Let's see, today's details.
Isaac Sandstrom Small was born at 8:15pm, 31-Jan-2002, 3 lbs, 15 oz.
Nathaniel Sandstrom Small was born at 8:18pm, 31-Jan-2002, 3 lbs, 2 oz.
Zach (*) is breathing room air and swallowing food (breast milk) dripped through a feeding tube. He's a little jaundiced (to be expected), and is getting UV to help him get over it. Zach is down to a few stick-on leads (EKG, temperature) and a venous catheter on the back of his hand (an IV tube that they left in his hand so they can give him fluids and medicine, and take blood samples, w/o having to stick him).
(*) We agreed on the nickname Zach for Isaac, but haven't discussed how to spell it. Zach, Zak, and 'saac, are all possibilities. What's your vote?
Nate is breathing room air, with a little extra blown in through his nose. Along with the nose air tube, he's got a catheter in his hand and one in his umbilical cord (for food and liquid). His blood pressure is stable (he was on a little dopamine at first to help keep it up), and he's getting a light dose of caffeine (14 mg/day, about the same as in 1/4 of a cup of coffee) to help with apnea.
(Pre-term kids have trouble remembering to breathe; a little caffeine helps them along. They used to use a fancier mild stimulant, then a study showed that caffeine had fewer side effects. I guess I shouldn't be surprised -- humans have been using it for a very long time, without any real problems.)
For the detail oriented -- both have heart rate of about 150 bpm, respiratory rate of 100/min, and blood oxygen level of about 95 (unknown scale). All nice and normal. The graphs on the monitors for our kids are nice and regular. (Some of the other kids graphs wander up and down, and I worry about them. But not my kids.)
Carol will be coming home on Monday or Tuesday. The boys may be in the Newborn Intensive Care Unit (NICU, "NICK-you") for as long as eight weeks, but maybe less. (They're good at managing expectations.)
Carol got to hold Zach rolled in a blanket yesterday, and w/o the blanket, spread-eagled against her chest, today. (Zach's umbilical catheter was removed this morning.) This kind of cuddling is formally known as "Kangaroo care", and is beneficial for the psyche of the parent and the neurological and physiological development of the kid.
I got to hold Nate rolled in a blanket today (he's still got his umbilical catheter), but maybe he can get some skin-to-skin tomorrow.
Carol is using a breast pump to stimulate milk production and to get some for Zach's feeding tube. Once Nate is off the nasal air tube, and appears to understand swallowing, they'll give him a feeding tube as well. This may happen in the next few days.
They are both in "isolettes", which are somewhere between an incubator and a Skinner box. The isolette provides them with some quiet, better-controlled humidity and temperature, and less direct light (there are blankets over the isolettes). Moving to the isolettes is a step up -- it means that the boys are stable enough that the nurses in the NICU don't feel the need to poke and prod them every 15 minutes.
(Humorous mental image -- until today, both Nate and Zach were in tiny bassinettes, small boxes, really, under heat lamps. They call them "warming trays", sort of like at a buffet. In order to help Nate retain heat, they covered the top of his tray with plastic wrap -- the same kind you'd use to wrap leftovers before sticking them in the fridge!)
The most reassuring thing that Carol and I have heard is that ours are not the kids that the staff are worrying about. Sure, they're early, and small, but they're not doing anything unexpected, everything is under control, everything is going very, very, smoothly. There are some really tiny, tiny babies in the NICU, and some very, very worried looking parents. We're not in that league, and neither are our kids. We're very lucky, very grateful parents.
Hattie made signs for the boys, with "Nathaniel" and "Isaac" written on them. On each she drew a picture of their isolette. On Isaac's, she drew a picture of a quilt over the top; on Nathaniel's, she drew a picture of herself, with a needle, thread, and patches of fabric for the quilt that she is making for him. Hattie appears to be completely unfazed by the tubes and wires -- we told her that the kids were early, that they need some help breathing and eating, and that they're going to grow up quickly. She enjoyed seeing them this morning, and after I showed her it was OK, she put her finger in Nate's palm. Nate closed his fist over Hattie's finger, and boy, did her face light up!
Pictures taken yesterday, Saturday 02-Feb-2002. Click on the thumb-nails to get a larger version.
Both Zach and Nate are now in "isolettes", which give them a nice quiet cave-like place to hang out. Zach was under lights yesterday to combat a little jaundice, hence the cool shades. Nate's bunny is visible above his head. Both of them have a number of leads (EKG and temperature) and a venous catheter in the back of their hand (Zach's right hand, Nate's left hand -- one way to tell them apart, as long as I don't flip any negatives). Nate also still has an umbilical catheter, because he isn't ready to swallow food.
Zach, the larger one, was being fed via a tube inserted in his nose (visible in the large version of the photo below, but not in the thumb-nail). That has been temporarily discontinued; it appears that there is a build-up of gas in his stomach. Once he figures out how to burp, they'll start letting him swallow his food again.
The boys are doing a good job passing meconium (the thick tarry substance that comes out before the real baby poop starts). It's a good sign -- it means that their digestive systems are up and running. (OK, that was probably more information than you needed.)
Carol observes (complains?) that Zach takes after me, at least in that he likes to sleep with his arms over his head.
 Carol and Zach, Kangaroo-cuddling |
 Nate |
 Zach getting a tan |
Carol came home today!
Zach is back on the feeding tube, and Nate has one as well, now. I was wrong when I wrote that the feeding tube allows (requires) them to swallow; it doesn't. It goes directly into the stomach. But their digestive systems get a work-out, unlike "feeding" them via IV. So both Nate and Zach are getting a few cc's of mother's milk, a few times a day.
Hattie had a birthday party for the twins in her class at day care today. Cupcakes for everyone.
The feed-Carol-and-Chris campaign got seriously underway today. Dinner was thanks to Madhvi and Mike, who provided us with a wonderful spinach pie and possibly the best lentil soup I've ever had. And Chris Thorpe came by and dropped off five or six dinners worth of left over bbq, thanks to Peg -- two chickens, two quarts of pulled pork, and a couple of pounds of smoked brisket. With all the offers of food we've been getting, we won't need to cook again until 2003.
And the unending stream of flowers continues; a beautiful arrangement from my lab at Sun arrived, along with tulips sent from Michael and Rachel in Sydney. (The tulips came from California; Michael and Rachel are in Sydney.)
Carol came home today!
The first day of our new routine.
Carol pumped milk for the boys every two and a half hours, around the clock. This means she (and sometimes I) got up throughout the night to set up the pump, pump for 20 minutes, decant the milk into a sterile jar, label the jar, freeze it, wash the pump parts, and try to get back to sleep. Assuming you ever woke up in the first place. My guess is that within a few days we'll be able to do it without fully waking up.
It's sort of like having a hungry infant around the house, except without the diaper changing. And the snuggling.
We have our work time at Hattie's day care Thursday morning, so I spent most of the morning with the four year olds. Some kids were out today, so they didn't formally need the extra adult presence, and they kicked me out around 10:30. But I had fun playing with the kids, giving them snack, and telling them about the weird dream I had last night, which included a toddler, wearing a fleece snow suit, riding a giant baby chicken.
I took Carol out for Pho (Vietnamese noodle soup) for lunch, which was her first trip out into the real world since last Thursday. A big bowl of chicken soup, whether made by a Jewish grandmother or a Vietnamese one, feeds the soul.
We then went and spent about four hours at the hospital. Isaac is off the UV lights, so Carol got to snuggle with him skin-to-skin for an hour. Smart boy that he is, he discovered the ultimate source of his milk supply and spent some time trying to figure out how to turn it on. I don't think he could coordinate sucking and swallowing, but it did both our hearts good to see him give it a try. It tired him out, though; after five minutes of exploring, he went to sleep, and slept spread-eagled on Carol's chest like, well, a baby.
