baby steps, bob

Only two weeks post surgery, at three weeks of age, Sam was ready to move to the step down unit. This was the week immediately following my release from the hospital. The purpose of the step down unit is to transition the baby to less round the clock care from professional help, while integrating the parents as care givers. Duke said that Sam was ready. I didn't feel ready. I felt like a six year old that had suddenly become a mommy: immature, irresponsible, and definitely not smart enough. I am aware that there is a huge danger in the telling of this story that I will overuse the word, "irony." I apologize in advance. The irony in this particular segment is this: I had just been released from the hospital after being treated for an extremely severe case of mastitis. I was being strongly encouraged to continue pumping because, "He needs the breastmilk. It's so good for him. It's the best thing for him. He may even transition to nurse..." So I kept on keeping on. As it turned out, Sam's body couldn't process the fatty acids in the breastmilk that I was killing myself to pump, so they had to switch him to a thick, chalky, light brown formula that was easier for his system to digest. No breastmilk allowed. While in the step down unit, one of the things that we did was attempt to introduce a bottle. This was a very incremental process. Sam only drank a tiny amount from the bottles; the remainder of his nutritional needs were fulfilled through his epigastric feeding tube. His medications (of which there were many) were also administered through the tube.

We had to learn things in the step down unit. Things that I did not want to learn. Sam had to be given heparin injections twice a day in the subcutaneous fat in his thighs. Finding subcutaneous fat on a baby that weighs less than 7 pounds is no easy trick. He was such a scrawny little thing. We also had to learn to pull and insert his feeding tube, and then check it for placement once it was inserted. That meant sticking a very long, thin tube down the baby's nose and running it down his throat until it reached his stomach. Then you attach an empty medicine syringe and puff a bit of air into the tube while listening with a stethoscope to his tummy. Hear the "Foop" noise? That means it's placed correctly. Word up: babies don't like having feeding tubes stuck up their noses and down their throats. I learned how to operate the feeding pump that would incrementally push formula from a bag into his tube. I was also instructed in how to correctly pick up my baby. Did you know that when a baby has heart surgery, you can't pick them up like a normal baby? If we lifted Sam with our hands under his armpits, it could put too much pressure on his incision and cause severe injury. The step down unit is not the place you want to stay if you value sleep. I was so thankful to be there because it meant Progress with a capital P, but if sleep deprivation was fatal, I'd have died a long time ago. There was a moniter over Sam's bed that sounded an alarm every fifteen minutes- 24 hours a day. My cell phone alarm went off every three hours so I would wake up to pump. And nurses had to come in every three hours to bring Sam's formula so we could start the feeding pump for him to eat. And then there was maintenance staff that came in to empty the trash and clean, rounds with doctors and nurses that came to discuss patient status... it was always something, day and night.

 

Sam had a "hat." They moved his IVs to a vein in his head. Honestly, I can't remember why exactly, but I know there were good reasons. They had to periodically take blood from Sam to check his heparin levels and this was a real problem. He was a very hard stick. Getting blood from Sam's tiny little collapsing veins was a battle that was waged long after we left Duke. I dreaded the blood tests. Sam would scream and scream and then I would hear that inevitable prounouncment, "We didn't get enough. We have to stick him again."

 

So, to restate the obvious, there was a lot for us to learn. I didn't want to learn these things. But just like when I went to the hospital and the nurse said, "You can't leave until you have a baby," the folks at Duke said, "You can't take him home until you learn these things." Well. Since you put it THAT way... sigh. Hand me the syringe. And we learned.

 

While we were in the step down unit, I learned that due to the high level of antibiotics given me during my bout with mastitis, I had developed a horrible case of thrush. So all that milk that I pumped since being sick: down the drain. (Since Sam wasn't actually drinking it, this didn't affect his diet.) Another thing I subsequently learned is that when you have that particular type of thrush, it's very stubborn and extremely hard to cure. I was given a long list of things to cut from my diet in hopes of eradicating it.

 

We stayed in the unit for a week. Then they told us it was time to leave. I'm sure I smelled like fear and panic. I was so looking forward to going home and seeing my sweet daughter and sleeping in my own bed... but this baby? I wasn't so sure I could take care of him. I felt like I'd been given a crash course in nursing and that the instructors had definitely overestimated my ability to perform under stress. We'd only been at Duke for a month. He had surgery three weeks ago. He's not ready to go home. Don't these people know how dangerous our home is? Putting him in the car seat was a challenge. There was a constant worry niggling in the back of my brain, "Is he still breathing?" We stopped at my parent's to pick up my daughter and she got to hold him for the very first time.

 

And then... we were home. Welcome home, Sam. This is your room and your crib and your sister and your house. It was so.... quiet. No beeping monitors, no screen with Sam's vital stats on it. That part was a bit nerve racking because while at Duke, we could easily see exactly what was going on inside Sam's body. Now that we were home, it was all guess work. And now I was home. With a month old baby that is not like other babies- with a 6 year old that desperately needs to catch up on Mommy time- with the responsibility of resuming homeschooling looming over my head- with doctor's appointments to schedule- a bad case of thrush- pumping every three hours- feeding every three hours- a post partum check up for me to schedule (ha, that never happened)- and an overwhelming feeling of being completely overwhelmed. Did I mention that I almost killed my baby the first night we were home? Yeah. True story.