Julian visits the NICU
Started: 2015-04-11 16:01:49
Submitted: 2015-04-11 23:18:19
Visibility: World-readable
In which the intrepid narrator's new baby tries (and fails) to become a million-dollar baby
After being born, Julian did not allow us an undue amount of uninterrupted sleep on his first night as a baby, but one of the secret advantages of his being a big baby was that he was more likely to eat more and sleep for longer, as if he were an older baby with the equivalent weight. When he awoke during the night Kiesa summoned me to pick him up and hand him to her to feed, since she was still recovering from her c-section and wasn't yet totally confident to stand on her own.
On Tuesday morning Kiesa was unplugged from the remainder of her tubes and monitors: her IV and catheter came out, and the nurse took away the neat glowing-red pulse oximeter on her toe and the compression socks leggings trying to prevent blood clots from forming in her legs. She was a little shaky at first but quickly adapted to walking again, barely twenty-four hours after having a baby surgically removed from her abdomen.
I ate breakfast in the hospital cafeteria, then walked along the labyrinth in the hospital courtyard, contemplating the major change in my family life that was still unfolding as I walked. I returned to the room to accompany Kiesa and her mother out to the open-air balcony around the corner from our room, where Julian met the harsh light of the daystar for the first time. The nurses were very impressed with Kiesa's recovery from her c-section. She was thrilled that she went straight for a scheduled c-section without bothering with a trial of labor first, so her she had only one delivery to recover from.
Around noon the nurse stopped by to run a blood oxygen test on Julian with a glowing-red pulse oximeter strapped around his foot. She was a little worried by the results -- she wanted an SpO2 measurement around 95%, but Julian was fairly consistently measuring around 85%. Julian sounded fairly congested, and the hand-held bulb aspirator was not especially helpful in extracting any of the mucous we were pretty sure was stuck in his nose, so she called in another nurse to help her her hook up an elaborate suction apparatus with tubing hooked up to a vacuum port in the wall. (I wondered what that was for.) This seemed to work at first but the effect didn't last.
The nurses rolled out one more test with two pulse oximeters: one hooked up to his right hand and one hooked up to his left foot. The idea was to test whether his blood oxygen saturation was different at different parts of his body; if so, that suggested a more serious problem with his heart and circulatory system. This test suggested that Julian didn't have an imbalance; his blood oxygen was just low.
This worried the nurses enough that they called in the staff neonatal nurse practitioner (on loan from Children's Hospital in Denver and working on-site in twenty-four hour shifts) and transferred him from the regular postpartum ward to the adjacent NICU and began running a bunch of tests on him. Kiesa followed Julian into our new room, and her mother and I packed up our stuff, reloaded the cart (which I'd only barely begun to unpack after wheeling it from PACU into our postpartum room the day before), and moved it to the parallel hall on the north side of the wing. This ward was quieter, with only three of the six rooms occupied. (I caught only the briefest glimpse of the premie in the adjacent room, who looked about half of Julian's size.)
The NICU rooms featured a dedicated nursery for the baby, centered around a warming incubator surrounded by the sorts of elaborate monitors one would want to keep a baby alive. (These machines did not go 'ping' precisely, but did beep extensively.) The nurses set Julian up on the incubator, hooked his pulse oximeters up to the monitors, applied three neonatal ECG leads to his chest, and put him under an oxygen hood to help him breathe. (The ECG leads kept falling off; the nurses complained that he was sweating while feeding. We appear to have gotten off easy; on the Internet I saw terrifying pictures of babies hooked up to proper twelve-lead ECGs.) They called in an x-ray machine, which was a self-propelled cart operated by two nurses and painted to look vaguely like a giraffe. They put an inch-thick plastic plate on the incubator table under Julian, gave him a lead chastity belt to protect my grandchildren from the x-ray, shooed me (and everyone else) from the room, and took the full-body x-ray.
The next step was using a portable ultrasound machine to get an echocardiogram. The tech apologized that she needed to take about a hundred pictures, and she wasn't kidding. Kiesa stood next to Julian's bedside and let him suck on her finger while the test went on. The last handful of images were the hardest to get; the tech needed to point the wand downwards from Julian's neck, so Kiesa and another nurse had to prop his head up while he fussed -- but they pulled it off, and they sent the images down to Children's Hospital for analysis. The nurses talked about giving Julian an IV for nutrients and fluids (which they said they'd probably do through the still-existent veins under his umbilical stump) but decided he didn't need it. They took him out from under the oxygen hood and put an oxygen tube under his nose, held in place by adhesive stickers on his temples.