Nate is still under the lights, so we couldn't pull him out. I held him some through the port holes of the isolette. He seemed to like the company.
Medical term of the day: "PIC line" (Permanent IV Catheter), also known as a "spaghetti catheter". Since the veins in Nate's hand are so small, they can't feed too rich a glucose solution into them through the catheter -- I think a too-viscous glucose solution would just block up his tiny veins. So they thread a thin catheter up through a vein in his hand, back into his chest, where the veins are bigger. Then they can push a richer, thicker solution into him, and hopefully, get his weight up. All babies lose weight in their first few days, but when a kid starts out at 3 lbs, you want to limit the weight loss as much as possible, and start the weight gain as soon as possible. He's taking as much as he can through his stomach, and the glucose will help bulk him up. (He's currently being fed through his umbilical catheter, but that can only stay in for a week or so.)
(I found a definition of PIC line at this web page.)
And, finally, we started to work on the Peg bbq backlog. We got 2/3 of the way through the brisket. This just leaves the half-gallon of pulled pork, the two whole chickens, and the other half-pound of brisket. We're going to reek of meat and hickory smoke before we finish it all off...
More news as it occurs. I'm off to bed.
Nate is off oxygen, and breathing room air! Hooray!
No matter that I described yesterday as the first day of our new routine, today was really the first day of our new routine. Carol spent the morning at home, resting and catching up on her email. She ate lunch, and then got a ride to the Brigham (Brigham and Women's Hospital) from Liz. (Thanks, Liz!) From 1:00 or so until 4:00, she cuddled Isaac and Nate.
My day consisted of taking Hattie to day care at 8:30, running some errands, going to the office, spending the middle of the day at work, and then leaving around 3:00 to drive to the hospital to snuggle the babies for a little while, before taking Carol back to Cambridge to pick up Hattie.
A treasure beyond price -- Lois and Mark, neighbors, took Hattie for dinner, where she happily played with their kids (Heather and Eli) until bath time. Carol and I got to relax, eat dinner, and talk, without any (a) four-year-olds, or (b) beeping and interrupting nurses, in the background. Heaven. Thanks, Lois. Thanks, Mark.
A beautiful fruit basket from Ursula arrived today. More pears than we can eat -- I'll have to learn how to make pear tart. And tonight's dinner was, once again, thanks to the bounty provided by Peg -- smoked chicken. And I took the half of the chicken that we didn't eat and threw together a quickie casserole that will take care of another meal or two. As I wrote earlier, due to Peg, our protein for the remainder of 2002 appears to be taken care of.
Not to short-change the big news of the day -- Nate is off the breathing tube, and is taking care of himself completely from room air! This is a major developmental step, one that I didn't expect for several weeks. But, the folks in the NICU thought that he was regulating his blood oxygen fine by himself, so they tried him out, and he was just fine. He also got his PIC line (see 05-Feb), and without the umbilical catheter, Carol could Kangaroo-cuddle him. He's still on the UV lights, so he only got about half an hour of snuggling, but Isaac got almost an hour of skin-to-skin. The boys are growing up in front of our eyes; the day-to-day changes are magical to witness.
On a more mundane front, the floor guys put down the first layer of polyurethane on the new kitchen floor. That means that in another three days they'll be done with that half of the new flooring, so we may actually finish the renovations before the boys come home!
Last night I wrote "off to bed". Tonight, as a sign that things are getting back to normal, it's "off to 'The West Wing'." More news as it occurs.
In about 45 minutes, the boys will be one week old!
Usually babies lose weight their first week or so. With kids that weigh three and four pounds, it's more of a concern than with an eight-pounder. Yesterday Nate was still dropping, and Zach had kept his weight steady. Today, both of them gained weight, which is a great corner to turn.
Although there are sure to be setbacks over the coming weeks, this past week has consisted of daily good news. We're trying to bank the positive feelings, with the hope that they will tide us over when setbacks occur.
When I showed up at the hospital at 4:00 to pick up Carol, the lights were low in NICU-B, and there were curtains up in front of B-3 and B-4 (where the boys are). Carol was deep asleep in the recliner, with Nate sacked out on her chest. Once she woke up (it took a good ten minutes for her to completely surface) I asked her what time she'd started snuggling Nate. She said "since about 1:30 -- I think." So although Nate got started on the Kangaroo-cuddling a few days after Isaac, I think he is completely caught up, what with his marathon 2 1/2 hour stretch today. Although he really should have been under the UV lights, I think the nurses didn't have the heart to wake either of them up.
They're both eating well; Zach is taking in 30 cc's of milk at each feeding, 4x day (120 cc/day), and Nate is taking in a bit more than half that.
We got a beautiful basket of fruit and other goodies from Sleepycat. Thanks!
Hattie and Carol and I celebrated my 40th birthday in a very low-key manner; casserole (made with chicken from Peg), and a cake from Bread and Circus with Hattie-and-Dad frosting. We'll celebrate my birthday more officially in a couple of weeks.
The boys continue to gain weight, and look great. Carol got to spend a few hours with them today, but due to traffic (on one end) and a conference call (on the other) I only got to see them for a couple of minutes.
Keith and Jackie provided us with a very large ham this evening. Keith promises me that it'll keep in the freezer until we're ready for it. (For some reason, our friends have us pegged as meat-eaters.) (They know us well.)
Hattie took pictures of her brothers to Friday's show-and-tell at day care. They were a big hit.
With some luck, we'll get to spend more time with the boys this weekend, and maybe I'll get to kangaroo one or both of them. You don't really feel like a new dad until you've been peed on.
No big news today. Nate and Zach both gained weight, for the second day in a row. Nate is close to his birth weight; Zach has a little way (weigh?) to go.
Nate has been switched to an eight-times-a-day feeding schedule from six-times-a-day, since he'll be able to digest smaller meals better. He's also on a little bit of oxygen, as there's little reason to push him to develop his lung capacity when we're trying to get his digestive system moving, and get him to gain weight. So we're letting him put less energy into breathing, and more into eating.
Dinner was (once again) supplied by Peg. Even though we tried, we only got 3/4 of the way through one of the two quarts of pulled pork (a.k.a. "barbecue", for those of you in North Carolina) that Peg supplied us with. We'll be eating smoked meat for weeks.
Hattie and I spent the afternoon at the New England Aquarium while Carol snuggled the babies. Tomorrow, Stephanie is taking Hattie and Amanda to see Blues Clues Live, giving Carol and me a few hours of peace and quiet with the boys. (Hattie is still too young, at almost-five, to really enjoy an extended visit to the NICU. The high point of her day was going to a candy store at Quincy Market and buying some candy Lego. It's really neat stuff -- you can really build things with it, and then eat them. It's perfect for a four-year-old.)
I'm off to give Hattie her bath, and then bank some sleep.
Zach and Nate are moving up in the world!
They have been upgraded from the ICU part of the NICU to the nursery part of the NICU. The nurse (Gaby) won my heart by telling us that they're already practically the star pupils of NICU-A. In NICU-B and NICU-C, the ratio of baby-to-nurse is 3:1 or 2:1; in NICU-A and NICU-D, it can be 4:1. It's a quieter, more relaxed, and more spacious area, and we take it as a sign that the boys are doing well.
I'm sure that another reason is that the NICU is overcrowded at the moment. Although they can handle more, their target population is 48 babies, but at the moment they have 62. Since our guys are doing well, we have no problem with them being upgraded to the nursery.
