Bittersweet Monday

I knew Monday would be bittersweet from the start. The marker board in Ana's room now listed an anticipated discharge date and time (8/29 at 10 am). Ana awoke with the same headache as the day before and after a visit from her doctor, we found out she may have a spinal headache from her spinal block during the c-section.

The anesthesiologist stopped by and asked a lot of questions about the headache. It did indeed, seem to be a spinal headache, but it was very mild. He gave Ana a couple of options and Ana chose the drink coffee and water option. She gave up coffee during the pregnancy, so she was happy to have a cup in the morning. It seemed to help some so I started packing up our room. We didn't have a baby bag, so the packing went pretty quick.

After the nurses stopped by and gave us our drugs and paperwork for a breast pump, we went to get the car. Ana will be on blood pressure medicine for the next 4-6 weeks, pain medicine for the incision in her belly, and pumping since little Naomi is in an incubator. I didn't realize our life was going to be pump, eat, travel, pump, eat, travel. As a side note, I can now assemble a breast pump quicker than an Ikea table.

After re-parking the car, we made the trek over to Children's to visit Naomi.

She was still doing well and there were no major changes to report. We stuck around for care time and it was my turn to take her temperature and change her diaper. Little did I know, the nurse had given her a suppository earlier. I've changed diapers before, but the meconium was ultra sticky.

Ana on the other hand got to experience the highlight of the evening and I was so happy to be a witness. Ana got to hold Naomi for the very first time. After approximately five minutes of rearranging cords and tubes and getting Ana a kangaroo time gown, mom and daughter were reunited. I was in charge of tear wiping while Ana relaxed and bonded with her little girl. Naomi relaxed and snuggled in her mom's arms. It was wonderful after going five days without either of us getting a chance to hold her.

Finally, Naomi was due for her cares again and all too soon, she was back in her incubator. We gathered our things slowly and asked many questions before making the sad journey back to the car and back home. Naomi will most likely be in the hospital for 6 to 10 weeks. It will become our second home.

One step back

Sunday didn't start out as well. Ana awoke with a bad headache. It was enough to keep her in bed as the doctor's were slightly concerned. Her blood pressure was still high, so she caught up on some much needed rest while I made the trip to Children's. It was also the first time I really had a chance to reflect on the past three days.

I made it to Naomi's room around nine, just before her cares. The biggest change was Naomi was on a CPAP machine! She was breathing well enough that they could remove her breathing tube. Because preterm babies are not natural breathers, they were giving Naomi caffeine, so dad and daughter enjoyed their caffeine together. The caffeine stimulates Naomi and I so we don't stop breathing.

For those of you who don't know, Ana has hook toes. Hook toes are big toes that curve up and can be used to pick up clothes, towels, or almost anything else from the floor. Combined with a Chuck Norris round-house kick, hook toes can be a deadly. Ana and I used to joke that our baby would probably have a beard and hook toes. Fortunately, Naomi doesn't have a beard and this morning I had a chance to check her toes. No hooks yet.

I also realized that most people don't know what Naomi's room looks like. It's pretty small with a fold down couch for Ana and I to stay if we would like. Naomi's incubator occupies the middle of the room and she is surround by various machines. The east wall has a sink for scrubbing and cleaning and cupboards for various supplies. There's a lot of beeping, and buzzing, and wheezy sounds. After awhile most fade into the background noise of the NICU.

When we arrive each visit, we wash our hands for two minutes from finger tips to elbows. After we rinse and dry, we rub our hands with the alcohol foam that is found everywhere in the hospital. When people come to visit, they get to wash their hands too.

After that, we are allowed to "hold" Naomi. We press a button on her incubator and open the doors. Because of Naomi's developing neurological system, we simply cup our hands around her head and feet, or place our finger in her hand. It would stress her if we were to stroke her skin because of her stage of development.

