Saturday, March 22, 2008

Finally, Post-Op

Here I am almost two weeks later. This is where I longed to be - on the other side of this surgery. It is done, my TAC is placed. I feel like I've been fixed - as if my "problem" has been repaired. Deciding to have another child and when is back in the air for me. This recovery (although not terrible) has shed some light on what life is like post c-section with a toddler in tow. Keeping in mind that a new baby and breastfeeding/pumping didn't enter into this most recent scenario, I step back and observe the disruption with extreme caution. For one, Precious Miracle seems too young for me to have another child right now. Who knows, in two months, I could change my mind and could easily find myself holding the end of a stick with a plus sign slowly getting "pinker".

Just to recount my surgery:

First of all, Precious Miracle appeared to have some respiratory issues the weekend prior to my surgery. Our doc was not on call so we treated her as best we could at home with nebs and supplemental O2. It turns out the appointment with pulmology that I canceled just the week before was desperately needed. We were lucky they were able to squeeze us back in during our previously scheduled time slot. Knowing my mother would have to drive to the hospital with supplemental O2 made me very nervous. During my last minutes at home, I decided that I would be much more comfortable if my husband stayed with Precious Miracle. My mother was taking me to have my TAC placed.

We needed to drive back to my mom's to pick up good ol' Uncle Jerry so my mother wouldn't have to drive home alone (the hospital was about 1.5 hrs away). To get us there on time, I thought it would be best if I drove. So I did, all the way down 202, 76 with its usual backups, over the Walt Whitman to 42 and then finally to route 55 which would be the longest leg of the trip, 30 miles to our exit and then wham, there was the hospital. It looked like a prison from the outside. If this doc wasn't so good, I might have reconsidered...

We parked and unloaded my two bags full of all the things I would need for my max, 2 night stay. I found Dr. Davis' office at the testing unit and waited until he was ready to sign my release form. He pretty much answered all my questions during my last visit so all I really needed to do was sign. The only hang-up was staples versus stitches versus just steri strips. I did not like the idea of having 20 staples removed from my stomach and told him I was more comfortable with steri strips as, "it healed great last time".

Following protocol, he took me from his office to an exam room just to listen to my lungs and check me over. On the back of the door was a chart showing the "tree" of lungs at four different stages of fetal development. It was sponsored by Synagis and reminded me in my state of nervousness why I was electing to have my stomach cut open. A sense of calm came over me and I was brave in holding back my tears.

Dr. Davis confirmed that the lump in my right breast needs to come out. (It was removed on Wednesday the 19th and thankfully, it's benign. ) He was surprised that it was scheduled so soon after my TAC but I really just preferred to get all things surgical behind me.

Off to preadmission testing where I had to get a blood pregnancy test. Negative. No surprise there. I went out to the waiting area and called to check on Precious Miracle. In the middle of my conversation, they called me back to pre-op. I said a quick goodbye to my hubby.

The nurse escorted me back. My nerves began to fire up a bit. I changed into a blue gown with geese in flight and used the bathroom across the hall and brushed my teeth. I crawled into the bed and began to shake. It was chilly and between the temperature and my nerves, all I could do was shake. This prompted the nurse to retrieve some warm blankets and place them over me.

A tech popped her head into my curtained off quarters and told me someone would be by with a fetal monitor. I told her that I was not pregnant. She looked surprised. My nurse came back in to place my IV. Before doing so, she confirmed, my name, date of birth and reason for my surgery. After providing all the info, I followed up with, "I am not pregnant. It is a pre-pregnancy placement". She looked perplexed.

My IV was placed in my left hand. Boy, did it burn really bad for about 5 minutes. Apparently, it's this new cleaning solution they use on your skin. The burning was unreal and I even questioned whether or not it had been tested and proven to be safe for use in humans. I hope they don't use it on their pediatric cases. (They have a PICU and do plenty of outpatient surgery, so I was told.)

The anesthesiologist came in to speak with me. Yet another person I had to inform that I was not expecting. When he heard that he highly recommended that I go with general in lieu of the spinal. If I were his wife, he told me (unsolicited by the way), he would have done general. I told him I've had trouble waking from general in the past. And was fearful that perhaps knowing this, they might not administer enough and I could wake up mid surgery, unable to move yet feeling every slice, cut and tug. He then went through statistics about how rare it is but then admitted that he had one patient during his career that experienced this very phenomenon.