I also talked with one of the doctors about the NICU population; I asked her how many were term (but sick) vs. how many were pre-term. Her feeling was that maybe 80% of the kids in the NICU were pre-term, but that reflects the population on any given day, not the percentage of kids admitted; the pre-term kids stick around longer (sometimes months), so that skews the day-to-day population. Even though I didn't learn what the odds are of a baby ending up in the NICU, I did get a feeling for what percentage of the kids I was seeing in the NICU were there because they were early. It was reassuring to learn that mostly I'm seeing kids that I can (presume) are healthy but early, instead of kids that are sick.
But back to our boys, Both are now completely on milk, although Zach's is getting a little boost of what I've been thinking of as "protein powder". It's a bit more than that, though -- Carnation instant breakfast, maybe? Although Nate was the small one, he's been gaining weight more steadily, and is now over his birth weight. Zach is still a little under his birth weight, so they're beefing him up. (Nate is still smaller, but some days he puts on 50g, so in theory he could make up the 400g difference in birth weight pretty quickly.) Nate's PIC line was taken out yesterday, as they have a lot of faith in his continued ability to chow down and beef up.
Both boys are on an 8x/day schedule instead of 6x/day, since it's easier on their digestive system.
We did have one little scare yesterday. It's possible that Nate has picked up an infection, so they're giving him antibiotics until they know for sure. They check the boys periodically by culturing a blood sample, and Nate's came up positive, with a bacteria that was antibiotic-resistant. It's a little confusing, since he seems very healthy, so they did a second culture, and drew a little spinal fluid. They're running the new cultures now, and hoping that neither turns up positive. It's always possible that the initial culture yielded a false positive (e.g., there was some contamination of the blood sample), which is what we're hoping for. The heavy-duty antibiotics that he's being given are tough enough on him that they don't want to give them to him unless they have to.
His blood/brain barrier is not that well established yet, and so a blood infection can become meningitis if we're not careful. Hence, the spinal tap, to make sure that if there is an infection, it's staying in his blood stream. The initial results seem to say so. But, we're watching out (or, rather, the doctors and nurses are).
I got to spend almost three hours cuddling Isaac yesterday. Hattie went to see Blues Clues Live with her buddy Amanda and Amanda's mom, Stephanie. So Carol and I both had a very peaceful, quiet visit with the boys. We put Isaac down on my chest a little after one o'clock, and we both settled down in the recliner. I drifted for a couple of hours, and then was really out for about half an hour. Isaac didn't stir (other than a little finger-scratching and foot-wiggling). I have to agree with Carol -- they are incredibly sweet boys. And there's nothing more relaxing than having a baby asleep on your chest.
Joyce and Henry came over, with a large lasagna and a dozen cooked chicken breasts, so although we were making good progress on the BBQ, between the lasagna and Keith and Jackie's ham, we're yet again completely overwhelmed by food. Our fridge never looks this full.
We've got great friends. You're really taking wonderful care of us. Thank you all; we truly appreciate it.
Highlights: Carol drove Harriet to school today, Nate drank from an eye-dropper.
This morning, Carol gave driving a try. I convinced her to take my Volvo, as it has an automatic transmission and is a little more solid than her Jetta. She got Hattie to school without a problem, but we had some snow flurries mid-morning, so she took a cab to the hospital.
As I arrived at 3:45PM, Isaac was leaving for his MRI. We (and the twins) are taking part in a study of premature babies being conducted at Children's Hospital, along with the Brigham. In short, the goal is to see what the effect is of having parents spend more time cuddling their babies, and having the babies bundled up, curled in the fetal position, in their incubators. The theory is that the kids will be healthier, calmer, and better citizens all around. Nate and Zach are in the study group, so we're being encouraged to snuggle the kids. (Ah, the lengths to which we are willing to go, to further the cause of science!) As a side-effect, the doctors take the occasional MRI of the kids heads, and take notes on how fussy the kids are. They said that they'd send us copies of the paper(s) once the study was done; in the meantime, if you're interested, you can do a google search for Dr. Heidelise Als, who is the PI of the study.
I got to kangaroo-cuddle Nate today, and while he was resting on my chest I was given the opportunity to drip milk into his mouth. Carol and I decided afterwards that the syringe (really, more an eyedropper) held, in total, 1 cc of milk, but Nate got through about half of it, driping litle or none on my chest. I would push a drop of milk out of the syringe and spread it across his lips. He would then move his lips in and out, and lick at his lips. If his mouth was open, I'd put a drop into his mouth.
It all disappeared, and it had to go somewhere, so my guess is that he's figured out to swallow, at least small amounts.
Nate's secondary and tertiary cultures came back negative, so either the first one was contaminated, or the antibiotics have already knocked back the bug. He'll be on antibiotics for a week or so, and continues to seem completely normal and happy. So maybe it was a false alarm, maybe it wasn't -- but it appears to be behind us.
Laurie and Bill sent us a beautiful fruit basket that arrived today (thanks guys!), and Grandma Ann (happy birthday!) and Grandpa Wayne sent Hattie a box of books about being a big sister, as well as some about a boy named Nate, and some about a boy named Zach. She loves her new books. And Madhvi dropped off a yummy chicken and potato curry/stew, along with some rice, so we'll go another day without starving. And even more importantly for the long term, she dropped off a big box of baby clothes and two Snuggli carriers -- thanks, Madhvi and Mike!
I didn't get a chance to see the boys today, so this is second-hand. Now that Carol is comfortable driving herself, and I don't need to pick her up, it's harder for me to leave work early to go to the hospital and visit with them at the end of the day. I'll spend Thursday evening there, and visit over the weekend, but the daily snuggles will be with Carol. (Maybe I can get her to write some updates for me.)
Isaac is doing well. He "passed" his MRI with flying colors; all the brain parts they hoped to find are there. We got a hard-copy of it; it's interesting to see all the slices through his head, from back to front. The doctors running the developmental study told Carol that if we bring our copy of the first MRI to the follow-up, the radiologist will explain the differences to us and point out the areas of development (and what they correspond to).
Unfortunately, Nate's blood and spinal fluid cultures came back positive (bacteria). So, it's good that he's on the antibiotics. The blood culture has been growing long enough to let the doctors recognize what it is -- it's a variant of staph that is usually found on the skin, not in the blood. They're going to draw new blood samples and run another set of cultures to see if the first ones were contaminated somehow, e.g., they picked up a bug from his skin when they drew his blood. The spinal culture is showing something different -- the nurse said "gram cocci", which is Greek (er... Latin) to me. She said that it's something that's seen in the spinal fluid, and the antibiotics that Nate is already on should knock it out. We're taking comfort in the fact that the staff is on top of things, and we're not worrying. At least, not too much.
I'll relay more information as I learn it.
When you see Nate, he certainly doesn't look or act sick. If the infection was serious, he'd be tired, and nowhere near as active as he is. For a kid who is less than two weeks old (and eight weeks early), it's surprising how far along he is. For example, he can lift his head and turn it -- something that normally doesn't happen until a kid is older. (Isaac doesn't do it.) Admittedly, he's got a small, light head, but he's developed some exceptional neck muscles. Also, to everyone's surprise, he can apparently focus on, and track, objects visually, which is rare for a kid that young. Admittedly, at this age, his eyes have a fixed-focal length, but still, Carol, I, and Dr. Als have seen him pick out an object and track it. He's an amazing kid. (But we're not going to push him. His violin lessons won't be starting until April. But I have set up a chessboard in his isolette.)
More news as I learn it. Time to sleep.
Carol spent a couple of hours with the boys, and they're doing fine. Isaac did his best impression of a baby sloth, hanging on to her chest and sleeping. She tried to get him interested in latching on, but he was more of a mind to sleep. Yesterday Carol got him to drink a few drops of milk from an eye dropper, but today it didn't seem like it was worth the effort.
