I’ve been itching to post Joel’s birth story, but until today, writing it seemed a task insurmountable, because, turns out, being a parent to a living child and to a dead child is hard work. And so is breastfeeding. So much so that I struggle to envision the day where I partake in activities unrelated to lactation. And also, the idea of writing Joel’s story has seemed daunting, because I spent seven action-packed days in the hospital (three prior to his birth and four after), but today I’m attempting, in this different sort of timeline format, and I’m hoping that I can resume my regular writings shortly so I can share my other recent experiences as well as process the inevitable shitstorm of complicated emotions that accompany bringing home our beautiful baby boy almost exactly one year after leaving our other beautiful baby boy behind. So here goes…
Thursday, July 21 – I write this post, which exposes so many of my OCD tendencies and also helps me confirm to myself that our planned C-section date of Sunday, July 31, 37+4 gestation is indeed the most medically-sound time to deliver our wimpy white boy. What I don’t say is that after months of agonizing over picking this date, it also seems ideal for the following, more superficial reasons: 1) it doesn’t require us to reach a new calendar month, 2) we managed to convince ourselves that 31, the inverse of 13, is sweetly serendipitous as opposed to creepy, and 3) my doctor was scheduled to arrive home from Jamaica on Saturday, July 30 and agreed to come in and perform my C-section the next morning, assuring me she wouldn’t consume enough alcohol on the plane to adversely affect her surgical skills.
Friday, July 22 – I attend what I believe to be my second-to-last cord pathology scan. (Friday, July 29 was scheduled to be the last.) Joel’s cord is positioned perfectly, with not one nuchal, body, or limb wrap to be found. Still, I warn the sonographer that if she wants to estimate weight she should do it now, as there is no telling whether we’ll make it to July 29. But she doesn’t, because apparently a growth scan requires a doctor’s order.
Saturday, July 23 – Joel has a great day movement wise. I feel a renewed sense of confidence that July 31 will be Joel’s birthday. I start to clean the house and begin thinking about what I might do in the next week to prepare to bring a baby home.
Sunday, July 24, 11:00am – We venture to Crate & Barrel to buy some new throw pillows, because ours are looking raggedy and are shedding feathers. Something’s felt off all day though, so for 20 minute we sit in the car waiting for me to log “enough” movements to feel comfortable going in. We eventually go in, but we leave minutes later, because I’m still worried.
Sunday, July 24, 3:30pm – I go to a friend’s house to meet her new puppy even though things continue to feel a bit off. I get through the visit with Joel moving just enough for me to feel reassured.
Sunday, July 24, 8:30pm – I notice Joel is hyperactive, to a level which doesn’t feel remotely normal. Upon further investigation, we notice his heartbeat is also extremely elevated, but not just in a normal, healthy acceleration-type way, rather his baseline is ~180 beats per minute (BPM), with accelerations approaching 200 BPM.
We flip our shit, imagining Joel is in great distress, and we frantically gather our belongings in preparation to head to the Maternity Trauma Center. I tell Mark to grab the rest of the rainbow chain, as deep down I know I won’t be coming home again before we deliver. We jump into Mark’s truck and speed to the hospital. Mark drives like a maniac, while I hold the Doppler to my belly – I go between being unable to detect a heartbeat and detecting a heartbeat in the 190s, which only adds to the madness. I scream at Mark about his driving, “If you get in a wreck I could have a placental abruption!” (I’m not crazy at all.) We call Dr. Collins, almost hysterical. (Bless his heart for taking all of our calls.) We explain the situation and ask whether Joel is dying. Dr. Collins offers his familiar, reassuring words, “He’s okay for now. He isn’t dying. You just need to find out what’s going on.”
We check into the hospital, and the nurse hooks me up to the fetal heart rate (FHR) monitor. We quickly confirm that Joel’s heartbeat is indeed elevated. Though we’re somewhat comforted to see strong accelerations and moderate variability, indicating a well-oxygenated baby.
Joel’s heartbeat remains elevated for at least two more hours, and no one is sure why. One resident reassures me, “Well, sometimes tachycardia can be caused by an infection, but you don’t have a fever,” to which I reply, “No one has taken my temperature.” Everyone decides I could potentially be dehydrated, despite my insistence that I’m not, and nurses attempt (four times) to start an IV. (I have tricky veins, apparently.)