This morning, I got the opportunity to learn even more about what we can do when we visit. Around 9 am is care time which involves all of her care for the next four hours. They lump it all together so she can sleep for four hours before the next care time. Care time consists of taking a temperature, changing a diaper, cleaning her mouth, changing her CPAP mask, and checking the UV sensor. I am sure there is more that is being conducted, but those are the major items. I got to change her diaper and take her temperature! I thought changing a diaper on a one-month old was difficult, but when you throw in wires and an incubator it gets even trickier. When your daughter is a little feisty, it's a bit trickier yet. Once you are done with the diaper change you weight it. Being a new dad, the next step is bragging about how much your daughter's diaper weighed.

The highlight of care time though was getting a chance to see Naomi's whole face for the first time! No mask, no CPAP!

After care time, I went back to the room to check on Ana. We were moved the day before from the c-section/surgery wing to the postpartum wing. It was a happy and a sad change. The c-section wing is a sad place. A lot of families were as scared as we were when they arrived and some were not as fortunate as Ana and I. On the other hand, the postpartum wing was filled with families and little ones. Everyone was happy and showing off their newborns to family and friends. It was during this transition, that I tried to remember how lucky we were without being sad because Naomi wasn't nearby.

Later that evening, Ana was feeling better. Here headache had subsided and her blood pressure was considered okay for travel. She did a post c-section hop from the bed to the wheel chair and we headed off to see Naomi. A post c-section hop is a gentle slide from bed to feet to wheel chair. It's kind of the opposite of the traditional hop since it involves always being in contact with two support surfaces at once.

I didn't tell Ana, but I knew that when we got there she would be able to help out with the cares. One of which was oral care. Oral care is the precursor to feeding. The nurse and I decided it would be best for Ana to give Naomi her first taste of milk.

Since she was born on the first day of the state fair, they serve up milk on a stick for her! The milk is wiped around the gums via a long cotton swab. Ana also got to change a diaper.

...and take a temperature.

Before we left, Ana let Naomi give her a kick or two for old times sake.

So, while the day didn't start out as well as I had hoped, it ended with another wonderful trip with Ana to see Naomi.

Also, visitors are welcome! We are limited to having four people in the room at one time, including ourselves. We can rotate if needed. I'll ask you to wash your hands for two minutes and use the alcohol foam. You'll need to text or email us ahead of time so we can get a visitors pass for you at the front desk. it probably goes without saying, but if you aren't feeling well, they will not allow you into the NICU.

Thanks again for all of the support. Ana and I are very fortunate to have such a wonderful family and wonderful friends.

Two steps forward

The weekend was a blur. Saturday was filled with family visits and trips to see Naomi. A lot of flowers arrived for Ana. Unfortunately, Naomi can't have much in her room so we didn't take her any flowers.

Ana made the trip three times and was feeling much better. The doctor said her platelets were rebounding and her liver enzymes were almost normal. I'm sure her rapid rebound was due to the Sweet Martha Cookie Therapy.

The only lingering concern was her blood pressure, but it was low enough to travel by wheel chair.

We made the first trip a little before lunch time. We lingered for awhile with Grandma and Grandpa Buhr, not really wanting to leave. Eventually though lunch time came and we left. My brother picked me up to get my camera cleaned to remove the big glob from the censor (it's the dark spot in the middle of all of the early photos). The highlight of the visit was capture on film by Grandpa Buhr as Ana reached into Naomi's incubator.

Meanwhile, Grandpa Buhr got his chance to push the wheel chair. It sounds like he failed his driving test as Ana didn't let him push again during the weekend.

Our second trip of the day brought the biggest change. Naomi's bilirubin level was high, otherwise she was doing well. She was now wearing a cool pair of shades and taking a tan.

I warned her about using a tanning booth when she is older. For now though, I let her bask under the Drager Photo-Therapy 4000.

The nurses have been very kind to us and are doing a wonderful job of taking care of Naomi. They entertain our questions and enthusiastically answer them. We learned all about Naomi's breathing tube and gas concentrations.

I've also started to recognize the different alarms that go off while we visit. They monitor her heart rate, her chest wall activity (breathing), and her blood oxygen. She was pretty much receiving the equivalent of room air through her breathing tube.

Our last visit extra special. Uncle Ben and Aunt Alison gave us a couple of story books to read to her at night, so we brought "Pajama Time" along to read to Naomi. We read quietly beside her little incubator and wished her a good night. Having babysat a little niece nearby, I have a little experience swaddling, so I wished I could swaddle her in her sleep sack and put her in her crib.

