The Bees Knees

I'm pretty stoked today. Elijah has been in a good mood and has breastfed for 20 minutes at every feeding that I've been here for - yay! Brian and I were discussing that we are in dire need of a vacation. We need to scoop our THREE boys up and go somewhere to veg for a bit. Just waiting for Elijah to hatch his escape plan.

There is definitely something lovable about my days; there is plenty to keep me busy. During the majority of it, I have the pleasure of snuggling my little guy in my arms. I can think of nothing better! Otherwise, I'm pacing the cafeteria lines, deciding if it's a mooshy veggie or fried cheese stick day. On the front door of the hospital, there is a warning sign saying there is secret audio and/or video surveillance. Maybe there is a bored security guard keeping tally of how many times I snub the green beans. Sometimes, I wave at random cracks in the ceiling tiles, just in case someone behind a monitor is feeling lonely. 

I miss my bigger boys. Even if they were allowed in here, they'd probably be miserable after the first 15 minutes of trying drive the IV pole around. They're better off at home with Grandma, where Ian is striking up conversations between his cars, and Isaac is learning to say "contaminated pants". They build tents, walk to the park and have all sorts of fun. Brian's mom says the boys even crawl into a bed or tent and fall asleep without protest for their naps. I think I need video proof of that. 

I don't know what I'm going to do when they get bigger. I keep popping out babies, but they won't stay put. I'm not sure whether to keep at it or resign myself to the fact that they are just going to grow. I love their innocence. The perfect image of that is my memory of Ian when he was just settling into toddlerhood. One of his favorite "jobs" was to bobble to the mailbox with me to get the mail. One day, as we were approaching the mailbox, scruffily decorated with annuals, Ian reached out with one little finger and petted a big, fuzzy bumblebee. The bee didn't know, didn't care or didn't think him a threat, but I was immediately tensed, ready to scoop and run. Something about that transaction burned it into my memory, and I admired my son all the more. 

He's a little more "wise" now. I can't say if he'd try to get friendly with any other stinger-laden insects, but he thinks he knows a thing or two.  Brian was reading him a Dr. Seuss book last night and Ian noticed one of the female characters looked mad. Brian asked him what she was mad about. Ian replied, "She's mad about mans". Sometimes I have to wonder just what exactly he picks up on and what is coincidence, but I'm starting to think kids are pretty adept psychologists.

I'm nagged by motherly guilt regarding Isaac, the poor victim of Second Child Syndrome. He is just as hilarious as Ian, but usually in such an indescribable, nuanced way that words wouldn't do it justice. He's making leaps in his verbal skills, but isn't in position to blurt out the quotables yet, like his older brother. Still, it  seems he ought to get some space on the page, too. I have nary a record of most of his milestones. I couldn't tell you when his top-left molar came in. Apparently, I had way too much time on my hands when I had only one child. But, for the record and my conscience, Isaac rocks!   :o)

Daddy's A What?!

Here I sit in my favorite (*gag*) waiting room, shut out of NICU once again for a surgery, bored, but grateful it's not for Elijah. Two TVs are blaring sports and trash TV. Really, I couldn't be less interested that you don't know who the father is. Might as well use this time to write an update on my new strange life.

I just signed consent for a new chemo treatment (which apparently we're not going to do after all), and am contemplating lunch. I had a very pleasant day yesterday. All the staff are nice, but I really clicked with this particular nurse. We shared our obsessions with new pens and paper, containers, and high-fat candy bars. I lamented about my milk supply. She meticulously documented the day. While mixing one of Elijah's feedings, she inadvertently dribbled some milk out of a syringe. "No worries, I have plenty," I playfully jabbed. "Oh, snap!" she replied with a wince. Good times. She was the first nurse we interacted with when Elijah was transferred to Egleston, and she really helped put our minds at ease and instill confidence in us about his care. She's the only one we've had who pulls up a chair and leans in and ask questions when a doctor comes in to consult with us. Consequently, she's often there late to finish her charting, but we really appreciate her attentiveness and skill, in addition to her fun personality.

The boys at home seem to be settling into the abnormal as the new normal. Every evening, when we come home from our respective "jobs" - Brian from work & me from the hospital, the older two are sitting on the steps by the door, waiting to say "surprise!" or are dashing through the entryway, happily cheering, "Mommy! Daddy!" Grandma Cummings has one of the generously-donated pans of food heated up in the oven and tells us all about their day's adventures. She is not alone in her interest to get Isaac potty trained.  That boy's sport is the defecathalon. Trying to gauge his interest, I asked Isaac the other night if he'd prefer to poop in the potty or in his diaper. Ian chimed in with, "Igick wants to poop on Daddy. Daddy's a potty." I learn something new every day.

Grandma was particularly impressed yesterday when Ian used Lincoln Logs to add head lights to his monster truck. He used a long one across the doors as a cross beam and placed short logs on each end as lights. He did a demo for us when we got home. It actually was quite cool. Then he lined up some Hotwheels and drove over them. Later on, he rigged one of his Jamestown settler's cannons under the hood so his truck could blow smoke. After we crawl in bed at night and turn off the lights, Isaac tells us he's afraid of monster trucks. Ian corrects him that monster trucks are not scary; they're nice. And they like to be petted.

Ian's 3-year-old imagination grows more vivid every day. One time, after accidentally leaving the door cracked open, we caught Ian coming in from the garage. Brian asked him if he'd gone into the garage by himself. "Yes." "What did you do in the garage?" "I did cartwheels in the garage. And I hurt myself." Most days, when we ask him what he did that day, he replies that he "played at Miss Emily and Luke's house" or "played with Collin and Jayla". We know he can't reach the gas pedal on the car yet, so he's full of wishful thinking.

