Wednesday, November 16, 2011

The Long and Bumpy Road

            It should have been a wonderful Christmas. We were in a home we loved, work was going well and our two year old son was just coming to an age to really start enjoying the holidays. However, while the extended family was celebrating, my wife was silently struggling with the knowledge that the small life she carried within her was lost, and she was awaiting the final act of the miscarriage. She was very early in her term, so it was not physically difficult for her, but emotionally it hurt her to the core. All had gone so well with our first pregnancy, and we looked forward to adding another child to our family. But my wife had grown suspicious because she was not feeling the same way she had felt early on with David, and after a trip to the doctor and a blood test later, it was confirmed that the numbers no longer supported pregnancy.

            It was a somber few months, but that spring we decided to try again and in April our hopes were confirmed- we were again expecting! After the sad news of December, we approached this pregnancy with a nervous optimism. Unlike the last time, my wife, Sara, was appropriately morning sick with this baby- something she always took as a good sign. To her the sicker she felt, the better the baby was doing, and this baby must have been doing VERY well. In fact at the end of the first trimester, when she should have been gaining, my wife had actually lost 11 pounds. No matter what remedy she tried, the morning sickness would not abate. Finally, with the threat of hospitalization at the loss of another pound, the tide turned, the food stayed down and my wife started putting on weight. But I’m jumping ahead of myself. A lot transpired during those first few weeks.

            Because of the prior miscarriage, the obstetrician wanted to proceed with caution, so at about six weeks into the pregnancy, my wife had her first ultrasound. The small blip on the screen with the flickering heart assured us that all was well this time. However, it wasn’t long before my wife started spotting small amounts of blood. Could it be happening again? A second ultrasound followed a few weeks later, and again all things appeared normal.

The end of the first trimester was approaching and we were finally starting to feel more relaxed about things. The time had come for the first real meeting with the doctor to check on Sara and the baby’s progress. Dr. Soper, my wife’s Ob-Gyn, first meets with expectant parents in her office to answer any questions and to get a history before examining the mother. We had a nice discussion, and it was beginning to feel like our first pregnancy where everything had sailed along so smoothly. After the discussion, the nurse escorted Sara to the bathroom to change into the examination gown. My wife had only been in the room for about a minute, when she burst out with the most terrified look I have ever seen on her face. With wild eyes and a sickening pallor, she looked at me and frantically said, “I’m bleeding!” In fact it was a very significant bleed which had soaked completely through her dress. Both of our hearts sank and we thought, “We can’t be losing another child, especially when everything seemed to be going so well.”

            Dr. Soper guided my wife into the exam room and began her physical. She, too, was expecting the worse and began a speech I’m sure she’s repeated many, many times in the past. “You know, Sara, it is not uncommon to lose a baby at this stage of the pregnancy. When they are lost at this point, it usually indicates there was a major problem with the fetus which would have prevented it from developing properly. It is really for the better that they are lost so soon. Before our more advanced testing, many women probably miscarried at this stage and never even knew they were pregnant.” They were words we knew were true, but at that moment there was little solace in them. The physical exam did not reveal any clues as to what was happening, so Dr. Soper reached for the Doppler. “Let’s just go ahead and listen just to make sure.” We all knew what was going to follow- a deathly silence broken only by the natural sounds of Sara’s gut. Dr. Soper placed the device on Sara’s belly and after shifting it a time or two, there it was- the pucka, pucka, pucka of an infant’s heartbeat! A wave of relief swept over both my wife’s face and the doctor’s face, and I was overcome with emotion. Tears of joy started flowing freely. Part of it was knowing that our baby was still alive. Part of it was the joy that always accompanies hearing the heartbeat of your unborn child for the very first time. But a portion of my tears were for my wife who was so hurt by the earlier miscarriage and who was so afraid she was losing yet another child. To see that fear erased from her face meant everything to me. I was so overcome, I had to step out of the exam room and return to the waiting room.

            The next hurdle was the blood testing to evaluate the baby’s progress. One of these tests was the alpha fetal protein (AFP) level. Abnormal results can suggest problems such as spina bifida or anencephaly. While the other blood results came back as normal, the AFP was elevated. Did our baby have neurologic defects? We started pondering what the future held for us. We even had discussions of organ donation should our baby be born with anencephaly. Dr. Soper tried to reassure us by informing us that elevations of this protein are not definitive and in fact, not all doctors even run them because of the high numbers of false positives. To be safe, however, she suggested another ultrasound to look at the spine and skull.

