Friday, September 28, 2012

Still here!

Hey there, it's been a while!

In an announcement that will come as a shock to no one, I have had little to no free time since starting residency.

Shocker, I know!

I've been through so much in the three months since residency started that this post can't even start to describe it. Here's a brief summary, but I couldn't possibly express how residency has affected me as a person in three very quick months.

My first month was on the infectious disease service. It is one of the busiest in the hospital, with lots of complex infections. And any patient with HIV, no matter how well controlled and with any medical complaint, gets admitted to the service. I had no ID (infectious disease) background, but I learned a ton. I worked insane hours, mostly due to my intern inefficiency. It took me a few hours to admit each patient--mostly because my history & physical for each patient is a novel--and that will get better, I know. But the first time we had to track our weekly hours for duty hour compliance, I worked 98 hours. Yes, that is over 80 hours a week--but those hours are averaged over 4 weeks. And I'm not faulting the program at all. They are great about having things in place to get us out on time, and with only one exception, every senior resident I have had has been outstanding with helping me get done.  It's just that when you have patients crashing and two admissions that come in right at the buzzer, it's difficult as a new intern to get out in time.  That has gotten better, which I am thankful for!

My first month, I saw so much interesting stuff. I saw patients with HIV who have no detectable viral load and a CD4 count that is better than mine. I also saw HIV patients that were not well controlled or newly diagnosed (but had likely had the disease for years). I saw toxoplasma in someone's brain, tuberculosis, cryptosporidia infection, and other complications. Some patients got better and went home. Others unfortunately didn't. It was a very humbling and informative rotation. It was also an emotional rollercoaster. I had good days and bad days--though I think I was only close to tears once, and I kept it together. Sleep deprivation definitely diminishes my ability to keep my emotions in check!

My second month was general medicine at the VA. Again, I learned a ton, and I was insanely busy. I had some bread and butter patients, and I had some rare cases too. I actually saw a lot of infectious disease here--pertussis, west nile, pseudomonas bacteremia, and others. When they say general medicine, they mean it; we had everything. It was another month of very long hours too. I did finally lose it the last call night I had. I had a patient with a very bad infection who was unstable, several other very sick patients, and I got two admissions at the last minute that I really did not think needed to be admitted. I knew I would be there late, likely till 1 AM or later. I was furiously working to transfer my very ill patient and admit my other two patients. This is when I had the only resident I have worked with that wasn't very helpful. His comment was that I needed to be faster, because now he was going to get yelled at for me breaking duty hours.  I was tired and drained emotionally; I was already upset that I didn't get to see my sister leave to go back to California that day, after staying with us all summer.  I held it together long enough to have a nice cry in the bathroom for a few minutes, pulled it together, finished my work (late, but I did the best I could), and I left.

Last month was outpatient primary care. It was exactly what I needed after two extremely busy months on the wards. Mostly 8-5, no weekends, no call...awesome! It had its own challenges--you went to a different clinic every half day, so it was difficult to change gears, figure out what each attending wanted, learn how they like notes written, etc. I did get a chance to catch up on life--and see my kids, who were shocked to see me every day!

This week, I started time in the MICU (medical intensive care unit). As I posted on facebook, changing rotations every 4 weeks means that you have a day every month--the first day on that service--where you feel the most stupid that you've ever felt. That day was Monday in the MICU. I did no ICU during medical school. I could've done it as an elective, but I did more teaching electives so that I could have an extended maternity leave. My first day, there are patients bleeding, stopping breathing, and otherwise crashing everywhere. It seemed like everyone else was totally calm and knew just what to do. I had to actively breathe so as not to freak out. On the wards, when a patient is unstable, you send them to the MICU. I always assumed the people in the MICU knew more than I did. Now I am the MICU! In all fairness though, I probably have less patient influence in the MICU than anywhere else--which is best for everyone. There is always at least one critical care attending, and we have 24 hour MICU fellows. Plus, there are four senior residents and four interns covering 20 beds. And the ICU nurses are absolutely amazing. They do more than any other nursing staff I've worked with--and I think my hospital's floor nurses are outstanding. These ICU nurses know everything, and they are completely in tune with what the patient needs. Having them around helped me get my heart rate under 150 bpm!

The ICU is such an interesting place--there are patients in for a short time, just requiring a tuneup before they go back to the floor. And then there are patients who are SICK. Many patients are unfortunately in the end stages of their diseases and will pass away in the MICU. This is tough for me, especially because many of these patients are young. I have one patient now that had been barely hanging on--I don't know how much I can describe on here, but every morning I came in and half expected her not to be there. I am off today, and I prayed that she'd get a miracle. And today I found out she did--if all goes well, she'll have a new chance at life after today. I had no part in her getting better, but I'm so glad that now she has a chance!

I'm still completely intimidated by the level of illness in the MICU, but it's gotten better in a few days. My senior residents tell me that I'll be comfortable here by the end of my 4 weeks. I don't know that I'd go that far, but we'll see.

I actually haven't done any procedures yet in the MICU--I've been told I'll have patients needing central lines, hemodialysis catheters, arterial lines, and other things that I will learn how to put it. I'm a little intimidated by that, but I look forward to learning. I did do my first lumbar puncture within days of being on the infectious disease service--and I had a champagne tap too (no red blood cells in the cerebrospinal fluid from a traumatic tap). That's given me a little confidence that I can overcome my nerves and do what needs to be done in a pinch. I don't want to do critical care long term; I'm not enough of an adrenaline junkie! I am learning a ton though.

Life has been insanely busy these last three months. There has been some life reflection in the fleeting quiet moments I have that made me think about what I want out of life long term. It has me rethinking medical specialties, but I am still very undecided. More on that another day.

For now, I'm home today (because I work both days this weekend). Time to finish the bills, get my car fixed, and generally tackle the massive to-do list that backs up after months of working 80 hour weeks.

Again, no promises on frequency of posting. I'll do what I can, but my guess is it will be a busy month!  In general though, I am doing well, my kids are hanging in there (thanks mostly to Tim doing the kid care, with help from Amy for a few months and our families in emergencies). I've had low moments to be sure, but overall I am learning a ton. I've got a great group of supportive people in my program--which is absolutely mandatory. So far, so good.

Sunday, June 24, 2012

Because Facebook is all I have time for...

Momentous day, as posted on Facebook:

Survived my first day of intern year. Only spent 15 hours in the hospital, ran to one code (which was a false alarm), and had patients that were much more stable than they sounded on signout last night. It was an anxiety-filled day, but much better than I expected. So glad to be in a program with wonderful, helpful, and smart people :)

Wednesday, June 13, 2012

Last day

Today is my last day at home. Tomorrow I begin orientation for my internal medicine residency program, and I start on the floors on June 24th.

Where has the time gone? I remember thinking that 4.5 months of maternity leave would seem like an eternity, especially after being back at work 6 weeks after Sophie and working weekends 3 weeks after Josh (and back full time at 8 weeks). 4.5 months? That's forever! I had a huge to-do list, and I had big plans about taking trips with the kids.

Well, time's up. Some of the to-do list got done, but most of it did not. We did manage a few trips together (like to the local zoo), but those were usually weekends when we could all be together. I think yesterday was the first day I took the kids somewhere by myself (that wasn't to a family member's house), and that was just a quick trip to the library. I've taken them out in different groups, but one adult to three kids had me scared. Actually, it was mostly just worry about Josh--what if he bolted or wandered off while I had all three by myself? Sophie is a good listener, and Noah doesn't move yet--Josh is the worry.  But, the library went fine, and now I wish I would've taken them out more on my own.

I am pretty nervous about starting back tomorrow. Some of it is due to the fact that I haven't touched a patient since November. I front loaded my fourth year schedule and didn't take any vacation so that I could take electives and maternity leave starting in February. I have a feeling the patient skills will come back--though I have been re-reading some med school material to make myself feel better.

A lot of my anxiety has to do with the kids. I know Sophie and Josh are fine at daycare. Actually, they are better than fine--they really like it, and they've each been upset when I've kept them home (though they usually get over it quickly). Noah is going to be nanny-ed by my sister until August, then he will go to daycare too. We have a mix of family coverage until my sister gets home from California, but I know he'll be fine.

At least he'll be fed...
 
over 300 oz of milk in the deep freezer, and a few more bags upstairs

Though I can't guarantee he'll sleep. He's surprised us twice now with 7 hours stretches of sleep at night, but most of the time we get a 3-4 hour stretch, then a series of 2 hour stretches. Hey, it's progress.

I do have a few regrets about my time home:

-I wish I had made more of an effort to pump. Yes, 300 oz is awesome, but that was just random pumping. If I had tried to pump regularly, at least once a day, we might've done better. I am not going to beat myself up if I can't keep up with him once I go back to work. I'll bring the pump, and I'll do my best, but I had trouble keeping up with Josh once I started third year. I am sure residency will be even harder. More in the freezer would've prolonged the guaranteed breastfed time.

-I wish I would've gone out more. A big problem was that I was so sleep deprived for probably the first three months. I got less than four hours of sleep--and those were in short bursts--most nights, and he wasn't a consistent napper. I think I got two naps in the whole four months I was home. I just didn't feel like I was coherent enough to take him out when I was so tired. And he was still colicky for the first few months--the last thing I wanted was a melt down in public.

-I wish I would've made exercise a routine. I just started watching my diet a few weeks ago, and I've lost a few pounds (and am now down to about 10 pounds under my pre-pregnancy weight, with a lot more to go). Tim signed up for the Warrior Dash in August, and he's been getting up at 5 every morning to train. I wish I had that motivation. I had planned to get up before 5 several mornings a week so that Tim was still home with the kids. With the poor (or no) sleep I was getting, I couldn't justify purposely sacrificing potential sleep to exercise. Noah and I have gone out a few times walking, but the weather has really only started cooperating in the last few weeks. I've always been exercise-averse, and I feel like I just lost a once in a lifetime opportunity to make exercise a habit.

-I wish I would've cooked more. By no means did we starve, but I had planned to try a bunch of new recipes (especially for the crock pot) so that we wouldn't fall into a rut when I went back to work. Didn't happen. I am hoping that when my sister comes home, maybe she can teach me some healthy recipes that aren't too much work.