Apparently, even 22-month-old Isaac can get his fill of Ian's embellishments. Ian was trying to tell us last night about how sad he had been. He said, "I was sad. Very very very very very...very very..." and after the umpteenth "very", Isaac curtly interrupted with, "very sad."

Trying to add normalcy where we can, we took the boys to church last weekend. That probably wouldn't be their first choice of normalizing activities. OK, I'll drop the baloney - it was for us. The service was infused with the sweet songs of several children's choirs. I thought that would spark Ian's interest, so I stood him on my knees and enthusiastically whispered, "Look! The children are singing!" Always the diplomat, Ian bellowed, "The children are hurting my ears!" Sometimes, Ian is a little more clever with his words. The other day, Ian held out a toy he was done with and said, "Hold this, Dad." "Please," Brian suggested. "Yes you may!" Ian cheerfully replied. Foiled, Brian took the toy.

The Elijah Cannon: Part 4, Treatment Begins

I was amazed by the size of the CHOA Egleston NICU, the quietness of it, the professionalism, and the hosptality. We could tell immediately that they had "it" figured out here. They understood that the experience was more than a baby in a bed - that each baby comes with a family, and each family comes with fears and needs. We were almost immediately grateful for the transfer. We came to realize that we never really had that "left to dangle" feeling. It seems like down almost every hallway, someone would stop to introduce themselves and genuinely address our emotional and physical needs. A social worker spoke with me first and let me cry out Elijah's story on her shoulder. She addressed the issue of finding a way to spend time with each of my children that I could feel good about. She provided us resources for trying to find a place to stay and ways to try to get financial aid. Then a chaplain met with us. Then an ambassador. They've all been very accessible and in regular contact. Every nurse and doctor explains what they are doing to Elijah, as well as what steps they are taking to ensure his comfort and safety. If we are away, they call us on our cell phones to keep us posted. They treat Elijah with gentleness and compassion and us with respect. They encourage our involvement in his care and help us feel important to the process. They've done the neatest "extra" things too. They gave us a journal to write in, and occasionally, the nurses write a note in it from them or from Elijah. I was also given some Mommy Love Squares - crocheted squares I can wear close to my heart and leave with Elijah so he has my scent near him when I'm away. One nurse also made Ian a big brother book out of photos she had taken of Elijah, and wrote a story in it and illustrated it with some stickers and scrapbook supplies.

The facility has sleep rooms, handed out nightly on a lottery basis. We tried that for a couple nights, until we decided it was more beneficial to sleep at home. They have showers, lockers, laundry machines, a work out room, pumping rooms for breastfeeding moms, a business center, a snack room, a library, classrooms and more. Parents get very discounted meals and parking, and breastfeeding moms get free meals.

By the following Monday, Elijah had a Central Venous Catheter surgically implanted, a bone marrow biopsy taken, and an X-Ray, PET scan and MRI. Tuesday, he started chemotherapy with Vinblastine to be given weekly and Prednisone given daily. The tests confirmed lung, lymph, bone marrow and possibly spleen involvement. That was hard to swallow, but by then we already knew that the initial treatment would be the same, regardless. We also understood that this chemotherapy was different than cancer chemotherapy, in that with cancer, treatment starts aggressively, whereas with LCH, treatment is started slowly and built up as needed. His side effects were expected to be minimal with the low doses he gets.

Elijah had been intubated for the surgery, but when they tried to extubate him, he didn't do very well, so they put the breathing tube back in. A bronchoscopy showed significant swelling and lesions in his upper airway, which were restricting his breathing ability. He also got a blood transfusion to try to give his system a boost. After his first dose of chemo, on Tuesday, January 26, his skin actually seemed to look a little worse, which wasn't an unusual response. Wednesday night, our pastor and some church elders came in to pray with us and Elijah for his healing, and read from James 5. It's ironic and reassuring that the passage speaks of the great prophet Elijah's faith.

I don't know why, of all the times I contemplated it, I chose that night to finally show Ian and Isaac pictures of Elijah. I'd been trying to hold off for Elijah to look "good", but enough people convinced me that at least Ian could understand and "handle" the idea that Elijah needs some special medicine and help from the doctors and nurses. I did choose one of his earlier photos, when he had more spots, but just a feeding tube. The boys loved the pictures and didn't seem at all concerned about how he looked. It felt so good to "introduce" their new brother to them. Ian said, "Come out of the picture, baby Elijah!" He hugged the picture to his chest for quite a while, occasionally looking at it or kissing it. The next morning I got some tape and Ian taped the photos to the wall. Throughout the next days, he would occasionally move them all to a different wall. Sometimes one of the boys would pull down a picture and carry it around for a while.

Shortly after, we were talking to one of the neonatologists, and he arranged to sneak Ian in for a visit. Ian thought it was very cool to wear the special mask, and he climbed up on the chair at Elijah's bedside and gently touched his leg and belly. He seemed captivated. He looked all around at the machines. Elijah was on a ventilator at this point and Ian pointed to the screen and said, "This goes all the way to baby Elijah". He got down and inspected the bed and the drawers and wheels and buttons. He stayed so quiet and gentle. It's frequently hard to tell what Ian thinks of something. When we asked him what he thought of Elijah, Ian said, "He's good."