            Unlike the first two ultrasounds, we came to this one with real fear. What was it going to show? How would we react to the news? Dr. Soper began by first palpating the baby through Sara’s growing belly. She talked out loud to herself as she felt around for landmarks delineating the hidden infant. She quickly found what she thought was an elbow and started working her way from there. One thing she said as an offhand comment quickly caught my attention and stabbed at my heart. “Where is your head?” she murmured as she continued to poke and prod on my wife’s tummy. The fear of anencephaly once again rose to the surface, even though I knew she did not mean the baby didn’t have a head (something I knew was impossible, but I was not thinking rationally.) So the ultrasound was begun, and soon we saw an image of our child. It was not the cute, round baby-sucking-its-thumb-in-the-womb sort of image, it was more of a scary, demon-like skeleton staring back at us. This was simply because we were still early in the pregnancy and our baby had not yet finished developing and had definitely not reached the point of laying down fat. But it was a beautiful image, nonetheless, because it showed a complete and intact vertebral column, and a normally formed skull. The baby looked just as it was supposed to and was moving just as a baby should at this stage. Again we breathed a huge sigh of relief, but we wondered when would the worries ever stop with this pregnancy?
Sara finally showing a "baby bump"

            However, the tide seemed to have turned for the better. Sara’s extreme morning sickness passed and she was able to regain ten of her lost 11 pounds in one month. With caring for the house and a now three year old son, she was frequently tired, but she felt that both her health and the baby’s health were on a steady tract. Her belly grew, and I laughed at her as she would try to rise from the bed. To me she always looked like a beetle flipped onto its back, limbs paddling trying to get a purchase on the air. But one morning about 33 weeks into her pregnancy, Sara sprang from the bed in the blink of an eye and charged to the bathroom. Her water had broken seven weeks before her expected due date. She wasn’t necessarily experiencing labor pains, but she was sure that her water had broken. We called the doctor, and she wanted us to come in for an exam. My parents dutifully drove over to watch our son as we headed off wondering what lay ahead.
            Dr. Soper examined Sara and said that she was not in labor. She suspected a high tear on the amniotic sac that had allowed some fluid to leak, but all seemed fine at the moment. However, given that our son had come four weeks early, we had recently lost a baby and now Sara’s water had broken, the doctor thought it was in everyone’s best interest to order Sara to bed rest until the baby came.

            Bed rest certainly made life interesting. We had a three year old son, and I had a full time job. Honestly, I can’t remember how the mornings went or who fed and dressed David. I do recall my parents coming by one day to do laundry and entertain him for a while. It is said that videos should never be used as a baby sitter, but they were sure a life saver as Sara and David would often lie together in the morning and watch his favorite videos while I was at work. At noon I would hurry home to feed David his lunch and help Sara with anything she might need. After letting him play a while, I would get him settled into bed for his afternoon nap then again return to the clinic to finish my day. When I returned home in the evenings, Sara would be out of bed, sitting on a chair by the stove, cooking our simple dinners since I was not much of a cook myself. After dinner, Sara obediently returned to bed while I did the dishes then, shifting gears, I entertained a restless three year old until his bath time. Once I had him bathed and we had read a book together, I tucked him into bed and began cleaning the house, sometimes not finishing until midnight. This period unfortunately fell during autumn when the leaves were falling from the trees like rain and the ever growing grass was soon hidden under a thick, yellow carpet of discarded foliage. I am very particular about my yard, so on my day off that week I was outside mowing and mulching leaves and preparing my flower beds for the winter, frequently taking breaks to come in and check on Sara and David. I was longing for some free time to just sit and relax, but that wasn’t to be. The experience of maintaining a house, a yard, a job and a family alone definitely opened my eyes to the life of single parents, and mothers in general. I have a whole new respect for those individuals and realize now just how easy I have it in life.

            A week into bed rest, Sara felt the first twinges of labor. When it became obvious that this was not another false alarm, we again called and roused my sleepy parents from bed to come and watch David while we headed off to the hospital. Dr. Soper was already there for her morning rounds, so she quickly popped in to check on Sara. It was agreed that she was indeed in labor but still quite a ways from delivering. The doctor left us with specific instructions before heading off to rounds and morning surgeries - get down to business and deliver the baby, but not too quickly since she would be busy the first half of the morning. In fact she gave us only about a one to two hour window between her morning at the hospital and her afternoon appointments at the office in which to deliver. Unlike David’s birth which had advanced so quickly, this time we actually had time to do what the films in birthing class had shown. We began our long walks up and down the corridors of the labor and delivery unit in an attempt to move things along. It was during one of these circuits that we were reminded just how perilous birth can be and what a precious gift a new baby really is to a family. We had noticed staff hovering near a particular room, and through snippets of overheard whispers, we realized the room was being set up to allow a set of new parents to view their baby which had died. What a sobering thought as we prepared to bring our own child into the world.
            As the morning grew late Dr. Soper returned to check on Sara’s progress. Although she was happy that we had not cut into her morning schedule, she had doubts Sara was progressing quick enough to make her suggested delivery window. So the doctor made an executive decision to break Sara’s membranes. Once the procedure was completed, Sara got out of bed and prepared to once again wander the halls. We made it as far as the door to our room before Sara dropped to her knees in pain. With the membranes ruptured and much of the fluid cushion removed, the baby had dropped much further into the birth canal- a position we quickly learned is not conducive to standing and walking.