Things I am happy with:

-Despite having the to-do list, I did a better job this time of just going with the flow. I recognize this is probably the last baby we'll have, and this is definitely the longest time home I will ever get. If Noah just wanted to snuggle all day, that's what we did. Some days were productive, many were not, but I always tried to put Noah's needs first.

-I have so far avoided the mind games that plagued me the last two times I seriously committed to losing weight. This blog actually started while I was doing "crazy talk" and coming to terms with my binge eating disorder. Diets in the past have really messed with me, and ultimately I've ended up worse off than I was when I started. This time, I have been able to detach myself emotionally. When I have a rough day, I move on to the next day. I know why I have good weeks and bad weeks. The diet has been far from easy--if they were easy, no one would be overweight. It is a constant job to make good decisions. And whatever the outcome in terms of weight loss, my number one goal is to avoid the mind games that have plagued me in the past.

-I am looking forward to starting residency. Of course I am nervous, but I feel like I made a good choice in terms of my program and my field of interest. I am looking forward to the interaction with my co-interns and my patients. I've missed that.

Today is bittersweet. I am happy to take the next step--especially not being a student for the first time since I was 5! But I know how much residency will take time away from my family. I know Tim can handle it, and we stayed here so we would be able to call on family if we needed to. But I'll miss all of the time I've had with the kids. Seriously, all I have to do is look at them, and I smile.



I know I will still get time with them, but I also know there are many nights that I'll miss dinner, playtime, and bedtime. I make a point to tell them how much I love them. I tell them that just because I have to go to work doesn't mean work is more important. I love my career, and I love helping patients. That is part of me as a person. But my family takes priority. Once my training is done, I will have the ability to choose what type of career I want to pursue. Until then, it'll be about quality time, even if the quantity isn't what I'd like it to be.

Tomorrow, I'll be someone's doctor. That is frightening and exciting. I respect that responsibility, and I don't want to be just an ok doctor--my patients deserve better. It's time to find the balance in my life in a whole new way.

Thursday, May 17, 2012

Time never stops

It's been an introspective few weeks. Tim's grandmother passed away last Tuesday after a long battle with cancer and many other serious health concerns. While her illness allowed enough time for everyone to say their goodbyes, it was tough watching her be in so much pain. She did live to be 90, which seems like such an amazing thing to me. Tim now has no living grandparents. I have my mom's mom, and that is all.

I can remember my dad's grandmother vaguely, but I do have strong memories of all four of my grandparents as well as three of Tim's grandparents. That's truly a gift. It got me thinking about how each of them has passed away on different terms.

My mom's dad passed away when he was 74. It was not an easy few weeks--he had several heart attacks, and there was much contention about whether to let him go or try heroic efforts in ICU to potentially let him live less than a full life. It tore my mom's family apart for many years--my mom came in on the not at all popular "let him go" side--and I still think things are tense sometimes because of the rift that formed. I don't wish to speak ill of the dead, but of the 14 years of memories I have of my grandfather, I honestly can't think of a happy one. Most are neutral; he would sit at the kitchen table by himself, watching his shows, while everyone else congregated in the living room. Some memories are negative; he had a mean temper, and some of my older cousins got on his bad side on more than one occasion. Still, he was my grandpa, and we shared a birthday, so his death was a sad time.

I remember being 14 and thinking that 74 seemed old. My grandmother was a widow at 69. At the time, that didn't seem so strange. It was the first death close to me that I was old enough to remember. I do remember my grandmother being so upset at his funeral, and I remember thinking that I wouldn't be so upset at the loss of a man who had basically been a nasty alcoholic his entire life. Remember, I was 14 then. Things were very black and white for me.

I think back now, and many things strike me. One, love is a strange thing. It's not black and white. Someone can hurt you over and over, and you still love them--you still miss them when they are gone. And now having some experience with alcoholism (and Al-Anon) in my own life, I understand how alcoholism as a disease affects families. My mom's family is textbook for the family of an alcoholic. I can see that now; I couldn't see it then. Each person deals with the struggles of the disease in different ways, and that isn't always obvious to outsiders. As a young teenager, I couldn't see it.

I also think about the ages of my grandmother and grandfather differently now. 74 and 69 are no longer old--they are young. Tim's parents are in their mid-60s. They are thankfully healthy and full of life, but I can't imagine losing them any time soon. And my grandmother--she has had almost 18 years of living as a widow. She initially stayed very involved with her church and her friends, but that waned. And then she was in an accident and could no longer drive. And then her church closed. She's had multiple cancers and serious health issues, and her memory has been declining. But now my aunt lives with her, my mom and her sisters pitch in to keep her company, and the family tries to visit as much as we all can. Still, she has had a tough life. No one knows how much time they have left on earth--I hope it is still years for her--but I'm learning it is what you do with the time that counts.

Tim lost both of his grandfathers while we were dating. His dad's dad, who I only met a few times, was a fiery Irishman. Tim's dad's family isn't close, but his grandfather always seemed very nice on the occasions I saw him. He died suddenly of a heart attack while I was on vacation with my family, so I missed his funeral. What I remember most about his passing is the aftermath--Tim helping to clean out a house that could've been on Hoarders, the contention about whether to include one of Tim's uncles in the will, etc. It seemed very stressful, and it was one of the first times that I thought about making sure I didn't leave a mess behind when I left this earth.

Tim's other grandfather, the husband of his grandmother who passed last week, died in 2001. I was at the NIH for a semester, and when I came home for Thanksgiving, Tim's grandfather was diagnosed with a brain tumor. I never heard what kind--though now I can guess--and he died less than two weeks later. My biggest memory of that time is taking all of my finals at NIH early, packing up my part of the three person apartment into my little Chevy Cavalier, and setting a land speed record to get from Washington, DC to near Cleveland in about 5 hours. I had just enough time to change and switch cars before calling hours. I was 21 then and old enough to be a little more savvy about love and loss than I was at 14. I remember Tim's grandpa as a kind, quiet man. He didn't talk a lot, but he was always smiling and friendly. There was so much sadness at his funeral. Everything had progressed so quickly with the cancer that no one really felt like he was gone. He and Tim's grandma had been inseparable--Tim's grandma didn't even have a driver's license. And Tim's grandma had been the one with health issues for many years. While sadness was the number one emotion at his funeral, worry about his grandmother's future was the number two emotion. She ended up living 10+ years without him, but she eventually moved from their apartment into an assisted living facility in the same complex. That was an absolute godsend for her--it kept her social, kept her memory sharp, and kept her chronic medical diseases in check. And when it was time for hospice, she could stay in her room and get the care she needed.

I lost my father's parents in the span of about a year. My dad's dad--my Pop-Pop--was exactly what you think of when you think of a grandfather. He was warm and loving. He lit up whenever the grandkids came around. He had special habits that were all his--getting us to eat vegetables by calling them "racing beans," telling us crusts of bread are what make hair curly, sharing his butterscotch candies, showing us the moon...there are so many things that I remember. Most of all, I just remember how much my grandparent's house was always filled with love. My grandfather developed Alzheimer's when I was a teenager. I think he was officially diagnosed about 7 years before he died, but the signs were there before his diagnosis. It was heart wrenching to watch him progress in the disease. He could still smile and nod when you talked to him, but he wouldn't be able to tell you your name if you asked. Initially you could tell he still knew who his family was, but as time went on, we all became strangers to him. The last few years of his life were especially difficult on my dad's family. Everyone wanted to keep him at home--no nursing homes--but he was wandering off and could occasionally become aggressive. My dad and his siblings each took one night a week at my grandma's house so she could at least get some rest. It was draining on my grandma, my dad, his siblings, and all of the families, but the unspoken word was that you did what you needed to do because of family.

My grandpa passed away in May 2005. He was in hospice with pneumonia for only a few days before he passed, but it gave everyone a chance to say their final goodbyes. I think we all had mixed feelings. It was such a heartbreaking loss to lose Pop-Pop, but we had lost him years earlier to Alzheimer's. We had been mourning him while he was still alive. It was so hard to watch such a wonderful, dignified man become a child again. Alzheimer's is a horrible disease. We all dug into our faith--which had been modeled for so many years by my grandparents--and realized that if you truly believe in heaven, you have to be happy that he is finally in a place where he was no longer contained within the prison of Alzheimer's. I knew that my grandmother believed that; she had the strongest faith of any person I've ever met. The most heartbreaking thing I have ever seen was when she accepted the US flag at the veteran's cemetery for my grandfather's service in WWII. That strong, vibrant women looked pale and fragile. Just watching her try to be the matriarch in the face of all of her pain made me sob.

Although she would absolutely never say it, we all felt like taking care of my grandfather had to be a burden to my grandmother. She was a vibrant, active women. She had been going next door to my dad's family's church nearly every day before my grandpa got sick. They used to sit on their front porch and say hi to everyone who passed--and she knew just about everyone in their town. I thought that returning to her social life after my grandpa passed away would restore the twinkle in her eye that had dwindled with his illness. Instead, she always seemed a little sad. She would light up whenever she had visitors--and a chance to cook a big meal--but I always felt like there was a little part of her missing.

The last time I saw her was at Easter in April of 2006. We were at my aunt's house, and she seemed so happy to see all the grandkids looking for Easter eggs. I have pictures of her on my aunt's front porch smiling widely at the chaos in the front yard. We talked briefly about her upcoming back surgery. She called it a minor surgery to relieve a pinched nerve. She was looking forward to being able to be active again without dealing with all of the pain.

I was in the lab when my mom called and said she had passed away. She had the back surgery, but then she coded in the recovery room, and they couldn't bring her back. The thought is that she probably had a heart attack. We were all in complete shock--she had no major health problems, and no one expected any problems.

I posted about her here. One year to the day that my grandfather passed away, we buried my grandmother. That was by far the hardest funeral I have ever attended. She was the center of the family. I had thought she'd be around to see my kids. She left about a year and a half too soon for that. She was in her late 70s but seemed so much younger. I still miss her--I think about how much she would've loved to see all of the great-grandkids that have been born. If I can give 1/10th the love that she gave to her family, I would consider my life a success.

