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.

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.

Baby B

Today we learned that baby B is significantly smaller than the other two. Baby A is 2 pounds 6 ounces, Baby C is 2 pounds 3 ounces, Baby B is one pound 10 ounces. She is tiny. This lag in growth could be attributed to many different factors and it isn't possible at this time to determine the actual reasons. However her vitality appears to be strong. She is breathing actively, moving a lot. So she is "tiny and tough." The hope is that she continues to grow. They are going to do a biweekly growth study. The medical team is monitoring the three very closely. If their health appears to be deteriorating, the team will decide to deliver them. We hope to avoid that and keep them inside for two or three weeks more.

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.

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"?

Here we are -- January 23

This is how we are doing today, January 23rd. It's been a busy week of learning to do less and less, and Luciana is getting better at it. We have all the daily problems of life, but since we seem to be managing them better, they are more or less just a backdrop for our big event. We have been down to one car all week because my car went into the shop last Thursday, and it took them three days to diagnose the problem, and since then can't get the right part. It has snowed several times, so there has been lots of digging, snowblowing and salting. Some neighbor recently figured out they could get on our wireless network and grab tons of bandwith for BitTorrent downloads (I'm guessing) so I had to learn (finally) how to program the router to have a password. In the midst of this, Luciana's computer lost its (tenuous at best) connection to the internet, and we still haven't puzzled that one out. The garbage disposal is jammed, so we are constantly unclogging the sink drain and thinking vaguely about getting someone who knows what they are doing to come fix it. Perhaps on Saturday Varlei will come, as he has promised, to fix the many things. Meanwhile we are learning to move slowly, and we are learning to reassure each other. Last night it turned out that I was not mentally prepared for the day of the birth at the hospital, in that I had always figured I would be there through the whole process, and then when everyone was settled in and safe -- if everyone was settled in and safe -- I would go home for a few hours sleep before coming back in the morning. No! No! No! What kind of husband thinks this kind of thing?!? It must have been my autistic side getting activated. So it turns out the proper plan is -- I will sleep in the chair, ever ready to jump up and make sure the babies are alright so I can return to reassure my poor wife, who will be recovering from major surgery. Of course, if I had undergone major surgery (does appendectomy and gall bladder removal count as major surgery? maybe not) I would just as soon be left alone. But... hey, that's me. Luciana does NOT want to be left alone. Now that I understand that, things are fine.
I think for the first time I began to visualize the situation at the hospital and I realized I will probably be so excited that I will stay up all night anyway!

Old skills in new situations

You know why I like to spend time at work? Beyond the sheer pleasure of being with people and the endless puzzles and knots that people present, there is the reassuring experience of being on solid ground with myself. I know what I'm doing, I know what there is to do, there seems to be a reasonable match between these two sets, and so "I'm okay."
Which helps me understand the distress of a person -- like my wife -- who has been thrust into the opposite case. She doesn't exactly know what she is doing, and she doesn't exactly know what there is to do. All the challenges and questions that come up evade any automatic answer, because she is simply not allowed anymore to do anything she normally does.
Can she get out of her maternity bedrest to attend a meeting at school on the very important topic of X? No, she cannot. Her boss gets wind of her intent to attend, and calls her up to say, You can't come to school, it's not allowed, you're on medical leave, we can't tolerate the liability issues.
Can she keep working on reports while at home? No, she cannot. They want her to turn in her raw scores and hand over her laptop. They are saying, We'll take it from here.
Which leaves her in the lurch with herself.

Trying to calm down

We are going through a tough transition. L really hates being on bed rest. She lies down and sleeps when I am out -- as soon as I get home, she jumps up and starts "doing." So we have sit-com style conversations:
L: "Oh you're here. I can walk the dog."
Me: "Nooo (irritated) I can walk the dog."
L: "Well, I can make some dinner."
Me: "Nooo (more irritated) I can make some dinner."
L: "Well, while you make dinner, I'll go out and get some firewood to start a fire."
Me: "You're driving me bananas, woman. Lie down on the couch and watch the g**d**n inaugural parade and let me take care of this stuff."
L: "But I feel so useless!" (sniffles)
Me: "You're not useless, you're taking care of three infant babies! So please go do that."
None of these conversations end too happily. But in general we are trying to hang in there.
Like all else in life, this is merely transitional. See quote from Samuel Johnson below....

Time has passed

Geez, I haven't written on this blog since the end of September. Let's see, I think I was still exuberant about the triplet situation back then. Even through the financial markets were crumbling away. I didn't care. I was euphoric. Then one day I was driving the Jeep down
Route 9 and I suddenly thought, "Triplets! Jeeez. I didn't want Triplets! I only wanted one. A Baby. Not three. Just One." That was the beginning of a long middle period. In the middle period, I was somewhat remote from myself, irritable with people, overly focused on work-related issues, and prone to complaining about life. People would ask about the babies and I would force a smile and say, "Great." This was the period when the psychiatrist next door would see me every week and say, "Triplets?! I'd shoot myself!" and I'd say, "Yeah, thanks for that!" The middle period lasted what seemed like a long time. I am recovering from the middle period the past few weeks. The first signs of recovery from the middle period are symptoms of fear and panic. Holy Crap! My wife might die! I have to say, nothing could be worse than that. Children with birth defects and life threatening illnesses I can handle. Luciana dying - unimaginable. She said to me about three weeks ago, "If I die, I want you to take the girls and go to Brazil and my mother will help you raise them." I used all my patience to restrain myself at that moment. But as my recovery from the middle period progresses, I am less covertly panicked and more openly panicked, which is progress. Today Luciana saw her doctor, who gave her a letter releasing her from work after this Thursday. She'll be home, not on bedrest, but resting and not traveling around town. For that I'm grateful. I'm constantly hounding her: Don't bend over to pick that up, don't get down on your hands and knees to rummage under the sink, don't carry the laundry up from the basement. Etc. etc.