I decided (weeks ago) that I wanted a spinal with mild IV sedation. I told him that I would prefer to stick to my original plan. He said ok. I also confirmed that he, the actual anesthesiologist, NOT the nurse anesthetist, would be administering my spinal.

The nurse anesthetist was actually the next person to visit my "room". He reminded me of Ross from Jay Leno but not quite as flamboyant. His happy-go-lucky nature put me at ease some. He reviewed with me the triple cocktail of meds I was to receive as part of my IV sedation. I explained that I was a "pioneer" and that I needed to be aware during surgery so I could talk with Dr. Davis and report my findings and experience back to fellow preemie moms also suffering from cervical insufficiency. He agreed and claimed he understood. I thought I was good. But would later learn that I wasn't.

Dr. Davis came to my "room" to walk me back to the OR. He took my glasses for me and promised to return them to me in recovery. He asked if I had any final questions. Indeed, I did. I explained to him that I was beginning to get concerned that he only placed TACs during pregnancy, as EVERYONE in the unit thought I was with child. He reviewed with me his hospital rotation and as it turns out, usually schedules his "out of town" or non-pregnancy following patients at one of his other two hospitals. In other words, he only usually places TACs on the pregnant women in his practice at this hospital. I was satisfied with this answer and was ready for my TAC. Before we left for the OR, I reminded Dr. Davis that of all the doctors, I picked him.

As I was wheeled back, I was holding onto a picture of Precious Miracle and Hubby in the snow. My inspiration. I think that is what helped me be so brave - remembering all the suffering that Precious Miracle had in the NICU - how could I not face this head on? My mother, on the other hand, was not brave. She began to cry as they pushed me down the hall. Also clenched in my fist were the purple rosary beads that Precious Miracle had, just two days prior, worn as a necklace. I thought about bringing the special rosary beads that were my grandmothers, the woman Precious Miracle is named after. Those rosary beads were with me during my five days of bedrest, my c-section, my recovery in the hospital and every single day that Precious Miracle was in the NICU. They were always in my front pocket. Today, they are in a special case in her diaper bag. I left them with her knowing she was going to DuPont and wanted them to be close to her. These purple rosary beads are special too, just in a different way.

On the way back to the OR, I told Dr. Davis that I would have liked to have done a documentary about my experience, something to share with and help others. He said I should have told him two weeks prior, that he could have arranged that. I asked if we should reschedule.

I got an IV full of versed, an amnesia drug, to relax my nerves. I felt just a tiny bit loopy, not too bad. I transferred myself over to the OR bed. I had to sit up, feet hanging over the side, back hunched, to get my spinal administered. Dr. Davis was the one who held me from the front. It took me back to my c-section, where I cried into the arms of this nice African American nurse as the doctor did my spinal while I was on my side. I couldn't sit up because Precious Miracle was falling out of me. I cried tears of fear and anguish. Today was different, today was a new chapter.

The nurse anesthetist asked if I needed a little more medication and I said yes. But I meant a little more, NOT a ton more. I woke up in recovery not remembering a thing.

Recovery was tough because I couldn't get my body temperature up. My first memory was a vague conversation with Dr. Davis about a small uterus. It hung in my mind and I couldn't get rid of those words. Small uterus. Fucked up cervix AND small uterus. What does this mean?

While the nurses put a big tarp over my stretcher and plugged a blower of hot air underneath (like an air mattress), I dosed. I was awakened every so often by the compression of the blood pressure cuff attached to my right arm. "Is your pressure always this low?" Then a thermometer would show up in my face. "Still not high enough." I made an attempt to drink some apple juice and eat a graham cracker.

Dr. Davis came by to see me again. He remembered that I needed my glasses and I was a little more awake so I could ask my question. "What does a small uterus mean?" He wheeled a chair out from around the nurses' station and we had a "heart to heart". He kindly and positively told me that I would more than likely deliver at 32-34 weeks, not the 37-39 originally thought. Anything after 34 is "cake" he told me. I shared with him my fear of an older preemie and the problems that I've read about. We've been so blessed with Precious Miracle, could we be blessed again? He went through all the statistics that were all too familiar. Albeit, this time they sounded better.