Nate apparently has two different infections. The antibiotics should knock both of them out, he's not showing any side effects from them, and he's doing well. He continues to be a happy, healthy baby, not a sick one, so nobody's too worried.
And he continues to surprise everyone by being precocious -- a nurse was holding him, and when Carol spoke up, he lifted his head, twisted around his body, and looked in Carol's direction. This is pretty amazing for a kid who turns negative-six weeks old tomorrow.
Carol and I plan to spend tomorrow evening in the NICU with the boys, doing some heavy-duty snuggling. (I also hope to squeeze in a nap; I don't think either of the boys will mind.)
Happy Valentine's Day, everyone.
No big news to report today.
Carol and I celebrated Valentine's Day in the NICU, cuddling the babies. She held Nate and I held Zach for about 45 minutes. Nate is not the only precocious one; not to be outdone, Zach arched his back and lifted his head for me. At 8:15PM the two of us (four of us?) said "hooray", to celebrate the boys' two-week birthday. (Carol pointed out to me that the birth times I recorded here differ from the birth times on their birth certificate. I have 8:15 and 8:18; the county has 8:13 and 8:15. Maybe my watch is slow -- but I was there, and the county wasn't.)
I then got to hold the two of them together for a little while. Although they were squirming a lot when they were kangarooing separately, when we put them together they both fell right asleep. The nurse turned their heads towards each other, and they looked incredibly sweet. Carol took some pictures, and if any of them came out, I'll scan them in and post them here tonight or tomorrow.
The latest word on Nate and his mystery infection contradicts the previous word. (I'm beginning to get used to this.) The blood cultures (there have been two of them now? three?) and the single (to-date) cerebro-spinal fluid (CSF) culture all grew a staph bacteria that is normally only skin-borne. The current wisdom (according to last night's doctor-on-duty) is that all three (four?) of the cultures were contaminated, and that Nate is not now, and never was, infected. In support of this, Nate continues to be a happy lively baby, not a sickly one. On the other hand, the nurses in the NICU are very conscientious, and it's difficult to believe that they'd get it wrong.
So, they're going to do one more LP (lumbar puncture) to draw CSF for another culture, and several doctors and nurses are going to stand around and make sure the site is very clean beforehand. The staff seems as tired of this as we are, and they want to get it settled.
Tomorrow is Saturday; Sanjay is bringing us bagels for breakfast, and then Cliff and Joyce will be coming in town. We hope to take Cliff and Joyce to see the babies, since they won't be around to visit them when they come home.
Cliff tells me that Joyce mandated that he take me out to a movie. My guess is that Carol had something to do with this. If there is time between baby-visits, maybe we'll go see the new remake of Rollerball. The original, to which my father introduced me, was a great movie. (I hope that the new one is not overly burdened by MTV ultra-violence. True, the original was violent, but it gave at least some of the characters the opportunity to demonstrate nobility and real integrity.)
On Sunday, Margo, Ursula, and other unnamed co-conspirators are throwing Nate and Zach a baby shower, to which Carol, Hattie, and I are invited. (Had Zach waited until the due date, the boys would have been there as well.)
Sorry for being so long between reports. It's been hectic here.
Isaac is doing very well, moving right along, officially over two kilos and continuing to grow quickly. He's also figured out how to get milk straight from Mom, including the swallowing trick - smart boy! (Joyce warns me that if I don't spend more time writing about Zach in this journal, a few years from now, when he learns to read and looks this up on the 'net, he'll be angry that my coverage was so lop-sided. Trust me, Zach, we're thinking of you, too.)
Nate continues to be "mystery boy" at the hospital. They are re-running his CSF and blood cultures, which as of yet have shown nothing. His white blood cell count is up, however, so they started him on yet another antibiotic. But he continues to be healthy, strong, and happy.
The other development in Nate's health is a little blood in his stool. He was recently started on fortified milk (as Zach has been getting for a few days). The current thinking is that the fortified milk has been tough on his intestines, and that's where the blood is coming from. He's back on IV feeding for a week or so, to give his gut a chance to heal, and after that they'll start him back on regular milk. He misses having food in his stomach, though -- he's become a real pacifier baby, and, in the words of one of his doctors, he's "mad as a hornet". (This is really not the behavior of a kid who is fighting a serious infection. Although we're sorry his stomach is off, we're happy to continue to see signs that the cultures were contaminated.)
While he's healing, Nate has been moved back to NICU B, where he can get a little extra attention. It means no double-snuggling for a while, but it's only for a little while.
The baby shower took place yesterday, and was huge fun for Carol and Hattie. Unfortunately, due to a combination of Cliff's bad influence, a very nice bottle of scotch he brought with him from Manhattan, and my poor judgement due to lack of sleep, I was unable to attend the party on Sunday because of an overabundance of scotch consumption on Saturday evening. It meant that I got to catch up on my sleep on Sunday, as I was unable to get out of bed, but it also meant that I didn't get to see all the people who came for the shower. Thanks to everyone for all of the food, clothes, and toys -- they're all wonderful!
And, as promised, a couple of new pictures. The one with Carol is from Feb 4, two weeks ago; the others are from last Thursday, Valentine's Day, Feb 14.
 Carol and Nate 4-Feb-2002 |
 Dad, Isaac (left), Nate (right) 14-Feb-2002 |
 Dad, Isaac (bottom), Nate (top) 14-Feb-2002 |
 Isaac (left), Nate (right) 14-Feb-2002 |
This is Carol - Chris shouldn't have to do all the updates!
Let's see: Isaac reported first last time, so it's Nate's turn today. Everything continues to go well. Nate is on day 5 or so of a week of IV feeding. I like to think of it as a vacation for him - although he certainly likes to have milk in his belly, it is more work for his body. He's stable, getting lots of rest, and continuing to gain weight. His nurse told me that when he's alert, she takes him out and holds him and lets him look around, which is the kind of thing he appreciates.
Isaac is continuing to gain weight like mad, and they turned off the heat in his isolette yesterday to see if he can maintain his own body temperature. There are at least two more big steps for him to take before he comes home: graduating to an open crib, and being strong enough to drink all the milk he needs in a day. Right now he can make it through almost a whole feeding, either from a bottle or from Mom, before he wears out, but then he's too tired to do the next feeding. Pretty good for a 34.5-week old. I tell him there's no rush.
Tonight is date night, and thanks to Jessie, our devoted Hattie-sitter, both Chris and I will get to visit the boys.
I apologize for the long delay between updates. We've been busy, the boys have been busy, and we have been suffering from both a lack of, and a surfeit of, information.
Isaac is growing like a weed. He's in an open crib, regulating his own temperature just fine, and, biggest news of all, learning to nurse. He even drank his 9:00AM feeding today from a bottle! He's still got some distance to go with nursing; it takes much more coordination to nurse than to drink from a bottle. At the moment he's getting 42 ml (about 1 1/2 oz.), eight times a day -- about as much milk as would fit into a Coke can.
As I said, he's growing quickly. Today when I got to the hospital I did the grams-to-pounds conversion, and today he broke five pounds! There was an old rule-of-thumb that premature babies were ready to come home when they hit five pounds, and in Isaac's case, it's just about true. Once he's strong (and coordinated) enough to get all of his calories by nursing, he'll be coming home. It could happen within the week, or it could take a month.
