Hospitalized to Term

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HOSPITALIZED TO TERM

At one point later that Tuesday, my Israeli OBGYN Dr. B returned to me with an update: He had consulted with a high risk specialist, Dr. K. T. (the very same doctor both friends had recommended), who had indicated that because of how dilated I was, I should not have a cerclage; there was a risk that the suture would puncture the amniotic sac because of how low it was, thereby putting my baby in absolute harm’s way.

My eyes grew wide.  I was confused.  The frightening solution that I had grown to accept over the past day was now being presented as dangerous?!  Dr. B indicated that my only course of action was that I was to stay in the hospital in that position on bed-rest for the rest of my term.

It was November 24th, 2009, and I was 2 days shy of being 24 weeks pregnant.

I emailed everyone with an update.  I don’t know if I cried.  I may have been too scared to cry; after all, every bodily movement I had seemed to have some consequence on the actual life of my child.

I stayed in my control mode and may have wondered about getting credit on the American Airline tickets we hadn’t used, about disability that we would need to get filed on my behalf, and what other things I needed Craig to bring me in the hospital.

So long as I could think of things I could do, I would fool myself into believing I was in control of the situation.

When multiple members of the staff from the N.I.C.U. unit walked in that day, they calmly indicated they were there to inform me of my options, should my baby be born prematurely.  I don’t know if they had literature under their arms, but they looked like a bunch of fucking used car or door-to-door salesmen to me and I rejected their presence, as it was preparing for something that I couldn’t bear to have happen.  I told them to get out of my room immediately.  I was loud, assertive, and know that when they left, I was short of breath, and as I typed these words now, tears came to my eyes and a sadness rushed over me causing me to need a valium ~ at the memory of me shouting to them that my baby was not going to be born early, that I didn’t need to be informed of their (fucking) statistics.

Later my doctor would come in and tell me that he’d heard I yelled at them; he didn’t do it to reprimand me; he knew I was tough, and I guess wanted to communicate that is how I’d come across.  Perhaps it was motivation for me to be even tougher than usual.

My parents came that day or the next, or maybe both.  My mother said that instead of she and my father going to my sister’s, that they would order food in and eat there with Craig and I for Thanksgiving.  I guess I said OK, but when I repeated the plan to Craig, he said otherwise.  “It’s too small in this room and would be too crowded and I don’t need you around any stress.”  His voice was firm and his statement matter of fact; in the past, he would sort of tiptoe around the craziness of my family, namely my mother, whose behavior you’ll recall from earlier postings, but in this case, I almost saw his posture change.  I called my parents and conveyed the final decision.

On Thanksgiving Day Craig picked up pretty hefty turkey dinners for us from Izzy’s Deli, which was a couple blocks away.  We marveled at how much food they were able to fit into the container.  Moreover, we celebrated the fact that this was our son Finley’s 24th gestational week, and just this morning I had received 1 of 2 shots I would receive to accelerate his lung capacity.

I had learned so much about Finley on a physical level in those incredibly long 96-odd hours since being hospitalized: he was fully formed except for his lungs wouldn’t come along until around week 30, so we had to do everything we could to prepare him for life should he come early.  “I am a very strict mother and I told him he’s got to stay put,” I joked with whomever it was who had given me the steroid injection that morning in my butt.  There was no need to laugh at my joke, which I said with Craig at my side, squeezing or stroking my right hand had become his number one job; I just needed to keep repeating the fact that Finley wasn’t going to come out early, and however I was able to convey that to others, to myself, to my fully formed son inside me except for his lungs but including his little ears – his beautiful, very little, yet fully formed ears – I would take the opportunity.

In addition to learning about his gestational development, my son and I became very close. I suspect most pregnant moms don’t bond as much with their babies at this stage, because they are not so violently forced into the condition of his absolutely survival depending upon how she lies down, how little movement she should make; most women aren’t forced into a physical position with constant reminders that your baby’s very safety is at risk; most mothers don’t have nurses coming in twice a day specifically to check on their babies, with a visit from their doctor every.single.day.

Obviously any great mother has already been eating healthy foods and avoiding that which would put baby at danger, but this forced condition both caused and allowed me to spend a lot of time with him, speaking to him all.day.long. – I would tell him to stay in, how much we loved him; I rubbed his little body in my lower belly a lot – as that is where he was living, and we played music for him regularly.