When we were at the veteran's cemetery on Friday morning for Tim's grandma, my dad came down to help with Noah. We hadn't brought any of the kids to the calling hours or the memorial service the night before, and the big two went into daycare on Friday morning. Noah was pretty well behaved, but my dad took him just in case so Tim and I could say goodbye to his grandmother. After her service, my dad took us to the place in the cemetery where his parents were laid to rest. I showed Noah their names on the wall and told him how much they loved babies. I wished her a happy mother's day and said goodbye. When the kids are older, we'll take them to see their four great grandparents buried in that cemetery. We'll visit the other great grandparents too. We'll tell them about how much they loved their families. We'll look at pictures and tell stories. I want them to know that these people meant so much to us. Saying "family comes first" means much less than showing them people that lived for their families.

I can't believe how quickly time is moving. I remember events from ten years ago like they were yesterday. Tim and I have been together for 16 years--we started dating in 1996--and I still remember those early years. Now we've been married for almost 10 years. We have three kids--one of whom will be five this year!! Noah will be four months old at the end of the month. He no longer looks like a newborn. He's filled out--he's definitely an infant now. He rolled over multiple times yesterday (tummy to back), so he's officially mobile. Where has the time gone? Even being home with him most of these last few months, I still don't know where time is going.

Every time Noah hits a milestone, I get a little sad. While I would love for him to sleep better, I love the baby stage. I put the 0-3 month clothes away a few weeks ago and got choked up. That is likely the last time we'll use those clothes. This is probably the last time I'll have an infant learning to roll over. I know a few posts back we talked about maybe having another, and that door hasn't completely closed, but each day has us thinking we are done at three kids. There are lots of reasons, which I won't go into today, but I think the little baby days are quickly moving behind us. Being sad about it isn't a good reason to have another one--at some point (unless your last name is Duggar), you have to be done.

I love our little family. I am exhausted, but already I see that Noah at 3 months is easier than newborn Noah. And I look at Sophie and Josh, who (pretty much) sleep through the night, and I know the sleepless phase doesn't last forever. My kids are getting so big--I look at Sophie and am awed by the little person she has become. Josh's speech has exploded in the last few months, and his impish grin makes my heart melt. I know my time is going to be tight in the coming years. I signed up for that willingly, and I do have mommy guilt over it more than occasionally. We may not have the quantity of time together that I want, but I want the quality of that time to show them how much I love them. Both Tim and I came from loving families, and we've had great models of love in our grandparents. I want my kids to be close to their grandparents--I want them to have the same feelings of love, security, and comfort that I had. And I want them to grow up knowing the importance of family. If I can do that, I'll consider my job as a mom a success.


Monday, April 30, 2012

3 months

Where has the time gone? Noah is 3 months old today. Last week, Josh turned 2, and Sophie was 4 and 1/2. I have absolutely no idea where all of the days are going, but life just keeps moving faster and faster!

So, current stats:

Eating: well. About every 3 hours when he is napping well, a little more frequently when he's up. No latching issues with him since day one. Also, I haven't begun a pumping schedule yet to prep to go back to work. I've just been pumping before and after I go out of the house (like all the med school teaching stuff I've been doing). Somehow, I always end up with a lot more pumped that he drank. From that, I've got about 250 ounces of breast milk already in the freezer. Glad we have a chest freezer downstairs--I ran out of room in the main freezer! I'm hoping that the success with feeding continues--I know things will get a lot tougher when I am on the wards.

Sleeping: slowly getting better, but not great. I am not exaggerating when I tell you we have tried EVERYTHING to get him to sleep. If it's on babycenter, an online forum, or been done by anyone I know, we've tried it. Against my better judgment, he is sleeping in the bed, between Tim and I, because the only way he sleeps is to hold onto my face with both of his hands. Even then, he is up every 3-4 hours--which is much improved from the up every 90 minutes we were doing before. By the time I feed and change him, that was giving me only about 45 minutes of sleep in bursts. Now I get 2-3 hours at a time--if he isn't restless. Unfortunately for me, he is a loud, active sleeper, so I often get up to make sure he's ok or replace a binky. It's still a work in progress, but it is getting better. I really want to get him out of the bed ASAP (especially since I rolled out of the bed the other night, due to space issues). We know about pillows, blankets, etc, and have tried to make the bed as safe as possible, but I will feel much better when we can get him into the crib. The bassinet is now too small, because he wakes himself up with all of his activity (that inevitably hits the side of the bassinet). I'm working on the crib thing...

Routine: I'm trying to get him more on a schedule, which seems to have gotten him to the 3-4 hours of nighttime sleep stretches he currently has. Baths just wake him up, so we do those in the morning. I am trying the eat-play-sleep routing during the day. I don't wake him up if he is sleeping, but I'll feed/change him, then play with him for a bit to get him tired, and then get him back to sleep no longer than 2 hours since he got up. He likes to be part of the party, and the overtiredness was making him a bear to deal with at night. I'm working on the daytime nap situation too--so far, he'll only sleep in the swing or if I am holding him, which I am trying to work on too.

Can you tell that we were so desperate for any type of sleep that we tried everything?

Otherwise, things are good. The three amigos get along very well, and Sophie and Josh have both taken extreme interest in helping out with their little brother. The car got small quickly. We realize we will have to scale up to a minivan eventually, but we are trying to hold out as long as possible.

We've already upsized from 0-3 month clothes to 3-6 month clothes a few weeks ago, and Noah has hit a growth spurt that suggests we'll be moving up again in a few weeks.

I'm not getting as much done as I had hoped--this is more than twice as long as I was off with the other two--but I'm ok with it. I'm enjoying our time. I'd be lying if I said I didn't miss just have some alone time, or time with other adult humans sans kids, but I know residency is going to limit my kid time in the near future.

So yeah, time is flying. We've already brought up the exersaucer and the Bumbo seat, which Noah enjoys for brief periods. He is a loud, chatty boy who loves to smile and squeal (no real belly laughs yet). Pretty soon, he'll be rolling over (he's done it once already by accident), jumping in the jumparoo, sitting up, eating cereal, and probably getting teeth. These next few months will fly by too, I am sure.

Friday, April 13, 2012

Temporary quiet

I have a rare few minutes of peace. Josh is home after a nasty GI bug started last night, but he is napping. And Noah is napping in the swing. It's a strange feeling to have the house be quiet during the daytime--and it's rare that I actually have time to myself to think.

It's been a busy few weeks. Ok, let's be real--it's been a busy few months, even years. Things did get easier last week with all three munchkins being home. We didn't do anything outrageous, but I think we all got in a rhythm, and by the time Tim got home Thursday night, the house was in decent shape, and the kids were happy.

It's funny--things went well enough by the end of last week that Tim and I were actually halfway debating leaving open the option of a potential future fourth child (is that enough ambiguous terminology?) I was 99% sure at the end of a rough pregnancy, and 95% sure a month into a tough newborn period, that we were done with kids. At my six week visit, I spoke with my OB, and I was supposed to call back to make an appointment for some long-term pregnancy prevention. Funny thing--I haven't called back. I'm not sure why, but part of it is that as things get more manageable, and I see the kids together, I can almost picture another one.

There are lots of reasons why three is enough. First, my pregnancies have been getting progressively tougher. Second, we already have three. Third, it's a good number--each kid gets their own bedroom, and we all fit in a non-minivan. Fourth, we could start to get rid of baby stuff soon. Fifth, I am starting residency in a few months--and Tim will have his hands full with three. Sixth, they are all close enough in age that in a few short years, we'll actually be able to drive distances and take vacations that can have things to do for all of them. Seventh, if we do want to move out of state for fellowship in three years, the kids will be older--and hopefully won't require as much family backup for sick days. Eighth, while it would be lovely to have a sister for Sophie, each pregnancy's odds are still 50:50 for boys and girls--could I handle three boys? And last, we both have examples in our families of the last pregnancy resulting in twins...

Seems like an obvious list, right? There are other reasons too, though I like to think they are less influential (but I am human). I try not to go by what others think, but I am in a profession where many women don't have kids at all, and the ones that do usually stop at one or two. I already got some interesting looks from other doctors and scientists when I was pregnant with my third. Most people I spoke to though that since I had "the full set" (a girl and a boy), why didn't I just stop at two? However, I usually said that I wanted to be done having kids before residency, hence why they are close together, and that usually got a few understanding nods.  I am sure that if I was pregnant again, I would catch a lot of flack--was I not serious about residency? What about my future career? Did I just not understand how babies are made?

Again, I like to think that I am not influenced by what others think. And I know several male doctors who have large families, and no one says anything. But in those cases, the wife stays home or works part time. I do not have intentions of that, though Tim has offered to scale back once I have an attending/faculty position. Still, I would be an oddity among my colleagues, especially already planning to enter a male-dominated field like cardiology.

So with all of these reasons to be done childbearing, why am I even considering a fourth? Well...I'm not sure. We've got the baby routine down, and we have all of the equipment we'd need. Watching the kids play, I can imagine another one in the mix. They can fight like brothers and sisters, but they are absolutely adorable and loving. They are also each unique, and I'd love to see what a fourth would look and act like (somehow, they all have blond hair and blue eyes so far, despite Tim's dark hair and hazel eyes). We are blessed to have the financial means to take care of four, and who cares if Josh and Noah end up having to share a room? Sophie's current room is larger than the room I shared with my two sisters in high school. They'd be fine.

I guess the reason to think about another is more emotional, and the reason to stop is more practical. It's funny, I am definitely practical by nature, but every now and again the emotional part of me wins.

The funniest thing about all of this is that Tim and I had each been debating the same question, though separately, while publicly maintaining that we were done. On Saturday night, I just happened to say, "Is it crazy that part of me is debating doing this again?" Tim then said, "I was thinking the same thing!" You could feel the wave of relief--neither of us wanted to feel like they were forcing the other to consider something. But we were both thinking about the possibility.

