Holding on - and letting go.

I had the experience, for the first time in my life, of holding (one of) my newborn children. The girl for whom we haven't been able to agree on a name yet. I had her in my arms for about an hour. Of the three, she is the weakest and maybe has an infection in one lung. So she is still on the CPAP mask and getting oxygen at times.

It's an interesting situation. I have this tiny girl in my arms (she weighs about four pounds) and there are several wires leading from her to a computer, plus the alligatored-tube for the breathing mask. I can hold her in my arms and watch a big screen nearby and keep track of her cardiac rate, her respiration rate, and her O2 level.

A couple of times a yellow lamp started blinking, or a red lamp began blinking and an alarm went of. Paula the nurse, who is taking care of all our children 12 hours a day for the next few days, walked over casually and punched a button. "You can rub her back a little, that would help." I rubbed the girl's back and after a few seconds the cardiac rate came back up to normal. "Sometimes you need to stimulate her a bit to remind her to make her heart beat or to keep breathing." Oh, okay.

Actually, this is very cool. For the first time in my life, I'm holding a fragile little newborn who seems wrapped up in a trance. Can't open its eyes, can't even really cry right now. And I'm able to stimulate her so she keeps breathing. I think I can begin to understand all the moms I've been treating for years who are struggling and struggling with their teenagers. The moms come across as very controlling, very anxious, very literal about everything. One woman I've been working with, who is locked into an intense control struggle with her 30 year old alcoholic son, often responds to my suggestions for detachment by saying, "But I'm a mom and that's what moms do." Now I think I get it. If you are a young woman (not a 54 year old man), and you suddenly have this intense experience of bonding with a completely dependent infant, and you are responsible, maybe for the first time in your life completely responsible for another person's moment to moment existence, it may be an experience that you never fully master.

If you are a typical young adult, caught up in your own life, and mainly focused on breaking away from your parents' authority and from your own dependency on them, and you suddenly fall into an intense relationship like this where you have total authority and responsibility, and your child has complete dependency on you, you face a great challenge to enter into this experience and another great challenge to exit out of this experience into the next phase of development.

Your Birthday

Your birthday started out cloudy. But the sun came out in the afternoon. It got very warm for a February 27th - so the roads were wet from leftover snow melting. The sun was out for a few hours, while you were in the NICU learning to breathe and figuring out how to open both eyes at the same time. Then the clouds rolled in, black and heavy, and by 8 pm rain was covering everything. In February, you will learn, we are happy when it rains. But they are promising that it will snow on Sunday.

On your birthday the newspapers and radio were full of bad news. (I don't know what was on TV because your father doesn't watch much TV, but there was probably a lot of stuff about bad people doing stupid things.) You were born during the worst economic times since the Great Depression, and probably this will be a very important part of your whole life. That's the breaks. Heiddegger said we are thrown into existence and defined by a world of details and facts over which we had no control. The bad economy is one. I can think of another one too: You can't choose your parents.

On your birthday the world found out that Tom Brady and Gisele Bundchen got married. He's an American and famous for playing football, she's Brazilian and famous for being pretty. They will probably have very attractive children. Your mother is Brazilian and she's only famous locally, for being pretty, smart, loving, stubborn, wiley, inventive, artistic and sweet. Your father is American and he is not even locally famous, but in the family he is well known for being wordy, thoughtful, highly tolerant of cold weather, still a fan of the Grateful Dead, a reader of long books, and a good listener. Your mother and father just had three very attractive children.

On your birthday President Barack Obama announced that he will withdraw all American troops from Iraq in 19 months. You will all be able to walk and talk by then but still too young to be drafted. But it's worth knowing that you were born in a time of war. There is not formal declaration of war, we're just at War against Terrorism. For the past eight years we have had soldiers, airmen and sailors fighting, mainly in Iraq and in Afganistan. If you want, I'll show you on the map where these countries are, and you'll notice they are on the other side of the planet. The world is getting smaller, the wars are getting more complicated, and you are going to come of age in a time when huge problems confront us as a People, not just a country.

On your birthday I listened on the radio to a French scientist describe the research station he and his team constructed in Antarctica (near the South Pole), which is completely dependent on sun power and wind power for all its electricity needs. The scientist hopes this will be a model to all of us to turn to alternative sources of energy, sources that don't produce carbon dioxide that fills up the sky, makes it harder for heat energy to escape into space, and contributes to Global Warming. You will be hearing about Global Warming your whole life, I expect, and I hope that you will be working to solve the problem of Global Warming. The way things are going, by the time you are getting out of college and can become really useful engines for progress, there will be many many poor and vulnerable people in the world already suffering tremendously from the effects of Global Warming. We humans are fascinating and brilliant, we have created art and science, saved lives and created prosperity, but for the past 150 years we did it all by sucking up oil and digging out coal and burning it for energy, and we have used up this great one-time energy gift very quickly and only now are we understanding the impacts on the planet's system. It's up to people like you to figure out the next step. Good luck - I'm rooting for you. When you are six years old and I tell you to take out the trash or help clear the table, it's only because I'm training you early to look around, see what needs to be done, and enjoy the tasks involved in making your lifespace clear, clean and pleasant for everyone. Once you've cleared the table, please take out the carbon dioxide. Thanks!

