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.

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.

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.

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.

The hospital room is an architecture that arranges experiences

What kind of experience is being arranged on this structure?

The Waiting Place...

...for people just waiting.
Waiting for a train to go
or a bus to come, or a plane to go
or the mail to come, or the rain to go
or the phone to ring, or the snow to snow
or waiting around for a Yes or a No
or waiting for their hair to grow.
Everyone is just waiting.

Waiting for the fish to bite
or waiting for wind to fly a kite
or waiting around for Friday night
or waiting, perhaps, for their Uncle Jake
or a pot to boil, or a Better Break
or a sting of pearls, or a pair of pants
or a wig with curls, or Another Chance.
Everyone is just waiting.

--- From "The Places You'll Go," by Theodore Geisel (Dr. Seuss)

In that intermediary neither-here-nor-there waiting-for-time-to-pass place, where people's activity consists of "monitoring," "checking," "keeping an eye on" and people are afflicted with sensations of boredom, anxiety, uselessness, fear, annoyance, and confusion. Questions can only be answered over time, situations can only be resolved over time. And while we are waiting, and wishing for waiting to be over, the babies are breathing, drinking, kicking, blinking, touching with fingers and toes, reacting to sounds and pressure, turning in the womb and (recently) putting their heads down toward the exit. They have been waiting too - developing from a single cell!!!!! to these complex creatures -- humans about to begin being with us!!!! In the excitement of it all, that gets hung like a coat on a hook on the wall of this bare utilitarian room, I find myself saying, "Take your time, there's no rush, we can wait two weeks, three weeks, four weeks, get yourself ready, we will be here when you need us." And I find myself feeling, "I can't wait!!!"

But I can. Luciana can. We all can. So we do!

Confinement

I was emailing with a friend of mine, Susan Shulman, a wise therapist, and detailing some of our ups and downs of the past week. She reminded me that in the Victorian era (when the rates of maternal and infant deaths were quite high, if I remember correctly) the proper English lady went through a period called "her confinement" that brought into focus an entire regalia of social etiquette and mannered emotions. My Lady Luciana is now in her confinement as well -- but the way they roll in new-school at Tufts Medical Center, you're in an electrically-powered bed under the observation of a ($4/day) television screen, and subjected to arduous tests on baby vitality three times a day. Not so restfull.

Things I learned today

Things I learned today include:
a. all three babies are breathing (amniotic fluid) and actively getting their lungs ready for real life.
b. they have interlocked their legs and are running and kicking a lot.
c. Baby A has the hiccups today.
d. a kidney specialist is going to be
consulting with the team to ponder the intricacies posed by Luciana's double kidney.

Here's a picture of a 28 week fetus inside the mom. Imagine three of them! Well, ours are smaller, but at this point they measure in the 45th percentile for size compared to the population of single babies!!

That's all ... so far!

Your basic news update

What's happening now is:

• Luciana began to experience spikes in her blood pressure
• She began to spill protein into her urine
• She only has one functioning kidney anyway, and it's doing all the work of filtering toxins and waste products from her blood for her and three children
• She is pumping nutrition & oxygen through three placentas to supply three two-pound 28 week embryos 24 hours a day
• Ten days ago the doctor gave her a letter and sent her home with the instructions: no more work
• She found being home and feeling useless almost intolerably intolerable
• So she was more often up and out of bed, working on reports ("I only have three more, I only have two more..."), connecting to her online posse, cleaning the kitchen, doing the laundry, pushing furniture around, shredding mountains of waste paper.
• When I was out at work, she would lie down and sleep. When I came home she would bemoan the lost hours and start working at things again. Then we would argue with each other about this.
• On Monday she had high blood pressure and I made her call the medical team. They had her come in and detected some signs suggesting early stages of eclampsia. They kept her in the hospital much of the day, sent her home "on bed rest" and ordered her to collect urine for 24 hours and come back in on Friday.
• All week she struggled to learn how to lie around and rest. It was a struggle, a struggle with a struggle, a struggle against struggling. Mantras like "I am a flower bed" didn't help much.
• On Friday she went in and they analyzed the data. On Friday night they called to say, Tomorrow come back and we're admitting you for a couple of days.
• Yesterday they admitted her. The on-duty doctor told her, Settle in, you're going to be here for a month.
• When I visited last night, she looked okay! Cheerful, bored, unhappy to be in the hospital. Mentally it's a torture. But she notices that when she lies in bed her blood pressure goes down, and when she sits up, her blood pressure spikes.
  
• The regime looks like: rest, lie down, watch TV. Blood pressure monitoring several times a day. Monitor the babies' heart beats three times a day. Every other day an ultrasound to measure the babies' growth.
• If the babies keep growing, good. If her blood pressure stays controlled, good. Because at this point, 28 weeks, their lungs are not up to the task of absorbing O2, their brains are not up to the task of breathing regularly, their GI tracts are not up to the task of absorbing nutrition. In two weeks, they will be.
• The immediate goal is to get through the next two weeks and see how things are going.
  
  

What would Target do?

I visited Luciana in the hospital last night. The medical center bustles with busy people during the day, but at 7 pm on a Saturday night you can rattle and shuffle all by yourself down the long hallways.
The only person I saw asked me, "Is this the third floor?" I held up two fingers for her to see, and she muttered in dismay, a sound I have made myself many times because it's not possible to get found in this place before you first get lost. A minute later I realized that she was right. It was the third floor, Once she figured I knew where I was and she didn't know where she was, that woman became lost. That's the way it goes in here.
I did find Luciana, by calling her on my cell phone and getting repeated redirections, finally closing in on "maternal and infant health." Part of the disorientation to the hospital environment is that everything is named from the perspective of the workers.
That's why I like shopping at Target. Everything is labelled from the shopper's perspective: cookies in this aisle, vacuum cleaners in that aisle, air freshener beyond the prilosec area, batteries every third endcap, help desk over here, and exits clearly marked with red signage. Shoppers are the people pushing bright red carts, Targeteers are the people in bright red shirts and tan pants.
In the hospital, you have to learn to look at things from a medical provider's perspective. She's not longer my wife, the mother of my children, a woman with high blood pressure induced by the demands of providing everything necessary to three two-pound gestating embryos. She's a patient who ... I can't actually twist my mind around into the perspective that comes up with "maternal and infant health." I guess the patient is not relevant here, in that the name has no direct orientation to a patient. The designation's primary target is "health," an abstraction for which I have no immediate reference (except that, like pornography, I generally know it when I feel it). Specifying health a bit more, we are dealing with maternal and infant health. I suppose they used to call it the maternity ward. Why can't they call it Mothers & Babies Ward? Or "Your Family Starts Here"?