Isabella's Story, Part III
Part I, Part II
The Friday Isabella was born, I saw her twice. Once from my hospital bed and once standing or sitting next to her. She was hooked up to a variety of tubes as the NICU team tried desperately to save her.
At first, we were focused on the meconium. We kept hearing that some "stressful event" caused her to release it which she then aspirated. One of our pastor's sons had also released meconium in-utero and was fine. Our evening nurse's daughter had aspirated on meconium and was a healthy child.
The first joint meeting with the neonatologist was Friday afternoon. A NICU nurse called both of us downstairs. My c-section was only a few hours earlier and it took a little while to get maneuvered into the wheelchair. When I was in the wheelchair getting ready to exit the room, another nurse came into my room and said to wait, the doctor would come and talk to us.
We waited for fifteen minutes. The longest fifteen minutes of my life. My recovery nurse looked worried and our thoughts immediately went to the worst possible scenario - she had died.
When the doctor entered my recovery room, he updated us on her vitals. Her oxygen saturation was low, she had hypoxia, DIC, pulmonary hypertension, metabolic acidosis, her blood pH was 6.7 (and should have been 7.2 - to us this did not sound bad; we did not know the scale is logarithmic), they had given her platelets and blood transfusions, and they were still suctioning meconium from her lungs. She was on a cooling blanket, the first 24 hours were the most crucial, and they were waiting for more test results.
We asked whatever questions we could think of, but neither of us are physicians and we did not realize the implications of the information he had told us.
I knew hypoxia could be bad. Hypoxia is a significant decrease in the amount of oxygen to organs and tissues. As a Speech-Language Pathologist, I've taken several neuro classes and have worked with people following various hypoxic injuries. Depending on the degree of damage, hypoxia can lead to cerebral palsy, brain injury, and cognitive disabilities.
Shortly before he left, I told him that we had been terrified that something had happened to our daughter and it was horrible waiting the fifteen minutes for him to come upstairs, assuming the worst. He replied that they had been working on resuscitating her, but were successful.
What!? And he did not think this was the first thing we needed to know? Talking with our midwife later, it sounds like she was successfully resuscitated several times over the course of the two days. At the time, we did not know.
Shortly after the update, we went downstairs. We watched her belly rise and fall with the rhythm of the intubator. Her eyes and ears were covered to reduce the stimulation. I cried watching her, still not knowing the true color of her hair or her eyes, aching to hold her but only able to rest my hand on her foot. Her hair was plastered to her head due to the meconium and it was difficult to determine the color.
My husband told me we needed to name her. We had come up with several names, but had not decided on one yet. It took very little time to agree on Isabella. It means "devoted or consecrated to God." We did not know if she would live or die, but knew we trusted her future to God, regardless of the outcome.
We updated our family periodically and were somewhat optimistic about Isabella's recovery. The physicians in the family knew that Isabella's case was dire, but did not want to alarm us with this information. We learned later that as soon as they both heard "DIC," they knew she likely would not survive.
In the evening both my midwife and OB separately visited. By God's grace, the midwife we had worked with my entire pregnancy was on-call when I went to the hospital and was in the operating room. She was shocked by Isabella's condition and was the first to tell us that Isabella was "very sick." Our OB came by our room as well and said she was praying for us and had her family praying as well.
Around 9:30 pm, the night neonatologist came to my room and told us that they were able to get Isabella's blood saturation up from 30 to 90 and she was doing much better. We slept as well as we could in a narrow hospital bed, arms aching for the weight of our daughter, holding each other, with frequent interruptions from nurses and techs to check my vitals.
Several friends who had also had babies in the NICU told us to get rest while we could. The NICU nurses know what they are doing. Spending large amounts of time at her bedside so early in a likely lengthy hospital stay would sap our energy and there was nothing we could do. Get rest and recover from surgery. The neonatologist had also told us that she would likely be in the NICU for three to four weeks, so we were preparing ourselves to spend the foreseeable future in the hospital.
During this time I was concerned about my daughter and my husband was mainly concerned about me. Throughout the four days in the hospital, he did an excellent job advocating for my care. He made sure to stay updated on my vitals and asked for my blood pressure to be rechecked when it was more elevated than healthy. I learned later he had recently heard several stories about the alarming rates of maternal mortality following childbirth and was terrified he would lose me due to someone not recognizing important signs.