On your birthday there was a picture in the paper of a woman named Laura Pendergest-Holt, a tall and well-groomed and apparently wealthy woman in her early 30s, wearing a nice business suit and a pair of handcuffs, being lead into court to attend a bail hearing on charges related to an international financial fraud that evaporated $8 billion of other people's money. She looks like a person who worked hard in school and went to the right college, who showed up to work early and stayed late. She looks like the kind of person who convinced herself that she was doing the right thing, even though it appears she was up to her neck in fraud and that she had become a very good liar to a lot of people. The world is full of people like this, who look good, live in the right places, go to the right school and sponsor the right charities, and who lie through their teeth and live a life of greed and destruction. Somehow you're going to have to find a way through life that involves a minimum of lying and a maximum of dealing with reality the way it is. The Truth, they say, Will Set You Free, but the truth is a painful path to walk. It turns out, and Ms. Pendergest-Holt can now tell you, the lie is a painful path to walk too. So when we get into wrangles about "did you do your homework?" and "where were you last night?" let's all try to remember: the goal is not for me to have control over your life. I don't want control over your life (a little positive influence would be nice but I don't expect to experience that so much either). The goal is for you to learn to tolerate things as they are, tolerate yourself as you are, and live with things in truthful way as much as possible.

On your birthday the newspapers were full of stories and pictures about things I don't care about. There is a lot of human life and experience going on that I consider vapid and pointless. But don't let that stop you. If you grow up to be someone interested in fashion & clothes, or if you really love sports, or if you think that developing a new recipie for cranberry muffins is the peak experience you must climb, then by all means pursue it. The road to excess is the path to wisdom. I have a great affection for recordings of a band that hasn't done anything significant and new since 1976. I like to quote a British poet who died in 1827, and I like to read about the lives of artists and poets who have been dust for 200, 300, 400 years. I don't know why, and no one else really cares. Life is a long process of finding things you care about and paying attention to them. Just like I seem to have found the three of you. Your mom and I have been paying attention to you since last August, when you were conceived. We have been waiting all this time for conversations and cares and conflicts to begin. And that began in a new way on February 27th, 2009.

Happy birthday, girls! We love you!

The team

Our team that delivered three babies at Tufts Medical Center. Dr. Wasserman, second from right, did the surgery. In gratitude to her and the entire time for their wonderful skills and caring hearts.

A blessing

A blessing we haven't named yet, born second on February 27, at 7.46, weighing 4 lb 3 oz.

Jessie

Jessie, born first, February 27th at 7.45 am, weighing 4 lb 7 oz.

Evelyn

Born third, Feb. 27, at 7.47 am at Tufts Medical Center, weighing 2 lb 8 oz

February 27 is birthday birthday birthday

Luciana's water broke at 4 am this morning. That was Baby A's little water bag - Jessie. Labor contractions started right away. Luciana called me at 4.30 to tell me in detail all the things I ought to do at this point. Because I was pretty sure I could handle my end, I hung the phone up and started getting ready. So she called me back to go over some fine points:

• put clothing on
• dress for winter
• back out of the driveway and look both ways
• drive safely and responsibly
• bring a cell phone

Since this was all very good advice I did what any husband and father-to-be would do. I reassured her that this was all very helpful to me, and I hung up.

I got to Tufts Medical Center at 5.17 am. I have to say, the traffic at 5 am is mild compared to 8 am. Fortunately, having my wife in the hospital for three weeks and visiting her a lot, I have had practice at several things. I knew the route and could drive without thinking, which was good, because I was not. I knew where to park and all that. I knew how to find the Labor and Delivery unit. (Follow the signs to Labor and Delivery, that always works.)

I was very excited and pretty scared too.

Luciana was on her side on a stretcher in a room in the Labor and Delivery Unit, and she was crying and groaning because she was in the middle of a contraction. The crying and groaning happened every two minutes for the next hour and a half. But the time seemed to go by quickly because I was busy holding her hand and wishing I had a cup of coffee. Also, I was reassuring her that the staff was not working some conspiracy to avoid delivering her babies until the day crew arrived. I was pretty impressed with the attending physician, a tall and very fit man wearing a military style hair cut and dressed in scrubs. He listened to Luciana explain her predicament and then told her there are risks to premature delivery for the babies, water breaking and contractions do not constitute labor without signs of cervical changes and so no one was doing anything for now. Then Luciana would repeat her position again - her cervix never opens, she went through 18 hours of labor before and it never opened - and then he would repeat his position again. These people were not really communicating.

So after he left the room, Luciana was left with her Brazilian Conspiracy Theory: everyone is always trying to avoid taking responsibility and avoid doing work. "We're in America now," I said somewhat sotto-voce because I knew that she wasn't paying attention to my thought process anymore anyway.

Then one of the residents did an exam and decided her cervix was indeed opening up. Now everything was different. Five minutes later she was in the OR getting her spinal and I was putting on a paper space suit and booties. I put it on and I did look ridiculous. But that is how I was supposed to look.

The delivery was wonderful and scary and intense and I enjoyed the hell out of it. The anesthesiologist, Geoffrey Wilson MD, sat with us and explained everything. He was sort of the Virgil to our Dante. He was also making sure that Luciana didn't feel any pain and he did an excellent job there too. I was afraid to look over the sheet at first because I was sure I would freak out, but I made myself look.