Friday was the first time I'd really seen Elijah smile. He must have grinned because he was hatching a plan. That night, he surprised us by losing a tooth we didn't realize he had. Then, on Monday, he extubated himself and was breathing more calmly than I'd ever seen him breathe since he was born. By Tuesday, his nasal canula was removed and he was breathing great on room air. That day, he had his second dose of chemo. Wednesday, he was moved into a regular crib. His tube feedings of breast milk were gradually increasing. Friday, we joined our church family in a day of fasting and prayer for Elijah's healing. That night, he was moved to the step-down unit. On February 9, he had his third dose of chemo and the next day, his Morphine was discontinued, since he hadn't needed any in a while.

By Friday, February 12, Elijah was in great shape. He was up to full gravity feeds and was having success with small bottle and breast feeds. He was spending a lot of time alert, happy and active. I felt pretty spoiled, coming in every day and holding him for hours, talking to him, singing to him, smelling him, and soaking him up. Very early Saturday morning, we got a very surprising call. Elijah was back on the ventilator. They weren't exactly sure what the problem was, but Elijah had been cranky, breathing hard, and grunting. They suspected sepsis. Hours later, we got another update that he was not septic, but instead had a pneumothorax. One of the LCH "bubbles" in his left lung had burst, causing air to escape from his lung into the space around his lungs, collapsing his lung. They aspirated the air out with a needle and observed him for a while, but eventually inserted a chest tube. Later, we were shown the X-Ray, and were amazed to see that the lung had collapsed over so far it was pushing his heart into the right side of his body. His body had compensated really well for the event; apparently he had gotten just a little pale and mottled, but didn't have a really severe reaction. That probably had a lot to do with the staff being so attentive and moving quickly to his aid.

Saturday, we had a big snow, for our part of the state. We couldn't safely get to the hospital to see Elijah, and maybe it was just as well, since we would have felt the need to go, even though he would have been sedated all day and not looking so well. Sunday, Brian, his mom, the boys and I all drove up to see him. We took turns keeping the boys distracted while the grown-ups visited with Elijah. He was pretty alert and seemed as comfortable as could be. We pretty much plowed through the fact that it was Valentine's Day, and Elijah's 1-month birthday. Holidays have pretty much shriveled up into meaninglessness these days. Brian and I did make a point the week before to try to have a dinner date, but we couldn't really shake the cloud over our head. We just talked about our poor little boys the whole time.

Monday, the 15th, around noon, Elijah was extubated and has handled that fine so far. The next step is to get the chest tube out, when the X-Ray shows no more air in the wrong spot. His chest tube is currently on water seal, which means the suction is off. He handled his first full gravity feed, since his pneumothorax just fine.  I imagine, or at least the hope is, he'll progress to back where he was last Friday, and we'll start those scary/exciting discharge discussions again. It's relieving that this happened while he was still here, but it's very scary to think there might be other time bombs in his lungs, that we may carry home with us at some point.

My brain doesn't really know what to do with all of this. I'm craving a home life with the 5 of us together, but I fear it too. There will probably be months and years of wondering if he'll ultimately be okay. He's been a strong boy since birth, yet so fragile too, at the mercy of the beast in his body. I have no doubt, watching him go through all of this, recovering so well over and over, that God is holding His little boy in His hands and has plans for him. It crushes me to see what he has endured, not seeing an end on the horizon, knowing he's been a month on this earth and has experienced only the sights and smells of the hospital. I crave for him to know what it's like to have two bigger brothers kissing on him, and to spend his days and nights nursing at his mother's breast and dancing in his father's arms. Some days I feel assured it will happen. Other days, I make the mistake of reading too much about other kids' losing battles with LCH, forgetting that their fate has nothing to do with his, and dread that there will be a terrible backslide. He is an amazing little boy with an awesome God. I cling tightly to the promises that God is my strength and my refuge. I remind myself to be still and know that I am God. I feel fairly certain of what I can and cannot handle, but only God knows, and He will carry us through this journey, as He carries us now. He will be glorified through this.

I can already see some of the beauty in this. Completely unrelated social circles of ours, as well as those of our friends and family, have united to support us and pray for this little guy. Strangers and acquaintances from a web board I frequent spent a week bringing us lunches. Our church is still blessing us with dinners that we can pull out of the freezer and heat. We have received cards, emails, prayers and prayer blankets from around the country - the world even. We've been told of people who do not customarily pray, who are now praying for Elijah. Heaven knows this child's name! I choose to believe that little Elijah is surrounded by a bastion of mighty angels, sent from the Father, who loves this boy more than I could ever aspire to.

The Elijah Cannon: Part 3, I Always Knew Polka Dots Were Trouble

After delivery, it took a while for me to get transferred to a recovery room. What a different experience it was to be offered even crackers and juice. I wasn't terribly hungry, but I ate them slowly out of principle.  I felt like my blood sugar was low, or more perhaps like my blood was low. I also suspected my lungs and stomach had become lazy, because when I'd sit up, I felt a sensation like my upper innards were trying to fall into my newly vacated abdomen, and that was a bit nauseating. I was very anxious to go see Elijah, so when Brian told me I could come to the nursery to try and breastfeed, I summoned the will to keep my organs in place while I transferred to a wheelchair.

My parents were in the nursery adoring our polka-dotted Elijah and talking to the nurses. Mom and Dad are both nurses, so they speak the language. They were helpful to us in a thousand ways while they were here, and one of them was their ability to break the ice with the staff. Brian and I would leave the nursery sometimes not quite sure what to make of one of the nurses and we would return after leaving my parents to work their medspeak magic, and voila, the nurse in question had become friendly and hospitable.

