The 'P' Word

Many years ago, when my husband and I were DINKS (double income, no kids) we did some unusual things. One particular event involved housing a raccoon in our home. My husband worked for a wildlife rehab and sanctuary at the time, and when they were overrun with raccoons at one point we decided to take one home and care for it. It was a baby raccoon, but she was very...um...rotund. She was given the name of Beatrice, because we thought she needed a moniker that provided some lady-like character to her. It would prove to be the only thing about her that was lady-like.

She was greedy, selfish, gluttonous and could be very nasty during her play. Oh, but she was adorable! The two dogs we had at the time did not agree with this assessment. My doberman/shepherd was a senior in age and did her best to simply ignore the intruder. This proved difficult when Beatrice would 'hunt' her in the living room. The raccoon would sneak up behind the dog, grab her backside and run away. The old dog would move to a new spot and sigh as she laid down again. This was before we owned a video camera otherwise we could have easily won the America's funniest video with this daily occurrence.

The other dog was only about 5 years old and did not have any patience for the wild rodent that had invaded her home. She was a black lab cross so these creatures were for hunting and killing as far as she was concerned. After some training, she came to realize that she was not allowed to harm this raccoon and it was a very confusing set up for her. So she came up with a solution. She moved into the closet. As soon as the racoon's cage door was opened, the Lab went to the bedroom and settled into the closet. A place of refuge and safety from the creature that she wanted to kill.

We often remember this situation when we talk about trying to avoid unpleasant things now. Laughing about how much better it would be if we could just move into the closet and ignore the unpleasantness, whatever it may be.

Well, the unpleasantness at the moment is the 'P' word. Our beautiful, almost 11 year old girl has been transformed by the 'P' word. Puberty. Lord help us!

All of a sudden there is drama everywhere. Anxiety is oozing out of her daily routine.

"What if I'm not really sorry for my sins?"; "How do I really know that God loves me?"; "How do I really know that I love Him or you?"; "Do you think boys notice me?"; "If I don't clean my room perfectly every time, is that disobedience?"

Every topic from God to boys to personal hygiene to daily chores is being questioned to death. If her father and I try to talk about anything in depth the tears start to fall. At one point, I sent her to her room for a full afternoon because I needed to breath for awhile.

I know, I know, this too shall pass. In the mean time pray for me! My patience is hanging on by a thread. My husband has moved into the closet.

A Decisive Man

As I mentioned in the previous posts about Hoss, he came home from hospital with a feeding tube in his nose(NG tube). I have hated that tube from the first week it was inserted. It was necessary in the beginning simply because Hoss did not have the 'natural' skill to suck, swallow, breath - in that order. For the first 2 1/2 weeks since he was born, Hoss received all his nutrition from an IV line. Once he started to wake up more, we needed to get his gastric system moving - so, tube in and he started taking 2ml of breast milk. Seriously, just 2ml (30ml = 1 ounce) to test out his digestion and elimination. It did increase quickly, and before too long he was receiving 80ml of breast milk through the tube every three hours.

Here is where the problem arose. The tube enters through Hoss' nose and goes down his esophagus and into his stomach. The tube is there constantly, so his stomach entry cannot close completely. This causes regurgitation and acid reflux. The tube can irritate the esophagus and cause increased mucous build up - this happens in the nose, too. Therefore, whether he took 2ml or 80ml of milk something always came back up. The smell of acid was prevalent in his burps and the coughing and sneezing could make him mad.

How is this tube a good thing?

Adding to the trouble with the presence of the tube, the hospital staff insisted on following a chart about the amount of intake rather than looking at Hoss as an individual. Remember, policy and procedure comes before common sense. Eventually, the hospital was increasing his intake to 115ml every four hours (I had to request that it be 4 hours apart vs. 3h) and immediately after the machine stopped pumping the milk into him, he would throw up at least 1/3 of it. The gurgle from his stomach was audible from a good distance and was quickly followed by a huge amount of spit up (change that, it wasn't a 'spit up' it was a throw up!)

All this I put up with in order to just get him home! I knew once I had him in my own house I could start adjusting his care to suit his needs. And that is exactly what I did. From the moment we walked in the door, Hoss' eating schedule was changed to every two hours at a total of 2 oz - I would work with him to take a whole ounce from a bottle and the remainder came through the tube. It was hard work and could be very frustrating. Really, a baby is supposed to know how to eat, right!?