Of course, this happened to leak out during Easter at his family, and now they think it's a sure thing that we are doing this again. I definitely don't think we've decided either way. Last night, as I am giving Josh his third bath at 2 AM and washing another load of dirty sheets, I was pretty good with the idea of being done. Other times, I'd love to have another one.

I think we've decided not to decide for a year. Once Noah is sleeping through the night (hopefully), and Tim has a daycare routine with three, we will revisit the idea. I'll be toward the end of my intern year, and I will have a better idea as to how much I think I can handle. I also want to lose at least 20 pounds before I would get pregnant again, hopefully to lower my risk of gestational diabetes.

I guess we'll see. I honestly don't have any idea on how this will turn out. And life is so topsy-turvy right now for other members of my family (more on that soon) that I am wondering how much of this is just wanting comfort and control in my own life.

Who knows? The ending is still unwritten, I guess. If you had told me toward the end of my pregnancy that I would even consider another, I would've called you crazy. Now, less than three months later, and there's a chance we would do this again. Life is a funny thing.

But we do make cute kids.

Thursday, April 05, 2012

Houses, kids, and all those stresses of "adulthood"

I am posting this on Thursday, but writing it on Monday (4/2) night. I don't like to advertise that I am home alone when Tim is traveling, so I try to keep that info limited to people I know. Tim left Sunday night for a business trip and got home late Thursday night. And I had all three kids home this week. By myself. I thought it would be easier than trying to truck them to and from daycare every day. I might've been wrong.

The fun started Saturday. Our water heater gave us a hint that it might be on its way out a month ago, but after turning up the thermostat, we've had no problems. Then, Saturday morning, I was running a bath for Noah and noticed that the water was barely tepid. And it wasn't getting warmer. Tim noticed the same thing at the kitchen faucet. He tried turning the thermostat up again, and turning the tank on and off, but nothing worked. Of course, we had debated running a few loads of laundry and giving the kids their baths on Friday night, but we figured we had all weekend.

And of course, the tank broke on Saturday, and Tim was leaving Sunday. The same thing happened at the old house--the water heater went the day before he left for San Francisco for two weeks. We also knew that replacing a powervent natural gas water heater ran us about $900 in 2005. We checked online and made a few phone calls, and the best we could get was just over $1300 for the same type of tank. Inflation sucks. But, the company said they could have a new tank installed by the afternoon.

Of course, things never go according to plan. The plumbers took a look at the way the builder had installed the old tank, and it wasn't up to code. They had to run new lines, which also meant punching a new hole through the concrete block foundation to vent it out the other side of the house. And the expansion tank needed replaced. All of this added several hundred dollars.

Tim and I are hoping to finish the basement in the next few years, and part of that involved possibly moving the hot water tank (and maybe the furnace, though that is much more complex) in order to gain some floor space in the middle of the basement and wall off some of the mechanical items in a corner. We talked to the plumber about that idea, and he said the cost to install the water heater in its current location and then move it later was very much higher than the cost to just install the new water heater where we wanted it to be. So, after some discussion, we took the first step toward a basement remodel and agreed to move the tank.

The final result was ~$2200 and a delayed install--because of code requirements and re-doing lines, they couldn't put the new tank in until Tuesday. At least we had gotten our tax refund back. Instead of going into the minivan fund, it'll get us hot water for a while. Hopefully the furnace isn't next--it acted up a little over a month ago as well. Both are original to the house (12 years old). That's old for a water heater and on the young side for a furnace. Crossing fingers for only one major repair at a time...

We headed down to Tim's parents for dinner, laundry, and baths/showers. We had planned to go visit Tim's grandma in the nursing home, but we unfortunately had to reschedule. She's in hospice with stage 4 colon cancer, with an ileostomy and ureteral stents because of the size of the tumor. From the sounds of things, she's also in heart failure. She's doing well though, considering she was diagnosed last summer and has had two heart attacks and a minor stroke just in the last few weeks. We saw her a few weekends ago, and we wanted to bring the kids this time, but I think we are rescheduling for Easter. She's a tough lady--she's made it 90 years. She's already beaten the statistics, so I am making no predictions at this point.

We got home late Saturday night--late enough that Tim and I both stayed up past two until Noah stopped fussing enough to attempt sleep. Sleep didn't happen much, as usual, but time marches on. Sophie and I went to Palm Sunday services and the grocery store (which I should remember never to visit on a Sunday). After naps, the kids and I headed to my parents for dinner, and Tim went to the airport. Dinner went fine, though bathtime was marred by Josh pooping in the tub--and it was green from the blue icing he had on his cupcake the night before. He and Sophie had been sharing a bath, and I think Sophie was scarred for life by the poop. She started screaming and crying, "I want to go home!" It was all my mom and I could do to not laugh hysterically. I showered Sophie and Josh off in another bathroom while mom scrubbed the tub of green poop.

Trying to get three sleepy kids in the house and into beds by myself was tricky, but the big two went down without much complaint. Noah and I had a rougher time, but he did have an almost two hour block of sleep. The rest of it was fussing and replacing the binky every few minutes, with a feeding and a diaper change about every two hours.

Monday morning went ok--low expectations helped. We watched cartoons in my bed for a while, then an easy breakfast. Tim's parents came up to watch Sophie and Josh (and wire new electrical for the hot water heater, just in case). I took Noah to his two month checkup. 23 inches (from 19.5) and 12 lbs 11 oz (from 8 lb 8 oz). Both the other kids were sleeping several hour stretches--Sophie was at 5 or 6 hours--by the time they were at 12 lbs. Noah, not so much... The doc thought he looked fine otherwise and just suggested patience. He said most kids sleep through the night between 2 and 4 months. Here's hoping.

Things fell apart a bit in the afternoon. Sophie and Josh didn't nap, despite my efforts. Sophie was mostly quiet, though awake. Josh was climbing and jumping off things most of the time. About 3:30, Sophie came downstairs (and cried because I told her she had to rest with no tv for a while), Noah started screaming bloody murder from a dead sleep, and Josh was crying in his room when I told him for the umpteenth time to stop jumping and lay down. For about half an hour, it was total chaos. I gave Noah a dose of tylenol for his red, warm legs from his shots, but it took a bit to kick in. Finally, a little after 4, Sophie calmed down, Noah ate and fell asleep, and I brought Josh downstairs.

Things got better. We did pancakes for dinner. And then, just before bed, Josh walked over and said, "Poop." I turned him around to check his pants, and I saw poop up his back, outside of his shirt, and down his pants. I unrolled a bunch of paper towels, laid him down on them, and proceeded to de-fecalize him with wipes. Since we had no hot water, a bath was out. He had a similar (though less voluminous) blowout on Saturday for Tim, so maybe he knows there's no hot water for a bath. After cleaning him up, I looked for where the blowout had occurred. I found a bum-sized area on top of a small legal pad filled with Sophie's drawings--and some overlap on the rug.  I cleaned that up, and as I was taking the big two to bed, I saw the biggest spot: there was a bum-level spot on the front edge of the microsuede recliner. As in, the recliner that is one of two pieces of furniture that is NOT a hand me down in the house. I cleaned it up as best I could, and I am praying I didn't ruin the nicest piece we own.

Since bedtime, Noah has been awake. He's feisty from about 9 PM until, well, about 9 AM. It's not as simple as having his days and night confused. He tried to sleep at night. But he is just...ANGRY. He fusses and cries. He doesn't like the swing or the buzzy seat (which he loves during the day). It's not textbook colic, because he doesn't cry continuously the entire time, and he can be calmed briefly. But brief is the key word. It's not usually more than 5-10 minutes before he's fussing again. And the ear-piercing screams at 2 AM. Ugh. But here is hoping he grows out of that.

In all, my first day of single parenting three kids was a FAIL. And I even had Tim's parents to help for a few hours! I'm not sure what else will happen before Tim gets home, but I know I will need a nap. Desperately.

Thursday, March 22, 2012

Rated R read

Ok, this is a rated R read for sure, but Tim is a frequent reader of cracked.com and found this article. Don't read with kids around, or if you are easily offended. If, however, you can get past the sarcastic swearing and vulgar examples, it has some truth to it. Not directed at my family specifically, but I think anyone has had experience with at least one family member, ever, can acknowledge some truth to this.

New blog coming someday, I promise. Match Day was the 16th, I got where I wanted (staying at my home program in Cleveland=not a lot of anticipation, since pretty much anyone who wants to stay, does.) Still not sleeping, but I'll update when I can, I promise.

Wednesday, March 07, 2012

Internal conflict and mommy guilt

I don't have a lot of time to blog anymore; therefore, most posts I've put up are either to narrate an event/reflection in order to preserve it for the future or to vent about something so that I can let it go.

This post is a reflective vent, I guess. It's honest. But it's also not likely to make me any friends. I will qualify my statements in a little bit, but here's the crux of my emotional stress:

I think three kids might have been one kid too many for me. I feel completely incompetent when I have the three of them by myself.

Qualifiers: I love all of my children dearly, and I obviously don't have one specifically in mind that is the one too many. I wouldn't trade them for the world. I can't imagine life without them. And honestly, the only slim glimmer of regret I have about being done having kids is that I am emotionally grieving that 4th child we could have had.

But the last week or so has been really hard. I've had help--and it's still been hard. Josh and Sophie have been going to day care most days since shortly after Noah was born. However, Josh got a nasty cold last week, and I kept him and Sophie home one day just because I could. The morning was rough, but my mom came up around naptime and helped make dinner and wrangle kids. It was manageable.

Josh was nearly 100% improved Sunday night, and then he woke up Monday morning blazing hot. There was no way I was sending him to daycare, and if he wasn't going, I didn't want to battle with Sophie that she needed to go. I did think about sending her--mostly because Noah was up Sunday night with what I presume was his first cold. But, I kept all three kids by myself. And it was ok--Josh was right back to his regular self with some Motrin, and he ate and played like normal. He went down for a nap, and when he got up at four, he was on fire. His temp was 103.2, and I called and got him the last appointment at the doctor's office. Tim was able to duck out of work to take him to the appointment at 5 so that I didn't have to drag two sick boys and Sophie to the doctor myself.