It was totally fascinating. These people I have met over the past weeks all were very focused, and they had their hands inside my wife's body, up to the write and more. Dr. Wasserman reached way in and pulled out a baby! Baby A (Jessie) was flailing around and started crying in a cranky way right off the bat. She looked like she was smeared with zinc oxide and blood. I saw Dr. Wasserman cut the umbilical cord with a pair of scissors like she was cutting a piece of tape. There were four people waiting to take Baby A away and they did.

Dr. Wasserman reached way back inside. Dr. Wilson said, "You're going to feel a strong push now." Throughout all of this Luciana was lying on her back with her head near mine, smiling and feeling now pain, while her body got pushed one way and another. You just got to love anasthesia! I looked up and saw Dr. Wasserman pull another baby out. Baby B! (Formerly Baby C). Again, flailing and yucking and crying, and they took Baby B over to a table nearby.

Dr. Wasserman went back in once more and came out with Baby C, Evelyn, who was clearly smaller than the other two. She cried a lot!

I cried a lot too. I wasn't crying about anything in particular, I was crying about everything in particular. I looked at Luciana's face and I cried. I looked at Dr. Wasserman getting instructions from the attending to reach in and pull hard, and I cried. I saw another baby come flying out into the cold world and I cried. If someone had showed me a picture of one of the policemen in Bermuda with the short pants and the tall socks I would have cried. It just seemed like the appropriate response to everything.

Luciana kept saying "What are you crying about?" and "Tell me what you are crying about." But I was in the zone beyond words, sort of enjoying it, like an astronaut on a long tether free of the capsule for the first time weeks. So I was happy just to be overjoyed and overscared and overrelieved and overloaded. As they say at AA meetings, It's all good.

Someone brought the littlest girl over for us to touch and hold for a few seconds. So tiny! Well, she's the one who looks like me, poor girl. She'll need special help dealing with that.

Very soon, all three girls went out to the NICU to be "settled down" -- a euphemism for assessed, stabilized, treated, etc. The surgical team went about their business of sewing Luciana up. I took a few looks. Surgical openings in the body cavity really scream "Reality!" at you in a big way, especially when it's your wife and this is not on video. I was glad when that was finished.

Everyone was thrilled with how Luciana did. She carried three babies beautifully for 32 weeks and 5 days, and she handled labor and delivery with tremendous spirit and joy. She was obviously thrilled to see her babies and I suppose everyone could see that she and I are deeply in love with each other. What other kind of nuts jump off the cliff of middle-age back into the canyon of parenting?

Marina and Eliani arrived soon after and were thrilled to see Luciana and hear about the babies. We were able to go to the NICU to see the girls for the first time. The two bigger girls were on CPAP masks to help support their breathing. Naturally, the little one was breathing on her own, crying and reacting to us (affect: annoyed).

A clerk came to the nurse to get the forms filled out. So this is what I heard:
"Diagnosis?" "Prematurity."
"Condition?" "Fair."

Can't ask for more than that.

It took Luciana a few hours to get out of recovery. During that time I went over to the NICU and sat with the meninhas, got to know the wonderful nurses in the NICU (really, this kind of work attracts some very nice people). I went back to Luciana and helped the Labor nurse to wheel her over to meet her babies. Oh, it was very nice to see them together. Then Luciana got back to her room in the Maternal-Infant Unit ("Your family starts here!") By then I was exhausted and had a stabbing headache so it was time for me to go home, walk the dog, and sleep.

I'm sure there has been ongoing drama in my absence but I will have to check back into that later.

Some semblance of order

We met with The Doctor yesterday.

She's actually a very nice woman who grew up in Quebec. For the purposes of our discussions these days, however, she is The Doctor.

First we had to deal with Luciana's intense wish to get out of the hospital. Having her family visiting is a crazy-making overstimulation, I can tell. Suddenly she is seized with the intense desire -- more a complete plan than a wish -- to get out of the hospital and go out to a restaurant in Everett so she can take her mother to see her two children singing together. This absolutely has to happen and there is no reason to think that it shouldn't happen.

Except, as I point out repeatedly, she might fall down or slip on some ice, we might get into a traffic accident, some drunken lout might fall onto her table at the restaurant, or any number of other completely unanticipatable events might occur leading to an injury to her and the babies at a critical and very vulnerable time.

She apparently doesn't see how vulnerable she appears to me. My negative reactions to her wish-plan runs along the vein of "why are you trying to harsh my mellow?"

Finally I simply said, "No, I won't cooperate, I won't drive you, I won't take you, I won't go anywhere near this." She says, "Why can't you listen to me and listen to my feelings?" "I've heard your feelings but I'm not going to help you."

The Doctor says, "Good, so I don't have to be the bad guy here."

Then we talked about "how long." "How much longer?"

Of course all the same considerations are in place as before. If any of the babies show signs of distress, or if Luciana's pre-eclampsia deepens, or if labor begins, then the team will deliver the babies. But if none of that happens, there is an end-point anyway. March 8th is 34 weeks. The Doctor says, If you get to 34 weeks then we will schedule a delivery. "We can schedule it right now if you want."

Then there is a very funny conversation.