Elijah had an oxygen mask nearby, to occasionally give his Oxygen saturation a boost. He was breathing fast and his chest was retracting. We tried to nurse, but the poor guy couldn't breathe through his nose. The inside of his mouth looked mangled with sores. The little toughie was staying remarkably calm, though.

I can't remember exactly how or when his transition to the NICU occurred, but he was moved there in fairly short order and fitted with a feeding tube, IV and nasal canula for oxygen. I remember becoming very fixated on pumping. Since he was starting off with soy formula, providing him healing and protective milk was very important to me, particularly in my helpless-feeling state. Nobody had a clue what was wrong with him.  We were suspecting these sores were in his nose and throat, causing the airway constriction and discomfort, but we weren't really considering anything internal at this point. I was not sure how to think or feel. He was strong in utero and handled labor and delivery like a champ. His APGARs were 8 and 9. He did not seem like a sick baby. My mind framed him like a healthy baby with a stuffy nose. He just needs a little help until these sores heal. I sure wanted to hear a name for these sores.

Three days of round-the-clock pumping, holding, praying, kissing and rocking passed for me. Three days of pokes and prods, tape and bandages, scans and exams passed for Elijah. It was time for me to be discharged. I broke down, not knowing our options, mourning the inability to be wheeled out of the hospital in an overloaded wheelchair, proudly displaying my new little bunny. This was the first time it really sank in that this could take some time. This was when I started to feel like a completely inadequate parent to all three of my children.

We were graciously granted accommodations in a "room-in" room across the hall from the NICU. It was a very small, very basic room. It had one small bed for both Brian and I, and now we are Spooning World Champions. There was also a small closet to keep all our belongings and supplies in. Thank you, Tetris. Completing our cell was a bathroom, bedside table, recliner, television, and a clock that perpetually said three o'clock. A really awesome nurse hooked me up big time. Think of it like being a female washing up on a desert island with a crate of Maxi Pads - not a situation you'd hope to find yourself in, but one you'd come to see the value in once you'd come to terms with your fate. SuperNurse brought in towels and all sorts of post-partum care supplies, eliminating my concerns on that front. My parents came in with tons of groceries that kept us fed three meals a day for the remainder of our stay there.

Allow me to digress for a moment to rain praise on my family. Almost all of our immediate family lives in Florida, except my brother, who flies from California to all parts of the world and back, as a medical escort and flight nurse. However, I know as fact that he would have jumped on this wagon in half a second, were he nearer. My parents, my husband's parents and my sister all volunteered a week of their time to come up to Georgia, and they set up a rotation so that we would have nonstop help for weeks after Elijah's birth. Other members of the family have supported this rotation in other ways from home. They have deep-cleaned and organized our house, and maintained it through the 2- and 3-year-old "storms" we have at home. They've kept our boys at home, in their routines, in good company, and drove them up to see us each day while we were cloistered. They shopped and cooked. I can't imagine the additional stress we would have felt without their help. My parents have provided a special level of support, because, as I eluded to in a previous section, they went through a very similar situation with my sister.  My sister was born with a heart condition that required major surgery as a newborn. My parents have been able to empathize with the fear, helplessness, loneliness, grief, stress, frustration and pain of having to leave my new child's life completely in the hands of God.

Not to get ahead of the story, but my husband's mom has provided an invaluable support to us too. We wrestled with all sorts of arrangements, trying to figure out the perfect balance to divide our time between Elijah and our boys at home. We live 6 miles too close to get into the Ronald McDonald house. The boys are forbidden from the hospital for flu season. We had strangers offering up basement apartments and friends offering extra rooms in their homes. Finally, we spent a night or two at home and were moved by the healing powers of dinner at our own table, a soak in our own bath, and sleeping snuggled up with our boys in our own big bed. The boys responded so well to that arrangement; they handled goodbye in the morning so much better than a midday goodbye at a park, because they knew we'd be back for the night. But we still needed an arrangement for the day. Brian's mom responded by moving her home-based business up to our house to stay long-term until we are settled back home with Elijah.

Now, back to our time in the hospital cell. I found it a little bit comforting to be in a teeny room. Maybe it's like a scared animal quivering in a log. Something felt safe about its smallness. I don't care to relive in this account every dreary-long day in that room, nor do I care to spill the poison of the mistreatments and injustices we felt. It was quite a roller coaster with frequent ups and downs of fear and hope. I was pumping every three hours around the clock. It was a chore, but gave me a feeling of involvement and duty. The pump, though high-grade, was inefficient and uncomfortable. As soon as I finished (after 30 or 40 minutes), I would dash the milk over to Elijah's room. I would change him and hold him for at least an hour, believing strongly in the comforting and healing abilities of kangaroo care.  The nurses spoke many times of how he screamed and was in terrible pain, but I never witnessed that behavior the entire time I held him. That convinced me that he needed to be held as much as possible. After a few days, I was completely bleary-eyed and the lack of sleep was heaping mud on my emotional train wreck. Brian and I started off trying to be with him together, to have 4 ears to listen to the updates, then soon switched to alternating schedules to give the other some nap time, even though I still had to get up to pump. Even that was not sustainable. After regular lectures from the nurses to get some sleep, I painfully chose to allow Elijah to be formula fed for one or two feedings at night. I felt like a terrible mom for it, but knew I wouldn't be much good to him if I ended up sick. My milk supply was keeping up almost exactly with his feedings. Finally, after 4 or 5 days, my milk really came in and I started getting ahead so he would never need formula.