The spit up still happened, but it was only small amounts - like any baby can have. However, Hoss was not progressing on the bottle very quickly. Part of his therapy was to encourage him to take a pacifier (to improve his suck), he did not like the 'doe-doe' as we call it. So the question remained, 'how are we ever going to get rid of the tube if Hoss won't take a bottle?'

I have found a few ladies on-line who had been through the experience. This brought mixed encouragement as some of their children have taken to the bottle after a few weeks of working on it, but some children are still on the tube after their 1st birthday! "Please God I don't want this tube here that long!"

One week to the day that we arrived home from hospital, Hoss was literally spitting out the nipple from his bottle each time it was offered to him. He was getting mad at me for sticking back in his mouth and I was getting frustrated with him for constantly turning his face into my chest.

Wait a minute...duh! Hoss was looking for the breast. So, I offered it to him half-heartily - not really expecting much. Then he nursed for 25 minutes in total. Go figure. All this time the experts were insisting the therapy with the bottle was the only way - and I was listening. Even an anti-socialist like me can get caught in the trap of ignorance. It took an infant to point it out to me!

From that point on, Hoss has chosen the breast over bottle. He is taking a doe-doe now, which is something I am most grateful for at 4 a.m. To top it all off, three days after he decided he would be a breast fed boy, he also pulled out the NG tube by himself. Which is good, because I might have received some prying questions from doctors if I had removed it. Did I mention how much I hated it?

Meet the tubeless wonder boy: First day at the beach!So there you have it...a little child shall lead them.

Policy and Procedure

Living in an institution can really bring the characteristics of a society to light. While Hoss was in different hospitals during his first 6 weeks of life, I was living in and around those hospitals, too. As both Hoss and I started to come out of our respective comas (his drug induced, mine emotionally induced), I started questioning different events that were directly affecting our situation - much to the chagrin of some of the medical staff.

The first incident involved the use of morphine on my little guy. Yes, I understand he would have a heck of a headache from the brain hemorrhage, but morphine is not a drug that I have ever appreciated. I have seen it do some nasty things to people and had some loopy moments myself on the one occasion that it was prescribed to me. So I asked for the plan to reduce it in Hoss' medication regime. The standard answer, "that's up to the doctor."

Well then...let's get hold of the doctor. I patiently listened to the doctor's explanation as to why the drug was implemented. Then asked again..."what is the plan to reduce it?"

Slowly the staff realizes I am not going to nod my head up and down at their 'expert' opinion and then they actually set a plan to reduce, then remove the drug from the medications that Hoss is taking. Excellent decision.

Keep in mind that I truly see SickKids hospital as a place that does incredible work with some amazing success stories. The staff are gentle and kind to parents as well as the patients. However, even the staff can become institutionalized in the way they operate. That means they stop thinking in individualized cases and stick to policies and procedure (or protocol is another word they like to use). Where I ran into the most difficulty with this lack of common sense in favour of policy and procedure was at the second, smaller hospital after leaving SickKids.

When an infant is born in hospital and has never been discharged to home, that infant is always placed in the hospital nursery rather than a general paediatric unit. So it was for us when transferred out of SickKids. The second hospital booked us right into their nursery that was set up to hold 6 infants at one time. However, during our two week stay that nursery held up to 10 babies because of sudden admissions from OB. It was tight quarters!

As Hoss began to improve, I found the situation inappropriate for his needs. Because of the many parents, visitors and staff coming and going through the nursery it was difficult for Hoss to concentrate on learning to take a bottle (I had given up on breastfeeding earlier and started expressing the milk due to the lack of privacy). The high number of babies in the nursery also made it nearly impossible for the staff to work with Hoss on his bottle when I was not there. It was much easier for the nurses to just plug him into the machine on his feeding tube. Therefore, I would spend four days at 12 - 14 hours in the nursery in the hospital working with Hoss to improve his feeding skills only to leave for two days at home and he would not have any practice at all.

(BTW this same problem occurs for the elderly that I have generally worked with in my former career. Therapy of any kind simply does not happen with hospital staffing levels. It isn't the nurses to blame, they simply do not have the time to put into therapy exercises. If a senior has a hip replaced, the exercises and walking practice simply do not occur with hospital staff. Which leads to the adage 'people do not get better in the hospital' - at least not where the extra time is needed.)

This gave rise to my approaching the staff about Hoss being moved out of the nursery to a general paediatric room where parents are expected to stay 24hours to provide the extra care. Once again I ran into the policy and procedure wall.