Me: "The 8th is a Sunday. You can't schedule it for a Sunday."
TD: "And I don't work on Monday and I want to do the delivery. Which would make it Tuesday, the 10th."
L: "I don't want to wait until the 10th. Marina's birthday is on the 7th. I want to have the babies on the 5th so I can go to her birthday party."
Me: "We'll have a birthday party here on the unit. Anyway, if you deliver on Thursday you're not going out of the hospital to a birthday party two days later."
L: "Sure I am, why not?"
Me: "Because you just carried three babies for 34 weeks and had a cesarean section and you're fifty years old??"
TD: "It would be better to do it on the tenth than on the fifth."
L: "I can't wait that long." And then also says something very complicated about her family that I won't go into details about right now. But it was very complicated and even a Medieval doctor of Laws couldn't have followed the twisted reasoning. Still, it all seemed to make perfect sense to Luciana.

So I said, "We can't agree about this now, and it may never matter because things may force our hand later this week or early next week, so let's just postpone the decision until next week."
Which seemed to please The Doctor and Luciana both.

So we left the meeting with three very clear and different ideas about what is going to happen.

Luciana is sure we are agreeing to a delivery on the fifth.

The Doctor is scheduling a delivery on the tenth.

I am sure that we are going to get tangled up in all this again next week.

Thanks to the endodontist & the neurologist

I am really enjoying the experience of not-pain.

I was in a state of serious pain for about three weeks.

A neurologist started treating my TN (trigeminal neuralgia). After two and a half weeks we got to a level of tegretol that actually made a difference. Thank god for tegretol, even if it makes me sort of sleepy and feeling like I'm operating on a tape-delay compared to the speed of life.

An endodontist treated my absessed tooth with a root canal and penicillin and as of today I don't have a toothache any more. Thank god for his training and dedication.

Luciana is really annoyed

After 45 minutes of this monitoring action, Luciana is really annoyed.

And this is the highpoint of her day.

Or will be, until her mother arrives from Brazil (later today).

Current events

I'm really enjoying the radio news & the NY Times lately.

Yesterday Tom Ashbrook was interviewing Richard Florida, a city planner whose vision of the future is that most people will live in vast urban stretches (like Charlanta between Charlotteville & Atlanta) and Chipitts (Chicago to Pittsburgh), fewer people will own homes and prefer renting so they can shift their location more quickly & easily, and large developed areas of the US are going to become more or less abandoned.

Today Ashbrook interviewed some economic experts who were grappling with the question: if you nationalize the banks but call it something else what will happen to our economy. I already new that Citibank is on the verge of collapse and is probably a zombie bank. I found out that WellsFargo, which holds my mortgage, is probably a zombie bank too. Where are all these goddamn genuises that made so much money faking an outrageous economic expansion for the past ten years? Why can't Ashbrook get some of those big brains on his show? Oh, probably because they are so busy saving the economy (or rowing toward their offshore accounts).

In the future:

• very few of us will own homes because the creative knowledge workers are busily shifting from one end of the country to the other trying to chase employment;
• many of us will visit with our friends and family by videoconferencing and Facebook (or its future development)
• people who can't afford to own a car will wear a green cap as they ride their bike to the train station
• our kids will major in Mandarin chinese so they can grow up to sell what's left of the country on the Asian markets (before they begin rowing their boats slowly offshore)

It's going to be fun throwing our triplets into this mix/mess.

Dolphins, dragons and lions.... oh my!

I was thinking about Luciana's preoccupations with preparations. She was crazy with anxiety because I didn't get all enthused about buying helium-filled balloons to put on the door of the house. Before she was hospitalized she kept fantasizing about having people visit the house, sitting on the couch in the living room and drinking iced tea. She even went out and bought a large wooden tray to carry the drink on. She was despairing that we don't have a large glass pitcher with matching glasses. My reaction to all this: what madness!

I was reading last night about the Hundred Years War (Reformation & Counter-Reformation in the Netherlands) and found a wonderful description of the public works that were thrown into place to celebrate the arrival of the King of Spain's appointed regent in Brussels. All the artisans and artists suddenly had work, throwing up spectacular (and temporary) triumphal arches decorated with appropriately Catholic imagery, while housefronts and public places were fronted with great representations of dolphins, dragons, lions and monsters.

Maybe the balloons and the ice-tea-on-trays are just domestic versions of these great public celebrations, creating ceremonial passage through which the new Prince (or Princess) can make a suitably important entry.

Maybe blogging is the literary equivalent to erecting a cardboard and wood archway decorated with dolphins and dragons. An entryway for the arrival of princesses in this digital age.

Hanging out with the crew

Mid day on Tuesday, hanging out with the crew. Two nurses and my wife, clustered together at the bed while they do another heart-rate monitoring. It's become totally routine. We are all laughing about Luciana's bossiness and calling her the "charge nurse." When I came on the unit she was standing in the hallway by the refrigerator, getting some cranberry juice and counseling a Brazilian woman who had her baby two days ago. L is in good spirits today. The babies have moved lower, making more room for her to breathe, so she was actually able to sleep for four hours this morning (from 4 am to 8 am), leaving her quite refreshed.

So refreshed that she is pushing a plan that she get released from the hospital tonight so she can go with her mother to Somerville to listen to Fernando singing at Cafe Bello. Yeah, right, like that's ever going to happen. I don't argue with these things, I just refer her to the medical team. One of the many good things about the medical team is that they maintain a rational focus on the mission and don't get distracted by patients' odd and impatient impulses. Which is good, unless you're the patient with the odd and impatient impulse.

They are having trouble getting all three babies to register on the monitor at the same time, which is a requirement -- they need to have all three recorded for 20 minutes continuously. It's not easy to do.