Turns out it was an ear infection, and after a bit of a debacle at the pharmacy, he got his first dose of antibiotics Monday night. Tuesday morning he wasn't even warm when he got up, but the kids have to be fever free for 24 hours before going back to daycare, so I had another day home with all three kids yesterday.

That second day was much rougher. I hadn't really slept in several nights because of Noah. He was gagging himself every time he ate. And he'd fall asleep and then start coughing, which would wake him up. My nights were spent trying to settle him every 15 minutes or so.

By Tuesday, I was exhausted, and I happily accepted help from my mom. Tim had to work late. I knew I would be completely wiped out on my own. Mom came up and let me catch a 2.5 hour nap, which is the longest stretch of solid sleep I've gotten since Noah was born over 5 weeks ago.  She bathed the big two kids, cleaned up the kitchen, and made the house look like a hurricane hadn't hit it for two days straight.

Even with a nap, I am completely exhausted. I was secretly relieved that the big two were headed back to daycare today. Noah still isn't himself, and today was spent with him glued to me (and with multiple clothing changes for both of us). Tim worked late again tonight, so I took Noah in to pick up Josh and Sophie at day care. Josh threw fits the entire way out because I couldn't carry him. Then he threw fits when we tried to go outside on the deck and enjoy the first 60 degree day in months. 

And this is the soundtrack of dinner this evening:
Sophie: Mom, mom, mom, mom, mom, mom, mom...
Me: Sophie, one second. Sophie, sit down. Sophie, use your fork.
Sophie: Mom, mom, mom, mom, mom, mom, mom...
Josh: No! (swats at air). More, more, more (throws spoon). No! (swats at air). More (and repeat).
Noah: screaming as I hold him in one arm and try to cut Josh's carrots one handed. Screaming as I try the bouncy seat, the swing, the bassinet, etc. Calm for a minute, and then coughing--which restarts the screaming.

I had an almost out of body experience at that point. I looked at my kids, and while I loved them, I didn't like them very much. And that made me feel awful.

I thought about the billions of women around the world who do this mothering thing so much better than I do. What mom doesn't like her kids? While that feeling only last a split second (though the guilt will last a lifetime, I am sure), I couldn't believe that I was so bad at this. I had three kids--two of whom have been at daycare most of the time--and I was overwhelmed. My mom was one of nine kids, my dad was one of eight, and my mom stayed home with the five of us until I was in high school. I know tons of stay at home moms. They all make it look so easy. How could I suck so badly at this? Isn't mothering an instinct or something?

I felt like I was in over my head. I'm stubborn, and I somehow end up doing things the hard way much of the time (exhibit A: my PhD). I thought that if I could overcome all of these external barriers that had been put in my way throughout my life, surely I could handle something as natural as having kids. And three kids is not a crazy huge brood, especially compared to what I grew up with in my extended family. I can handle three.

We thought about the third child rationally: we can afford three in daycare (for a year, anyway). We have the space. The timing means we are done before I start residency.

We thought about it emotionally: we love our kids, and wouldn't it be great for them to have another sibling.

And like I said before, I wouldn't trade any of them. If I could go back in time to a year ago, and talk to myself before I got pregnant, I couldn't tell myself not to have a third. Having met Noah, I can't imagine life without him. So this is a very weird place for me to be in. I felt like I was treading water as a mom with two kids, and I feel like I am in completely over my head with three.

What a selfish feeling. I don't stay home with them, and I am about to start a time in my life where I will work 80 hours a week; where I will miss dinner at least two of every four nights and miss bedtime one of every four; where most weekends will require me to work at least one day; and where I will rarely (if ever) get to drop them off or pick them up at daycare. Most of my mommy guilt revolves around not getting to see them enough. And now I am selfish enough to be overwhelmed when I do have all three of them together?

I feel like total crap. I feel like I don't have enough of the good parts of me to split between three kids. I suck at being a stay at home mom. I was thrilled if we were were all out of pajamas by noon and had eaten something that wasn't completely crappy food for three meals. I know these moms who are super organized, have well behaved children, and are able to go out and do educational things with a herd in tow. The thought of me taking three kids four and under out anywhere by myself scares the tar out of me.

We were blessed to be able to have kids; we were blessed to have that happen three times; and we are blessed that they are all pretty healthy. How dare I not be grateful for that every moment of every day.

Maybe it's the hormones. Probably it's the lack of sleep. And I know it will get better. That's actually part of what bothers me--looking ahead instead of enjoying today. Sophie is at this amazing age where she is asking questions all the time. She's so inquisitive. But I feel like I am constantly dividing my attention, and because she can amuse herself, she gets the short end of the stick. I make sure we have one on one girl time, but I don't have the undivided attention she deserves.

And I worry about Josh. He's the middle child, and he's always been a challenge for me. And now he's moved into the terrible twos. We've tried to set up the house in a way where we don't have to constantly be telling him "no." I don't want him to live in time out. But he's taken to swatting people when he doesn't get his way, and hitting means time out. So--he spends a lot of time in time out. I don't want that for him. I try to get one on one time with him too. He loves books, and I think I probably read 30 or more books to him on Monday (they are still short books...) I make sure we cuddle, and that he sits on my lap, and that he gets time to choose the activity we do. I don't know if it is the age or the new sibling (or both), but I've really noticed that he has been acting out a lot more.

And then there's Noah. Poor kid hasn't been himself for days. And a little knowledge is a terrible thing--six weeks of pediatrics experience and I'm thinking about all the things it could be. I'm praying every time that his temp is under 100.4 so that he doesn't have to get admitted for a sepsis workup (which involves a spinal tap). Because he hasn't had nasal drainage--just a cough--I'm thinking maybe it's reflux. Then I think about the few episodes of forceful spitup, and instead of thinking that it is due to air (which is probably is, since it usually comes with a big burp), I start to think about pyloric stenosis (he's the right age, male, etc). He's eating well and outputting well, which is basically all a baby has to do, but I keep going through all of these scenarios. It doesn't help that I worry about whether there really was something wrong with him that caused his NICU stay (instead of attributing it to transient tachypnea of the newborn, which is what it probably was). The doctor thought he looked fine at his two week visit. The one month visit was just a nurse appointment to get his second hepatitis shot. I'll talk to the pediatrician again at the 2 month visit, but I just need to find a way to stop worrying.

I just feel like I am failing each of the kids in a different way. Maybe if I only had one or two, I would fail them less. Again, I could never pick one child over another. I just wish I was better at this mom thing.

Even when it is only Noah and I at home, it's a struggle to do even minor things. Some days he sleeps in the bassinet, and I can actually cook/clean/cross things off the to-do list. Other days are like today, where he doesn't rest unless I am holding him. I've tried the Moby wrap and a baby carrier, and he'll put up with them for a short time, but he doesn't like it for long. None of my kids have like to be swaddled, so maybe that has something to do with it.

I just feel like I'm a veteran mom now. It was ok to not get out of bed when I was home on leave with Sophie. She was my first--I was still learning. Noah is my third. I should be a domestic rock star by now.

Instead, I need help. Lots of it. I'm so tired by the end of the day that Tim does most of the dishes/toy pickup. Dinners are usually quick meals or leftovers from days when I did cook. I sometimes get bursts of energy that let me clean a room or two. Honestly though, without my mom's help yesterday, I would've been even more of a wreck. And I don't begrudge Tim the nights he has to work late. In a few months, he'll be covering for me when I work late half of the time.

Shouldn't I be able to take care of three kids by myself without feeling like I want to pass out at the end of the day? With just a newborn, shouldn't I be able to cook and clean during the day so other people don't have to pick up the slack? Shouldn't I be reveling in every day I get with my kids while they are young instead of daydreaming about a time when we won't need a diaper bag and we can actually all go to a restaurant without a meltdown? I know time is short. And with the recent tragedies all over the news, I know that each day is a gift. And yet, I still find myself looking at the clock during dinner and counting the minutes until bedtime.

I know that this makes me sound like a crappy mom. I'll say it again: I love my kids, and I wouldn't trade them for anything in the world. I really try my best to teach them right from wrong, how to be compassionate, how to share. I try to keep them safe from every danger. I want to do what's best for my kids. And that is where the guilt comes from: would I be a better mom if I only had one or two instead of three?

That's my internal struggle, but it is also a moot point. We have three, I love all three of them in ways I could never quantify, and I just have to find a way to be a better mom to them. Whether or not they are going through tough developmental times, it doesn't give me the right to not be the mom they deserve.

One other qualifier: these moments of bad mommy-ness feelings aren't all the time. There are plenty of times (mostly when the kids are not trying to kill each other) where I feel like we must be doing ok. Sophie and Josh can antagonize each other, but they also love each other. My heart melts when Josh runs up and hugs Sophie when she falls, or when Sophie brings Josh a toy so that they can play. I love that they have each other. And I love that someday soon, Noah will be able to interact with them too. I just pray that the sibling experience they will have with each other counteracts all the mistakes I make as a mom. It's that sibling love that makes me feel better about deciding to have three. They will have each other. I loved having siblings, and I know Tim wishes he had some. It makes a house chaotic. And it creates much drama. But what I learned growing up is that even if you fight with a sibling, you always love them, and they always love you. And no matter what, they are always on your team. No one will fight for you like a sibling will. That is what I love about family. Even if you don't like each other sometimes, you always love each other.

And that is what I told myself tonight. I still feel bad for not liking my kids, even for a millisecond, but I will always love them. God help me when then become teenagers, but I will always love them.

I am going to try and be a better mom. I don't think I'll ever be a supermom, and I think it is good for everyone that I am not a full time stay at home mom, but I love my kids. I'm trying my best. Hopefully, when I start getting sleep again, I'll have more energy to give. I don't want to be in survival mode forever. I want to enjoy each second with my family. Those seconds will be much more scarce in the near future. I need to remember that.

(And PS: just so you don't think this is all hormones, I did take a postpartum depression screen. The high score is 30, the cutoff for possible depression is 10, and I scored a 4. No thoughts of hurting myself or the baby. No crying. Just the occasional feeling--like tonight--of being overwhelmed, and some infrequent worry about if everything is ok with Noah. Like I said in the first part, the blog is a venting tool for me. Most of the time has been just fine, but I really needed to air this out tonight).

