Wednesday, November 16, 2011

The Long Version

I swear, I feel like I've been beaten.

This morning, my OB released me. Charlotte had been doing perfectly (eating, maintaining her temp, no breathing trouble, even gained an ounce of weight back last night) so I was confident we were going home. We started packing and had our stuff by the door.

I was pretty sure Charlotte was going to be jaundiced. It's super common anyway, particularly in preemies, even more in breastfed preemies and her bili had gone up the 2 previous days, though not to a concerning level. But it usually peaks between 3-5 days after birth, so I kinda expected it. And then about 2, she started looking pretty yellow to me and didn't eat well at all.. just really sleepy. (Common symptoms of jaundice.)
At 5, she ate well, but was downright orange. The nurse thought the same thing and had did a heel prick to send her serum level off. But I wasn't freaked out or anything. I'd already discussed it with her pediatrician at rounds the day before and knew we could go home with a bili blanket if it came to that.

Well, her pediatrician rounded at 7:30 and said her level had gone up a lot- it was 14. She wanted her on the lights right away and wrote an order for us to get a bili bed at home and a nurse visit for tomorrow to draw her levels again right away.

They took Charlotte to the nursery and brought her back naked on this bili bed. Charlotte was furious. They had a couple of blankets over her, but Charlotte was NOT to be consoled. She was just flailing all over the place. I had only slept 2 hours all night because she'd had a little cluster feed at one point and then all the stuff with the tests and all that, (plus you know, it's the hospital. I swear someone comes in every 10 minutes to wake you up and tell you to go to sleep.) I was hoping to lay down a bit, but it wasn't to be.

David and I both tried to calm her down, but w/o being able to actually hold her, that was difficult.
An hour later, her nurse comes to take her temp. It's 93. Nurse is convinced the thermometer isn't working. Goes and gets another one. Still low.
Takes it rectally. it's actually 93.
Holy shit, that's REALLY bad.

I start to freak out, I want to hold her kangaroo style right away to help get her temp up while the nurse is paging docs. the nurse won't let me. I'm beside myself.
She finally takes her off the nursery under the warmers. (This probably only took 10 minutes, but seriously, I could have increased her temp at least a LITTLE in 10 minutes. I'm still pissed about it. I swear if I never hear the word "policy" again, it's too soon. More on that later.)

She comes back, tells us that the NICU team is coming to evaluate her and she's paged our pediatrician. I pretty much knew then that we were going to have to stay. Our pediatrician is really conservative, and she'd already been nervous about us going home with her bili high.

The NICU NP comes in to talk to us and has the hospital social worker with us. Yeah, that definitely means bad news. She was as nice as could possibly be, she really was (is) but you know, the news still sucked.

She said that with the jaundice and then the temp drop, they wanted to get her into an isolette and under the lights. there was also the CBC they'd done when her temp was so low and her white blood cells were just slightly low, so they wanted to repeat that in the morning to make sure it wasn't the sign of an infection (newborns will often do the opposite of adults and drop their levels instead of raise them.) She doesn't really think it's an infection, but will be cautious.

While I was talking to her, my pediatrician calls my hospital room and she's convinced it IS the sign of infection and definitely thinks she needs to be in the NICU.

They take Charlotte and go. I sob.

And sob.

And sob.

Her nurse takes pity on us and arranges for us to keep our hospital room until 7 tonight and says maybe we can get a courtesy room down by the NICU. That doesn't happen, but I can stay on the couch in Robbie's NICU room. Just means that I'm by myself and still healing from a c-section, which isn't ideal, but it is what it is.

In the midst of all of this, Charlotte has a couple more feedings, which she completely sleeps through. I have to bottle feed her instead of nurse and even that is difficult. It's either the jaundice or the cold (even though she's now warm) or infection.. who knows. I was a wreck.

I managed to pump enough for a few feedings, thankfully, so at least I had that (not that she couldn't have formula but at this point, I'm hanging on to what I can.)

My mother-in-law brought Robbie up for a quick visit, which is a welcome distraction. This gives  Charlotte a little time to get admitted into the NICU, then come down to see her. It's one of my favorite nurses with her, which was a huge relief. As soon as she sees us she just shakes her head. "She didn't want Robbie to have all the stories."