At any rate, it appears that we have backed away from "progression into labor" at this point, so the optimistic and ebullient previous entry must be disregarded.

Tuesday Feb 24

Luciana called me from the hospital last evening to let me know she is having regular contractions. Every 20 minutes or so. Earlier in the day there had been some concern, she says, about Baby B - they didn't find her practicing her breathing during the twice-daily ultrasound monitoring. But now, in the evening, she's doing fine again. One of the ob-gyn docs had examined Luciana and said her cervix is "softening" but not yet opening. It seems that her labor is beginning.

Today there will be a long ultra-sound examination to measure each baby. The results give a good estimate of how much each baby has grown since the last exam two weeks ago. Likely, Baby B will show very little sign of growth.

Things are pointing toward a conclusion, and soon, I think -- if soon can be counted in a matter of a few days rather than weeks. Our time-table is shifting.

I was standing outside in the dark behind the house last night, waiting for Julie the bulldog to do her business. It was about 10 pm, I had gotten home from the office and was pretty tired. It was very cold, very windy, I was bundled up in my leather jacket, hat and gloves and making that mild moaning noise that people make when they have to stand in the cold and they aren't used to it (I doubt that Ivan Denisovich would have been moaning in the cold behind my house last night). I had one of those perceptions in the peace and quiet that this part of my routine, the routine of the past three weeks, of keeping house by myself, of waking up in the morning and walking the dog, of keeping up with the dishes myself and spending time alone with the dog, these times were about to become obsolete and would see rather dreamlike and from-a-different-era in the near future.

We are transitioning. Her labor has begun. Babies should be arriving soon.

waiting

This was the best night I've spent in the hospital. Went to sleep with contractions coming regularly each 20 minutes and crushing my round belly for 25 seconds. The nurse turned the monitor up and confirmed my hopeful perception: I was contracting. Same at 2:00 a.m. and at 4:00 a.m. I wrote down the times on my Sudoku book - completing a challenging puzzle I had spent lots of time during the day without seeing the solutions. Saw in everything a magic sign that things were turning to the better.
Woke up this morning less swollen, active, rested. My belly is lower than before, with a funny assymetrical shape, similar to the hump of certain Indian breed of cattle. So far, no contractions. Had to accept that this body follows a misterious protocol, that neither myself nor the doctors can preview, anticipate or change. My role is stay hydrated and go through another long round of tests.

Yesterday, Baby B flunked two heart activity and one vitality test (she wouldn't breath during a half an hour ultrasound) but finally, passed the forth test with maximun score. I've caressed whichever part of her body was poking my liver and told her about the waiting time. It seems that she and babies A and C got it better than I did.

Interesting times

Just for fun, for the sake of looking back, I thought I'd throw in some of the current considerations going on in the world around us:

• Economically, $100 invested in the US on 12/31/07 is currently worth $53. It could be worse: in Britain that same investment is now worth $45, in Russia $23, in Iceland $3.
• Bernie Madoff, the current Ponzi-Scheme king, has been joined on stage by a guy from Texas named Robert Allen Stanford. Stanford didn't steal as much - only $8 billion - but he rates a slot on the NPR news cycle and the NY Times front page all week.
• Jade Goody, a British woman who has spent her entire adult life becoming famous for becoming famous (via reality shows like Big Brother) has galvanized the entire British population. She was diagnosed with cancer last year and has been living out her treatment, her treatment failures, and her approach to death all on camera. She's getting married next week (her groom was just let out of prison) and will honeymoon at one of Elton John's palaces.
• US car manufacturers are at the edge of a cliff. We may be mourning the end of the Pontiac line of cars. No GTOs for the girls when they grow up.
• The newspapers' front page features articles about long lines at food banks across the country.
• North Korea and Iran continue to make threats that they are developing nuclear weapons. Hilary Clinton travels to Indonesia today to begin a new dialogue between the West and the Muslim worlds.
• Benjamin Netanyahu is likely to be the next prime minister of Irael. That worked so well before.
• The California legislature has finally agreed on a budget, so the entire state is not going to go bankrupt (yet).

The proverbial Chinese curse seems on target: may you live in interesting times.

Bridges from now to then

I went to visit Luciana yesterday and found her with four of her school buddies having a visit.

After they left, the medical team came in to discuss the situation.

Baby B has IUGR (interuterine growth restriction) for the past several weeks. The new development is that they found, using a doppler, that her supply of blood through the umbilical cord is becoming restricted. But her vitality signs are still good.

Upshot is, they want to keep going with the pregnancy rather than deliver. Luciana was feeling desperate, that Baby B isn't getting supplied with nutrition any more. But it's not as cut and dried as that. The doctors' current judgment is, she's getting enough to benefit by staying inside. Risks of delivery at this point include bleeds in the brain and GI tract, and infections. It's safer for all three to stay inside, especially B because, with the growth restriction, the maturation of her organs is probably somewhat delayed relative to her gestational age. Although Luciana is feeling terribly burdened, to the doctors she looks really good. So they want to push on, aiming for 32 or 33 weeks. Probably we aren't going to go more than 14 more days.

So my prediction two weeks ago that 2/19 would be delivery day was wrong.

Luciana and I talked it over and settled back down for another couple of weeks of hanging out in the hospital.