The next morning, Isabella had worsened. The encouraging report from the previous evening had not held and her oxygen saturation had again plummeted. The highest they could get it was 79-80. However, the morning report from the daytime neonatologist who had worked on her the previous day was similar to other reports we had heard. She was a fighter, the first 24 hours were the most critical. She was on a cooling blanket and they would attempt to slowly reheat her body on Monday. Her brain scan showed diminished background activity, but it might have been related to the cooling blanket.
My father asked what the long term impact of hypoxia would be developmentally. The doctor gave the highly optimistic (though accurate) response that there was no way to know. Some children make almost full recoveries and go on to be typically developing. Each case is unique and it is impossible to predict the outcomes.
Looking back, I wish we were told, in grieving layman's terms (which means repeated information using simplified vocabulary and explaining, multiple times, any medical terminology), that the prognosis was bleak. We should prepare ourselves for the possibility that she could die, while praying she recovered. Yes, the first 24 hours are the most critical statistically, but surviving the first 24 hours does not guarantee survival. Especially on an individual basis.
Saturday morning, my in-laws came down to meet her. A few hours later, my sister-in-law arrived. She is a physician and has delivered hundreds of babies. Her ability to talk with the medical staff and interpret the information for us was invaluable.
I saw Isabella once on Saturday morning. I was exhausted and was following the advice to not wear myself out when she might be in the NICU for a month. When I saw her Saturday, we could not touch her. Even touching would be too much stimulation. One of the NICU nurses offered me her stool. I sat on it and cried. Every cell in my body wanted to hold my daughter, feel how much she weighed, touch her skin, smell her unique scent, talk to her, look at her eyes.
I have never felt so helpless. There was nothing I could do to influence my daughter's condition. Something had happened while she was still inside me that initiated the event that caused her to release meconium. I wracked my brain trying to figure out what I did to cause my daughter to become this ill. Was it the loud movie we had seen several weeks earlier that she had hated? Was it sleeping in an odd position? Not coming into the hospital as soon as I felt the first contraction?
My husband wheeled me back upstairs. I did not know I would finally hold her on my next trip to the NICU.
Part IV
The Friday Isabella was born, I saw her twice. Once from my hospital bed and once standing or sitting next to her. She was hooked up to a variety of tubes as the NICU team tried desperately to save her.
 |
| Isabella on Friday afternoon |
The first joint meeting with the neonatologist was Friday afternoon. A NICU nurse called both of us downstairs. My c-section was only a few hours earlier and it took a little while to get maneuvered into the wheelchair. When I was in the wheelchair getting ready to exit the room, another nurse came into my room and said to wait, the doctor would come and talk to us.
We waited for fifteen minutes. The longest fifteen minutes of my life. My recovery nurse looked worried and our thoughts immediately went to the worst possible scenario - she had died.
When the doctor entered my recovery room, he updated us on her vitals. Her oxygen saturation was low, she had hypoxia, DIC, pulmonary hypertension, metabolic acidosis, her blood pH was 6.7 (and should have been 7.2 - to us this did not sound bad; we did not know the scale is logarithmic), they had given her platelets and blood transfusions, and they were still suctioning meconium from her lungs. She was on a cooling blanket, the first 24 hours were the most crucial, and they were waiting for more test results.
We asked whatever questions we could think of, but neither of us are physicians and we did not realize the implications of the information he had told us.
I knew hypoxia could be bad. Hypoxia is a significant decrease in the amount of oxygen to organs and tissues. As a Speech-Language Pathologist, I've taken several neuro classes and have worked with people following various hypoxic injuries. Depending on the degree of damage, hypoxia can lead to cerebral palsy, brain injury, and cognitive disabilities.
Shortly before he left, I told him that we had been terrified that something had happened to our daughter and it was horrible waiting the fifteen minutes for him to come upstairs, assuming the worst. He replied that they had been working on resuscitating her, but were successful.
What!? And he did not think this was the first thing we needed to know? Talking with our midwife later, it sounds like she was successfully resuscitated several times over the course of the two days. At the time, we did not know.