All sorts of specialists from around Atlanta were in and out of Elijah's "room" - Infectious Disease, Dermatology, and more. Finally, one doctor said "Blueberry Muffin Baby". An extraordinary number of tests were run on the little guy. One by one, they'd come back negative, and each sigh of relief would carry us through the rest of the day. Finally, they decided he wasn't contagious, so no more harassments about gowns and gloves. A chest X-ray showed what looked like pneumonia in his lungs, so he was on antibiotics just in case there was infection.  After a few more consults, another doctor said it looked like a form of Langerhan's Cell Histiocytosis. Since his skin was healing so well, they were hoping it was Congenital Self-Healing Reticulohistiocytosis - something that would just go away on its own. That was a huge, though premature sigh of relief.

My face leaked constantly that first week. I cried out of fear. I cried out of relief. I cried when I left my older boys. I cried when I left my new one. I cried when I pumped "just" 10mLs. I cried when I pumped a "whopping" 60mLs.  I cried when Elijah got poked. I cried when he smiled at me. I cried that our boys had not yet met their new brother, and tried desperately not to wonder if they ever would. I cried hardest of all when Brian returned to the room from his visit with Elijah and told me a specialist from Children's Healthcare of Atlanta at Egleston looked at Elijah's case and was pretty sure the LCH was in other parts of his body and that he wanted him transferred to CHOA Egleston and would probably need chemotherapy. I immediately pictured my fragile newborn looking even more hairless and emaciated, suffering worse from caustic drugs. They moved quickly on the transfer, that same Saturday. We didn't even have time to pack. I went with Elijah on his Angel II Neonatal Transport ambulance. Brian packed up the room and followed.

The Elijah Cannon: Part 2, Labor & Delivery

From this point on, I might start inventing details, but I'll try to keep them interesting.  Hopefully my doula, Kim will be able to provide me some details to fill this in. So much has happened since the L&D event, and during most of my labor, I think my mind escaped to another dimension.

So, there I stood at 10 p.m. Wednesday night, in the bathroom, leaking and bewildered. I got on the phone with Kim to give her a heads up.  I told her I'd call Dr. Tate, per my instructions. Brian, well, I can't recall what it was he found necessary to do - perhaps dash upstairs to alert my parents - but he asked me to put my drippy self back in bed with the boys and try to get them to sleep. I'm not so sure he was thinking straight, but I gave it a go.

My parents had driven up the day after I originally thought I was in labor.  After a couple uneventful days, we had been really hoping they'd get to see a baby while they were up.  Just in case, we promised them a visit if they missed out. I wasn't thrilled about the time of day this was taking place, but at least we were for sure on the road to a baby now!

I called Dr. Tate, and his response slightly disappointed me, but looking back, I should not have been surprised. I had envisioned staying home and trying to get some sleep, or a hot shower and waiting until labor really kicked in. At the moment I wasn't feeling much contraction activity. Doc T wanted me to go in and have the baby checked to make sure there was no risk of cord prolapse, etc. It's good that he wanted to play it safe. By his reputation, you'd think he was a big radical risk-taker, but that's just from those who haven't studied the facts. He has a fantastic record with Vaginal Births After (Mulitple) Cesarean (VBAC, VBAMC, VBA2C etc), breech babies, multiples and other non-standard births.  What's unique about him these days, is he knows how to handle anything that comes up, with solutions other than C-Sections.  He can turn babies, use forceps or vacuum, dive into emergency surgery, or whatever is needed. He believes in labor and birth and in a mother's body's ability to do what it was made to do. His approach this night wasn't like I've heard before from other doctors, though.  Typically they would barrage me with all the scary possibilities and risks - I would feel like I was being scared or manipulated into a course of action.  All of my encounters with Doc T during the labor process were full of sweetness, confidence and compassion with a tone of reasonable caution. He never led me to feel manipulated, and told me outright he believes in informed consent, such that he gives the facts and his opinion, but it is my decision. I always felt valued and respected.

After my talk with Doc T., I called Kim back to let her know the plan.  We were going to keep her posted on the triage results and call her in when needed. She reassured me that we could take this step by step and make decisions for ourselves based on what felt right, such as whether to officially check in, or leave to do some walking after triage.

Mom was up by now, and we chatted a bit.  She remarked at the similarities to her third labor - a pasta dinner, followed by some stretching exercises, followed by water breaking. The similarities unfortunately did not end there, as we would find out later.

Brian had the car loaded up and we hit the road. We hadn't gone far before the contractions picked up to a regular pattern.  I think we picked up some breakfast, but I can't recall for sure. By the time we'd stopped at a gas station to pick up illicit snacks and drinks for the labor room, I was getting very uncomfortable and contractions were 3 minutes apart.  By the time we were within 10 or 15 minutes of the hospital, I knew I would want Kim with us soon, so I texted her, asking her to come in.

We got checked in and set up in a triage room. My water break was confirmed and I had a sterile speculum exam. At some point we were moved to our labor and delivery room. I paced around the room for a while, stopping occasionally to lean on a chair or the bed.  Eventually the nurse was nervous enough that she got me pinned down to strap on the monitors. Elijah's heart rate was doing well. My contractions were regular and getting stronger. At this point I loose almost all sense of time.  For a little while, at least, I was able to participate in conversations and watch some Super Bowl commercial candidates that CareerBuilder.com had out for voting. Shortly after, I checked out.

I lived the next 8 or more hours two or three minutes at a time.  The pain became unbelievable. I'd always had really bad menstrual cramps that would have me curled up in bed groaning, if I had the luxury. I was anticipating that labor would be largely like that or slightly worse, followed by some more intense or even excruciating pain right before and during delivery. I figured I'd want to work the circuit of defiantly shedding my monitors to sway in a hot shower, or pace the floor. I assumed I'd work up a big appetite and want to graze on my hidden snacks and drinks. Whoa mama, was I wrong!