Tuesday, February 21, 2012

Learning and re-learning

Noah was three weeks old yesterday, which just seems unreal to me. With this being my third go round, I figured I'd be a pro at multitasking--especially since the big two kids are at daycare during the day. Wrong. Other truths I am learning and re-learning:

-Sleep when the baby sleeps is total crap. Ok, I actually learned this with Sophie, but it's been true each time. At least during these first few weeks, baby sleep tends to be short in duration. And when it is a decent length nap, it is not predictable from day to day. Usually, naps last a few minutes, unless I am holding Noah. Sometimes, like yesterday afternoon, he'll actually sleep somewhere (bouncy seat, bassinet) for a few hours. Figuring that he will wake up soon, I don't bother to lay down. Then, as time goes on, I figure he can't be far from waking up, so there is no point in laying down now. Inevitably, I get ready to take a nap, and then he wakes up. Completely unpredictable, and the reason why I haven't gotten a single nap since he's been born.

-I can function on very little sleep. I think back to fall 2010, when I was back in third year med school, writing my PhD thesis in the evenings, teaching chemistry on the weekends--with a 6 month old baby and a three year old. I was only getting a few hours of sleep a night for several months, and I managed. Noah is waking up every two hours or so at night right now. It is getting better--now, instead of crying for an hour each time he gets up, he eats, gets a diaper change, fusses for a bit, and then goes back down. By the time I fall asleep, I get about an hour of sleep until he gets up the next time. Not ideal, but still manageable. Better than the 0 hours of sleep I got initially.

-Pregnancy is expensive. We have good health insurance through Tim's work, but anything beyond a regular OB office visit has an additional out of pocket cost to us. Each ultrasound costs us between $100-200, each NST was over $40,  each prescription for test strips or insulin was $25, and each high risk OB appointment had a copay. Add the deductibles for Noah and I each having an inpatient stay, and it adds up beyond four figures quickly. And I haven't seen the NICU bill yet (which I hope is fully covered). We added it up with Sophie, and insurance was billed over $25000 for a normal, healthy pregnancy. I expect the NICU bill alone to come close to that. Thank God we have insurance (even with the out of pocket costs), but is it any wonder why one hospital stay is enough to push an uninsured (or underinsured) person into debt and bankruptcy?

-I don't love hearing him cry, but I know Noah will be ok for two minutes if I need to put him down to go to the bathroom, or if I need to eat something (speaking of which, how is it that a sleeping baby knows exactly when you are going to eat? Sixth sense or something...)

-Low to no expectations is the way to go. I still have thank you notes to write, and my pre-baby to-do list hasn't gotten shorter, but I remember now how days with newborns go. They grow up fast, so I don't mind that most of my day is spent cuddling. Noah is already bigger than he was just a few weeks ago. This is the first time I actually have a real maternity leave, and I want to enjoy it. With Sophie, I was working from home on my thesis, and with Josh, I was back in the lab on the weekends less than three weeks post-childbirth. I need to embrace the opportunity to live my days with a minimal agenda. Not easy for a control freak, but a necessary lesson.

-Daytime TV sucks, even with satellite. Seriously.

-I need to listen to my body. I am still learning this one, as evidenced by the previous post re: what is/isn't labor. But, when I got a GI bug this weekend, I learned from last time and tried to stay hydrated. I needed three liters of IV fluids during labor before I had (very concentrated) urine output. I knew my GI stuff the night before labor was bad, but I didn't realize just how bad it was. I didn't want to end up in the hospital this time, so when I started noticing things like, "hey, my mouth is totally dry, and my skin is tenting a bit," I sent Tim out for powerade, and I kept drinking fluids all day. Disaster averted.

-I made a good choice with my husband. I don't think I say it enough, but Tim really keeps things together on a daily basis. In the mornings, Noah tends to get up between 6-6:30 to eat. By the time I feed and change him, it's about 7. Tim gets the kids up, changes them, brings them in to say hello, then takes them downstairs for breakfast and gets them out the door by 7:30. All without me getting up. Unfortunately, this doesn't usually mean I get more sleep. But he tries. He does all the daycare runs, most of the laundry and dishes, and whatever errands need to be done. He rocks.

-Typing one handed is slow and error prone. Sorry.

-Routine is king. Thank goodness the big two have routines. It has saved everyone's sanity. After the first week of craziness, the older two went back to daycare; I felt bad being home without them, but it has been the best thing for everyone. They know exactly how their days go, which gives them security. They see all their playmates at school, which keeps them social. And when they get home, we have dinner, playtime, baths, and then bed between 7:30-8 o'clock. I'd love to keep them up later, but we've learned that they need every bit of that sleep--and they still get up around 7 AM on the weekends, so we try to keep bedtimes consistent then too. We've learned what life looks like with no routine, and it ain't pretty.

-Quality time is important. Tim and I have made a point to have one on one time with each of the kids. It might be an hour coloring, or reading books, or playing with blocks. The activity matters less than the time. Once we got re-settled into our routine, we found time to spend individually with Sophie and Josh, and that has stopped a lot of the acting out problems we had right after we brought Noah home. It's still a work in progress, but it's getting better.

-Help the siblings feel like they share "ownership" of the baby. I don't think "ownership" is the right word--I don't "own" any of my kids--but I am too sleep deprived to come up with a better term. We want Sophie and Josh to feel like they have important, unique jobs as siblings. Sophie loved helping with Josh, but now that she is older, she loves helping with Noah in new ways. Even Josh has shown that he wants to be involved--when Noah cries, Josh runs over and grabs the binky (which was his just a few months ago), brings it to Noah and I, and lays his head on Noah's lap while he says, "shh, baby." It's heartbreakingly adorable, and I take no credit for it. I don't have any idea how to teach them to love each other--they just do. It's awesome. I can encourage them to help each other, and I try to reinforce the positive behavior when I see it, but the rest comes from somewhere beyond me.

-Motrin rules. I missed being able to take anything other than tylenol while pregnant. Ibuprofen is so much better!!

-It is awesome having family around to help. I debated applying to other cities for residency but decided to stay in Cleveland. I am positive that was the right choice. My family has been so great with meals and extra sets of hands. Tim's mom surprised him and flew up from Florida the weekend after Noah was born, which was great. It is so wonderful to have people we love nearby. I don't know if we could've had one child, let alone three, without all of the support.

-I missed chocolate. It's a short-lived relationship though; I am giving up chocolate for Lent, so the past three weeks will be all the chocolate time I get for a while. That is probably good for my waistline.

-Still can't have broccoli early on in breastfeeding. 3/3 with gassy babies post broccoli. It does get better as they get older, thank goodness.

-Procrastination isn't all bad. I haven't had a haircut since January 2011--something I can get away with having curly hair that hides uneven ends--mostly because I haven't had time. I never meant to grow my hair as long as it is now, but it is now long enough to cut and donate. I donated my hair after I had Sophie to Locks of Love. Since then, several people have told me that Beautiful Lengths is a better program, and I plan to send my hair there. I want to have my hair appointment scheduled before I chop, just to make sure I am not walking around with crazy hair for months. Soon though, the hair will be a manageable length again.

-Three car seats in the back of a car is a pain, but possible. It's a huge pain trying to buckle Sophie into her booster in the middle seat. Trying to get three of them into the car in a parking lot in an organized way, when I am the only adult, is like trying to plan a military operation. A minivan would make life so much easier, but the longer we wait, the more money we save not having that car payment. That's me, queen of the pros and cons list, master of delayed gratification.

-I though pregnancy brain was bad; newborn brain is worse. As evidenced by the fact that I had more to say, but can't remember...

Thursday, February 09, 2012

Baby recap

I had forgotten how life with a newborn goes...I get 15-20 minutes at a time to do things, but I only get occasional blocks of time to accomplish something substantial. Hence, the delay in the recap.

My disclaimer on this is that the baby recap is as much for me as it is for you--so, there may be a lot more detail in here than you care to read about :) Hopefully it'll be enough detail for me to someday make a baby book (since I have such a stellar track record to this point: 0/2).

As I alluded to in the last post, the story actually starts on Monday, 1/23. I was in for my scheduled non-stress test, which just involved me sitting on the fetal monitors for about an hour. The nurse showed the strip to the doctor in clinic, and he was concerned at the number of fetal decelerations I was having. Basically, the heart rate would go from a baseline of about 150 bpm to 165, but then it would drop into the 110s/120s for a few seconds after each acceleration. Sometimes the drops were associated with contractions, sometimes not. The thought was they were probably variable decelerations, but since I was 37 weeks and technically high risk, the doctor wanted to be safe, and he sent me for a biophysical profile.

I went to wait for the ultrasound, but I was continuing to have contractions every 5 minutes that were a little uncomfortable. The doctor had made it sound like delivery was potentially imminent, depending on the BPP, so I gave Tim and my mom a heads up while I waited. The techs that did the ultrasound commented on how big the baby was (estimated at 7 lbs 14 oz at 37 weeks--a biggie) and how low his head was. In fact, they had to mash on my pelvic bones to try and get a head measurement--and of course, they were pressing right over where I had injured myself falling several weeks earlier. The pain was pretty rough, but I understood that they needed the measurements to get a good reading.

The doctor came into look at the BPP info, and everything (amniotic fluid levels, fetal movements, breathing, tone, and heart rate) looked fine. Ironically, the doctor reading this ultrasound was the same that read my final ultrasound when I was pregnant with Josh--and in both cases, his suggestion was just to deliver. For Josh, it was at around 38 weeks, and the suggestion was because he was measuring so large. This time, his first question was, "What is your cervix doing?" His thought was that if I was making progress at all, I should just be delivered.