Nate has been mystery-boy, gnawed-fingernails-boy, lost-sleep-boy, and just about every other kind of boy you can think of. He seems to have turned a corner, and be getting better (finally), but over the last ten days, we've gone through thinking Nate
- had a blood infection (possibly not true; we're not sure)
- had a CSF infection (possibly not true; we're not sure)
- suffered from necrotizing colitis (sp?), i.e., blood in his stool, possibly caused by the additive in his milk (which were there to help him grow more quickly)
- suffered from rapid breathing (higher than 100 breaths per minute), due to anemia, because of all of the #$!$!& blood tests he's been given to try to figure things out (so he got a transfusion, of about an ounce) (his total blood volume is about four ounces -- 1/4 cup -- so an extra ounce can help a lot).
- suffered from rapid breathing because of an overly acidic system, which is treated by adding sodium bicarbonate to his IV (first he gets caffeine -- now alka-seltzer).
- suffered from rapid breathing because he was just too warm -- so we cut back on the blankets.
- suffered from, not a bacterial infection, but a viral infection -- what those of us bigger than 4 lbs call "just a cold".
- suffered from fluid in his lungs due to over-hydration, because of the transfusion.
- suffered from pneumonia -- fluid in his lungs -- because of his cold.
Then, today, when I got to the hospital, I find that first, he never went on the C-PAP -- the diuretic was doing such a good job that his lungs started to clear quickly. And that his respiratory rate had come down to the point where they were thinking of taking out his nasal cannula (the tube in his nostrils that blows in a little extra oxygen). And that the nurse wanted to take him out of the isolette and put him in a crib. And feed him some milk. (He's been on IV for about ten days.) And feed it to him orally -- from a bottle.
My first reaction was that we weren't talking about my son Nate -- that there had been some sort of mix-up. Once I was sure it was Nate, I thought that the nurse (one I didn't recognize) was being very, very aggressive, so I tracked down Nate's senior doctor. Dr. Van Marder told me that no, the nurse was right, Nate had had a great night, and he had turned around and was moving right along.
And when I left at 4:30 to go pick up Hattie, Carol was feeding Nate from a bottle. (Carol adds: Well, I was trying to feed Nate from a bottle. It turns out that Nate will take mother's milk from a bottle if a nurse gives it to him. If I try that, though, he can smell that I am the source of all milk and he firmly clamps his upper jaw over his lower lip. It's clear he's feeling better.)
We'll sleep much better tonight.
Nate continues to improve, Isaac continues to do well. Isaac nursed quite a bit, and Nate gave it a try as well. We think Nate not only showed tremendous effort, he actually got some milk into his belly.
Nate's respiratory rate was running a little high, but when I took him out of the isolette and let him cool off (going from two blankets, to one blanket, to no blankets) his breathing slowed down to the point where it was arond 20-30 breaths per minute. So maybe it's just that he's running a little temp (I measured it, about a degree warm), and that's why he's breathing hard. If we can keep him cool, he'll breathe more slowly, and get to rest a little easier.
Carol asked one of the doctors running the developmental care study about Nate's being sick, and whether the delay in some of his tests (e.g., his MRI) would affect his participation. The doctor said to her "oh, no, all of the babies in the study get sick. I mean, all of the babies in the study except Isaac -- he's the only one who hasn't had any kind of set-back." Zach's a pretty special kid, it seems. (But we knew that already.)
The boys are 4 weeks old today!
Everybody's doing well, and the nurses are starting to focus on why we haven't taken Isaac home yet. "Why hasn't this baby had his eye test? His hearing test? His car seat test? Have you bathed him? Signed up for the CPR class? Sent out his college applications?" Sounds like he'll be home in short order, as soon as the Brigham whips his dilatory parents into line.
For those of you who watch Korean public television, Isaac's going to appear on a show about kangaroo care and its benefits. The interpreter seemed overwhelmed with how cute he is, as she should be.
Nate's mystery-boy status is still well deserved, since his viral cultures came back negative. However, since he's doing well, this isn't really a matter for concern. (Apparently viruses are tricky to culture, so the guess that he's recovering from a respiratory virus is still a reasonable one.) He's rapidly increasing his milk consumption, having gone from 6 cc's 6 times a day to 11 cc's 8 times a day between Monday and Wednesday. He should be on "full feeds" (that's 30 cc/kilo/day) by the end of the week, and he still finds time in his busy schedule to nurse at least once a day.
Nate still gets a little oxygen through the nasal cannula, but we've noticed that whenever we kangaroo him, he sets off the alarms for overly high oxygen saturation and the nurses have to crank down the O2 feed. It's very flattering, and nice to know he recognizes us.
Nate had an echocardiogram yesterday, since occasionally a nurse or doctor says will say he has some sort of murmur (and then the next four people to listen don't hear a thing). The attending physician, finishing up her February tour of duty, decided to settle this issue once and for all by ordering the test. Naturally, this being Nate, preliminary results indicate that his heart is fine. He took the whole thing in stride (can I say this about someone who won't walk for a year?). He continues to act like a happy, alert, hungry Nate. I think he just likes puzzling the NICU staff.
I gave Isaac his first parental bath yesterday, and the nurse took the momentous step of pulling out his feeding tube. (He pulls it out himself pretty often, too, but doesn't manage to get the tape off his face.) He may need it back if he can't take in enough nutrition by mouth, but in the meantime it was the first time I've seen him with no wires or tubes attached. Very satisfying.
Tonight both Chris and I get to visit the boys! This is particularly important since when he uses the camera, the shutter works.
Yesterday (Saturday) was Hattie's birthday party -- check out the pictures!
And after the party, when Carol went to the hospital, she was told that they had decided to discharge Isaac the following day -- today! Yeesh! So Carol and I have been running around like headless chickens, trying to get everything pulled together. Hattie and I put up curtains, so it would be dark enough for Zach to sleep. Carol and I put together a list of all of the things we have to buy today so we can bring him home from the hospital (a small-enough car seat, receiving blankets, diapers, bottles, etc., etc., etc.) and she and I will be taking an infant CPR class this afternoon. If all goes as expected, the next update will be written with a new baby in the house!
Isaac is home! (Nate, not to be left too far behind, has been upgraded (downgraded?) to the less-intensive care unit.)
Sleep deprivation is beginning to set in. We're lucky that Zach is a fairly sleepy baby, who likes to eat a lot, and then sleep for four hours or so (for those of you not intimate with infants, 4 hours is long. 4 hours is truly appreciated. Most parents don't get 4 hours for a while). Perhaps he's catching up on all the sleep he didn't get at the hospital -- for all their efforts, the hospital is still a pretty noisy place.
Sophie the dog was very happy to make Zach's acquaintance -- much sniffing of the car seat and bassinet, accompanied by constant tail wagging. Won't she be surprised when we show up with a second baby in a few weeks!
Carol goes and visits Nate daily and tells him how much fun it will be to have him home. He's over four pounds now, bigger than Isaac at birth, but still has to get over his cold. His nurse did tell us that he's now loud enough to get her attention from a closed isolette in another room, so any respiratory distress doesn't seem to be cramping his style too much.
It's getting to be a wonderfully normal occurrence to report that all is going well. In the hospital, Nate has moved from an isolette to an open crib. More significant, his oxygen supplementation rate is coming down, and he's asserting himself more strongly. When I went to feed him yesterday, he tried to drink milk from his shirt, my knuckles, and his oxygen line. One of his nurses told me he had a "hissy fit" when his milk wasn't ready quickly enough. We all hope and think he might be getting over his virus.
Isaac is doing quite well at home. The pediatrician says he weighs 5 1/2 pounds. He has managed to catch a cold, but for now it's just in his nose, not ears or lungs, so the main issue is keeping his nose clear so he can still eat. Since babies don't take cold medicine, his treatment is saline drops in the nose (he hates it) and a little suction bulb to pull out the mucus (he really, really hates it).
