Arrival, Part 2: Special Care

Our hospital doesn’t really have a “NICU” per se; it’s a special care nursery for babies born after 34 weeks (we made the cut-off, yay!) or born with some problems that aren’t necessarily life threatening ones. The nursery has lifesaving equipment in case of an emergency, but they couldn’t, for example, keep an infant on a CPAP for a very long time because they aren’t trained for that. If that became the case for someone, they’d have that baby transported down the street to Memorial, where they have a Level III NICU for very sick babies.

So that already makes the place a little different from what I’d expected. I watched videos about babies in NICUs because I knew that twins have this tendency to come early. From what I’d read, 35 weeks was the average, but I was placing money on anywhere from 32 to 36 weeks, regardless of anyone else’s expectations. Towards the end of my pregnancy, the placing money was kind of a “hope” more than anything else because I was enormous and uncomfortable and itching so bad I wanted to peel my skin off with a cheese grater. Of course, nobody ever wants their baby to be sick or to need time in the NICU because, well, it hurts.

But I’ll get to that.

When my surgery ended and I was wheeled back to the eerie room with its pseudo Lovecraftian aesthetic, my twins headed straight for the special care nursery. We got a report later from the nurse who’d taken charge of their care, explaining the treatments they’d received upon arriving there. She explained about babies breathing that it was like inflating a balloon. The first time you inflate a balloon, there’s a lot of resistance, but if you leave a little air in the balloon when you deflate it, it will inflate much easier the second time.

(I don’t know who’s inflating and deflating balloons out there, but I’m here to tell you, friend, that is not how you use a balloon)

Baby lungs are the same way, but when babies are born before their lungs are completely mature, they can just expel all of the air from their lungs, which means that although breathing still happens, each subsequent breath is as difficult as their very first, and they get very tired, very quickly. The solution is a CPAP machine, or one of several other methods of forcing air into the lungs and keeping it from all escaping completely. “But we don’t have a longterm CPAP machine here,” the nurse-or-doctor explained (and apologies that I don’t remember; I was kind of still on a lot of drugs when she talked to us), “so if they do need that–and they don’t yet, but if they do, we’ll have to send them to Memorial.”

She told us other details about the twins’ oxygen saturation and CO2 saturation and how they were working to balance that out, but assured us that they were really strong and healthy for 34-week-old twins. “And big!” she added and laughed. Isaac topped out at 5 lbs, 12 oz and 18.75” long, while Carrie tipped the scales at 6 lbs, 1 oz and 18.5” long. They didn’t necessarily fall into the category of MAHOOSIVE, but for perspective, another 34 weeker came in about four days after they were born and weighed in closer to 4 lbs. So they’re not delicate for their age either.

But the twins were alright; that’s what I gleaned from the entire conversation, even though my head was swimming and I couldn’t feel or move my toes. The trouble was that I’d have to wait to see them for several more hours, as jumping right out of bed after major abdominal surgery isn’t the best idea of all time.

Kyle got to see them first, and I don’t begrudge it of him because he took pictures and videos for me. By the time he got there, both babies were breathing room air and sleeping, as exhausted by the ordeal as I was. They had so many wires and tubes and IVs hooked into them that they looked sort of like they were part of the Matrix, but of course, they weren’t.

And they were so pink, too, healthy and pink. I held onto that quite a lot over the next several hours as my nurses changed shifts and I faced the big requirement for going to see them: peeing.

(I’m going to tell the story of my first time peeing after the surgery later, because I want to write about the twins now. Aren’t you so excited to read about me peeing? I know you are)

The peeing thing happened at around 4 a.m., and I was exhausted and dizzy and my eyes kept closing and I hurt everywhere, but I DIDN’T CARE because I literally would have walked barefoot on a mile of Legos to see the babies at that point. And thankfully, the hurty part ended quickly and with me sitting in a wheelchair and wrapped in blankets, like the sickly character in a novel that takes place in a time when ladies wore really large dresses. And it was 4 a.m. and Kyle was half asleep and I was half asleep, but we still all wheeled down the hall, merry as can be, to go and see the babies and to finally have skin-to-skin contact with them.

Skin-to-skin contact is one of the most important things you can do for your baby in the first hours of their life: it helps them to regulate their breathing and body temperature, it helps with bonding, and it’s just an emotionally uplifting thing overall. If the twins hadn’t been preemies, I’d have spent the first two hours of their lives holding them both against my bare chest, letting them feel my heartbeat and warmth, smell my skin, remember me. It’s what I did with Sam, and something we practiced very frequently even after he left the hospital. Kyle did it as well, and I honestly cannot emphasize how much it meant to me, how much good it did, and how much I’d wanted to do it again with the twins.

