overwhelmed, and afraid, we slept fitfully--wondering what the next phone call might bring.

We'll always wonder what kind of man Garrison would have grown up to be. We'll always wonder what kind of brother, son, or father he would have become. I can say with all honesty that we'd trade all of our worldly possessions to have him back. Everything... without question.

When Lillian passed, I was sure she was up in heaven, safe and sound, holding hands with my mom. I was so hopeful that it happened for a reason and that we would one day understand. With Garrison's passing, my hope is that they're all together and that Lillian will have a big brother to pass the time with until we can all be together again. It sounds nice to write that down--I just hope one day I find peace in believing that's how it works. Right now, there's no peace.

My faith has been shaken.

And, there's two other girls who still need us to believe in miracles.

The Wheelock Quads are Born (Part 3)

The NICU roller coaster begins.

We need to mourn our losses, but that time is not now. Now, we have to turn all of our attention to our two perfect little babies--Amelia and Elena.

For the most part, they are doing well. They're both on Vapotherm at the moment (which is a step down from CPAP--their noses are too small for CPAP!). They were both extubated (taken off the ventilator) rather quickly, and other than a short re-intubation of Amelia for an apnea, they're doing well with their breathing. Their oxygen saturations are in the mid to high 20s or low 30s. Room air is 21%, so this is pretty good.

The big news this week was that the PDA (Patent Ductus Arteriosus) in their hearts closed with medication and no surgery will be necessary. This meant that they could start with feedings. Mommy has been pumping away, so we're hoping our little ones will start packing on some weight before long.

As expected, Elena is the wild one. She came out kicking and screaming and she continues to do so today. We constantly catch her yanking on her feeding tube and she's squirmy for sure. She looks quiet in this picture, but don't be fooled.

She's blue because she's undergoing phototherapy for high bilirubin levels (jaundice)--pretty normal for preemies. She's the bigger baby for now, and her numbers have been pretty consistent despite the occasional bradycardia. She also cries when we bother her too much, though it sounds like the squeak of a mouse.

Amelia is our little calm baby. She just hangs out.

She's a little behind Elena on her breathing, but not much. She was the first to get off phototherapy--even though she eventually had to go back on. She seems perfectly at home in her isolette (incubator). We've heard some peeps out of her, but not much seems to bother her. She really likes it when I sing to her. I know because she told me--she's very smart.

In general, Crissie and I are doing okay. We definitely have our moments, but we're so thankful for our beautiful girls. We're home today, and walking into their bedroom with four beds was hard. Seeing all the embroidered baby boy gear in the closet was more than either of us could handle. We definitely planned to bring all four home, and looking back, we wouldn't have done it any different.

The doctors keep telling us that Crissie has to heal from her c-section before we focus on assisting with caring for the babies (her incision is infected, btw--just thought I'd mention that). Well, the truth is, we both have to heal from our emotional wounds before we can give all of hearts to Amelia and Elena. At times, we're depressed, we're angry, we're hopeless, we're inconsolable. Then we walk into the NICU and it all goes away when we're with our girls.

Our hope is that there will be a joyous homecoming for our girls in the months to come. But until then, we ride the roller coaster that is 'life in the NICU' and we deal with our emotional baggage in the space between.

Thoughts and prayers are still welcomed. The four of us all have a lot of healing to do, and a little peace would be a nice change too...

Wednesday, April 14, 2010

News from Today's Ultrasound

Following a pretty tough weekend, we had a lot of lingering questions that remained unanswered. However, there was really only one question that we needed answered that would affect an outcome.

We still didn't really know whose water broke.

We assumed it was Lillian's. Seemed like a fair assumption and most of the doctors and nurses agreed. Certainly made sense at the time. We gotta' give Dr. Stedman credit where it's due, though. He was the only one who ventured a guess that ended up being correct--even though we weren't thrilled when he first postulated the notion.

Crissie's cervix is funneling and Garrison is at the bottom of the uterus. Think of it as a regular funnel with a water balloon in it. If you piled a few more water balloons on top of that first balloon, you'd basically have Crissie's uterus. The weak point from a pressure standpoint is Garrison's balloon at the point directly over that void above the cervix, or the open tip of the funnel cone.

So, that was Dr. Stedman's theory and the ultrasound today proved him right. Lillian's sac appears to still be intact (which is actually good news) and Garrison's is ruptured and continues to leak.

This isn't ideal, but it's not the end of the world either. It's been almost 6 days since the sac ruptured and the biggest threat was infection that usually strikes in the first 3 days. Crissie's been non-symptomatic and the babies' heartbeats have been looking really good. If we can avoid stuff like chorioamnionitis, there's hope that we can hang in there as long as Crissie and the kiddos continue to put up good numbers. Garrison continues to produce amniotic fluid and that fluid does continue to accumulate in his ruptured sac, but it also seeps out from time to time.

We're getting close to 26 weeks. This is an important time in their development. Certainly, there are plenty of healthy people walking this earth who've been born that prematurely, but we continue to fight for every day, every hour, every minute. We have to give them the best possible chance.