Doctor, with patient look of condescension, "it isn't the general practice to move an infant out of the nursery when they have never been discharged to home before"

Me: "I understand that, however, for Hoss it would beneficial to improving his feeding skills - which is the only thing left to work on before his discharge"

Doctor: "well, general paeds is considered to be more infectious because of the people being admitted from home. Hoss would be vulnerable to several new viruses. Now, if he doesn't progress on his intake at the bottle we may look at sending him home with the feeding tube in place. But, that would be in the future and isn't generally done either."

Me, with patience and polite tone: "Are you telling me that the nursery is less likely to have viruses enter it? This nursery that has 4 babies more than it is supposed to have, therefore 4 families more sharing the room all together. Plus all the visitors that come into the open nursery to visit all 10 babies and, because of the extra babies, the nurses that are currently working on both general paeds and in the nursery - when Hoss would have a private room in general paeds with just his own family visiting. How is this a better set up?"

Doctor, with stunned look replacing look of condescension, "well, I guess that does sound unreasonable when looked at it in that way...but, policy and procedure have been set up this way."

Me, working really hard not to be condescending: "Tell me who to talk to about changing policy and procedure for Hoss' best interests. He needs his mom here around the clock in order to provide his direct care. Unless anyone can guarantee that his occupational therapy will be completed properly even when I am not here."

Doctor, with look of resignation, "I'll see what we can do."

One day later, Hoss was moved to general paediatrics. The room had a pull out bed for me and was private - no roommates. The nurse on duty that day looked at me with an amused smile, "I do not know how you managed this, but I know that alot of moms in the nursery have asked before and have been told it does not happen. After all,..."

I finished her sentence for her, "I know...policy and procedure."

Hoss and I were in the hospital for four more days. We did get discharged home with the feeding because I pulled out the secret weapon that the 'experts' find hard to ignore.

"I am a nurse, after all." Never mind that I am an experienced mom that is confident in the care I provide to my child. Never mind that no one cares more about my son's health than myself and my husband. That would not have convinced the 'experts' to discharge us with what is considered a complex medical concern. However, being a nurse hits the right button and everyone breaths a big sigh of understanding.

After all, as a nurse I totally understand policy and procedure.

Though He Slay Me... (part 2)

I was so angry with God, but afraid to say it out loud. Is it okay to angry with God? Will He strike me down if I admit it to anyone? The bible tells me in several places to 'pour out my heart', but my heart didn't have anything nice to say to Him. Why is He putting my family through this trauma? Why is my newborn son's life hanging in the balance after waiting ten years for another child?

WHY?!

My son was born on June 13th and I was having this conversation with myself in my first full shower on June 15th in the parent's room at SickKids hospital in Toronto. The neonatologist had visited us this same evening to discuss the findings of his assessments and tests so far. The doctor's best guess was that our son had suffered a stroke during birth - because he was big and came fast. The only test remaining to complete was an MRI, which would be completed that night. We would have confirmation on a diagnosis within 24 hours, but we needed to be prepared for the possibility that our baby would not breath on his own, may never walk or come out of a constant seizure state.

How does a parent sleep after a conversation such as this? I can tell you, there is no sleeping.

We could visit our boy anytime we wanted, 24hours a day. He was on such heavy medications, including three seizure drugs, that he was unconscious. The many tubes and wires that were attached to him made it difficult to touch him and he was very swollen from many needle pricks and fluids he had received. All this, and the machine doing the breathing for him, he looked more like a robot than a baby.

The next 24hour wait is very much a blur in my mind. I know I ate, because my dad and his wife came and brought food to us. I know I walked around the hospital, because I remember feeling great resentment about how cheery they had made the environment (I wanted my surroundings to be just as black as I felt). I know my husband was at my side the entire time, because I remember holding his hand almost constantly. What I don't remember is talking, or thinking, or acknowledging anything. Both my husband and I were living in a fog.

For as much as we, as parents, were being drawn through the 'valley of death', our little Duck was having a hard time, too. In some ways it was harder for her because she was not at the hospital with us. She was seperated from her entire family and had little information other than her new baby brother was very sick. We were trying to protect her from the worst, but she is far more intelligent than we were giving her credit for being - she already had started praying for a miracle.

We finally reached the next evening and the neonatologist returned to our room, bringing the social worker and the duty nurse with him. This, to me, was a sign that he wanted extra support for the negative news he was about to deliver. He drew a picture of a brain to show us what had been discovered from the tests. Our son had suffered a brain bleed in the left ventricle of his brain. The blood that had collected in the ventricle had caused the seizures and some brain damage could be seen on the wall of the ventricle.

He raised his head to look at us and said, "this is far better news than a diagnosis of stroke".

What? This is good news?