The school buddies were pushing us to begin thinking about plans for taking care of the girls when we get home. We need to set up an online calendar that shows when volunteers can come to the house to help.

We haven't even bought cribs and baby seats yet. And I'm obsessing about getting a minivan and selling the MB.

But it's very hard to think much further ahead than tomorrow.

My hand has healed but my teeth are hurting all the time. Pain has a way of bringing you right down into the moment. At the moment my upper and lower jaws both ache and I have sharp pain in my front teeth. It moves around. I guess this gives me a window into Luciana's experience. She and I spoke last night at 10 pm. She was short of breath, a little panicky. I think her experience moves from moment to moment too. The days of actual babies and cribs and being home all seems very far away from us right now. Marina was talking to me yesterday about plans to go to NYC next Tuesday morning to pick up her grandmother, who is flying in from Brazil to stay for 40 days. I could barely lift my sights up that far ahead.

Luciana said last night, When this is all over it will seem like nothing. I've made the same point to her as well. We both now about the way time opens up as you go through it, how it compresses when you've gone through it. Crossing the bridge, the canyon yawns below. Once you're past it, it's just another bridge you used to get along your way.

Is that the roar of a waterfall I hear up ahead

We are waiting. We are waiting.
Then sometimes we are feeling that something is gathering momentum.

Today the team did a doppler exam of the blood flow in the umbilical cord of Baby B (Evelyn). She is the one who is not growing. They weren't too happy with what they saw. There is a decreased flow of blood to the baby.

There is going to be a team meeting and a consultation this afternoon. So maybe the team is going to recommend that it's time to deliver. Or maybe not.

Uncertainty.

Previously on "Lost"

In times of uncertainty, people naturally return to intuition, inspiration, superstition and other forms of out-of-control knowledge that match their experience of travelling in terra incognita.

Apparently with the conception of triplets, Luciana and I crossed that boundary into unexplored territory several months ago, and the people around us began to behave (at times) like characters from the TV series "Lost."

My favorite guy (right) is John Locke, eponymously linked to the tabula rasa epistemologist of the late 1600s & early 1700. The Lost Locke is a paralyzed Fool of Life who finds his powers restored when he crashlands on The Island. He becomes a visionary who follows dreams and intuitions, and when necessary he stabs people in the back to get his tribe moving in the right direction.

No one in our sphere has taken on Locke-ean proportions, but people have been known to act rather strangely. Yesterday Luciana told me she had a long visit from a couple of cow0rkers -- and thanks for the visit. Interestingly, one of the workers urged Luciana to name one of the babies -- after her! She wants us to name a baby after her! Luciana was a bit confused. She asked me, "Is this an American thing?"
"No, sweetheart," I told her. "This is a strange thing."
But naming is a strange thing anyway. I awoke two weeks ago from a pretty sound sleep with no trace of dreams around my head but just a simple thing in it: a name: Evelyn. I don't know where Evelyn came from. My only associations are:

• Evelyn Waugh - a good writer but not one of my favorites.
• A movie named "Evelyn" which I never saw, but which treats the story of a man trying to get his children back from the government (I think) starring Pierce Brosnan.

Okay...

But the name Evelyn hung around in my head. Within a couple of days we were hearing about Baby B - very tiny, not growing, but more active and vital than the other two. And I "knew" her name was Evelyn. Every time I thought (think) of her as Evelyn I start to tear up, and sometimes I just start to cry.

Who am I to argue with that? So I named her Evelyn, first privately, and then with Luciana. And it seems this is her name.

Luciana told her mother that we had named Baby B Evelyn, and she said that she had written that name down on paper but was afraid to tell us because she was sure we would reject it if she suggested it.

Okay... More of that "Lost" effect.

Meanwhile, there is a team of doctors who are monitoring Luciana's vital signs, blood test results and reports of discomfort, and monitoring the lives of the growing girls, and they are convening (today, I believe) to sort out their differences. There is a camp that holds out for 34 weeks, and a camp that is pushing for 32 weeks. They have to make up their minds.

In this age, the uncertainties are projected into a team of experts, who contain these feelings and try to work with them in a way that feels related to some kind of reality they can measure, assess, and influence.

Children of John Locke the philosopher. I'm grateful to them for playing Leader as we traipse through the jungle of this unprecedented experience.

who cares?

Some call, some come over. Some invite my husband to a nice family dinner. Some stop to ask about my huge belly and when the babies will come. Some stop by after delivering newspapers before down. Some stay awake and check on my blood pressure at 4 a.m, just because it was a bit higher than normal at night. Some stop at a closing store and pick the best bargain for the babies, knowing that I can't enjoy shopping for a while. Some offer to bring a car seat a relative doesn't need anymore. Some offer to put our names on the sharing book at church, so more people will keep us in their thoughts and prayers. Some knit a blanket, some open old boxes and find two generation old baby garments. Some organize a brunch, invites a few others and they all together move my office downstairs and create a nest for the babies. Some bake me a cake, some witness my husband learning how to cry for no apparent reason. Some draw me blood with delicate hands, some tame the agonizing pain throbbing on my husband's face. Some leave much more interestings activities to be with us, eating Chinese food out of plastic cups during a family visit to the hospital. Some use their vacation time to spend hours watching TV, sitting near my bed. Some email, some write cards, some paint funny boards telling me to be pacient and wait for Nature's calendar to operate its miracles. Some pray for us an entire rosary. some take away the dinner's tray without letting me awake from a pain-relieveing, light sleep.