Isaac went for his weight check today and met his primary pediatrician. He's gained 4 ounces in 5 days! His head is definitely in the grapefruit class now (Nate is still working his way out of "large orange"). Every day he's more awake and alert during the day -- cause for celebration, especially since this is often accompanied by more sleepiness at night. He's also made some great strides in breastfeeding, or his mother has (this being a cooperative enterprise): we figured out that the main thing bothering him was that the bottle gives milk immediately when he sucks, but there's a slight delay with Mom. Once he gets over that hump, everything works fine.
Nate is still working on lowering his oxygen requirement. Today he managed to organize constant cuddling from 3 pm to 8 pm by pulling in a combination of nurses, study doctors, and Mom. This makes everybody happy. He's also drinking his full allotment of milk and continuing to yell as if he's being starved. He now weighs 4 1/2 pounds, for a 50% weight gain in six weeks.
Everyone is looking forward to big sister Hattie's 5th birthday tomorrow!
Nate's trying to teach us patience. He remains on oxygen, and in the hospital. Apparently the way you get over respiratory problems at this age is to grow more lung tissue, so the doctors are focusing on making him gain weight. First the milk is enriched to 24 kcal/cc by adding formula powder; then to 28 calories with corn oil; then to 30 calories with Polycose, a kind of sugar. They tried taking him all the way to 30, but that seemed to make him uncomfortable and he won't gain weight well if he doesn't rest. So he's back at 28. His latest weight is 2220 grams, about 4.9 pounds.
It's hard to gauge his behavior from day to day, since he's asleep for about two out of three visits, but when he is awake he does seem his usual feisty self. Nobody's in a big hurry to send him home, so we'll just try and wait him out. Today, Chris is visiting in the early afternoon, and I'll go visit when Chris returns.
Isaac is doing all the lovely things that babies do, and reminding us of some of our old nicknames for his sister ("Cheeseneck," for example). Today is definitely bath day! Though I remain convinced that he strongly resembles Hattie, I notice that his proportions are different. When she raised her hands as high as she could, they came up only to the top of her head. Isaac's whole hand is above his head. Maybe he'll be tall and long-limbed; for now he looks like a potato.
Hattie's life just became more complicated because her day care center is temporarily closed. Harvard, doing construction in the center's building, found arsenic- and lead-contaminated soil and is investigating the situation. I doubt there is any risk to the kids, since the contamination is at low concentration and was buried a foot below ground level, but Harvard is playing it safe for now. All the parents are hoping that this turns out to be no big deal and that Harvard doesn't decide that closing the center is the easiest way to guarantee safety. We'll find out more tomorrow.
Sorry for the late update - things are going well, but very busy. What's it going to be like when both boys are home?
Nate's at the hospital, still trying to break the oxygen habit. We found out from the attending physician that every infant goes through a touch of anemia about two months after birth, as the mother's red blood cells die off and the kid has to produce his own. For most infants, you wouldn't even notice without blood tests, but for Nate, it means a few pale, listless days. This is much less scary now that we have an explanation! Nate is now over five pounds (a hulking 2300 grams) and does seem to be gaining color again.
Isaac has turned into a serious big hungry boy and put on 14 ounces in 9 days. Since gains of 1/2 to 1 ounce a day are regarded as just fine, he's outperforming.
Hattie's day care center also reopened. We heaved a big sigh of relief, especially since that's where the boys will go in September. Yes, they did find measurable amounts of lead and arsenic in a couple of soil samples, but the amounts were not great enough to be dangerous, and they were also perfectly normal for Cambridge. (After all, that's 300 years of history with lead paint and only 30 without.)
Sorry I haven't written recently. My days have been divided up between somewhat limited work hours, somewhat limited Isaac care, and somewhat limited sleep. Since it's Saturday and things are quiet, I thought I'd post an update. (Carol is off getting what I've been jokingly calling her last haircut ever, and Hattie is playing with her pal Noah at his house, thanks to the infinite kindness of Karyn and Ron.)
(Not to single them out -- infinite kindness has also been demonstrated by Madhvi and Mike, Henry and Joyce, Margo and Keith, Lisa and Will, Stephanie and Kevin, Lois (congratulations on passing your orals, Dr. Stanley!) and Mark, and others as well. Before the twins were born folks said that they'd be happy to have Hattie over for play-dates, but I thought I'd have to call around and try to arrange things myself. Instead, Hattie's friends and their parents are fighting over her time -- both this weekend and last, we had three play date offers for the two days. Thank you so much, everyone. We really appreciate the breathing room, and Hattie loves the time with her friends. Not to mention how bored she'd be at home with sleepy-eyed parents who keep saying "no, I'm sorry, you can't watch a movie, no, I'm sorry, I can't help you with your computer game, no, I'm sorry, I can't really read you a book right now, no, I'm sorry you're so bored, and can you keep it down, please? Isaac is trying to sleep.")
(And thanks for that platter of the best bread pudding ever, David and Gail. I didn't admit when you dropped it off, but neither Carol nor Hattie like bread pudding, so I ate it all myself. Yum!) [N.B. from Carol -- this just isn't true. I love bread pudding. Chris tried to corner it but was not successful. As he says, Yum!]
But on to the twins.
I received a call about half an hour ago. Nate's going to get a transfusion this afternoon, about two tablespoons of blood. This should cheer him up tremendously. Carol played down Nate's anemia in her note; it's actually been quite a topic of discussion in the NICU.
As Carol and I learned this past week, your bone marrow produces red blood cells in reaction to your hematocrit (proportion, by volume, of blood that is red blood cells) dropping below a given level. (It's sort of like the thermostat in your house; below a given temperature, the furnace kicks on; above it, the furnace turns itself off.) Babies are born with a dormant red blood cell production system; up until birth, they have been getting red blood cells from Mom. The cells live six or eight weeks, and then start to die off. When enough have died off, the baby's system is supposed to kick-start and produce cells for the kid.
So, since Nate is eight weeks old, it's not surprising that his hematocrit is dropping. Normal range for a newborn is 50-70% red blood cells; his dropped to 28%, then 24%. He's very pale, but still eating pretty well, is keeping up the oxygen level in his blood, and in general is a pretty happy guy. The worry is that his hematocrit level will get too low before his red blood cell production kicks in, and his health will be at risk. Along with hematocrit level, they have been tracking the level of immature red blood cells (reticulocytes) in his blood. This is increasing, which is good -- it means that production has started. The question is whether enough are being produced.
It's possible that, because he got a transfusion about four weeks ago, his hematocrit is dropping faster than it would normally. From something one of the nurses said, I am under the impression that the red blood cells in the transfused blood are starting to die off -- that they expect a hematocrit drop to take place three or four weeks after a transfusion. It may just be his bad luck that the marrow start-up hematocrit dip is happening at the same time as the transfusion dip. Unlike with ice cream, a hematocrit double-dip appears to be a bad thing.
There are two sides to this debate, though.
- On one side, the attending physician has been willing to let Nate's hematocrit level drop. She has been feeling strongly that giving him a transfusion is the wrong thing to do. Although it will make him less pale, she believes that he's feeling fine, and we would be putting him at a (tiny) risk of infection or allergic reaction, and at a (larger?) risk of over-hydrating him, and having to give him a diuretic (as was done when he was fighting pneumonia). And if he's ready to produce red blood cells himself, let's let him do it. He'll have to go through this eventually, and if he's big enough (over 5 lbs.) and healthy enough to do it now, we should let him do it now. So she's been letting him ride.
- On the other side of the fence have been Mom and Dad (who want him to be a rosy baby) and some of his nurses (who appear to be less aggressive about pushing a preemie to get the red blood cell production going).
To my ears, both sides are intellectually appealing. To my heart, the sight of my little, pale, vampire baby makes me want to give him a transfusion.