But I didn’t get the chance until 4 a.m.

Still, at 4 a.m., I took the fucking chance. I was too tired and too eager to really care who was seeing me with my hospital gown flapping down about my waist after the nurses helped me to unsnap it. They closed curtains around the twins’ corner (they have their own corner of the nursery because there are two of them and they’re both in incubators), but honestly, a parade of leering assholes could’ve marched through the nursery and gawked at me and I would not have cared from the second I held each of my babies against my chest.

(this is very sappy and crunchy, like eating a tree)

And then we had to leave. They were too small and delicate to be out of their incubators for very long, and I needed my rest and my medication. Before we left, though, the nurses explained all of their lines and wires to us. The twins each had monitors checking on their heart rate, breathing rate, and the oxygen saturation in their blood. They had IVs in their hands, delivering liquid nutrients and calories to their tiny bodies, since they were still too unstable to try eating from a bottle. They had little thermometers giving feedback on their temperature. They were wrapped in hospital blankets, and they had those funny striped hospital hats on their tiny heads.

Which was something I couldn’t stop thinking about, even after we left: how tiny they were. Now, mind, they’re pretty big for 34 weekers, as I’d said before; but I also have to point out my basis for comparison, which is Sam.

When Sam was born, he wasn’t one of those monster babies that you see on the news where they look like they already know how to drive a truck and sing baritone, but he was still a very respectable 8 lbs, 11 oz and 20.5” long. He’d already mostly sized out of newborn clothes and was definitely too big for newborn shoes, bringing to mind the saddest six-word story ever written:

For sale: baby shoes, never worn.

That was written by Ernest Hemingway, and it’s objectively sad until you realize that the reason the baby shoes were never worn is because the baby had unexpectedly ENORMOUS feet, and that baby was Sam. I still remember reflecting sadly over a pair of fuzzy monster shoes I’d bought right after we found out he was a boy. They were too small. He never wore them.

So that’s my basis for comparison, a baby too big for baby shoes and newborn clothes, not monstrously huge but definitely never tiny.

And here were these little peanuts, big for 34 weeks, but compared to their brother and most newborns I’ve held, absolutely teeny. Teacup sized. Their heads and hands are so tiny, their noses are eensy, their ears are weensy, but what gets me the most is their feet. Their feet are SO SMALL. It’s absolutely ridiculous! Each foot, each of the four baby feet, is the length of my thumb. I do not have long thumbs. In fact, they’re kind of stumpy. And my babies’ feet are smaller than my thumbs.

Their feet also do not fit in the baby shoes, but this time because they are far too SMALL.

Anyway. We had to leave. And the next couple of days became a sort of confusion when it came to visiting the nursery. When you have a healthy baby, you can go down to the nursery and see them and hold them and love on them any time. You can request specifically that your baby is brought to you for feedings; if you’re in a baby friendly hospital, your baby will be there anyway. You can hold them while they sleep, you can hold them while they’re awake, you can change their diaper any time and let their siblings and grandparents and aunties and uncles and cousins hold them, and it’s grand.

You can’t do that with NICU babies.

NICU babies, you see, need to spend a lot of time in incubators when they’re very young because they can’t figure out how to regulate their body temperatures yet. You can theoretically keep the overall room temperature really high and hope that works for them, but it’s usually not high enough, and if they start to get cold, things go downhill quickly.

So they stay in incubators except for brief visits outside when they’re being examined or eventually fed. And in theory, the outside visits happen roughly every four hours (side note: dear nursery, thank you for getting my babies on a schedule long before we could ever hope to do so at home), but sometimes there’s a checkup you didn’t know about or sometimes the babies wake up early or sometimes you’re trying to get there on time but you keep getting cornered by medical personnel wanting to check your incision, and by the time you get there, the NICU nurses just smile apologetically and say, “Oh, we just finished with his feeding and put him back to sleep. He needs to rest now.”

And this also hurts.

Because you want what’s best for them, you want them to get the best possible chance, but knowing that you missed having them in your arms by that much is a bit like a punch to the face.