            From there things proceeded much more quickly and soon it was time for Sara to start pushing. While my wife was going through the struggles of delivering our baby, a group was quietly gathering in the corner of our room. This was the team that handled premature births, and they had been called in because Sara was delivering six weeks before her expected due date. At 11:35 in the morning, Rebecca Jane Fifer came into the world weighing in at 5 pounds 13 ounces. Dr. Soper announced it was a girl and held her up briefly for us to see before handing her over to the assembled specialists. The group of nurses and doctors carefully examined our daughter and determined that although she was early, she did not require special care. (Her initial Apgar score was only four out of ten (considered fairly low) but five minutes later she retested at a full ten.)
Our new little daughter

            After several minutes, which I’m sure felt like a lifetime to my wife, Sara was finally able to hold her new daughter for the first time. While Rebecca snuggled in, Sara called to break the good news to her mother and I, likewise, phoned my parents. This brief bonding period completed, it was time for the nurse to take Rebecca out of the room to clean her up, but she returned a short while later with some unexpected news. While being washed, Rebecca had experienced a period of apnea and had turned blue. Given that she was premature, this meant one thing – Rebecca was headed to the neonatal ICU, or NICU as it was more commonly called, for further observation. We were unsure just what this meant or how long she was to be there, and so began yet another long period of anxious waiting.

Momma getting to bond with her new little daughter
            The afternoon was ticking by and still we did not have our baby to hold. I was restless, so to pass the time I watched the world go by from our room’s window. From my vantage point I could look out across the grounds and see the highway in the distance as well as the looping drive bringing cars to the main entrance. Off to my left I could see the top of the parking garage, and that is where my attention was focused when I saw a man trying to get into a truck. He first tried the door, but it was obviously locked. The next thing I noticed was that he had stepped back and was now kicking at the driver’s side window. I thought this was very unusual, and I couldn’t understand why he just didn’t call for help to get his truck unlocked. When the kicking failed, he began searching for some club-like object, and finding one, he proceeded to smash out the window that way. Quickly climbing into the truck, he started fishing around for something under dash. Being rather slow and naïve, it was only then that I realized he was breaking into the truck and stealing something. Not knowing exactly what I should do, I went out into the hall and found the nurse sitting at the information desk and told her what I had seen. She immediately contacted security, and when I returned to the room and looked out the window, I could see patrol cars on their way to the top of the garage. The thief, who evidently realized the police were coming, took off running, and the chase was on. I quickly lost sight of all participants and turned away from the window, thinking the excitement for the day was over. About a half hour later, there was a knock at the door and a policeman stepped in. I had hoped to remain anonymous throughout this adventure, but the nurse had given him my name and room number. The officer quizzed me on what I had witnessed and took a peek out the window to see for himself what my perspective had been on the crime. I assured him I was of limited value because the parking garage was so far away I could not give him any sort of detailed description. All I knew was that it was a guy in jeans and a blue plaid top. The officer told me they had caught the individual they believed was the thief with the car stereo or tape deck still in his possession; however, he had stripped out of his top and was no longer wearing blue plaid. He asked if I would be willing to come with him to identify the suspect. I again tried to explain that I had not seen him well enough to pick him out, but the officer insisted. He assured me that he would just drive me past the individual, and the thief would never see me. Although I knew I would be of no help, I consented and climbed into the police car. As promised, he drove me past the suspect, but the part about not being seen was another story. He drove slowly past the man, stopping only a few feet away and as he did so, an angry looking guy in handcuffs stared me down. I prayed my name would not appear in any police record that this guy could access when he was free because I thought he might hunt me down. At the same time I had to laugh at the ridiculousness of the situation. My wife had just given birth, my daughter was in the NICU and we knew nothing of what was happening to her, and here I was sitting in a police car identifying some thief.