I try not to feel too scared of all this care - so it stays in my heart as an affirmation of goodness (mine and others') for a long, long time.
(Luciana)

Explaining the gap

We haven't posted in several days.

For Luciana, the excuse is that she is hugely pregnant and lying in bed in the hospital. They don't let her get upright that often, so her typing access is limited.

For me, the excuse is that I arranged for Verizon to install their FIOS system last week. The very good-natured technician came to the house as agreed, and Marina helped cover the situation so he could be here for 6 hours, drilling holes in the house and running wires. When he left, the internet was on (so was the TV and the phone but I don't care about those things). But then, after he left, the internet was turned off.

Somewhere inside the infinite system, someone flipped a switch or marked a radio button and my order was "unbundled" and my internet order was cancelled.

Seven phone calls later -- even Marina couldn't straighten it out -- I got hold of Robert today, and Robert figured it out and turned the internet on. We are back on line.

So I can gabble like this!

Joys of capitalism

I'm just throwing down a quick post before jaunting off to the endotontist to get a root canal done. I kind of feel like Stan Laurel, whimpering and unhappy because of the pain in my tooth (number 31 for those dental types tuning in).

But I am just loving the American system right now. Somewhere in Framingham there is a highly trained dental professional with an office full of expensive equipment designed by experienced engineers and fabricated by sophisticated machinists. All these people have been working for years, for decades, perfecting their art, so that I, a nobody, can call up and make an appointment (and get one that day, if necessary).

I don't need to be handsome, or famous, or even pleasant. I just need to have insurance or a credit card and this life-saving service is available to me.

What a country!

Valentines visit

We had tried very hard to accomplish things over the phone, setting priorities, deciding on how to handle problems such as broken garbage disposals and leaking ceiling, sharing the exaperating news of this 31 weeks waiting game - each attempt resulting in complete "failure to comunicate". Until he tells me how much his tooth was hurting and how bad the blisters in his hand looked like. It took me a while to realize that I could not hug him and reconnect as we had planned and needed - not until I let go the expectation of keep managing the house while enduring this probabion time in the hospital. There will not be a pink luggage with sweet preemie undies and baby cologne. Visitors will try to sit comfortably on chairs missing felt and they will probably notice the marks of dogs being housebroken over hardwood floors. And we may not even have baby chairs in the family van - simple because we don't have a van...not yet.
We had chinese food in improvised plastic container, the Valentines day floweres never got delivery and no item in our "to do" list was considered during his visit to the hospital. Instead, we looked at some newborn being taken care by a nurse with rare smiles and compulsive cleaning rituals and spoke about clinical stuff, an old habit of ours. We came back home, we came back to each other - everything else moving to the background. Nice to have priorities straightened out.
When the babies come to this world, they may not have every essencial assessory set up. But the will have a Mom and a Daddy that know a bit about finding each other in the midst of chaos.

measuring the odds

One machine counts their heartbeats with implacable exatitude. The ultrasound registers their position, movements, reactivity to touch and breathing patters - even hicups. The doctors measure their tiny bones and come up with their weight, with 7% measurement margin of error. Baby A weights as much or more than 35% singletons at same gestational age - 30 weeks. Baby C scores around the 26th percentile. And Baby B, always behind their siblings, falls bellow the 10th percentile - which grants her a diagonis of "restricted growth". In fact, while her sisters are getting fat with the cocktail of nutrients flowing throught the umbelical cord, Baby B fights for what her placenta can make available - relatively less.
With all these numbers come the risk analysis. 90% of preemies born at this point will be viable - maybe with sequels to be dealt with in a lifelong journey. If we postpone birth, the pre-eclampia thickening mom's blood and weakening her liver may creep in and increase the odds of more damage. Doctors consult with each other and we, parents, have to deal with the uncertainty expressed by the probabilities and the quantified information. The heart doesn't do well with numbers: during the shadows of the day I think about my baby B, weighting less than a kilo (1 pound and 10 ounces). But then the ultrasound shows her breathing - a sequence of effortful movements opening the tiny ribcage - and I start to believe that, as her father says, that she will do just fine - because of her 100% strong determination to live.

Nice Sunday visit

We had a happy visit this afternoon at the hospital. Marina and her great friend Luana came along. Luanna took photos -- we are making fun of the pictures that the young Brazilian couples get done when they are celebrating their pregnancies. I am supposed to be bragging here about my masculinity, I suppose. Anyway, you can see we are pretty happy (and silly). Luciana is in good shape, very cheerful and full of ideas and preoccupations. We all went down to the only restaurant in the hospital, an abysmally operated Au Bon Pain. Luciana had to stay in a wheelchair. I wanted to get her some fresh air and tried to push her outside through the revolving door, which occasioned a good deal of hilarity. Luana showed us how to use the Blackberry Messenger service, which is pretty much the same as IMing. We are getting to be very digital. It was a happy time.

I see this picture and think of the innocence of these two creatures. To be in our fifties and still able to jump into life with the innocence of young adults. I'm sure this is madness and folly - and essential Life itself. What choice do you have? Keep living or start dying.

Writing this blog, I often have the uncomfortable impression that I will "look at this someday" and feel very differently. I suppose, I fear feeling regret, I fear feeling foolish. So I am going to respond to myself by quoting myself -- this comes from an email I sent my son Felix this morning.