Ana and I want to thank everyone for their support, comments, and emails. I haven't had time to respond to everyone yet, but I will in time. Also, I just wanted to let everyone know that their comments will not post right away. I set up the blog so I have to review them first and share them with Ana right away.

Day Two

Day two started out as a rapid transition from groggy to coffee. After waking up from my super sleeper chair, I crawled over to Mapp's in the global midtown market for coffee.  Ana was still feeling sluggish from the magnesium-sulfate and was ready for the world to stop spinning.

Grandma Menk stopped by in the morning. After visiting for a little while we stepped out to let Ana get some rest while I started the process of canceling all of our reservations. The flight cancellation took a little while as I tried to salvage a future ticket, but the remaining cancellations went quickly and everyone was very understanding. Once I was finished Grandma Menk and I returned to the global midtown market for lunch and cookies. We were hoping to go see Naomi, but she was busy being feisty.

We found out in the morning that her venous line in her belly button was not in far enough. An x-ray from that night showed that they would need to try to put a venous line somewhere else. She has the tiniest little belly button (even for 29 weeks), so they wanted to try to start an IV in her arm. Trying to put a new line into her belly button was not an option because the risk of infection was too high. Before they began, they wanted to make sure she was stable. Her breathing was a little fast so they waited until the afternoon to perform the procedure.

Meanwhile, I began to practice putting on neonate diapers. First was the buffalo, next was the polar bear.

Later that afternoon, the nurse practitioner was successful. They wanted to perform an x-ray before removing the belly button venous line. The x-ray showed that her new line was placed well. After the good news, I traveled the tunnel again to Children's hospital with Grandma and Grandpa Buhr. It took me a little while to notice, the nurse had put a little bow in Naomi's hair! We took some pictures and headed back to Ana's room.

Later that night, I traveled the tunnel again with Ana. The previous night she traveled in a bed, but today she rode in a wheel chair. I was so happy Ana was able to make it to Naomi's room and that she was able to sit upright. Ana loved the little bow and we listened to the nurse as she explained all of the different guidelines in the NICU. We were both very tired as we rolled back to Abbott. A few tears were shed along the way. Before we headed back to Abbott though, we left Naomi's guardian javelina who also happens to have a pink tutu.

From momo's to parents!

Wednesday evening, Ana and I went to eat some momo's at Everest on Grand. It was a beautiful night eating outside and we talked about our upcoming trip to Seattle and all of the places we were going to stay...

At 1 AM on Thursday, Ana awoke with a slight discomfort in her chest. She told me that she was going to try to sleep on the couch because she was unable to get back to sleep in bed. After listening to Ana rummage around the house I went out to see if I could help. I gave her a back rub and it seemed to relieve her shoulder pain a little.

Soon after, Ana returned to the bedroom. She had taken her blood pressure and it was 175/115 mmHg. After a short discussion we hopped into the new Subaru to go to the emergency room. In the back of my mind I thought, this is good practice for when our baby arrives. Little did I know.

We arrived at the ER in Methodist Hospital at 3:00 AM. The nice lady at the check-in desk told us we should go to the Family Birth Center. Our tour of the Family Birth Center was scheduled for September 20th, so we had no idea where to go. After navigating the long hallways we arrived at the Family Birth Center and we were given a room. The first nurse stopped by and Ana described her pain. They collected a urine sample to check for protein and ordered some blood work. I mean while was reading a competing risk statistical methods paper in the corner for a meeting in the morning. Little did I know.

After three hours of waiting and one GI cocktail, the attending OBGYN stopped by to give us the news. The good news was Ana didn't have protein in her urine. The bad news was her platelet count was low and her liver enzymes were really high. Based on her blood pressure, her platelet count, and her liver enzymes, she was classified as having severe pre-eclampsia. The doctor informed us that they would transfer us to Abbot-Northwestern Hospital in Minneapolis because Ana was only 29 weeks and 3 days pregnant. Abbott is connected to Children's Hospital in Minneapolis and is renowned for their care. What we thought was going to be a meeting to let us go home turned into a very somber moment.