But, as I said, Nate's getting a transfusion. So what happend? Maybe it's that his hematocrit has fallen to 23.3% (below what appears to be a magic number, 24%). Or, maybe it's that the attending physician isn't on the floor today (she's in charge, but she gets to go home on the weekends). Or maybe a nurse in the "transfuse Nate" camp got the ear of a doctor on the fence and helped push him or her over.
In any event, Nate's getting his 1 oz. of new blood, he'll be a bit rosier tomorrow, and maybe he'll come home in the next three or four days. (And maybe a nurse, or a resident, will get a dressing-down from the attending physician -- but that's no my problem!)
Let's be fair to Isaac, and give him some column-inches as well.
As Carol wrote earlier, Isaac has been growing by leaps and bounds. If I remember correctly, at his Thursday weigh-in he was up to 6 lbs., 10 oz. This is more that double Nate's birth weight (3 lbs. 1 oz.), and heading towards double his (of 3 lbs. 15 oz. -- double that is 7 lbs 13 oz.). It's also a respectable weight for a term infant, which he will be in just one more week.
That thought causes us to pause. If the boys had arrived at their due date, they wouldn't have been born yet. These last eight weeks would have consisted of me going to work every day and trying to set up the nursery in the evenings, Carol lumbering around the house and saying "it's time for these babies to be born, already!", and Hattie drawing pictures of babies and cribs and asking "when are the babies going to be born, already?" That certainly doesn't describe our last two months.
Isaac is a very sweet baby. He does spend most of his time sleeping, with eating in second place. Lying peacefully in a parent's arms is third, and crying is a distant fourth. He smiles quite a bit for such a young kid. It's not a "social" smile, in response someone talking to him or hugging him; it appears to be a smile of pure pleasure. It may be when he feels full of warm milk, or when he feels relief after a good burp, but my suspicion is that he's smiling when he pees -- all of the sudden, there's this nice warm feeling, coupled with a sense of relief. We've got no data, though, since (except for one highly memorable incident) he's always wearing a diaper when he pees.
He's such a great kid.
I can't wait until they're both home, and I can snuggle them together.
On the house construction front, the work on the downstairs is essentially finished. All of the construction is done, and the floors are going to be sanded and refinished the first half of this coming week. After six months, it's amazing to see it all together. We're very, very happy with the results.
(Adding to our happiness is that we've learned of a house almost exactly like ours, in our neighborhood, that sold last year for about 60% more than we paid for our house. Like ours, it started out as a 2300-square-foot two-family, and, like ours, the first floor apartment was converted into living space, and the second floor into bedrooms. Unlike ours, they did not remove the back staircases as we did (giving us more room and more sunlight); they didn't gut and rebuild the bathrooms; they didn't remove the chimney as we did (giving us more floor space and flexibility with room layout), and they didn't put in a kitchen that was nearly as nice as ours -- no new flooring, no pantry, not as nice cabinets. So although we have no plans to move any time in the next decade, it's good to see that, starting with house exactly like ours, and performing the same conversion (except not executing it as well), the real-estate market values the result above what we've put into ours. Relief!)
On that topic, I have nothing but high praise for my contractor, Rick Young (R. H. Young Construction, 617 699 6900 (cell), Waltham, MA). He's very honest and fair. He works hard. He does good work. He answers his phone calls. His estimates are in line with other estimates I've seen. And he manages expectations very well. He's got a very small staff (one guy) and a number of very good subs he uses. Consequently, he's booked way in advance.
So Monday through Wednesday the floors get refinished. Friday we'll go through and dust everything. Saturday the new guest bed arrives. Sunday Ann and Wayne arrive. And the following Tuesday, the movers show up, to perform the world's shortest relocation of our living room, dining room, and kitchen -- from the second floor to the first. (It's even shorter that Keith and Jackie's move across the street from 6 Traymore to 9 Traymore.)
That's enough for now. Signing off. (And hello to all those strangers that Sharon pointed to these pages. Drop me a line and introduce yourselves; it's nice to know who's reading this stuff, esp. if we've never met.)
Nathaniel is pink again! He'd gotten so washed out that the nurses were dressing him in pink; he just looked too pitiful in any other color, but now they've got him back in blue. Also, he's breathing straight room air. That's the first time since February 9th! The nasal cannula is off, and he seems much less wiped out. Assuming he's stable in this situation, he might come home very soon. (I know, I know, I've said that before. But one of these times it's going to be true.)
My parents will be visiting starting this coming Sunday, so it would be wonderful timing for Nate to come home this week. The other piece of great timing is that the floors downstairs are being refinished this week -- the last piece of this stage of remodeling the house (next: the porch, before it falls off!). So as we go from 4 to 7 people in residence, our square footage will double.
Isaac seems to have entered a growth spurt involving a 3-hour feeding cycle at night, instead of that nice 4-5 hour cycle. Oooof. Just don't let it get any shorter, buddy.
A correction: Carol likes bread pudding. It's rice pudding that she's not crazy about. She got the last bowl of David and Gail's bread pudding, and agress that it was yummy.
There's nothing better than holding a baby.
Except maybe sleep.
News flash -- they want to release Nathaniel, tomorrow or Wednesday. More info as it becomes available.
Nate is coming home tomorrow. He's been doing really well since the transfusion, and they see no reason to keep him there any more. He's coming home four days before his due date. Coincidentally, Hattie was born four days before her birth date.
This is complicated somewhat by the fact that the finishing touches are being done on the downstairs tomorrow and Thursday -- re-finishing the floors. We can't walk on the floors between about 9:00 AM and 3:00 PM, which means we can't really go out or come in. Tomorrow, Carol and Isaac will come with me to drop Hattie off at day care, then the three of us will hang out somewhere (possibly at my office, possibly at Peets) until we can go to the hospital (about 11:00). We'll bring Nate home late afternoon, and then I'll go pick up Hattie. Thursday is a little more complicated, since the boys both have doctors appointments mid-morning. Margo had graciously invited Carol and Isaac to spend the day at her house; I hope she doesn't mind too much when Nate and I show up as well.
We've got some errands to run, now. It has been recommended that we are careful not to let the boys share bottles or pacifiers, even if clean, since it's a very easy way to transfer illness. So we've got to go out and buy a bunch of bottles from some other manufacturer. And it appears that "newborn" sized diapers come only in small (48-diaper) packs. We'll be going through one of those every two days. I wish they came by the case like size 1, the next size up (which we won't be ready for until June, probably).
It took a couple of weeks to get into the groove with having Isaac home. A few days ago, I was really starting to feel like we had things under control. My guess is that things will feel like they're spinning out of control, again, soon. This is foreshadowed by the fact that Isaac is going through a growth spurt, and feeding every three hours around the clock. It doesn't help that this happened at the same time he learned how to really yell (instead of just croak).
But our friends haven't forgotten us -- as I wrote earlier, Hattie's time is still taken up by play-dates, and just today Karyn dropped off a huge amount of matzoh ball soup. The matzoh balls were in a rubbermaid container marked "Carol and Chris", which I understand -- what I don't get is why the soup is in a container labeled "Java", which is the name of their dog. Instructions are included: "2 cups x day". Hmmmm...
Still no new pictures of the boys, but here's a drawing that Hattie made today. It's of Isaac lying in his crib and playing.
Nate is home!
Well, Nate has been home for some time, and we've been busy. He came home Wednesday, as scheduled. We put the champagne in the refrigerator to chill, and we may have time to drink it in, say, 2003. He went to the pediatrician and weighed in at 5 pounds, 8 ounces -- quite respectable for someone who weighed 3 pounds, 1 ounce two months ago. Looking back, I see that's what Isaac weighed at his first pediatrician visit. All the nurses say they no longer use the '5 pound rule' for determining when to send preemies home, but it does seem to work as a rule of thumb.