In the Jewish religion (or is it just amongst my friends?), it is bad luck to tell people the name of the baby before he’s born.  Craig had been the first to tell his family our son would be named Finley, and I followed by telling my sister and nieces (who told my parents – which is such a bullshit move, by the way; the lesson is don’t tell a 5 and 8 year old a secret!), and of course Dee.

Now, whenever a new nurse entered the room, one for the day shift, and one for the night, he / she would ask if we had a name, while gently searching for his heart beat with a sonogram device over my belly.

I never for one second considered not telling them.  The more I spoke of him by name, the more certain I was he would know how much he was loved; how clear it was that he existed; people would refer to him by name.  It was as if I was re-writing the Descartes quote of “I think therefore I am” to be “I have a name and therefore I am or will be”.  If I could leave the room and go to a mountaintop, I would have screamed, “Finley” for the world to hear.  But as it was, not only could I not leave my room, I couldn’t even leave my bed.

In addition to me being confined to the bed in the Trendelenburg position, with my feet 15 – 30 degrees higher than my head, I had to wear medical stockings to keep the blood flowing in my legs.  They were AWFUL!  They were itchy and cumbersome. They were placed on me by nurses, and then latched to the bottom of the bed, and hooked up to some device that had them massaging my calves so that they wouldn’t go into a state of atrophy.  Oh the nightmare of getting those off before I slid over to that makeshift toilet, directly adjacent to my bed.

The nurses were always different those first several days; perhaps because it was the week of Thanksgiving, there was a trade off of time shifts or something.  Accordingly, I had to instruct every morning nurse the same instructions I’d uttered the day before.  After they opened the blinds, unless Craig was sleeping there, as he did on the Thanksgiving weekend a couple of nights, I would ask them to rip off the day on the calendar.  In the right hand corner, to the right of the bathroom that I had not even entered as it was considered too far away from my bed for me to use, there was a sizeable daily calendar, and every new day brought me the satisfaction of knowing he had grown a little bit more, that he was bigger and stronger than the day before, that the steroid shot we had given him for his lungs was surely working and accelerating the growth of those vital organs.

Then after they would do those tasks it was time to take some pills, my Emergen C, for me to go to the bathroom, and then clean up a little before I would change dressing gowns and then the nurse would return to change my sheets.

By this time I had a huge pink plastic container that held my toiletries.  My mother had contributed quite a few, and of course Craig had brought what I needed from home.  I would brush my teeth and use mouthwash, while sitting on the edge of my hospital bed upright.  I would soak my washcloth into the soapy (Dove) water container the nurse would have prepared, and clean under arms and privates.  I would apply deodorant, maybe a little perfume so that I could feel civilized, and my Aveeno lotion.  This not being able to shave every day was wreaking havoc on my Excema, an annoying skin condition that was heightened by my nerves, so it was important that I at least used this lotion.  I would spray this weird hospital dry shampoo into my hair, and then brush it out.  I would fool myself into thinking that I felt clean, as I buzzed for the nurse so she could come change my bedding, and then put on a new dressing gown; I had been told that it was fine if I wore my own clothes, but the dressing gown just seemed so easy and as my mother had said, in this case, the hospital would do my laundry for me.

Craig had brought my green down comforter as well as a pillow, but during the day I didn’t want the comforter, so I had to instruct that day’s nurse to fold it and put it in the corner by my window.  Also by my window was my purse, which I didn’t have a lot of need for, several books, DVDs, and whatever bananas and apples Craig had brought that didn’t fit above the small frig that was below the TV, just to the left of the bathroom door of that bathroom that alluded me.

In addition to the 2 types of stool softener that I would take daily, as constipation is common for pregnant women and my lack of ability to move could interfere with my previously regular movement, I was eating a lot of fruit, per my doctor’s suggestions. Craig had just gone to Ralphs and gotten a fruit tray, since I complained that the hospital fruit tray tasted a little too frozen.

Directly to the right of my bed was a 3-drawer bureau.  On top was the hospital phone, whatever I was reading, my cell phone that was plugged into my phone charger, and my glasses, when I wasn’t wearing them.  In the top drawer was my computer, typically plugged into the outlet.  Leaning to the right of the computer was a lap desk so that when I used my computer, it wouldn’t harm the precious baby inside my uterus.  In the second drawer I had a fancy lotion my mother had brought by L’Occitane and some other toiletries that I didn’t need regularly, like my make-up, tweezers, nail polish / file / polish remover.  And in the bottom was my junk drawer, which was filling up nicely from the visitors I’d had.  There was a bunch of candy and some cookies and I tried to limit the amount I’d eat daily by moving what I’d allocated to the top of the drawer, but without fail, during the evening, I’d decide I was allowed to have one more fill-in-the-blank.  I liked candy and cookies before I got pregnant, but being pregnant had increased my habit, and then being hospitalized seemed to give me a pass to eat however much candy I wanted.