The sight of Charlotte in the isolette is almost more than I can take. Maybe it was PTSD, I don't know, but as soon as I saw her, I started sobbing again. Another one of my babies naked in an isolette in the NICU. My heart was just shredded.

The NP, Dawn, is in and out and says Charlotte's initial labs were good (they'd checked her electrolytes to make sure she wasn't dehydrated since she'd not been eating well for a few hours, but they were fine.).

It's about time for her to eat, so I decide to attempt to nurse her, figuring I'd just bottle feed her anyway. She ends up taking maybe 1/3 of a feeding by breast (improvement) and the rest by bottle. Nikki is off tending another baby who is having a lot of breathing issues, so I just hold Charlotte a while. Nikki comes back and I ask if I have to give her back right away to get her back on the lights.
THEN she tells me "well, you can hold her a little while. her bili really isn't that high." I say something about it having been 14 and she says it wasn't really 14, it was 10.


Yeah, turns out that 14 that everyone quoted was the skin test thing which is notoriously inaccurate. They hadn't even waited for the serum level to come back with the real level, which was 10. I ask what it really should be (pretty sure 10 being below the treatable level because that's what it was on the skin test the day before) and she says that different doctors have different policies, but in the NICU, they don't treat for a level of 10. I make myself proud by NOT starting to cuss. The issue that set off this whole thing wasn't even an issue?!

Of course, I tell myself that maybe it's for the best, Charlotte WAS acting lethargic and there's still the undetermined WBC issue and maybe God has us here for a reason. But I was twitching anyway.

The NP Dawn comes in to chat with us a bit and they discuss if Charlotte even needs to be on the lights. In the end, we all agree to just leave her on the lights as is. She has to be in the isolette for her temperature, may as well make the most of it and get her bili down. It will help her feel better, eat better and will make our pediatrician happy in the morning.

She had discussed the WBC level with the neonatologist on duty and he didn't think it was an issue either, but it will be repeated in the morning either way.

We check Charlotte's temperature and she's WARM. Dawn encourages Nikki to aggressively wean her isolette temp with the goal being to have her back in an open crib by morning.

A few familiar faces come by and catch up on Robbie. Everyone coos over Charlotte. I try not to think too much about how disturbing familiar everything is. I try not to notice the smell of the soap. I hear a ventilator alarm across the hall and my stomach churns, but I stare at length at the silence of Charlotte's monitors to reassure myself.

David and I go to the cafeteria for dinner. He insists I stay in a wheelchair since my blood pressures are still not great and I'm still recovering. He takes me for a "walk" outside. It's the first fresh air I've had in 10 days. All I want to do is get back to the NICU and check on Charlotte.

The night nurse asks if we'd like to bathe her. It's all coming back to me now. I stepped right in to do her weight (up .7oz from the night before, despite all the drama today) and sponge bathe. Then sat down to feed her. She nursed fantastically. I tried to top her off with a bottle and she barely took 5ml. She was full. Definitely improvement. She looks significantly less yellow and her temp is good.

Right now, what we need is for her to have a normal CBC in the morning. If that goes well, there's a good chance we can get out of here tomorrow. Dawn doesn't think it's going to be a problem. But as I told all of them earlier, Hope and I aren't friends right now. I'll believe it when we're walking out the door.

Right now I'm sitting in the NICU waiting for feeding time. I've definitely been here before. At least this time the rooms are private and I can spend the night, so I don't have to leave her behind. If she has to stay past tomorrow, that might change, but right now, I'm just going a few hours at a time. First we get through the night. We'll see what the morning brings.



A and W mom said...

This post tore me up.

cd0103 said...

Oh honey, I know it is hard and it brings back horrible memories, but at least she has 24 x 7 care and you don't have to second guess her going home early and having something go wrong.

Sucks, but better to err on the side of caution.

I am glad they felt like you were well enough to go home. That is great news given your post earlier!

Deep Thinker said...

Big {{{hugs}}} to you Trish. Hoping you both are well and get to go home soon.

Sarah said...

First of all, congratulations!!!

Secondly...I'm so sorry :( Those flashbacks SUCK. And...oh my gosh, I would have been freakin' furious too about the numbers. Gaaaah.

I hope you guys get to go home soon...!