Somehow, my body did all the things the nurses hoped it would do and I was ready to go to my room. Dr. Davis met my mother in the waiting area and walked her back to where I would spend the next two nights.

I was so hungry and wanted to eat something other than crackers but once I saw the tray, I lost my appetite. I was given morphine and it made me feel like I wanted to run around the place. I was up all night watching TV and just couldn't fall asleep for any length of time. My body started to itch and I asked specifically for Benadryl but the nurse insisted on another medication that I later learned counteracts the pain medications. I continued to itch and she continued to give me this mysterious medication.

By shift change, I was ready to deal with someone new. My catheter was removed and I was ready to make an attempt at getting out of bed. I tried to stay on top of my pain management and soon got a headache. I was in no condition to do any reading or catch up on computer work as I originally thought would be an integral part of my "free time" away from home. Hubby was on his way to see me. He brought some chicken noodle soup from Boston Market. I was too sick to my stomach to eat. I got up and sat in the chair and Dr. Davis came in with a med student to check on me.

My incision started to bleed during the night so the nurse had changed my steri strips. She mentioned hematoma and after hearing what my friend went though, I was quick to have Dr. Davis assess the situation. He said it all looked good. I asked him to please review what he told me the day before so my husband could hear accurate information.

I then started to get sick. I almost threw up in the bucket but somehow managed not to. Dr. Davis pressed on my stomach to determine if I had a spinal headache. It really felt like the start of a bad migraine. After hearing what my friend with the hematoma went through to fix her spinal headache, I was hoping the doctor wouldn't say those words.

As an advocate for my own care, I asked for a shot of dilaudid (works like a charm) and some compazine for my nausea. Dr. Davis agreed and wrote the orders. He also wrote a script for my pain meds for home as I would not see him the next day. Yes, I was spending one more night. Darn. I wanted to get home.

Before my dilaudid was given, I thought it would help if I showered. My wonderful husband helped me. This time, I brought my own clothes and didn't need to wear the mesh underwear the hospital provides. (My darling husband helped me put on those mesh underwear when I had my c-section.) It is times like this when I am reminded just how unconditional my husband's love is. I question whether I would be able to care for him the way he cares for me.

Wrapping this up, after sleeping the next 18 hours (dilaudid is good), I ended up discharging the next morning. Precious Miracle joined my mother and Uncle Jerry and we drove home. It was good to see my baby but better that my mom was there to care for her.

I spent the next few days in bed. The recovery was the worst part. Now that I am almost two weeks out, it doesn't seem so bad (except that I look pregnant and still can't put my jeans on).

I organized an egg hunt just five days post surgery. Had it been a c-section, I just would have been released from the hospital the day before the hunt. Not bad for getting back on my feet. And, nine days after my surgery, I went for same day surgery to have a lump removed from my breast. Today is day 12 post-op and I'm feeling pretty good.

Now, when this cycle passes, we can start TTC as they say in computer language. (Trying to conceive.) Are we ready? Or not?

Wednesday, March 12, 2008

My Shiny New Cervix

Well, it's in! My pre-pregnancy transabdominal cerclage was placed by Dr. George Davis on Monday, March 10, 2008. It was discovered during my surgery that not only do I have a short cervix but I also have a small uterus. Dr. Davis feels based on this new information that it is realistic to assume that I can carry to 32-34 weeks as opposed to the 37-39 originally thought. Not exactly what I wanted to hear but hey, 32 is much better than 24.

Monday, March 10, 2008

Sign, Sign, Everywhere a Sign?

My TAC placement is scheduled for tomorrow. I am nervous about having my stomach cut open and the recovery associated with major abdominal surgery. To complicate things, Precious Miracle is having some respiratory issues and is requiring oxygen treatment. I am uneasy about leaving her while she is sick.