            After returning to our room, my wife and I soon learned that Rebecca was doing well, but she would have to remain in the NICU for a couple of days. Part of being in the ICU was constant monitoring, including an ECG. While Rebecca was being monitored, they had noticed some PVC’s (premature ventricular complexes) which we were told were not that unusual in a newborn, or at least a premature baby. However, while watching for the PVC’s, they also noted some PAC’s (premature atrial complexes) which are apparently less common. To insure these arrhythmias were not due to a structural problem with the heart, a cardiac ultrasound was ordered. The next day the echo was conducted, and the young cardiologist gave us some concerning news. He could not be sure, but he thought he may have noted a tumor in Rebecca’s heart. He repeated that he was not certain of this at all, but a follow up scan at a later date would be necessary.
Grandma Fifer rocking her newest grandbaby in the NICU

            For the next three days we kept a vigil by our daughter in the NICU.  Sara was discharged from the hospital on the second day, but after coming home to see David and to get a change of clothes, she checked herself into a hotel adjacent to the hospital.  The buildings were connected by a long tunnel, which unfortunately, my wife had to walk a couple times a day, still feeling the discomfort of childbirth.  I remained at home with David in the evenings and, when I could get grandparents to watch him, at the hospital with Sara and Rebecca during the days.  Due to Sara’s water breaking so early, there was a fear of infection so Rebecca was started on antibiotics.  They were of a class I knew could cause kidney damage or hearing loss, so instead of being comforted by this layer of protection, I became more concerned.  They did repeated blood tests which showed all was going well.  At some point Rebecca had pulled the catheter from her arm, and now sported one in her scalp to allow the administration of the antibiotics.  Each day we would gown up and sit and rock her until a nurse needed to check her vitals or giver her medication.  I loved to sit and study her hands thinking ahead to that far off day when I would hold that same hand to walk her down the aisle.  
Studying the catheter in Rebecca's head

            On the third day it was decided that Rebecca was healthy enough to go home, but one final hitch threatened to derail even that.  Her weight had continued to drop and she was now five pounds six ounces.  The fact that we had another child and thus my wife was an experienced nurser was the only thing that convinced them to release her.  They began the process of removing her catheter and washing her hair in preparation for the official hospital portrait.  While we had laid in an ample supply of outfits for a new baby, we had not contemplated one coming quite so early.  As a result, we were left without anything for Rebecca to wear.  I recalled seeing some clothes in the gift shop downstairs, so I pardoned myself and hurriedly ran down to the first floor shop.  Rummaging through the rack of baby clothes, I was happily surprised to find a cute little pink and white outfit made especially for a preemie.  I snatched it up, paid my bill and scurried back to the NICU just in time to dress Rebecca for her “photo shoot.”
The official hospital photo in her new outfit.

            Finally, we were released to go home, but of course there were nagging questions following us.  Did she have a tumor in her heart?  Would she have any more breathing issues?  Would she start gaining weight or keep losing?  It seemed as though there had never been a time from the beginning of the pregnancy where there wasn’t some Sword of Damocles hanging over our heads.  When we arrived home, David ran to greet us and meet his new sister.  He was more interested in the video he had been watching with his grandmother, but he managed to disappear into his room, emerging with an armful of toys which he piled into the car seat and on top of Rebecca.  We were touched by his offering, but told him she was still a little young for those toys.  In less than a minute the novelty of a new sister had worn off, and David was again lost in his own world of play in the other room.
David admiring his new sister
Proud big brother

            Life settled back into a relatively normal pattern as we attended the typical new baby exams at the pediatrician’s office.  The only additional visits came when Rebecca started showing some jaundice, and we had to go in for bilirubin checks which left her poor little heals bruised from the repeated blood draws.  Unlike our son who had required frequent weight checks, once Rebecca started filling out she made up for lost time and became a very plump little girl with rosy cheeks and deep creases at every bend in her arms and legs.  The final test came that December when we returned to the cardiologist for a follow-up echocardiogram just before Christmas.  She was much stronger now and her movements made isolating the tiny heart difficult, but after a quick review, the doctor announced that there were no masses in her heart and all appeared normal.  It was the first time since the miscarriage a full year before that we no longer had a lingering worry. 
A nice, plump, healthy baby

            We decided 17 years ago, Rebecca was to be our last child.  We had one healthy son and one healthy daughter, and each successive pregnancy seemed to end earlier and earlier.  We didn’t like our future odds and decided to stop while we were ahead. Rebecca has grown into a beautiful young woman.  Only a few weeks ago we began our tours of potential college campuses with her.  The worries of her rough beginnings are now just distant memories, and the only times we are reminded of her fragile early days are those occasional moments when her asthma flares. But thankfully, even these have become fewer and farther between.  Our life is so blessed, and that is why I take this occasion to wish my daughter a very happy birthday and to say, “I love you.”
One of my favorite shots of the kids together.
David looks like a protective big brother, but he would have rather been an only child.

1 comment:

  1. She was such an adorable little child... such a proud dad you are, it comes across in all the postings where you mention your children.
    You will see from my blog... there has been good news today!