Shortly after the update, we went downstairs. We watched her belly rise and fall with the rhythm of the intubator. Her eyes and ears were covered to reduce the stimulation. I cried watching her, still not knowing the true color of her hair or her eyes, aching to hold her but only able to rest my hand on her foot. Her hair was plastered to her head due to the meconium and it was difficult to determine the color.
My husband told me we needed to name her. We had come up with several names, but had not decided on one yet. It took very little time to agree on Isabella. It means "devoted or consecrated to God." We did not know if she would live or die, but knew we trusted her future to God, regardless of the outcome.
We updated our family periodically and were somewhat optimistic about Isabella's recovery. The physicians in the family knew that Isabella's case was dire, but did not want to alarm us with this information. We learned later that as soon as they both heard "DIC," they knew she likely would not survive.
In the evening both my midwife and OB separately visited. By God's grace, the midwife we had worked with my entire pregnancy was on-call when I went to the hospital and was in the operating room. She was shocked by Isabella's condition and was the first to tell us that Isabella was "very sick." Our OB came by our room as well and said she was praying for us and had her family praying as well.
Around 9:30 pm, the night neonatologist came to my room and told us that they were able to get Isabella's blood saturation up from 30 to 90 and she was doing much better. We slept as well as we could in a narrow hospital bed, arms aching for the weight of our daughter, holding each other, with frequent interruptions from nurses and techs to check my vitals.
Several friends who had also had babies in the NICU told us to get rest while we could. The NICU nurses know what they are doing. Spending large amounts of time at her bedside so early in a likely lengthy hospital stay would sap our energy and there was nothing we could do. Get rest and recover from surgery. The neonatologist had also told us that she would likely be in the NICU for three to four weeks, so we were preparing ourselves to spend the foreseeable future in the hospital.
During this time I was concerned about my daughter and my husband was mainly concerned about me. Throughout the four days in the hospital, he did an excellent job advocating for my care. He made sure to stay updated on my vitals and asked for my blood pressure to be rechecked when it was more elevated than healthy. I learned later he had recently heard several stories about the alarming rates of maternal mortality following childbirth and was terrified he would lose me due to someone not recognizing important signs.
The next morning, Isabella had worsened. The encouraging report from the previous evening had not held and her oxygen saturation had again plummeted. The highest they could get it was 79-80. However, the morning report from the daytime neonatologist who had worked on her the previous day was similar to other reports we had heard. She was a fighter, the first 24 hours were the most critical. She was on a cooling blanket and they would attempt to slowly reheat her body on Monday. Her brain scan showed diminished background activity, but it might have been related to the cooling blanket.
My father asked what the long term impact of hypoxia would be developmentally. The doctor gave the highly optimistic (though accurate) response that there was no way to know. Some children make almost full recoveries and go on to be typically developing. Each case is unique and it is impossible to predict the outcomes.
Looking back, I wish we were told, in grieving layman's terms (which means repeated information using simplified vocabulary and explaining, multiple times, any medical terminology), that the prognosis was bleak. We should prepare ourselves for the possibility that she could die, while praying she recovered. Yes, the first 24 hours are the most critical statistically, but surviving the first 24 hours does not guarantee survival. Especially on an individual basis.
Saturday morning, my in-laws came down to meet her. A few hours later, my sister-in-law arrived. She is a physician and has delivered hundreds of babies. Her ability to talk with the medical staff and interpret the information for us was invaluable.
I saw Isabella once on Saturday morning. I was exhausted and was following the advice to not wear myself out when she might be in the NICU for a month. When I saw her Saturday, we could not touch her. Even touching would be too much stimulation. One of the NICU nurses offered me her stool. I sat on it and cried. Every cell in my body wanted to hold my daughter, feel how much she weighed, touch her skin, smell her unique scent, talk to her, look at her eyes.
I have never felt so helpless. There was nothing I could do to influence my daughter's condition. Something had happened while she was still inside me that initiated the event that caused her to release meconium. I wracked my brain trying to figure out what I did to cause my daughter to become this ill. Was it the loud movie we had seen several weeks earlier that she had hated? Was it sleeping in an odd position? Not coming into the hospital as soon as I felt the first contraction?
My husband wheeled me back upstairs. I did not know I would finally hold her on my next trip to the NICU.
Part IV
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