This really only stayed a problem while I was still at the hospital, and even when I couldn’t hold them, the nurses gave me all the news of their progress. Carrie has been progressing the fastest, but Isaac hasn’t been far behind, except that he has a fondness for what they call “bradys.” Bradys, where preemies are concerned, are times when the baby’s heart decelerates, and they can happen for any number of reasons. Isaac’s preferred reasoning is that he’s hungry and drank his bottle too fast, and that somehow makes his heart rate drop, which in turn makes his oxygen saturation plummet (this is called a “desat”), which in turn makes his mother freak the fuck out when she’s trying to feed him, even after the nurses easily get him back to normal and tease him for being such a brat.

Not that this, you know, happened to me yesterday or anything.

Now that I’m out of the hospital, we plan our visits and coordinate with the nurses, so they’ll know that we’re going to be there for the noon feeding or the 4:00 feeding or something along those lines, and they’ll make sure to try and postpone the feeding until we get there. Even if they can’t (read: Isaac is screaming and Carrie is kicking the walls of her incubator), they make sure to put off as long as possible so that we have a chance to at least hold them and rock them and change their clothes for the day.

(changing their clothes is illogically one of my favorite things because it makes them seem so normal and so like they’re just at home, and I need that)

They’re showing real bits of personality, too, different on some levels from what I got used to when I was carrying them, but familiar as well.

Isaac has two modes: enrage and asleep. If it’s taking too long to get him his bottle, if he feels like he’s not getting enough attention, if he needs a diaper, he’s enraged. And oh, that boy can scream. He goes from zero to RAGING in about 0.04 seconds flat, and he’s got lungs on him. Usually, the incubator walls muffle the babies’ crying somewhat, but not Isaac. He has a problem, and you WILL know about it.

But then when the problem is solved, he mellows out so easily and reaches this incredible state of peaceful bliss, especially with me or Kyle. He wants to be comfortable more than anything, so if he’s getting the attention he wants and snuggled up with someone he loves and has all his needs met, it takes another 0.04 seconds for him to fall right asleep and sleep so soundly and deeply that, yes, he occasionally had bradys in his sleep.

He also belches like a trucker.

Carrie, on the other hand, doesn’t really scream or cry that often. She’s more of a fusser, kind of like Sam was. If she’s not happy with her circumstances, she’ll give her own little cries, which are more of polite protests than anything else, but will immediately stop once things stop being weird. She’s far more interested in looking around and taking in the world around her, as much of it as she can see. When you hold her, her eyes just stay WIDE wide open and drink in everything, especially you.

She vacillates with how she does on feedings, and her feedings have a lot more variety than Isaac’s. Sometimes, she’ll just sip at 25 ml and be done; other times, she’ll chug 45 ml before you know what happened. She’s not a belcher, nor often a burper, which gets frustrating at feeding time, because you need her to burp in order to make room for more food, but nope. She prefers to just look up at you and will actually use what little neck strength she has to pick up her head and turn it to face you if it’s not already doing so (e.g., when you’re holding her forward and getting her to burp). And when the nurse can’t get her to eat anymore and I can’t get her to eat anymore, it seems to help a great deal when we get Kyle on the phone. She’s a daddy’s girl already.

They’re both such delights, honestly, and leaving them is the worst part of the day, even when you know that it’s just another day closer to when they’ll come home. When it’s time to leave, I’ll have packed up their dirty clothes and picked up their diaper bag, and they’ll both be tucked sweetly back in their incubators. They have blankets from  home now, muslin ones, that I slept with one night so that they would be saturated with my scent (which sounds creepy and weird, but scent is pretty much the only reliable sense they have right now). They’ll both be asleep or mostly that way, but because they’re in the incubators, I can’t really touch them, so I tap the glass and tell them to be good and that I love them and that I’ll see them tomorrow.

And then I go, and I thank the nurses on the way out, and I make jokes even though part of me is staying behind. I press the silver buttons that let me out of the maternity ward, after I have one of the nurses validate my parking ticket, and I ride home with Kyle because I can’t drive yet.

And sometimes, like yesterday, I go home and I cry and I cry and I cry because I know they’ll be home soon, but goddamnit, soon isn’t now, and I’m very childish and temperamental when it comes to having all of my babies under one roof and within easy access of my arms.

Rumor has it, though, that we’re just a few days out. Rumor has it that Isaac is getting off the monitors, and that afterwards, he and Carrie can both try sleeping in cribs instead of incubators. Rumor has it that we need to bring their car seats in for a car seat safety test (where the nurses make sure that they have the neck strength to not suffocate themselves in a car seat), and rumor has it that once they’re in cribs, it’s only another couple of days until they’re home with us.

And I really hope that rumor is true.

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