VISITORS:

Over that first week or so, lots of people visited.  I had my hands full scheduling them so that they didn’t arrive at the same time, and also was trying to spread them out as I knew I would be there for awhile.

Claire and Poodle came with some flowers.  I had been friends with Poodle – a nickname for Jon – for years; I had even been out drinking with him and Dee the night I met Craig.  His wife Claire was British and the two had come from getting their nails done to visit me. They brought me flowers.

Our good friends Leila and Pete brought me a bunch of magazines, and I remember telling Leila not to kiss me hello or goodbye as she smelled and looked so pretty and clean and showered, and I, a woman who prided herself on smelling good – just felt stale and itchy and not clean!

Jodi, a best friend since high school, came and brought me two Black & White cookies from Izzy’s, per my request.  I remember she was wearing a blue headband.

Kristie – who had been rooting for us to become pregnant and was over the moon once she learned we were – came and brought me M&M’s.  She was in early pregnancy, and had both made and taken the time – already with 2 little ones at home – to visit me after her doctor’s appointment on the Westside, having traveled all the way from Palos Verdes.  I remember that she told me that her husband had said to her, “Wow, she’s going to be in there for awhile,” to which she responded, “YES, let’s hope so!”

My parents visited together and also visited separately.  My dad brought me a box of See’s lollypops with all different flavors (even though I’d specifically requested chocolate).  My mother returned the next time with chocolate only.  She also came once dressed up after a holiday luncheon and looking and smelling very glamorous, like a movie star, with a holiday plant, a white Poinsettia.

My eldest sister had come with her mother in law Lynne, the nurse, the day after I was hospitalized, and the next time she came, she was there to pick up the birthday gift I got for youngest niece that Sunday before I was hospitalized (which Craig had brought from home).  I remember thinking it was stupid and insensitive of her to say that she couldn’t stay long because of how busy she was.  I mean really.

Our friend Jerry, Craig’s friend who he was with the night we’d met, came and visited, too.  He and Craig left my side to go have some beers at a local sports club. I was happy he was able to vent, as even Atlas can shrug under too much weight.

Dee, who I had considered my best friend, the one for whom we held a celebratory dinner party because we thought she was in remission the day before I was hospitalized, told me she was coming and asked what I wanted her to bring me. I ordered a bagel sandwich from her, and looked forward to seeing her on the appointed day.  That morning, I called her to find out her timing, and she told me she couldn’t come. I was disappointed, as of course these visits were the highlight of my days, but understood; things happen.  We re-scheduled, and I told her to get me that same bagel sandwich.  She flaked again.  I was sad and really mad that she hadn’t made me a priority, when I had prioritized her sickness by driving to the valley for breakfast or renting a car to go and babysit her youngest or throwing her a dinner party, etc. – for all of the months prior to my hospitalization.

And she wasn’t the only one to disappoint me; I really learned a lot about people’s character in this short time period; people who are the busiest always seem to make the time to fit another commitment in, and others – even a friend who was single with no children, worked only 40 hours a week, and lived only 20 minutes away from the hospital – didn’t make the effort to visit me.  But I didn’t have time or energy to focus on people who I now shelved or dismissed as petty and incapable friends; my number one focus was my son, and I relied on the love of the people who were besides me to help me stay calm and resolute.

That Monday in November, 2009

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I haven’t written in awhile, not because I’ve been too busy – necessarily – but more because I haven’t been ready to re-visit the horrors I began to live starting next, that fateful Monday in November, 2009.  I haven’t wanted to feel this sad; I haven’t been prepared to write and therefore re-live what it was like to change forever, really three times, within that eleven night period.  But since we’re super immersed in our next current fertility steps, and I’m all shot up with extra estrogen, taking two tablets a day and even having an extra patch on my right ovary that is literally feeding estrogen into my blood stream, I am extra emotional right now, and awoke with a little insomnia at 3 AM and decided it was time to rip off the band-aid.  Here I go…..