By this time it was the middle of the afternoon and we'd forgotten to eat lunch. We snacked on energy bars and sat down to wait. Julian was stressed and tired and spent three hours nursing. Kiesa was not designed to handle this sort of use, especially since her milk hadn't come in yet and she wasn't sure how well she'd be able to breast-feed after our breastfeeding debacle with Calvin; I wondered aloud when we'd want to start thinking about supplementing. Sometime later our nurse suggested supplementing, on the theory that as a big baby he was hungrier than Kiesa could supply at the moment, and we agreed to bottle-feed Julian donor breast milk, which the hospital provided for free as part of the tens of thousands of dollars my insurance would be paying for the birth and hospital stay. (The milk comes from women whose supply exceeds their baby's needs; they're not compensated for the milk, but the screening and processing and delivery costs something like $20 for a tiny four-ounce bottle. At barely more than a day old, Julian only drank an ounce per feeding, but we could see that it was going to add up quickly and decided we'd much rather pay for formula, especially once it became apparent that Julian was getting some milk straight from Kiesa.) Kiesa even agreed to try the supplemental nursing system (SNS), which used a tube from a bottle taped to a nursing mother to augment the milk the baby was getting directly from its mother. (On her birth preferences she vowed never to try it, given Calvin's poor results, but Julian was fairly adept at sucking properly, so she gave it a shot with reasonable results.)
Our nurse remarked that Kiesa and I were remarkably calm during the whole process, apparently unlike other parents going through the same thing. After our experience with pre-term labor last time, merely being transfered to the NICU for a full-term baby was easy, and there was nothing we could gain by complaining. (I also figured that since Calvin skipped the NICU, Julian was going to make up for it.)
Through the afternoon the results from the tests started trickling back. The blood samples did not show any evidence of infection, and the echocardiogram showed no abnormalities in his heart, aside from a tiny murmur that the pediatrician said was normal for newborns and closed itself up as it was supposed to within the first few days. The chest x-ray showed some streaking of fluid in the lungs, which was consistent with a c-section birth; babies born vaginally get their lungs wrung out by the process, so I contemplated the merits of a wringer to help c-section wring out all the excess fluid in their lungs. The nurse practitioner kept using the phrase "tincture of time", which led me to wonder if she and Kiesa's mother had the same phrasebook.
I headed out to pick up take-out from Tokyo Joe's (giving Kiesa a break from hospital food) and returned to eat supper. Our nurse misremembered the rules for visiting children (healthy siblings are fine, even on the NICU side) and Kiesa's mother thought she wouldn't be able to bring Calvin to visit, but we corrected the misunderstanding by the time Kiesa's mother picked Calvin up from school and took him through the labyrinth. My parents dropped by after skiing and visited their newest grandson for the first time. Before they arrived I called to warn my mother that Julian was in the NICU, but the experience was not what they expected -- instead of being able to see Julian through a window in a big nursery, we had our own private nursery (and nursing staff to match).
Our suite included our own bedroom with doors opening both to the dedicated nursery and directly to the hall. I got a pass to badge myself into the NICU wing, giving me twenty-four hour access. (If Kiesa ended up being discharged before Julian, she would get her own badge, and both of us could stay in the adjacent bedroom as we saw fit.) Kiesa was feeling much better from her c-section thirty-six hours earlier but worried that she might have pushed herself too far after standing next to Julian all afternoon. We went to bed on Tuesday night, and whenever Julian woke and cried during the night I got up to see what he wanted; whether I could soothe him back to sleep with the pacifier the NICU nurses gave us or whether I needed to bottle-feed him or whether Kiesa needed to breastfeed him.
On Wednesday morning we talked to the staff pediatrician, who confirmed the diagnosis of extra fluid in the lungs and that the only thing to do was wait for the fluid to drain while gradually weaning him from the supplemental oxygen. He suggested that we might end up bringing Julian home on oxygen if everything else looked good. I wasn't quite sure what to make of this idea but concluded it was probably preferable to keeping him in the NICU.
Kiesa began pumping to help stimulate her milk supply, and we continued to supplement Julian. The nurses gradually turned down his oxygen, watching his oxygen saturation to make sure it was still high enough. I made a quick trip home to pick up extra clothing and my work computer so I could file the right paperwork to tell them of Julian's existence (and take the opportunity to spam my coworkers with baby pictures). I ran into my lead when I stopped for a snack at my local coffee shop and mentioned, briefly, our excitement, while I tried to thread the needle between playing the hero with my project next week while paying the right amount of attention to my newly-expanded family.
In the middle of the night on Wednesday, Julian had a coughing fit that seemed to dislodge the rest of the fluid in his lungs. (I slept through most of it.) The nurse turned down his oxygen and eventually removed his supplemental oxygen entirely, leaving him breathing regular room air, and he kept his blood oxygen saturation up. When the pediatrician and obstetrician made their rounds on Thursday morning both said they'd discharge their respective patients that day. Kiesa's discharge came through first; Julian's discharge took until the middle of the afternoon. He passed his hearing test in the morning, and by noon he was unplugged from all of the monitors. It took another two hours for the rest of his paperwork to go through and we were able to strap him into his carseat and head home. (By way of the tiny Walgreens outpost on the ground floor of the hospital, which rented hospital-grade breast pumps, but we had to wait for the pharmacist to get off the phone from laboriously hand-holding a hepatitis patient upset with the way his medication had been handled by the medical system in general.)
I staged a recreation of me carrying Calvin across the threshold as we arrived home and prepared to integrate Julian into our lives at home.
For Kiesa's account of Julian's visit to the NICU, see NICU Drama. For more pictures of Julian's birth and first days, see Dawn of the Julian Era.