Felix had told me Friday that he was going to participate in a school academic competition on Saturday -- for people who know Felix, the idea of him taking part in an academic (or any) competition is a bit startling. He had to get up at 6 am to catch a 7 am bus. This morning (Sunday) I got in touch to ask how the competition went. "I didn't make it. My alarm didn't wake me up. No one called me until 11 am. I told them how bad I felt for missing it because I really do feel bad."

I IM'ed back a few short phrases, because the MMS message system only allows brief thoughts. I like it because it forces me to come up with fortune cookies:

• Regret is a feeling that passes with time
• Opportunities come and go, never to return
• People remember who shows up for them
• Their memory of you is all they know of you

My effort in life is just to keep showing up when I can, and to take the opportunities as they come, and to let the regret wash past me in waves just as it likes to do.

Nesting

I have been resisting, avoiding, mocking and generally keeping an arm's length from Luciana's nesting behaviors the past couple of months. It was a big concession on my part (arrived at by cogitation rather than through the heart) to go along with her and Karen to Babys 'R Us six weeks ago. (Memorable to me mainly due to my daughter's outburst against babies in general and these babies in particular, and due to our encounter with a friend who had recently had a near-death experience from eclampsia.)

Today I have crossed the line into nesting, and I find I'm loving it. Luciana is in the hospital, so it really is down to me to arrange the twigs and string and leaves into a nice little place for the babies. What I have found is that moving things around, painting walls, buying cribs etc all puts the babies right in front of my focus in a very direct way. It seems obvious I suppose to anyone who isn't partially autistic but it's a pleasant surprise for me! I have been feeling close to the girls (we think they are all girls) this morning as I tote things around and work at preparing the room. Tears are often in my eyes, just from an overflow of feelings.

The United Nations of Care

They come one by one, running tests and sharing their diagnostic thinking, with various degress of proficiency and power. The nurses may differ in the way they deliver their educated gentleness but are very skilled into breaking and entering the private territory of our bodies as if we were being born again, without the original sin - or shame.
The residents cant hide the enthusiasm of novelty, fascinated by the movement of three little babies in the womb, paying attention to details not necessarily related to medical purposes - I've learned for example that their heart rates vary in unison because one "provokes" the other into moving. One could say they are playing.
Fellows don't come to the room unless the team has met, discussed and made important decisions. Their faces reveal the seriousness of their commitment to care, to solve and to do what is right. They don't get much distracted by personal histories.
In this hospital, they come from all over the word: India, Algeria, China, Portugal, Israel, Greece, Cyprus and various ethnic pockets of the US. They meet every morning to discuss cases, trespassing centuries of animosity and prejudice. I wish medical professionals like the ones visiting my room had a place at the table where peace agreemenst are discussed: they know the the sameness of flesh and the unique value of Life.

Getting serious

Okay, it's getting serious now.

I went home on Wednesday (two days ago) at lunch time to check in with Luciana, and took her blood pressure. 171/92. Alarm bells went off for me.

Unfortunately, I was in the middle of my own medical crisis. Two days earlier a slowly resurging problem with trigeminal neuralgia suddenly went critical, subjecting me to very intense attacks of pain in my lower and upper jaw and around my right eye. I had gone to the doctor that morning and had started on tegritol, which I used in the past to control the symptoms, but I knew I was facing anywhere between 3 to 5 days on ongoing pain attacks before the tegritol would control the problem (and then I could enjoy the experience of being medicated with this anti-convulsant, which leaves me feeling a little delayed).

Alarm bells lead to a couple of things:

• my face pain escalated rapidly
• I called the hospital and they told us to come in
• Luciana went into her "Stop over reacting, this is not a big deal, and help me pack up my school-related work so I can be productive in the hospital" routine
• Luciana went into her "let's call someone we can pay to drive me to the hospital so you can keep seeing clients this afternoon" routine
  

It only took us about 20 minutes to get out of the house, but by the time we were on the highway I was really ovewhelmed. The pain was terrible, and I was very upset because she was telling me that when we get to the hospital I should drop her off at the front door and go back to my office. I started crying, partly with pain but mainly because I couldn't tolerate her pushing me away. Crying actually helps -- not with the pain, but with the interpersonal problem. She agreed I could park in the driveway and join her at labor and delivery.

We got a bed at Labor and Delivery without any problem. The people there are really great. They are very used to people showing up in all kinds of mental states. They took her blood pressure -- of course, it was back down to a health level. But they checked her urine and blood - there was protein in the urine and her hematocrit was low. So they elected to keep her in the hospital at least 24 hours to study the situation.

That was Wednesday. Yesterday was relatively calm. I spoke to her last night -- unfortunately just when I was having an awful pain attack, so she thought I was in terrible trouble. I wasn't in terrible trouble, I was just suffering pointless nerve pain.

Today we got the news. They have officially diagnoses her as having pre-eclampsia. That means that the babies may be having an adverse affect. Somehow pre-eclampsia and eclampsia affects the placenta's capacity to supply the baby with oxygen and nutrition. So she is going to stay in the hospital for the duration, and at some point the balance will shift. Right now, it's better for the babies to be in the womb. At some point the balance shifts, it gets too dangerous for Luciana to keep the babies inside and it begins to degrade their health as well. That's when they decide to deliver.

We are now officially waiting for the balance to shift.