I told the doc that as of the previous Friday (3 days earlier), I had no cervical change. He told me that he'd discuss with the clinic doctor that was in, and they'd get back to me. So, I hung out for about another hour. The clinic doctor (who I had never met) had me come back. He was very pleasant, and he suggested that we check to see if I was making progress. When he checked me, he said I was 4 cm dilated. He asked about contractions, and I said I was still having them every 5 minutes or so. He told me that he'd send me home for now, but he wouldn't be surprised if I went into labor that day. He thought just the cervical check might be enough to start real labor. I asked when I should come back in (since I was already having the 5 minute contractions). He said if things got uncomfortable, give a call and come back--he also said I shouldn't wait until the contractions got closer than 5 minutes, since third babies can come fairly rapidly.

So, I went home...and started having fairly painful contractions. They lasted over an hour, and I decided to start making phone calls. It was late afternoon by this point. I told my mom and Tim not to rush. We'd get the kids, get them settled, and then head back up to the hospital, just to get checked out. I wasn't getting contractions closer together, so I figured we had time.

Of course, after making this plan, the contractions very gradually started becoming less painful. They were still 5 minutes apart, but they were more manageable. I debated scrapping heading back up to the hospital. Instead, I called the office and spoke to the doc on call, explaining the situation. She suggested coming back in, just to be safe. So, about 7 PM, Tim and I headed back up to the hospital.

We got checked in and put on monitors. The contractions were still coming regularly, but the discomfort was nearly gone. The resident checked me, and she called me 3 cm, 50% effaced, and -3 station--also known as not really in labor. They kept me on the monitors for a while, and then we decided that I'd walk for about an hour, and she'd check me again. If there was change, she'd admit me. If not, home I go.

So, I walked around the hospital in my very fashionable gown for about an hour. I ran into one of my MSTP classmates who is now a surgical intern, but otherwise it was pretty much empty around the hospital loop. After the walk, it was back to the room to wait for the resident. The verdict: no change. So, about 11 PM, we headed home to wait for real labor.

I give you this false alarm to preface why I was thinking the way I was the following Monday. In the interim, I had another NST, my OB appointment, and some serious contractions on Wednesday. I had several more instance of uncomfortable contractions throughout the week, but the pattern seemed to be the same: contractions that started in my low back and wrapped around the front, coming every 4-6 minutes, and uncomfortable enough that it made me change position and do some deep breathing. Inevitably, they'd last about an hour, and then they'd go away.

I actually had almost no contractions on Sunday--which was a good thing, because late Sunday afternoon, my GI system went nuts. I didn't have a fever, and it was lower GI, but I lived in the bathroom Sunday evening into the night. I stayed downstairs Sunday night because I was still very uncomfortable from the pelvic pain (worsened by Monday's ultrasound), couldn't get in and out of bed easily, and I needed to make frequent trips to the bathroom. I could tell I was getting dehydrated, but everything I ate or drank exited quickly. I figured I'd do the best I could and just take it easy.

So Monday, 1/30, I left home about 9 AM for my 10 AM NST. Tim had offered to go with me, but because I hadn't had any real contractions in over 24 hours, I told him just to go to work. I started having some contractions just before I left. They were a little different than the prior week's contractions--less low back, mostly low abdomen/pelvis, with about the same amount of pelvic pressure. I figured they were due to the GI distress/dehydration, so I left for my appointment. As I was driving, I started timing the contractions. They were 4-6 minutes, and they were definitely uncomfortable. I was able to park and walk to my doctor's office, but I had to stop periodically and let the contraction pass. I got into the office and went on the monitors. Baby looked good, and the contractions were staying steady. The nurse had seen me with contractions like this before, and they weren't getting closer, so once the doctor cleared my NST, I left.

I debated asking someone to check me, but I was still thinking about the false labor from the week before, so I just headed back to my car. I called Tim just before I got to the parking garage, and he could hear me breathing through the contractions. I felt they were getting a bit closer--maybe 3-4 minutes--and I had to stop about every 30 feet to breathe. I wouldn't call them painful though; I thought that labor would be painful, and these were just uncomfortable. He recommended that I go back to the office. I told him I could always come back later.

I took the elevator to my car, and I could barely walk the short distance to where I parked. I had the keys in the ignition and was about to drive out, and something made me call the office again. At 10:50 AM, I spoke to the secretary (who recognized me, since I basically lived in the office), and the nurse she handed me to told me to come back, and she'd have the midwife check me, just to be safe.  So I waddled back to the office, deep breathing the whole way.

I got in a few minutes later, and the secretary wished me well, hoping this was it. I still had doubts. It took just about two minutes for the midwife to check me. I think she had doubts too--until she checked and said I was 6 cm. She looked at me incredulously when I told her I was going to go home. She said, "You're having a baby," and made the call upstairs to labor and delivery. So, at about 11:15, I called Tim and my mom to tell them we were having a baby!

The same resident from triage a week earlier came by to check me. At about 11:30, she called me 7 cm, 100% effaced, and 0 station. I was breathing through uncomfortable contractions, but while they weren't fun, I still wouldn't have used the word pain. She said she'd wait to break my water until the attending was out of the OR, but she expected things to go pretty quickly after that. I told her I was waiting for my husband anyway, and she asked if I wanted an epidural. I said yes please! I was hoping that would slow things down enough to give Tim a chance to get to the hospital.

The anesthesiologist got in shortly thereafter, and so did Tim. I had my epidural in by 12:30, but my blood pressures dropped fairly dramatically afterward, and it took about an hour (and several rounds of pressor infusions) to get my BP up over 100/60. Nothing scary, but it dropped enough where I got pale, dizzy, and nauseated just lying in the bed, and the docs wanted to make sure it was up high enough to keep getting good blood flow to the baby. By a little after 1, the epidural had take the edge off of the contractions--I could feel pressure, but the discomfort was basically gone. Life was much happier!

My mom and Jen came up soon after, and Joe was up not too long after that. Another resident had come by after the epidural was in, and she called me 9.5 cm with a reducible anterior lip--basically complete. I had done the 7-10 cm transition before the epidural kicked in; that meant I survived the worst part of labor without pain medication. I knew that the delivery was typically the most painful part for me--and the part that the epidural was least likely to help with, judging by past experience--but I was kind of impressed with my pain tolerance. I had gotten epidurals much earlier with the other two kids. I never even got to 7 cm before epidurals with them. The frightening thing was that the labor pains were never as excruciating as I expected, and I think I could've very easily had this baby at home (or in the car) if I had waited for the type of labor pains I was expecting.

At 3 pm, the midwife came by to check me again. My water hadn't broken yet on its own, but I was otherwise ready to go, so she broke my water. She suggested a trial push, which moved the baby down some, but she suggested waiting to push any more until after we gave labor a chance to push the baby down. Since my blood pressure had stabilized, the nurse sat me up, and we let gravity and labor work.

My OB popped by about this time--she has clinic off the hospital campus on Monday, but she heard I was in labor and wanted to stop by and say hi. Her partner had come by just before to introduce herself, and I thought she seemed like a wonderful doctor, so I told my OB that I was happy to let the on call doc deliver me.

I started having more pressure with each contraction, and I could tell that we weren't far from delivery. I never had a clear urge to push with Sophie--maybe because I pushed for 3.5 hours with her--but I did have that feeling with Josh. I was still unfortunately having some pressure due to my lingering GI issues as well, so it was hard for me to determine exactly where the pressure was coming from. I told the nurse a little after 4 that I thought we were close.

The attending doc came back shortly thereafter, and she checked me. The good news was that the baby had descended a bit, though he was still a little higher than she likes to start pushing. The bad news was that I was bleeding--a lot--and she was worried that I might have abrupted. The fetal monitors were still ok, but as the baby descended, it was harder and harder to follow the tracing. She said that she'd usually give me more time to stretch and let the baby do the work, but because of the bleeding, it was go time.

This is the part where things get blurry for me. Tim tells me that all of a sudden, there went from two people in the room (the attending and the nurse) to about 12. They had planned to call pediatrics for the delivery, just because of the diabetes, but apparently the bleeding caused a bunch of extra people to be on hand for me and the baby.

I think I only pushed about 10 minutes, but they were an excruciating 10 minutes. The pain was so bad that I couldn't even open my eyes. I was actually worried I might pass out at one point because I was so lightheaded. Tim and the doc did a great job of talking me through. The doctor told me afterward that the pain was likely so bad because of a few things: no time to stretch things out, the placental abruption itself is painful, and the little man came out sunny side up (occiput posterior). This is a painful position, and it effectively makes a tight space tighter during delivery. It makes sense, given my presentation: back labor, persistent anterior cervical lip, prolonged labor compared to presentation, and increased stress on the tissues at delivery. Looking back on how things were happening, I'm thrilled that the doc was able to deliver me so quickly. With the big head, OP position, and abruption, there's a decent chance I might've needed an emergency c-section. Instead, we had less than 8 hours of labor total, no need for pitocin this time, and a quick (though painful) delivery.

I got to hold Noah for a little while while they fixed me up. The doctor did confirm the abruption after the placenta was delivered. She told me that while it didn't mean I couldn't have more kids, it was something I should tell any future OB if I got pregnant again. I reassured her that another pregnancy wasn't in the cards, but I appreciated the information. Noah was doing well initially after delivery--his Apgars were 8 and 8, with some residual blueness just beyond the hands and feet. He measured 8 lbs 8 oz, 19.5 inches, with a head circumference of 36 cm. The pediatrician had checked him at delivery and thought he was doing ok. Not too long afterward (maybe 1/2 hour or so), he started grunting while breathing. He was still having normal oxygen saturation, but the OB wanted the pediatrician to come back and take another look. They came back shortly after, and they called the NICU fellow to come and look. The nurse had put Noah back in the warmer, with some blow-by oxygen, and his cyanosis had decreased centrally, with just a little remaining at the extremities. The NICU fellow discussed with the pediatrician for a little bit, and they decided that Noah should go to the NICU for respiratory distress, just to be safe.

I had a hard time with this. All of the ultrasounds had looked great, and I never had any problems with the other kids. I hadn't even thought about the possibility that they might have to take Noah to the NICU. I was beyond 38 weeks--full term--and I had a big baby. He should be great. But I knew it was better to be safe than sorry.