The pain rocketed to about a 15 on a scale of 10 and I felt pretty much paralyzed.  I didn't want to move, even a little.  It seemed like any time I changed positions, it triggered an even worse contraction. I tried standing and swaying with Brian and hated it - I felt like I was being suffocated on top of having my uterus twisted into knots.  Of course, he's almost a foot taller than me, so that's not particularly comfortable in any state. I tried leaning on the bed, which was so-so, but the contractions made me want to squat, and against better judgement, I hadn't trained for that. I spent a good deal of time on the ball, leaning on the bed.  That worked out fairly well because Brian sat on the other side of the bed and holding my hands and saying calming things to me between contractions and Kim sat behind me, coaching me through contractions and squeezing my back. I could effortlessly make minor position adjustments and stretch my back. Much of the time, though, I had planted myself somewhat Indian-style on the bed, grappling at my own back and, for some reason, often supporting much of my weight on my fists.  I knew I should try to relax my entire body, but something about that felt good.  I tried to focus on keeping my face and lower body relaxed.

At first, Kim's coaching seemed a little esoteric, as she was encouraging me to "go deep", but soon it completely clicked and became a tangible and effective pain-coping ritual. I could tell when I was losing control of the pain, as my voice would get higher and I'd feel more panicky. When in control, I prepared for the contraction by relaxing my body and clearing my mind, and as the surge came on, I began to groan in a low voice, and as it built, I would groan harder and deeper, while visualizing all the energy being directed down and out and being put to work preparing the way for baby and moving him towards birth.  I was thoroughly shocked and stupefied by the intensity of the pain - and the completely bizarre and feral noises I was making.

A well-meaning nurse kept popping in and would comment about hearing me out in the hall and ask if I wanted pain medicine.  That was a bad thing for me.  I already would struggle pretty severely with self-doubt at the apex of contractions, wondering how I could possibly endure another.  Having pain relief dangled in front of me really weakened my resolve. I never let go of my goal, though.  I wanted to birth a completely unaffected/unmedicated baby, and I held onto that, even with my weakest grip. I wasn't sure if time had slowed or completely vanished. I felt locked in a loop of torture and relief that seemed to have no end or beginning, and almost all other reality had vaporized. As each contraction would wind down, I would hear voices fading in reminding me to let go and relax and I would take a deep breath and try to blow away the residual pain and all I could gasp was, "ICE!" Brian would calmly hand me the cup of ice chips - those wonderful, delicious, delicate pellets of hospital ice - and I would crunch down on a few and feel my mouth rehydrate and the cool trickle of moisture down my throat, and then fade back out to await the next test.

Finally, when I was feeling entirely wild-eyed and beat-down, someone came in to check me.  I was so nervous to hear the answer.  If it wasn't a significant amount of progress, I didn't know how I would go on. It seems like she dug around for an eternity, which had me bracing for utter discouragement. But when she stood straight and said I was a 7, I rejoiced.  I was in transition!  About that time I first noticed the sunlight. Brian and Kim cheered me on - I was almost there! For a while, Kim would occasionally ask me to describe location of the pain. For the longest time, I was not sure if the pain was becoming more "cervical" or not. Near this time, I felt like I had to pee really bad, but was in a bit of a panic because I didn't think I could get out of bed through the contractions.  Brian found a pan and I managed to get out of the bed, and am pretty sure I missed the pan anyway, with the little that I could squeeze out. Oh well, one loses concern for these things. I think I finished the job later when I started pushing.

Soon after, my mind began to chant, "Where's Tate? When's he coming?" Every time the door would open I looked hopefully in its direction, hoping to see my doctor walk in. The pain had begun to include definite sensations of bottom pressure, and my contractions were ending in a much different, almost relieving sensation, accompanied by a wild roar of a vocalization. The seemingly omniscient "Doc T" strode in with his entourage some time after 9 a.m. In my mind, I leapt up with joy to see him and threw my arms around him with relief. In reality, I belted out a wolfpack battle cry.  He sat on my bedside and place my foot on his chest, ready to check my cervix. I felt a slight panic when I realized he was waiting for a contraction. As he examined me, I reflexively pushed at him with my foot. He instructed me to pull my knees up instead of pushing them out, which required a complete rewiring of my brain.  Whatever he was doing amplified my pain about ten times, which I didn't think was possible.  He stood up and announced I was a 9 and was already pushing and couldn't help it and that I'd be ready to push in about 15 minutes. This was around 9:30 a.m. People milled around as the minutes passed and I thought I was going to pass too.

I was lucid enough to answer that I did want a mirror. I amused myself realizing that I paused to marvel at how perfectly the mirror was placed. I crumbled into another contraction. Doc T tucked away his tie and checked me again. I realized then what he meant by pushing.  I realized the sensation I'd been feeling at the end of my contractions was my body pushing. Doc T suited up in his protective gear and started digging at my birth canal again.  That made me push like mad, but I had to be coached that I was fighting myself by making noise and not pulling on my legs hard enough.  I was afraid to hold my breath, like I'd burst a blood vessel or something. I thought I was pulling hard, but found I could go further.

