The Longest Night

The twilight continues with every piece of information you receive.  And you are constantly receiving information.  From the nurses.  From the specialists.  From the residents.  From the pediatricians.  From the financial administrators.  From the smiling, helpful staff.  Always so helpful.  Always smiling.  First, you’ll want to go left.  Then right.  Go down the green hallway.  Green.  You can’t miss it.

Except you do miss it.  You repeat their instructions, muttering them out loud while you try to navigate the labyrinth, but you still manage to walk right past your turn, your landmark. Even backtracking, nothing looks familiar, so you find another smiling staff member.  No, no, the orange hallway.  That will take you to the green hallway.  You can’t miss it.

Eventually, you stop asking directions, preferring aimless wandering to the constant feeling of being lost.

The doctors perform their rounds in the morning.  Six physicians, walking up and down the hallways in a pack, wheeling their laptops on special rolling carts.  They remain in the hallway.   They stand outside your child’s door and discuss her chart, her progress.  If you have found your way back to her room, you get to stand in the doorway with her nurse (one day, having just woken up, I stood in my socks while the well-dressed resident smiled down at me in her polished, sensible shoes) overhearing their updates that are obfuscated by your ignorance.  “Three litres per hour on a ventotherm.” “ Oxygen saturation levels remain normal.”  “Breathing rates still elevated.”  Nasal cannula.  Feeding tubes.  Monitors.  Radiant warmers.  Vents.  Bililights.  And all with their own sound, alert, rhythm, pulse, filling the background with a continuous, deafening chorus.  Something starts to beep persistently, alarmingly.  But nobody moves. Why is nobody moving?  Why do they never seem to respond?  You can barely hear the report the neonatologist gives.   You try to study her observant, patient face.  Try to read her lips as she calmly performs her assessment, gives her update.  Is this good or bad?  Is this progress?  What constitutes progress anyway?  Is the only movement forward a movement out the door?  A movement away from all of this noise?  And where do we go after we walk out of this room?  How do we get home?  Does anyone know the way?

Home.

Home.

That place we want to go.

You can’t miss it.

Sunday, September 1st: The first ten hours after my emergency C-section are a blur to me.  The anesthetic made me nauseous, and I spent most of the night vomiting into the blue bags the nursing staff were bringing me three and four at a time.  Sometime around 3am, I remembered that I had just gone through major abdominal surgery, and I began to hallucinate about splitting open as I wretched, my insides pulling the stitches and glue apart.  I was splitting down the middle.  I looked down at my incision and saw that it was intact.  But what about the inside?  They went through so many layers.  Maybe you just can’t see it.  Where I’m split.  I’m in two.  I’m torn apart.  Groggy, I asked the nurse if there was any danger.  She assured me that I would be fine—“That’s really strong glue they use!”—the anti-nausea medication was on its way, then she wheeled in the large, powerful hospital breast pump and told me that it was time for me to start pumping colostrum.  Maddie was still in the Special Care Nursery.  She had a ventilator taped over her mouth.  She couldn’t nurse.  If I wanted any chance of breastfeeding, I would have to pump every three hours to encourage my milk to come in.  The nurse suggested that I take a picture of Maddie to look at while I pumped.  “Sometimes it helps.  It makes your milk come in.  Reminds you why you’re doing this.”

The Special Care Nursery was at the far end of the maternity ward, at the end of a long hallway.  That first night, my husband pushed me to Maddie in a wheelchair while I held my catheter bag and IV.  Though the nurses encouraged me to remain seated, the bulky wheelchair wouldn’t let me get close enough to touch her.  I stood up and shuffled over to her, wheeling my IV and catheter behind me.  I was bent over, unable to stand up straight, and I couldn’t seem to convince my legs to swing from my hips smoothly.  They moved in halts and jerks.  I looked and felt like a crone, but the desire to hold my daughter for the first time was stronger than my discomfort.  I limped over and looked down at her.

Maddie_ventilator

She was swollen and red.  She felt hot to the touch.  Feverish.  Her umbilical cord had been cut short in preparation for an umbilical catheter (a direct line placed through her umbilical cord and into her artery.  It’s a painless way to draw blood in infants, and a way to directly pump oxygen into her system.  Maddie wound up not needing it, but her cord had been cut down to a flat scab over her bellybutton just in case).  The nurses had removed her hospital-issued blue and pink knit cap, and I could see her thick, black hair, still matted with afterbirth.  She had an IV in her left arm, which had to be immobilized with a soft cast over her wrist.  Her chest moved up and down rapidly.  Her nostrils and lips flexed with each shallow breath.  She was breathing fast.  Too fast.  They told me to look up at the screen above her head.  They pointed to a number.  It was hovering around 95, jumped to 110, then back to 89.  90.  94.  102.  98.  My husband leaned over to whisper.

“That’s her breathing rate.  They told me it should be between 40 and 60 for a newborn.  They’re trying to get it to slow down.”

107.  91.  96.

“There’s fluid in her lungs.  They started her on an antibiotic.  Just in case.  There’s no sign of infection right now, which is good.  They told me it was good.”

97.  100.  104.  104.  99.

As we left the nursery, we passed a little boy in a warmer.  I glanced up at his screen.  49.  51.  50.  50.  45.

I walked back to my room, dragging my IV behind me.  My husband pushed the wheelchair, ready to catch me in case my shaking legs finally failed me.  I tried to stand up straight as I walked, but I couldn’t.  I’m split.  I’m torn in two.  You just can’t see it yet.