The doctor continued to explain that the bleed had stopped on it's own and the blood would also reabsorb on it's own - our bodies are made to work that way. The damage was a small area on the wall of the ventricle that may affect our boy's right sided motor skills and his vision (they know this because the brain is mapped out very well). However, because he is just newborn, there may not be any noticeable affect. As he grows and learns to grab and walk and use his right side, he may simply adapt to any weaknesses and develop normally.

Yes...this was much better news than a stroke, which would have damaged a much larger portion of his brain. The doctor smiled at us and said, "I'm glad my initial assessment was wrong."

At this point, my nurse brain snapped back on - I started asking about care plans, future therapy, reductions in medications, etc. It didn't take me long to move past the dark world that I had been living in and move to a place of hope again.

It took a little longer to reconcile my feelings toward the Lord. The prayer of thanks was immediate, but I didn't have the answer to my 'why?' question. In the end, I have concluded that we are 'vessels of clay' and He will 'have mercy on whom He will have mercy.' I serve a soveriegn God and although I don't understand the purpose in this event, I simply accept that He had a purpose - and I may never know what it was.

For my thoughts are not your thoughts, neither are your ways my ways, saith the Lord. For as the heavens are higher than the earth, so are my ways higher than your ways, and my thoughts than you thoughts. Isaiah 55:8&9

To make the final part of the story short, our little man spent three weeks in SickKids before being transferred back to the first NICU where his seizures started. He stayed in that hospital for another two weeks and then CAME HOME! He came home with a feeding tube in place, but he was bright eyed and active. That activity has shown that his right arm and leg are strong and moving just as much as his left side!

I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well. Psalm 139:14

I will expound on some of the details that I've skipped over here (including a commentary about why I still don't support socialized medicine). However, with a newborn boy keeping me busy at home - the posts may be slow in getting out.

Meet 'Hoss':

And the best babysitter I could ever have:

Though He Slay Me... (part one)

When expecting a child, most women daydream of the time they hold their new little one in their arms. To be able to gaze into your newborn's eyes, count ten fingers and ten toes. These anticipations are the thoughts that come at the end of a pregnancy - at least, that's where my thoughts were before June 13th of this year. My son was born that day. Just five days overdue.

I woke up at 1:30 a.m. in labour and woke the rest of my family by 2:30 a.m. to get ready to go to the hospital. After phoning the OB nurse at that same time, my water broke and we quickly headed out the door. Only a short labour period past and my son was born at 3:57 a.m. - that's only 2 1/2 hours from beginning to end. Some women with long labours may be impressed, even jealous at this expediency. Don't be, it was not a good thing.

Our handsome boy weighed in at 9lbs and 6 1/2 oz, 22 inches long. He was very bruised about his head because of the speed he came through the birth canal. Immediately, the medical staff noted that his blood sugar was too low and started the process to raise it. Their efforts did not improve the situation and within 5 hours of delivery we were transferred from our small town hospital to a more technologically advanced Neonatal Intensive Care Unit about an hour south of us. Little did we know the events that were to come.


Because my boy was in the care of a NICU with 24hour monitors and high ratio of staff to patient it was noted that he started to have seizures. In fact, the seizures became continuous to the point that he would stop breathing and require resuscitation. This is only day two of his life. Before this day was over, my son was intubated onto a full time respirator and we were being transferred to The Hospital for Sick Children in Toronto with no idea why the seizures were happening or if they could get them under control. More seriously, would our son ever breath on his own again. We had only held him for a short time after his birth and I had not been able to nurse him yet.

When we arrived at SickKids hospital, we were presented with the some of the initial test results and physical assessments. They did not know why the seizures were occurring. They did not know why this baby boy would not breath on his own. They only knew that we should be prepared for the possibility of having to say 'goodbye' to our boy after only saying 'hello' a few short hours before.

This isn't how it is supposed to happen. Not only did I start sending desperate cries to God, I had so many questions as to 'why' He would allow this to happen to my family. While I am questioning Him, I'm also trying to answer my 10 year old daughter's questions that are the same as mine. 'Why, Lord, why?' I didn't have an answer for her. All we could do was cry together as a family...and wait.

I was drawn to the book of Job - here was a man who had suffered much and maintained his faith:

What? shall we receive good at the hand of God, and shall we not receive evil? Job 2:10b

Though he slay me, yet will I trust him: Job 13:15

Obviously, I wanted a positive ending to our trauma. I did not want to share in Job's strengths by losing my child. I did not want to say goodbye.

(more to come as I am able to write it)