This surgery is huge for me and for us with regards to our family planning. This surgery means that we are going to have another baby. Precious Miracle will be a big sister. This surgery really stands for so much. There was a different excitement associated with the idea of getting a TAC placed. It was a joyous anticipation of what would be. Now I am there and tomorrow, there is no turning back.

For my own records (since journaling by hand is a thing of the past for me) I wanted to track the markers leading up to this surgery...

On Thursday, I went for my preadmission blood work. I stopped in at Quest Labs next to Hubby's office. There was one other patient in the temporary lab space and one lab tech. They were in the process of moving to a newer space within the same building so the current accommodations were not very appealing. There were three magazines haphazardly strewn on square tables placed around the room as end tables. These magazines were all about hunting and fishing. Now, being located in Devon, I didn't necessarily think the clientele of this lab would enjoy reading about taxidermy. Well I couldn't have been more wrong. Two men walked in behind me talking about the elk they just shot and some other animal who was having it's skull stuffed and hide turned into a rug as we stood there. I had to laugh to myself.

The lab tech, Mrs. Cooper, was a gruff woman who gave me a hard time about the lack of diagnosis code on my lab slip. She called Dr. Davis' office with an attitude and demanded to speak with him directly. She proceeded to tell him that he was very bad and it was very wrong of him to omit this very important bit of information. "I'm gonna have to spank you", she said with authority. I almost fell over. The conversation continued on for several more moments. Ages were exchanged and Mrs. Cooper's war stories from Vietnam were told.

Dr. Davis then asked to speak with me. He told me to arrive on Monday at 11:00 a.m., that my surgery was scheduled for early afternoon. Ughhh, no food after midnight? How am I going to last for over 12 hours? He then instructed me to bring my pillow as hospital pillows, "aren't very nice" and "comfy pajamas" to wear the next day instead of "that gown the hospital gives you".

As my blood was drawn, I realized I could still back out. I walked out to the car and reiterated my experience to Hubby adding, "I'm starting to get nervous". Precious Miracle was in the car too. She had just had her final dose of Synagis. "But I want her to have a sibling", I thought to myself.

On Friday afternoon around 4:45, I checked my messages at home while on the road. The hospital had called with some preadmission questions for me to answer. I quickly called back asking for Lisa wondering if by missing this call, I would have to postpone Monday. Well, a woman by the name of Charlotte answered the phone. Lisa was no longer in the office so Charlotte took over my file. My nerves were acting up again as I wondered if I was doing the right thing. I told Charlotte my story, complimented her on her beautiful name (she told me she is trying to get her children to name their children Charlotte) and told her that speaking to her put my nerves at ease - for those who know my Precious Miracle, you know why!

Moving on to Saturday, I grabbed the mail to find a preauthorization from Blue Cross for my TAC placement. I later came to find out that the TAC runs about $25K. In contrast to the multi-million dollar NICU stay a micro-preemie requires, $25K is a drop in the bucket. They were smart to cover it and perhaps, it was another "sign" that I was moving in the right direction.

As I sit here Sunday night, well technically, Monday morning, I must admit my stomach is turning. I am hungry but can't seem to eat. My last official pre-TAC meal was a surprise plate of meatloaf and mashed potatoes. I should've had a third helping!

My body will no longer be the body that it is - the body that failed my beautiful daughter. I thought today how much more guilt I would have if Precious Miracle didn't do as well as she has. We are truly blessed. I feel that I never take that for granted. I thank God daily - several times a day - for what He has gifted our family with. Am I greedy to think that He will abundantly bless us again? My prayer is for healthy babies, healthy children.

Monday, March 3, 2008

It's Here!

I just got off the phone with Dr. Davis and it looks like my TAC is going to be placed on Monday, March 10th. The doctor is going to confirm OR space and get back to me with a time. I am both excited and nervous! I can't believe it is on the calendar! Finally...

Sunday, March 2, 2008

Still Waiting...

Of course when I want my period to arrive it doesn't. Here I sit, waiting to schedule my surgery. Wanting to schedule my surgery. It's been 35 days since my LMP and nothing. Perhaps it's the stress of wanting it to arrive that is wrecking havoc on my cycle. All I can do is wait.

Oh, and by the way, I have to get a lump removed from my right breast before we can get pregnant. Always something.

Back to waiting...