MONDAY, NOVEMBER 23, 2009

I spent the morning laying out items that we’d be packing for our trip the next day to visit Craig’s dad and stepmother in the Florida Keys on our bed.  I checked in online and printed out our American Airlines tickets.  Then, in accordance with the bus schedule, since we were still a one-car household, I headed out to take the 2-bus ride to my doctor’s office.  While I waited at the transfer bus stop at Venice and Windward Circle, I got a phone call from a sales rep.  He wanted to know what I was up to in work and life.  I told him I didn’t have any current projects, other than the fact that I was pregnant.  He said whatever niceties people say when they learn someone is pregnant, at the level at which we knew each other, and we chatted a bit more, before the call ended, and I resumed reading whatever book I was reading.  (I wish I remembered what book it was!)  I boarded the second bus and walked the 1.5 or so blocks to my doctor’s office, checked in, and waited.  I don’t remember my blood pressure being taken and being weighed, but I’m sure I was before I was sent to room number-whatever, where I removed my pants without being reminded, and placed the paper, large-napkin-sized blanket that doctors use – over my privates.

Dr. B entered the room and as I sat there with my legs spread out in their respective holsters, he started the ultra sound. When he asked how I was, I told him of the pains I’d been feeling, which I was sure were Braxton Hicks.  He looked up at me, him with his white hair and glasses, when I described the amount of pain, where it had been, and when it occurred.  He resumed prodding inside me, and I nervously began my small talk, telling him how we were going to go to Florida the next day to see Craig’s family for Thanksgiving.  And then I heard my doctor, the fantastic doctor with the very thick usually un-discernable Israeli accent, utter the terrifying sentence with absolute clarity, “You’re not going anywhere.”

The next hour was startling, shocking, and beyond scary.  I couldn’t understand exactly what he was saying as he was saying it, but I soon became to gather that the baby was poking through my amniotic sac, and that I needed to be hospitalized immediately.  The pretty nurse, the one who typically really annoyed me, kindly helped me into a wheelchair, and carted me through my doctor’s office, and as she awaited the written instructions from the doctor to accompany me to the hospital, I started crying.  There was a waiting room full of women, some with their men, some visibly pregnant, others not, who I could almost see through my hysteria.  I was crying so hard that snot poured out of my nose, I was hiccupping, and I couldn’t actually breathe.

The pretty nurse wheeled me out of the office, to the elevator, downstairs, across the street, and up a ramp to the UCLA Hospital in Santa Monica.  Somebody had obviously called just moments ahead and so after she maneuvered me through the maze of hallways that I will never forget but don’t really remember, we arrived at the ward where nurses were there to greet me and to transfer me from the wheelchair to the bed.

I had called Craig in hysterics before they’d even put me in the wheelchair to repeat what my doctor had said, and I called him again as I was being hooked up to all sorts of machinery, telling him where to go once he’d arrived.  By this time, he had already left his office in Hollywood and was on his way to me.

INCOMPETENT CERVIX:

My pulse was taken, the baby’s heart rate was checked; the tubes were connected to the monitors that allowed the staff to monitor both from their station and by my bedside.  Dr. B came in the room, and asked the staff if the Trendelenburg bed could be tilted any further.

In the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head by 15-30 degrees. This is a standard position used in abdominal and gynecological surgery. It allows better access to the pelvic organs as gravity pulls the intestines away from the pelvis. It was named after the German surgeon Friedrich Trendelenburg.  (Wikipedia)

He explained to me that we needed gravity to force the baby back into my uterus, that I had what’s called an Incompetent Cervix.

Incompetent Cervix is a medical condition in which a pregnant woman’s cervix begins to dilate (widen) and efface (thin) before her pregnancy has reached term. Internal  opening more than 1 cm is abnormal and cervical length less than 2 cm is considered diagnostic. Cervical incompetence may cause miscarriage or preterm birth during the second and third trimesters.  In a woman with cervical incompetence, dilation and effacement of the cervix may occur without pain or uterine contractions. In a normal pregnancy, dilation and effacement occurs in response to uterine contractions. Cervical incompetence occurs because of weakness of the cervix, which is made to open by the growing pressure in the uterus as pregnancy progresses. If the responses are not halted, rupture of the membranes and birth of a premature baby can result.  According to statistics provided by the Mayo Clinic, cervical incompetence is relatively rare in the United States, occurring in only 1—2% of all pregnancies, but it is thought to cause as many as 20—25% of miscarriages in the second trimester.  (Wikipedia)

He went on to say that we could sew my weakened cervix up, in a procedure called a Cervical cerclage.  The treatment consists of a strong suture being inserted into and around the cervix.  (Wikipedia)

By the time my doctor had verbalized this plan, Craig had arrived, and we were now under the informed assumption that the cerclage would be performed the next day, with a couple of days to follow in the hospital.