Much to our relief, Joel’s heartbeat finally begins to normalize, though I’m not convinced it’s because of the IV. But, by this time, it’s late, and the doctor on call has already decided to admit us overnight for observation.
We, along with the doctor on call, decide this pregnancy must end sooner rather than later – for our mental health, for the mental health of everyone involved, and possibly for Joel, because this most recent episode is certainly strange. Though I’m told that by itself it isn’t cause for immediate delivery. But nonetheless, we decide we won’t make it a day past 37+0. We move my C-section to Wednesday, July 27 at 12:30pm.
Monday, July 25, 7:00am – The doctor on call comes in and says, “His heartbeat looked good all night. You can go home! See you Wednesday!” to which I was like, “Actually, could we not go home? We’re just getting too close to the end. And you’re honestly lucky that we’re talking only a few days and that I haven’t been camped out here for the last month.” And he surrendered, probably reasoning that I was indeed correct in my assertion, admitting me to the “ante-partum” floor, or, in other words, the floor for pregnant women with 99 problems who require continuous monitoring until delivery.
Monday, July 25, 3:00pm – Apparently the ante-partum floor has scheduled activities for its “residents,” much like a tourist might find on a swanky resort in Riviera Maya. Except instead of yoga at sunrise or poolside bingo, there’s parenting classes and arts and crafts. We attend a parenting class, because, we’re having a baby in two days, which helps us connect with a pediatrician. I meet another ante-partum patient and find out she lost a daughter to a sudden placental abruption and almost lost another daughter to a sudden placental abruption. I’m angry that life is so fucking unfair.
Tuesday, July 26, 5:00am – Our night nurse comes in and has me switch positions because she claims she hasn’t seen enough accelerations within the last hour. She’s amazingly detail oriented and seems extra committed to ensuring nothing happens to Joel on her watch. But I start to second guess myself… Have I felt enough movement? I start to track movement again even though I’m on continuous monitoring. I’m officially losing it. Continuous monitoring is no freaking walk in the park for people wired like Mark and me.
Tuesday, July 26, 2:00pm – One of the residents who was working when Matthew died pays me a visit. She comes and sits at the foot of my bed, tissue box in hand. She cries as she talks about how she’s been following my rainbow pregnancy in the hospital chart, “So many times, I’ve wanted to come see you,” she explains, “But I’ve been so scared. I don’t want to cause you and your family more pain. I know you’ve been suffering from extreme anxiety, and I feel like it’s my fault. I know I’m the one who told you, for hours, that everything would be okay, and then it wasn’t, and I’m so sorry. I want you to know I’ve thought about you and Matthew every day for the past year, and I’ve replayed whether there’s anything I could have done to change the outcome…”
“It’s not your fault,” I explain, “It was an extremely tragic, awful situation…” I choke back tears, “And I wonder the same thing – whether I could have done anything differently. The truth is, we’ll never know, but it isn’t your fault.”
This sweet resident then asks if it’s okay for her to scrub in for my C-section, and I tell her that it most definitely is, so she’ll be there, along with the other resident who was there when Matthew died. While this may seem disturbing/PTSDish to some, it brings comfort to us, as these are two of only a few people in this world who met Matthew alive. And we believe their presence in the operating room will help us feel Matthew’s presence more strongly. Also, I’m thrilled at the thought of them sharing in some of our joy after walking with us during our time of such immense sorrow.
Wednesday, July 27, 4:00am – I awaken to realize my C-section is just over eight hours away. To say it feels surreal is an understatement. I glance at Mark, who sleeps peacefully on the couch next to me. I almost don’t even recognize him as my husband. I think about how, over the past three months, we’ve been functioning more like fellow med students than we have spouses, learning to read FHR strips with the best of ‘em. I wonder what it will be like to be a normal, married couple again.
Wednesday, July 27, 4:30am – Mark and I head to breakfast. We cry over cereal and yogurt and orange juice, reminiscing about the effort and anxiety and stress it took to get to this point and about how it’s soon coming to an end – there were so many times we doubted we’d make it to this day.