Pushing felt great. It's hard for me to say that and segue to saying it felt EXACTLY like pooping (like I read it would feel), but I guess there's something at least slightly rewarding about relieving myself of feces too. However, to continue with the TMI streak, large poops hurt.  This didn't register as pain. Tate was dumping oil down the pipe and massaging and stretching some part of my birth canal.  While he was doing that, it made me have to push.  They kept telling me not to push when I wasn't having a contraction, but I couldn't tell anymore when I was having a contraction. Doc T stepped away for a moment (I think to ready some forceps due to a brief decel), and I sat there marveling at the mirror, seeing a tiny circle of Elijah's head, wondering impatiently when I was supposed to push again. It felt like 10 minutes later (but clearly wasn't), that I decided to push, thinking maybe I was feeling the urge again. This time I held my breath and I wrenched my knees up. In the mirror I saw Elijah's head lurch out and Doc T lurch forward. There was commotion and I wasn't sure who was saying what to whom, but I couldn't stop. A moment later, the rest of Elijah sprang forth. Brian jokes that Elijah came out like a fighter pilot ditching his craft and the cord stretched taut like a rubber band springing Elijah back. So, on January 14 at 10:09 a.m. I pooped out my 8lb 13oz, 20", APGAR 8/9 son in 13 minutes!

Doc T offered an ever so slight reprimand and started mumbling about the damage. I wasn't physically aware of what he was talking about. I didn't have a chance to feel that "ring of fire" or the 4th degree tear or any of that. I was on a high with my sloppy new baby on my chest and it was amazing. I felt powerful and alive. Elijah and I stared at each other as I squeezed him and smelled him and babbled about how beautiful he was and "Hi, I'm Mom," and who knows what else.  There were after-birth things going on below, but I paid no mind. I started wiping him down, and noticed some of the "stuff" wasn't wiping off.  Knowing that babies are frequently born with all sorts of spots and rashes, I casually asked, "What are all these spots?" It quickly became apparent that he was covered from head to toe in red and blue blisters. Nobody had a clue what it was. I was about to see if he'd try to nurse, but he sounded really gunky, so they tugged him away to suction him.

They were taking some time with him, and in my daze, I wasn't aware that there was any significant concern with him, so there I lay, splayed out on the table, with nothing but a dislodged nursing bra, a cell phone and a very bright light in a formerly private place. I passed the time texting since-forgotten messages to since-forgotten recipients, as Doc T tried to put Humpty Dumpty back together again. After a bit, Brian told me he was going to accompany Elijah to the nursery for observation. There we go again, having our new baby whisked away. But, he came into the world the right way and I got to spend some time with him, so...okay. The stitching seemed to take forever and I seemed to have lost my gladiator toughness, because I kept yelping at the needle pokes, and Doc T tried to keep up with the numbing medicine.

Once I was all stitched up and the crew was packing up, I found myself bewildered again. This was supposed to be hugs and pictures time. There was supposed to be a milky-mouthed baby in my arms, and cheesy grins, hugs, high-fives and thank-yous all around. I lay there with no covers, no baby, no husband, completely tongue-tied, while everyone busily cleaned and charted.  I hope I at least thanked Doctor Tate. He provided me a priceless gift. Brian and Kim were fantastic too. I can't imagine how I could have plowed through that labor without them. Without Kim, I would have been an out-of -control mess and that would have put Brian in a very challenging and disconcerting position, trying to figure out how to meet my needs and help me cope with the agony. I very well might have crumbled into strategies that might have lead down a very different and unfortunate path.

A kind nurse finished cleaning me up and got me situated with a very welcome ice pack. Kim stayed with me while we waited for me to be moved to my recovery room and the next leg of my unwelcome adventure.

The Elijah Cannon: Part 1, Early Labor

Today's probably not the best day to be writing this.  I think I'm fighting the blues, but I'm not sure what else to do at the moment.  Throughout the weekend of the 9th, I was getting lots of Braxton Hicks (BH) activity, which was really exciting.  I'd gotten some during my first two pregnancies, but I don't recall having them with this frequency.  All day Saturday, with fair regularity, I was getting a mix of BH and mild contractions.  It felt so good to see my body at work, doing what it was supposed to do.  Sunday seemed like a "break" day, with only the occasional BH.  That felt a little disappointing, even though it was still only my 39th week.  I was excited to get this thing going.

Sunday night I went to bed with mild, regular contractions.  Monday morning, about the time Brian gets up for work, I was having more painful contractions that had been keeping me up for a couple hours.  I told Brian they seemed very regular and close, so I got in a warm bath and we started timing, as he got ready for work.  They were right around 3 or 4 minutes apart, sometimes two minutes.  I sent Brian to work, knowing that if this was the 'real deal' it could very well go on for hours or days.  I finished out a full hour of timing to be sure.  The contractions required a fair degree of focus, but I could still talk through them. As per my instructions, I called Dr. Tate to inform him.  To my dismay,  he wanted me to go into the hospital to get checked out, and make sure the baby was doing well.  I called my doula, Kim, and told her I'd let her know what the hospital said. She set my mind at ease about the visit, reminding me that after triage, it was still my choice whether to check in or go home.  I also gave my parents the heads-up that something might be happening.  Since we had to get the boys together, packs some bags just in case, and arrange for a sitter, Brian turned around and headed back home.