We're determined to bring all three home healthy.

Thanks for all the thoughts and prayers. Please keep 'em coming...

Friday, April 9, 2010

Our little angel...

Where to begin...

During our ultrasound yesterday morning, we found out that our little flower, Lillian Brooks (baby D), lost her heartbeat. We believe she had passed sometime between Tuesday and Thursday mornings. Lillian had always been the smallest of the four--hence the name Lillian, or Lil'.

There was nothing that could have been done to save her. Even if we'd known her heartbeat was slowing, the doctors would have had to face the impossible decision of taking out all four babies at 24 weeks, 5 days and risking the lives of the three to save Lilly. Instead, Lillian went quietly to heaven. Her brother and sisters stand a better chance of survival now, but we miss her all the same.

Crissie and I continue to hold it together emotionally because we know the other three need us to do so. We know that Lillian's struggles in the womb likely mean there were other issues of concern for her. She's in a better place now. We pray that her spirit will watch over and protect her brother and sisters (and her Mommy and Daddy) as we still have a ways to go.

This morning at 4am, Crissie had a membrane rupture (water broke) and we think it was Lillian's amniotic sac. This is scary because we'd hoped Lillian's sac would have held together a good bit longer, thereby limiting the others' exposure to infections. The good news is that the others' fluid levels seem to be hanging on. As I write this, I am continuing to hear 3 healthy heartbeats on the monitors and one very exhausted mother is sleeping comfortably.

Other news from yesterday's ultrasound: Garrison (Baby A) is a big boy. He's measuring 1 pound 14oz. Elena and Amelia are 1 pound 8 oz and 1 pound 6 oz. The 50th percentile for 25 weeks is roughly 1 pound 8 oz (for what that's worth). So, one of the girls is still a little small, but well within the range of normal. Bad news: Crissie's losing ground in the battle for cervical length. Her cervix has only about 3 mm left. The doctors have started her back on Motrin to help her retain what she has and they are still hopeful that she can hold out for a good while longer.

Speaking of doctors...

Painful news is not an easy thing to report. We appreciated Dr. Veillon's bedside manner in telling us something yesterday that we really didn't want to hear. He was both thoughtful and professional which must be a difficult balance to achieve in tough situations.

A word about Dr. St. Amant. If I was a doctor myself, I'd like to think I would be like Dr. St. Amant (or try at any rate). He's definitely our kind of doctor. He communicates the issues in ways we're comfortable with and he gives us confidence about the scariest scenarios. He speaks to our desire for scientific rationalization and our need for compassionate understanding. These last 36 hours have completely sucked, no question. But, Dr. Veillon and Dr. St. Amant were fighting hard for us and with us--and for that, we are grateful.

I'll try to finish this on an up note (since it's taken all day for me to write this)...

This past Easter weekend, Crissie and I were treated to several visitors who took time out of their own Easter plans to check-in on us. We had food brought to us. We had an Easter Egg Hunt in the room (thanks to the Markeys for letting us borrow your kids!) We even had all the nurses come down from the nurses' station to share some of their Easter feast. It was a really fun day. We can't say enough about how much we appreciate our friends and family (and our new friends and family here in the hospital). They've meant more to us than they can possibly ever know.

Pray for us, pray for our three little fighters and our little angel in heaven. Twenty-five weeks tomorrow!

We'll miss you Lilly. You, who was closest to your mother's heart, will remain always and forever...

Saturday, April 3, 2010

Week 24

So much to tell...

Yesterday, we got a visit from another quad-mommy and her quadruplets. That was pretty fun. Her little ones were all color-coded and strapped in to their quad-stroller. They were as cute as they could be. It's always so interesting to hear the perspectives of others who have been through this same adventure. We began corresponding as a result of reading each others' blogs. We definitely appreciated her and her mom taking time out to visit with us and it was so cool to meet her kiddos. Great kids. Great family. Good stuff.

Last night at midnight (after watching "Cloudy With a Chance of Meatballs"), Crissie got the first of two steroid shots designed to help stimulate lung development in preparation for premature delivery. Everything has gone pretty well today--she gets the second shot tonight. It's how doctors say: "Happy Easter!"

We're pretty settled in to our room here at the hospital. We have our food and our entertainment. Our nurses continue to be rock stars. Here's a look at our markboard in the room:

Hard to believe it's Easter already. Crissie's holding up really well. She's eating well. She gets showered regularly. She's even got these cool pneumatic massagers for her legs. She keeps busy on the computer or playing sudoku or facebooking with friends. Once a day, the nurses come and listen for heartbeats.

This is Angela and Tanyl checking out all the little heartbeats. It's fun to see when they try to find all four at the same time. I got to tour the part of the hospital where Crissie will have her c-section and where the babies will spend their first few moments of life. I took a video so that Crissie could feel like she'd come along. I had to get all dressed up as if it was "game day"...

I'm not sure why, but wearing those clothes made me feel like I needed to hold my hands that way... I looked like a cross between the lunch-lady and Dr. Evil!

Looking foward to week 25!