Wednesday, July 27, 10:00am – One of our church pastors pays us a visit and prays with us and our families and our dear friend, Michelle. I’m thankful for his calming presence and also thankful that apparently we’re still members of our church, as we’ve only been to church twice in the past 13 months and also, our pastors have seen my blog and probably noticed how my grief brings out my inner sailor – I’ve used every word in the book here. #nofilter
Wednesday, July 27, 11:30am – The IV team (yes, my small veins apparently require the highly-specialized “IV team”) attempts to administer an IV by way of stabbing me multiple times. (No way should they have allowed their freaking apprentice to experiment with me – haven’t I been through enough?!) Shortly thereafter, I’m wheeled back to pre-op. It’s almost go-time.
All the panic starts to set in, as over the past few months, I’ve devoted little thought to the actual C-section. I wonder how different this will be from my emergency C-section. Will the epidural hurt? Will it be freaky to be awake during surgery? Will Joel cry when he comes out? What if we’re making a terrible mistake taking him out at 37+0? Will I be able to look into the overhead light and see a reflection of my organs being removed from my abdomen? How will it feel to be in an operating room again? Will the peaceful experience that some moms, even some rainbow moms, describe even be achievable for me?
Wednesday, July 27, 11:45am – I change into my special gown – the one to which they blow in heat during surgery. Our doctor comes in one more time to answer any last-minute questions. I’m in tears – everything is going to start happening so quickly now. Mark asks our doctor, “Do I need to wear something special?”
“Just a gown and a hat,” explains our doctor.
“So should I get naked (under the gown)?” Mark asks.
“Well, the gown is see-through,” replies the doctor as the entire room erupts into laughter.
The anesthesia team comes in to administer the epidural, and it’s far more painful than I could have imagined. It takes what seems like far too long for them to get it into the center of my back, and it’s difficult to sit in the correct position for the amount of time required. I’m worried Joel won’t respond well to the medication, because, apparently, an epidural can cause a drop in mom’s blood pressure that some babies don’t like. Once it’s in, the doctors start testing the epidural’s effectiveness, and I’m worried I’ll incorrectly answer the pain tolerance questions and that, as a result, I’ll feel them cut into me.
I start to react to the medication – I begin feeling dizzy and nauseous and I start to shiver and violently shake, and then I start dry heaving into the bucket our sweet doctor is holding next to my head.
Wednesday, July 27, 12:30pm – Tears stream silently down my face as I’m wheeled back to the operating room, thinking about the stark contrast to the sprint situation one year ago.
And my tears continue as we enter the operating room.
Blinded by the sterile white room and the bright lights, I close my eyes as they transfer me to the table. I can’t help but remember how last time I transferred myself to a similar table, ripping off my street clothes as doctors tried to knock me out quickly enough to save Matthew.
Once strapped down in the Jesus position, I calm down a bit, though, because of the anesthesia, I’m having some trouble staying alert. Mark, and others, remind me, “Stay with us,” and I’m embarrassed that I’m less than present for perhaps the biggest moment of my life.
Mark sits to the left side of my head, while the doctors inform us about what’s happening. Periodically either Mark or I ask, “How’s his heartbeat?” and we’re continually reassured that Joel’s doing well.
“Where’s his heartbeat?” Mark asks again, “I don’t hear it.”
“We had to take him off the monitor. We’re making our incision. It won’t be long now.”
My level of alertness continues to fluctuate in the minutes following, as our doctor calls out progress updates regarding which layer of tissue he’s cutting into. He updates me, “You’re going to feel some heavy pressure/rummaging in your abdomen area as we take him out.”
I hold my breath, wondering if Joel will scream soon. The pressure feels weird, but it isn’t at all painful.
“One nuchal, loose,” our doctor announces.
“Come on, Joel. Please scream,” I quietly plead with him as if he can hear me.
Wednesday, July 27, 12:46pm – Joel’s out, and he’s kicking and screaming and wailing and flailing.
It’s the best sound I’ve ever heard, and there are no words to describe my feelings in this moment, so I won’t even try. Mark cuts his cord and someone brings him to my face.