Now we have to get in the groove for handling two babies. There are the good sleep nights - more than five hours per parent - and the bad sleep nights - less than five hours per parent. So if you find we're a little incoherent these days, you can guess why. The boys continue to be wonderful, healthy infants. Now I've got to go and give them baths.
Sorry for the lack of updates. Nate came home. Grandma Ann and Grandpa Wayne arrived. The renovations were finished. The movers showed up (on Tue 02-Apr) and moved our living room, dining room, some kitchen stuff, and 50 boxes of books to the first floor. We've been unpacking since.
The boys and the rest of us are doing fine. Nate is learning how to keep his food down. He's been gaining between a half an ounce and an ounce a day, and Isaac has been gaining an ounce a day. As of Thursday (yesterday), Nate is at 5 lbs 12 oz, Isaac is at 7 lbs 12 oz. Isaac is nursing exclusively, Nate is mostly still on the bottle. Once he's a little more mature and more pulled together we'll try to get him to nurse mostly or solely.
Last night when I was nursing him (at 11:00pm) I discovered that he's developed an incredibly charming, and somewhat sly, smile. He was digesting his milk, leaning over, half asleep in my lap, and every minute or two a very sneaky grin would move across his face, before he relaxed and went back to serious dozing and digesting.
I am more or less back at work, at least physically. It's hard to get much done, though, when you've gotten about four hours of sleep a night for the last ten days. Things start to get a bit surreal. Carol has been holding up quite well. I've been drinking too much coffee, which doesn't really wake me up enough to be coherent, but it does make it hard to get to sleep when the time comes.
Wayne and Ann have been holding us together. They're amazingly helpful, patient, and good natured. I hope that when I'm a grandparent I will be able to do as well by my kids when my grandkids are born. I can't thank them enough, and I hope they understand how much we appreciate their help. We would not be making it if it wasn't for them.
Hattie is being amazingly helpful, good natured, and sweet. She's now getting herself dressed every morning, unprompted. (This started two days after Nate arrived, without any effort on our part.) She also gets me dressed. I woke up one morning to find clean shorts, t-shirt, socks, and pants by the side of the bed. She's an amazing kid; Nate and Isaac have a great role model, and a tough act to follow.
The first floor boiler failed yesterday, so I've been hacking it. Fortunately, we have two boilers (one for each apartment, hence one for each floor) so we can keep the boys warm even if we don't have heat on the first floor. I suppose I should call in the plumber, but there's something very soothing about filling the boiler with water, then draining it, over and over again. (The goal is to flush out built-up crud, kicked up by the renovations.) It's sort of like when Hattie plays in the bathtub with cups, but with the added excitement of high-pressure steam.
Sophie (the dog) has come down with something, which is a little sad and scary. She's a little skittish, in general, and in the past in stressfull situations she reacts by having trouble keeping her food down. You've got to admit that new twins, a move, contractors, piano tuning, and a visit from the grandparents add up to a lot of stress for a little dog. Last night she started getting sick to her stomach about every hour, and was unable to even keep water down. Carol took her to the vet this morning, and they found that she was down to 40 lbs (she usually runs between 45 and 50 lbs), so they have her on IV fluids and are running some blood tests. I hope that once she's rehydrated and gets a chance to relax a little she'll spring back. We'll know more tonight.
Considering that she's 12 years old, her constitution isn't as strong as it once was. I have the sad memory of our losing Emily, our first dog, when Hattie was about six months old, a few months after a big move (out of the only house she'd ever known, to an apartment). Emily had been fighting an immune system problem for years, though -- Sophie has been basically healthy her entire life, and has the advantage over Emily of being a mutt, not an inbred purebred. Please keep Sophie in your thoughts; I'll update you on her status as things develop.
(2:30pm update: Sophie's blood tests indicate kidney disease. It may be that she got into something toxic, e.g., she drank some paint thinner, or it's just that she's getting old. A year ago she went through a period where she was drinking a lot of water and peeing a lot; the vet says that this behavior is consistent with kidney disease, but she would have expected it to continue, not clear up on its own, as it did at the time. The vet also cautioned us that dogs, esp. old dogs, don't handle kidney failure very well. We're moving her to an animal hospital where they can watch her around the clock. I'll post more as I learn it.)
Wayne and I got the new fancy phone system hooked up, and we hope to put together the LAN this weekend.
And last night we got the dining room completely set up -- piano tuned, rug put down, etc., etc. So of the twelve or so rooms in our newly-expanded 70 Chilton Street, one is officially done.
Thought for the day: a baby's stomach is about the size of the baby's fist. So Nate's stomach is the size of a golf ball; Isaac's is a little smaller than a handball.
More pix as we get around to them.
Donations of food and sleep gratefully appreciated.
We lost Sophie the dog today. The vet said that if her kidney problems had been caused by something she had ingested, or by bacterial or viral infection, she would have shown some improvement over the last three days. Instead, she got no better, and, as she became exhausted from constantly being sick to her stomach, she was getting worse. Sophie was a good dog. We'll miss her.
The boys are fine, the house is getting into shape (three and a half rooms set up, out of eleven), and we haven't completely exhausted the grandparents yet (although I think we're coming close).
Someone gave me some static about not putting pictures up for almost two months. I think we haven't taken any new ones in a month, and the film in the camera is from the month before that. We've been busy. Two different people have taken digital photos of the kids, so I have little excuse for not getting those pictures up here. I'll work on it when I get a chance.
Margo just put up some pictures from March 28, the day after Nate came home from the hospital.
We're now thinking of getting a part-to-full-time nanny to help out around the house until the boys start at Harvard Yard Child Care Center in September. In our fantasies, we'll find some nice young woman (or man) who loves and has experience with babies and is interested in and willing to do housework. If you know of anyone, or have any suggestions for leads, please get in touch with me.
New pictures, thanks to the developmental study folks. (Hi Samantha! Hi Nick!) Click on the image to see a larger version.
The day we brought Nate home from the NICU, Wednesday March 27. Zach is on the left, Nate on the right, in both images.
At home a couple of days later (March 29, I think). Carol has Zach, Chris has Nate.
Sorry that I'm not smiling. I must have been tired or something.
No big news to report. The boys continue to eat lots, grow quickly, and be impossibly sweet and cute. Carol and I continue to be short sleep, but slowly getting used to it. Ann and Wayne survived their two weeks in babyland, and are now safely back in Seattle, where it is calm and quiet. We've hired a nanny for the summer, who plans to start working with Carol today. The hope is that the nanny will free up enough of Carol's time that she can get in a half-day of work. (Taking care of two kids appears to take about one and a half people.)
Don't expect a lot of frequent updates to these pages. Now that the boys are home and stable, and we're impossibly busy with day-to-day stuff, there doesn't seem to be much to report, nor much time to do it.
Drop me a line if you want me to send you some email when I add an update here.
The boys are happy and healthy. Isaac is going through a growth spurt, so he wants to eat about every two hours, around the clock. (This has the obvious impact on our sleep schedule.) Nate and Isaac both smile in response to parental attention. Isaac appears to like playing "patty-cake" -- or at least he likes it when I sing the patty-cake song and clap his hands together.
Carol is back at work half-time and being productive. I'm at work and being unproductive full-time.
We're getting ready for our trip to Monterey, California (USENIX) in a week and a half. It'll be a zoo.
Here are pictures of Isaac, Nate, and Hattie (respectively) from when my parents visited a couple of weeks ago. Maybe I should break down and get a nice digital camera...