I was glad Brian was there, because it would have taken me forever to get everything together, stopping every 3 minutes to crumple over in pain.  Brian called our friend, Emily, who answered the phone with, "Is it baby time?"  We got the boys up and took them over to Emily's so they could play with their friend Luke, and headed to the hospital, making sure to eat on the way.  We arrived at Emory University Hospital Midtown around noon.  Dr. Tate has an outstanding reputation and record with VBACs (Vaginal Birth After Cesarean) and difficult deliveries, and although EUHM has to stick to its policies, many of the nurses respect him and seem to give his patients as much slack as they feel permitted.  I was not real keen on the internal exam this time because I'd come to the notion that it really didn't tell me anything.  My body wasn't telling me I was anywhere close to the finish line, so I knew that it would be just a number.  If I was 2 cm, I could be that way for days or minutes.  Regardless, I made my official prediction of 2cm, 80% effaced.  That seems to be my magic number.  It's where my body was with the last two pregnancies when it seemed to be the beginning of the end. To our nurse's amusement, I was spot-on. I kept my own clothes on after the exam. It helped to mentally bolster my feelings that I was in control of my body and that I wasn't going to be tied down there yet.  The nurse ( I wish I'd remembered her name - she was so awesome), hooked me up to the monitors. I noticed that as soon as I was on my back in bed, the contractions began to fizzle.  It's just like taking your car to the mechanic and it fails to show the problem when you get there.  The nurse started talking about the baby looking sleepy and she wanted to get him to look better so I'd have a better shot at being able to walk around.  I sat up a bit and asked for a drink.  She made me promise not to need an emergency c-section and slipped me a few cups of apple juice.  I chugged those and got out of bed, and the baby responded positively.  She thought the readings looked great and called Tate to let him know.  She reminded us of EUHM's policy for VBAC patients, and practically told us it would be wise to leave, since I would have to be on continuous monitoring and would be stuck in or beside the bed, possibly end up needing augmentation with Pitocin, and on down that track to another C-Section.  We high-tailed it out of there as soon as we could and headed over to IKEA to do some walking.

IKEA turned out to be an ideal place to do the labor walk - chairs, bathrooms and drink fountains around every corner. It was getting late in the day, and I was feeling like this time could be better spent playing with the boys, so when I could walk no more, we decided to head back to Emily's house to pick up the boys. By the time we got there, my contractions seemed to be fizzling down to 10 minutes, then 15 minutes, then I quit counting. Emily has some magic perfume or something that puts children under a spell.  Her house is about the only place I can show up and have my kids tell me to "Go away. I want to stay with Luke." We lingered there for a while, delaying the war that would erupt when we ripped them out of their place of contentment to head home.

The evening ended in an entirely unexpected and confusing way - with nothing.  I never realized early labor could behave that that with such regularity and intensity and not progress with continuity to more labor and a baby.  I reasoned it out that I was in a pattern of contraction day, rest day, worse contraction day, and figured the next day would be a rest day, hopefully followed by a real nasty real-deal baby-pushing day. Tuesday was in fact, a far more comfortable day than I cared to have. When someone asked me how I was feeling, my response was "unfortunately great." Wednesday came and to my dismay, it was also far too painless.  I was tired.  So tired. We curled up in bed and plodded on through "just one more story" with the boys. The last book was about to be snapped shut when  I said, "Uh oh, I think I'm leaking. Yep. Definitely leaking. Brian, my water just broke."

What's another word for hindsight?

I know, I know.  I'm slacking.  I'm also typing with a crippled keyboard, which is part of the reason I'm slacking, so if I miss a G, H, or ', it's not that I can't spell.  My superduper awesome sister is my laptop supplier.  I'm so stoked about this recent addition.  I looks really slick, but is a little alphabetically challenged. So, while I await my new keyboard delivery, I meticulously copy and paste "G"s, "H"s and  """s into my compositions.  I also engage in Elmer Fudd-ish exercises of thesaurus-fishing for non-G and -H-containing synonyms.

My second excuse for my blog tardiness is I'm simply trying to remain conscious.  This third-trimester stuff is exhausting.  I'm about 2.5 weeks out from my due date.  I feel like I could turn just a certain way and my legs would fall out of my hip sockets and collapse to the floor.  I pour Maalox on my cereal each morning. My meals and breaths could fit in a shot glass together. I keep reminding myself this is the easy part.

Ian's really quite an empathetic fella'. At my last prenatal visit, the office was unusually crowded and Ian and another boy ended up frequently vying for use of a particular truck.  At one point, the other boy became distracted with another toy, then got put in 'time out' by his mother for something while Ian enthusiastically enjoyed some peace with 'his' favorite truck.  He was crying on the floor next to a couch.  Ian observed the boy for a moment & came over to Brian and I and started talking about the boy being sad, and why he thought he was sad. Then he walked over to the boy, crouched down, and handed him the prized truck, trying fairly successfully to help the boy feel happy again. I was pretty impressed.

He frequently asks me "What's the matter?" or gently requests that I not feel mad.  He likes to play games with making faces or pretending to express a certain emotion.  He's lately gotten into defending his little brother.  He will say to us, "Igick doesn't want his teeth brushed. Don't make baby sad." He's pretty good, for a little guy, about using "I feel" statements.

Ian is apparently also a Discovery Channel junkie. Yesterday, he told me he wanted to watch Adam and Jamie (Mythbusters).  I didn't know he knew them.  This evening as I was cooking, he was singing the Boom-da-yada song Discovery had on its commercials.

I may have mentioned this before, but Ian has a perpetual Christmas spirit. He always has a song in his heart - mainly Jingle Bells, and loves any occasion for celebration. Isaac jumps right in on it too.  I could learn a lot from these guys.  They fill any room with such joy and enthusiasm and infectious laughter.

Isaac is a little mimicker.  He repeats what he hears with astonishing accuracy and clarity.  I think he has remarkable diction at times.  He's taking full advantage of having an older brother to learn all sorts of mischief from.

I'm so curious to see how the dynamics change with #3.  I can't imagine a more fun world than raising these little boys.