Craig held my hand and looked me firmly in the eyes and told me it would be OK.  Then we got into business mode.  He had a flight to cancel, to inform his father that we weren’t flying to Florida, and to retrieve some key things for me at home.

I reluctantly let go of my firm grip of Craig’s hand to allow him to leave and do these things, and got into my survival mode, this space where I just keep doing stuff so that I don’t have to think too hard about the circumstances.  I called my parents and told them what was happening.  I called my eldest sister and explained things to her.  She happened to have been with her mother-in-law ~ a nurse, on speaker phone from her car, and it was comforting and calming to get such an informed reaction from her, as to the commonality of a cerclage.  I called or left messages for other close friends Dee and Jodi.

Craig came back that evening with some things for me, like my reading glasses, phone charger, and some basic toiletries – even though I was confined to the bed and wasn’t allowed to shower.  Actually, I wasn’t even allowed to get up and walk the 10 feet to my hospital room bathroom.  They brought in a mobile toilet and placed it only inches away from the bottom of the bed, with a roll of toilet paper nearby, and I was instructed to go there and then return immediately to bed – and call on the nurse to empty the toilet for me.  It was pretty severe a sentence, I thought, but I did as instructed.

I was paralyzed by shock and fear to question that directive, or any of the others.

Dr. B returned and spouted orders to the staff about the angle of the bed.  “Can it be more of an angle?  I want her head 45 degrees from her feet.”  “This is as far as the bed will go back,” the nurse responded.  “Can we get bricks or something to put her feet up higher?” he asked.  I think the nurse thought he was kidding, but I don’t believe he was.  No bricks arrived, but his reactions made it very clear to me how much I needed to rely on gravity to keep my son safe.

I can’t remember if Craig stayed there that night, but the next day, since he had previously gotten Tuesday off as we had been scheduled to fly that day to Florida, he opted to consider it a work day, and so sat next to me while I watched TV from my angled bed, with his computer in his lap.  I distinctly remember that was the day that he got a Request For Proposal from a major ad agency for the one of the biggest accounts there is. We took it as a lucky omen that he was on the ground – meaning not flying, as otherwise there would have been an automated response re-directing that request to another co-worker, and with so much potential for commission on such a size-able account, we took it as the cup being half full that he’d gotten the email.

My sister and her mother-in-law visited me that day.  I don’t remember where Craig had gone, but they sat in my room and Lynne supported what the doctor had told me, that the cerclage scheduled now for Wednesday was a great idea, that it was a simple procedure, and would alleviate the problem of my incompetent / weakened / shortened cervix.

Over the next hours, I wracked my brain with wondering who else I knew that had experienced this.

I remembered that Robin – who I had seen only 2 days before at her son’s first birthday party, had been hospitalized late in her first pregnancy with her daughter for a similar thing.  I spoke to her and it turns out it was the exact same thing.  She asked me for some vitals, like where I was and who my doctor was.  She was happy that I was at that UCLA SM hospital, as she claimed it had the best N.I.C.U. unit in the state.  She gave me the name of her high-risk doctor, who performed her surgery.  I held tightly to her strong recommendation in the hospital, and sort of shelved the information she gave me about the N.I.C.U. – which stands for Neonatal Intensive Care Unit, as I had confidence in the cerclage that would be done thereby allowing me to leave this hospital in a few days, eventually delivering at St. John’s, as we had planned.

I emailed my friend Kathy and asked her for her older sister’s phone number, recalling that she was on bed-rest for most of her pregnancy. I spoke to her, who explained that she had been on bed-rest from around week 8 all the way through week 29, only in the actual (and same) hospital around week 23 until she delivered early.  She hadn’t had the same diagnosis or circumstance, and had given birth to a very premature son, but she also reported great things about the hospital, their N.I.C.U. unit, and the same high-risk specialist that Robin had mentioned.

I had been taught by my father that intelligence is strength, and felt comfortable being in full producer mode, doing my research, gathering information, and arming myself with intelligence so that when the doctor spouted next steps at us, Craig and I would be informed and thus prepared.

If only….