They gave Ana a steroid shot right away to try to help the babies lungs develop further. They also started her on magnesium-sulfate to prevent seizures. Soon the paramedics arrived and I ran to the Subaru a crying mess.

Somehow I managed to make it to Abbott without getting a speeding ticket. I parked the car, wiped the tears and ran to the 6th floor. The paramedics weren't there yet.

I found out where Ana would be admitted and waited nearby. Soon Ana and the paramedics arrived and the nurses at Abbott jumped into action. They ordered more blood work and made Ana as comfortable as they could. I continued to make phone calls to family and friends. Our parents were on their way to Abbott and I was hoping for the best. It all seemed so surreal.

When the results of the blood work came back from the lab, we were informed by the doctor that they had not stabilized like they had hoped. The doctor told us that Ana had HELLP. According to Wikipedia:

HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth.

HELLP is an abbreviation of the main findings:^[1]

• Hemolytic anemia
• Elevated Liver enzymes and
• Low Platelet count

Now I was really in shock. The doctor also informed us that the only known cure for HELLP is delivery and that they wanted to perform a c-section as soon as possible. Without delivery, Ana was at risk for seizures, liver failure, and other complications. As the doctor at Methodist told us, our birth plan was about to change.

Ideally, the doctors would have liked to wait at least 48 hours to deliver so the steroids can help the babies lungs develop, but we were out of time. After some preparatory work, Ana was taken into the surgical room. I soon followed and we both waited together on the less intense side of the curtain. We held hands and shortly little Baby Menk was heard crying as she was whisked away to the adjacent room. They took care of her right away.

After they had completed what they needed to complete on little Baby Menk, I was invited into the other room and took some photos and smiled as I saw our wee little daughter. I think I felt shock, stress, awe, and complete amazement in one moment. I was now a Dad and here was my little girl, all of 2.9 lbs.

She was wearing a little stocking cap like she was getting ready to ski, or maybe it was because her Mom skied one of the coldest Korteloppets when she was the size of a peanut. I got to help hold her hand as they trimmed the umbilical cord and attempted to insert a catheter into her umbilical vein. After being with my daughter for a while, I went to check on Mom.

Mom was in the recovery room doing well. She was starting to regain the feeling in her legs and was anxious to see her baby daughter. After a little wait she finally arrived. It was heartbreaking to watch our daughter in a little incubator and not be able to hold her. She stayed for a little while and then the NICU nurses took her to Children's.

I followed as Ana waited in the recovery room. We navigated the tunnels to Children's and soon arrived at Baby Menk's room. The nurses were wonderful and explained all of the things that were going to happen in the next 24 hours.  I used Ana's phone to take some pictures and headed back after a little while to check on Ana.

Ana was doing well. She was still on magnesium-sulfate and would remain on magnesium-sulfate for 24 hours after delivery. For those of you who do not know, magnesium-sulfate makes you feel very hot and also made Ana's head feel like slush. I shared photos and visited with our parents. In all of the chaos, Ana and I hadn't settled on a name yet and one of the grandparents was getting impatient. Ana and I had a team meeting and discussed our plans. We had settle on two girl names long ago, but hadn't had a chance to discuss them after Baby Menk arrived. After a short meeting, I went to meet our parents for dinner while Ana rested. During dinner I announced the name.

Naomi Marie Menk was our daughter's name. We both thought Naomi was a beautiful name and we wanted her middle name to honor two of the strongest women we know, Grandma Mary and Grandma MaryEtta.

After dinner, I took Uncle Ben and Uncle Adam to meet their newest niece. After they left, I returned to Ana's room shortly after Pastor Jen left. Ana said she said a lovely prayer.

As the evening went along, the nurses continued to monitor Ana's blood pressure. If it was low enough, they would let her visit Naomi. At 10 PM, Ana was declared fit for travel. I don't think you could have stopped her anyway. Two nurses helped move her to a cart and we were on our way through the tunnels.

A little after 10 PM, Ana and Naomi were reunited again!

After a wonderful visit to see our daughter we headed back to Abbott to get some much needed rest. I also want to say thank you to all of our family and friends for their thoughts and prayers. It means so much to us as we wander through life.