He’s absolutely beautiful – all 8 pounds, 4 ounces of him. And he’s… Tiny. All this talk of a HUGE baby – I expected him to be… Bigger. But he’s perfect, and I’m in love immediately. (Though I was in love much before he was actually born.)
Doctors take Joel back from me fairly quickly to check him out further. Mark turns his attention to Joel, who’s now on a table to my left, and everyone just kind of leaves me alone as the surgical team stitches me up. I hear someone note Joel’s birth APGAR score – an eight, and his five minute APGAR score – a nine. I’m relieved that his scores are so high, but then I notice that Joel is no longer crying. I plead to know what is happening, but no one attempts to keep me updated.
I overhear Mark and the NICU doctor discussing Joel’s lungs, noting that they are probably filled with fluid. I hear some discussion about Joel needing oxygen. I see the NICU doctor suctioning fluid from Joel’s mouth. And I hear Mark and the NICU doctor discussing the coloration of Joel’s hands and feet – they are blue/purple, which is normal/expected, but can be concerning if the condition worsens.
I beg Mark to keep me updated, and he periodically reassures me that all is okay, but I begin to lose faith, as Joel still isn’t crying. I feel sad and defeated and worried, but not as worried as I probably should be, as I’m still about to drift off to sleep… Until I overhear the NICU doctor tell Mark that she is considering taking Joel to the NICU if his condition doesn’t improve soon. At this point, I grow very worried, and I start to cry. Although a NICU stay is by no means a tragedy, after all we’ve been through, in this moment, the thought of Joel being taken away from us for any amount of time is horrible.
When the surgical team is done stitching me up, they transfer me back to a hospital bed and wheel me closer to Joel.
I can tell the NICU doctor is leaning towards taking him away, though his condition seems to be improving, so she seems to be debating… In the midst of her internal debate, Joel lets out a loud wail at which point our doctor instructs the NICU doctor to set Joel on my chest, just to give him one last chance to start breathing better on his own.
The NICU doctor heeds his instruction, and the moment Joel is placed on my chest, he starts breathing just well enough for us to be released to the recovery room, together, as a family.
And, much to our relief, we remained together, as a family, for the duration of our stay.
Turns out, Joel’s lungs were mature – he just needed some assistance transitioning to the outside world. And, in the following days, Joel passed all of his tests, though he flirted with borderline high weight loss and borderline low blood sugar levels and borderline high jaundice levels, though never enough to necessitate being placed under a lamp. But all of these issues/nonissues resolved relatively quickly.
During our hospital stay, I recovered incredibly well physically, though breastfeeding hurt like a bitch – 8/10 on the pain scale, seriously. However, I began to be confronted with the harsh reality that although this stressful rainbow pregnancy is now behind us, Matthew’s death leaves me facing perhaps more anxiety issues (unrelated to pregnancy) than I ever would have imagined, for which I may need to seek help. (More on this later.)
One of the best parts of our hospital stay was having so many visitors who were involved in our prenatal care – it truly took a large village to get Joel here safely. (Or maybe to reassure his parents that he might get here safely?)
On Sunday, July 31, around 10:00am, the exact time of my original, scheduled C-section, we were discharged from the hospital. As I was wheeled to our vehicle, I experienced the exact Return to Zero moment… The nurse wheeling me out asked, “Is this your first?” to which I replied, “No, our second,” adding no caveats. And because she was pushing me from behind, she didn’t see the tears that followed – the tears for Matthew, who, one year ago, should have made this same trip home with us but never did.
And this is much like how the days since have proceeded for me – profound joy for Joel and his safe arrival coupled with some immense sorrow related to losing Matthew. Re-grief, they call it. I’ll struggle with this grief and re-grief for the rest of my life, though it will take on many forms and hit me with varying degrees of intensity.
But we’re beyond thankful for Joel. He continues to thrive and is already almost ten pounds at three weeks old! And he’s bringing so much light into our lives.
NOTE: Special thanks to our fabulous resident, Dr. Amy for taking the amazing operating room photos. We joke that should her career in medicine not work out (it will – she’ll be very successful), she could easily make the jump to photo journalism!