They took Noah away before my family could come back up and see him. Tim and I got to hold him briefly, and they they took him out about 5:30. I was pretty upset, and the OB was very sweet and tried to comfort me. What we had been told at that time was that they would watch Noah in the NICU, probably overnight, and then he might be able to come back to the regular nursery the next day.

Jen had gone home to get the kids and get them dinner, and my mom and Joe came back up to the delivery room after Noah left. Jay and Kim came up with the girls too. It was nice to see everyone, but it felt empty to be in a delivery room with no baby. The NICU had said to give them an hour or so to get things situated, and then Tim could come over to check on things. He headed over there, and family got to go over a few people at a time to see Noah. Jen brought the kids up with my dad after dinner. It was nice to see them, though I could tell Sophie and Josh were a little confused about what was going on. The NICU did not allow kids under 12, so there was no way they could see Noah. I kept trying to explain that to Sophie, but all she had been told over and over again was that she'd get to see her baby brother at the hospital. It was too late to try and explain to her now why that couldn't happen.

We were waiting to be transferred up to a recovery floor, and as it got past 8 o'clock, I could tell Sophie and Josh needed to head home to bed. Tim was going to stay with me, and my mom was going to stay with the kids. People started heading out soon thereafter, and at about 9:30, we got moved to our room.

The women's hospital has two recovery floors, which were recently redone and are very spacious single rooms. The renovations had just started when we had Josh, but even then, the rooms were more than big enough. I was looking forward to finally getting to enjoy the new rooms. Imagine my surprise when they told me I wasn't going to floor 3 or 5 for recovery--I was going to 6. I had been on 6 for a cardiology consult in August. It was the gyn surgery/preterm labor floor. It was old, dark, and had little rooms. Instead of the nice, bright, large single rooms,  I was going to a small room that barely fit a bed and had a shared bathroom with another patient in the neighboring room.

When we got up to the floor, the nurse had some trouble locating postpartum supplies. He was very nice, be he said he'd have to go look for some items like large pads, a sitz bath, ice packs, dermoplast, and witch hazel pads. These are things that were usually pre-stocked in the recovery rooms--I had never had to ask for any supplies while I was there with Sophie and Josh. Once I got checked into floor 6, Tim wheeled me down to the 4th floor, towards the NICU. I hadn't seen my son in over 4 hours, and I was anxious to get there.

I was overwhelmed by the NICU. It had recently undergone a huge renovation. Each baby had their own room, with plenty of space, a rocking chair, a large couch, personal lockers, and a mini fridge. There were also multiple family lounges and bathrooms with showers on the floor. Between the main NICU and the stepdown unit, there were 82 private beds. It was unreal--like a hospital unto itself, but one that wasn't sterile and cold. There were lots of bright colors, and the NICU was subdivided into four "pods" that felt less overwhelming.

I was glad that Noah had such a beautiful place to stay, but it was still overwhelming to see him in his little warmer, with an IV in his left hand and a bunch of leads attached to his chest. He didn't require oxygen, which was a good sign, and he was sleeping peacefully when we got there.
I don't know how first time parents feel in the NICU, but even being a "veteran" parent, I found myself unsure of how to pick him up, feed him, change him, etc with all of his wires. The nurse was very nice and helpful--as were all of the nurses we saw in the NICU--and she helped us get settled in. We spent a few hours there Monday night, and the plan was for me to pump overnight and bring it down. He didn't eat after delivery, and he wasn't very interested Monday night, so I said it was fine if he needed a little formula in addition to what I could pump. I am sure that might make me unpopular with some people, but I thought his comfort and nutrition was most important--I knew we'd have lots of time for nursing later.

Tuesday morning, I waited for my doctors while Tim headed over to the NICU. Overnight, I had pumped twice and was anxious to feed Noah, but I had to wait for the on service doctor to see me. Unfortunately, it was the one doctor in the practice I don't particularly care for (and the one that helped deliver Josh), so I was underwhelmed when she finally came by. She obviously didn't know much about me--she thought I was a c-section, and she hadn't realized Noah was in the NICU. After she left, I walked over to the NICU and just caught the end of the team rounding on Noah. It turned out that he was signed up for a 48 hours stay, since he was now a "rule out sepsis" baby. He had already been given ampicillin and gentimycin, and until the 48 cultures came back, he couldn't go to the nursery. This also meant he couldn't come to my room, and I wouldn't be leaving the 6th floor. I was really disappointed by this--I was unimpressed with my floor (those postpartum supplies never did show up), and I knew this meant that Sophie and Josh couldn't come to see Noah while he was in the hospital. It also meant that I might be discharged before Noah. His cultures were due back at 7 PM on Wednesday--and I would be discharged Wednesday morning. I figured this meant he wouldn't be discharged until Thursday morning, after the NICU team rounded on him.

Tim had to leave to go to work Tuesday afternoon. He had a big meeting Wednesday afternoon that he needed to attend, and there was still some work to do for it. He left after lunch Tuesday, and I basically had Noah to myself in the afternoon. I avoided going back to my room--partially because I wanted to be with my son, and partially because my room creeped me out. I had a woman on one side who screamed all day long about her pain (thin walls--she was a 25 week pregnant woman who had come in with contractions, but once the contractions stopped and she was going to be discharged, she screamed about her pain constantly. Was she trying to delay discharge? Who knows...). I shared a bathroom with a woman on the other side--I could occasionally hear her on fetal monitors, but all I knew what that the bathroom was occupied either by her or her male companion for most of the day.  I went back to my room for my meals, my motrin every 6 hours, and my vitals check once a shift...and that was about it. I was walking back and forth from my room to the NICU less than 24 hours after delivery. It wasn't because I wasn't in pain, but I didn't have a way for someone to wheel me down there, so I did what I needed to do.

By the end of the day Tuesday, Noah was eating a lot better, and I had caught up to him with my pumping. I got to visit with a mom/former MSTP friend of mine, which made the day less lonely. Tim went home after work to be with the kids, and my mom and dad came up to the NICU. People had gotten to see Noah in the NICU on Monday, but no one had gotten to hold him. I had a nice visit with my parents, they got to hold Noah, and then it was back to my room for the night (pumping every few hours).

Wednesday, Tim took the kids into daycare in the morning, and then he came up to the NICU. I waited for my doctor to discharge me, and then I would head over to the NICU. My regular OB came by just to make a social visit, which was nice, but the service attending still hadn't shown up by the time the NICU team rounded. I felt like a prisoner in my room. I had pumped enough to feed Noah, but I wanted to be over there. Tim relayed good news from the team--his 24 hour cultures had been negative, and the suspicion for sepsis was low, so the NICU team was willing to discharge Noah around dinner time (with an informal call to the lab to make sure the cultures were still negative). That just made me more antsy to be discharged so I could go to the NICU. I was showered, packed, and ready to go since 9 AM. I had signed all the paperwork with the nurses. I was just waiting for the OB to lay eyes on me so I could go.

Noah was scheduled to be circumcised at 2 PM, and I wanted to at least see him before he went, so I told my nurse that I'd be over at the NICU at 1:45--and that the docs could call over if they came by. She was sympathetic to my situation, and she said she had paged them multiple times to see if they were going to see me or just sign off on the paperwork. I went over (finally!) at 2 to see Noah--Tim and Jen were both with him, but they had to leave by 2 for work/school, so no one would be there after 2. I stopped by, held him for a bit, and then headed back to my room. The nurse told me that the doc was just going to sign off on my discharge without seeing me (which sounded unreal to me, but whatever--I was tired of waiting). I grabbed my bags and some veggie sticks from the patient fridge (I hadn't ordered lunch, figuring I'd be gone before then), and I trekked over to the NICU.

Noah's circ was delayed until 3, so I got to see him for a bit longer (though not feed him yet, due to the circ). My former lab PI and my postdoc friend came over to visit about 2:30. They got to see Noah briefly before he was taken back, and then we chatted for a while. When Noah got back, he was ravenous, and things got a little hectic, so the visitors took off, and Noah and I hung out again. The nurse said that we might be able to go as soon as 5 PM, but Tim's meeting ran long, and there were a few paperwork issues, so we didn't actually get to leave until almost 7 PM. It was weird to finally get to hold Noah without all of the wires attached. I packed everything up, and when Tim arrived, we were ready to go. It was a much different experience than when we left with the two other kids. The recovery floors have a system--discharges start about 11 AM (we were usually out around noon), mom gets wheeled out carrying the baby, the baby has to be checked out at the desk with the electronic tracking bands deactivated, and the nurse wheels you all the way to the valet station and the car.  Here, Tim brought the car seat in, we put Noah in it, and we just...walked out. Obviously, there was security that we had to be buzzed through, but between me being discharged and walking myself over to the NICU, and now Tim and I walking out carrying Noah, things just seemed much less official.

We headed home, where my parents were watching the kids. We hadn't told the kids for sure that we would be home Wednesday, figuring it would be tough to explain another setback to Sophie. Instead, my parents had them ready, and we now have video of us surprising Sophie and Josh. It was adorable. I hadn't seen them since Monday night, and they hadn't seen Noah at all, so it was so nice to be a family again.



Things have been both easier and harder than I expected. Despite the first day setbacks, Noah eats like a champ--with none of the latching trouble the other two had. Sophie and Josh have both been great with Noah, but there has been some acting out for attention--Sophie much more than Josh. We are working hard to make sure they both get one on one attention, but there have been more than a few frustrating moments.

Noah is sleeping about as expected--not a ton at night, but that won't last forever.
I am recovering faster physically than I did with the other two, mostly out of necessity. The expected areas are still sore, especially when I overdo it. Happily, being sick for most of the pregnancy had some rewards. One, even recovering from delivery, I feel way better than I did pregnant. Two, I gained just under 20 lbs during the pregnancy, and I was at my pre-pregnancy weight 6 days postpartum and am now under it. This means I can wear real jeans again! Things are not back to pre-pregnancy shape, and I still have a bunch of weight to lose before I am back in a healthy range, but it's better than having 5-10 pregnancy pounds that hang around like they did with the other two kids.

Overall, we are all doing well.  It's still nuts to me to think we have three kids. We are working on how two adults manage three munchkins, but we will just learn on the job!