In the morning, Maddie’s pediatrician visited.  “We’re all so surprised by this.  Nobody was expecting this.”  She told me something about oxygen percentages.  About oxygen mixtures.  She said Maddie’s lungs were “sticky.”  They were giving her medicine intravenously to flush the fluid from her lungs.  My usually smiling, warm pediatrician was frowning.  She had always looked so youthful and energetic.  Lines had appeared across her forehead.  I realized I had never seen her in surgical scrubs before.  Her thick hair was pulled back.  She looked paler than I remembered.  Paler than her Hispanic lineage.  “I have to stop at the office this morning for one appointment, then I’m coming right back here.  I won’t leave her.  I’m going to be with Maddie all day, okay?  She is my priority.”

I nodded.  The stitches have failed.  I’m split.  I’m torn.

———-

“This is going to be the best for Maddie.”

I think we were nodding.  I think we were understanding.  I don’t think I was crying.  Not yet.  I know that my husband was standing next to me.  I know that I was sitting on a hospital bed in a well-lit maternity ward, on a bright Sunday in late summer.  But everything was dark.  I was focusing on the pediatrician’s face.  I had to.  Everything else had gone black.  If I stopped looking at her, if I lost focus for an instant, I knew that the blackness would swallow everything.  I knew the dark would take over.  So I stared at her face.  Yes, it was pale.  Paler than usual.

“I have to be able to admit when a patient’s needs are out of my realm of care.  And hers are.  I can’t get her breathing under control.  If we try to take the vent away, she won’t have the energy to breathe on her own.  She needs to be with experts.  With specialists.  This is going to be the best for Maddie.  I promise.”

The pediatrician had called in a team from Riley Children’s Hospital in Indianapolis.  They would be here within the hour.  Maddie was going to be placed in an incubator—boxed up—and sent by helicopter to the NICU.  A pediatric respiratory nurse was coming as well.  She was going to quickly assess Maddie, prepare her to be air-lifted, make sure that she was stable enough for the transport, then take her away.  Away from me.  Away from us.  Maddie would be sent off on a seventeen-minute helicopter ride to a facility that was an hour drive away.

My husband and his mother immediately left.  Because Maddie’s delivery was an emergency, he didn’t have any clothes with him.  He ran to our house and quickly packed a bag for himself, then the two of them drove to Indy, fast, in the hopes of meeting Maddie there.  I was still recovering from the anesthetic, still being monitored for any signs of complications or infections.  I had to stay behind.  Alone.  In the maternity ward.  My husband balked at the thought of leaving me, but I wouldn’t let him stay.  I couldn’t endure the thought of her arriving at the NICU without someone, without one of us, without her family.  She had to know, even if she couldn’t open her eyes, that we were with her.

It hadn’t been twenty hours since I had delivered her, and I had never seen her eyes, had never held her.

After they left, I hobbled down to the Special Care Nursery to wait for the team from Riley’s.  I ran my hand through her dark, dark hair, and watched her chest move fast—too fast—up and down as she lay on the warming table.  She was panting with shallow, rapid breaths.  She was still hot to the touch, her body overworked just from the effort of breathing.  Don’t stop breathing.  Don’t stop. Just slow down a little.  Breathe, Maddie.  Breathe.  Breathe.  She was swollen and red, and every now and again her brow would furrow and she would shudder, like a person in a lucid dream trying to wake up, trying to respond to the voices that she could hear but couldn’t answer.  I had to believe that, even in her stupor, even with the ventilator hissing, and the monitors beeping and wailing and alerting, even with my blood pumping so loudly I was certain the whole ward was being deafened by it, that she could hear me.  “I love you.  Mommy loves you.”  I said it over and over again.

When the team from Riley’s showed up, it was as though the Marines had arrived.  Three specialists, all in matching black flight suits, wheeling clean, complicated machinery in front of them.  They were confident, efficient, but gentle.  They sent me back to my room, the respiratory nurse promising that she was going to bring Maddie to me once they got her into the mobile incubator.  While I waited, I filled out some paperwork, and told the nurse my cell number.  She assured me that she was going to call me, personally, the second they landed, and that she was going to stay with Maddie on the ground as well.  “I don’t have any other flights scheduled for tonight.  I’ll be with her.”  The nurse looked at Maddie’s chest x-rays, and quickly assessed her condition. They increased the pressure in her ventilator, forcing more air into her lungs, helping to open them.  The entire hospital staff seemed relieved that they had arrived.  The nurses in the Special Care Nursery looked thankful that someone was given them firm, sure orders, that someone seemed to have a plan.  My pediatrician respectfully stepped into the background, the lines never leaving her face.

They brought Maddie into my room, wedging the large, plexiglass incubator between my bed and the wall, trying to get her as close to me as possible.  One of the men in the flight suits (they never spoke to me.  Only the respiratory nurse ever said a word), opened the small, round porthole on the side, and let me put my hand inside to touch her.  The skin on her fingers and arms was wrinkled and soft, loose.  Her arms and legs were too skinny.  They didn’t have time in the womb to store up the fat needed to fill her out.  Even though she was puffy and swollen, I could feel all of her small, bird-like bones as I reached in and took a hold of her hand.  Her right hand.  Her left was still bandaged in the cast used to hold her IV in place.  The nurse was again assuring me that she’d call immediately.  I think she said that Maddie really did look good, or at least that the nurse had seen far worse.  Every part of me ached to hold Maddie, to climb inside the incubator next to her, to shield her with my body, to warm her with my hands, to breathe for her too.  If they asked me to, I would breathe for her for the rest of her life.  I would give every single breath for her.  Her small, delicate fingers wrapped around mine, and gripped me tight.

Then, they wheeled her away.  It was 4:30pm on Sunday, September 1st.

I began to sob.

I’m split.  I’m torn.

———-

The nurses tried their best to keep me entertained, or at least busy, that whole, long night.  They brought me a tray of food.  Meatloaf, I think.  I remember there were mashed potatoes.  I hadn’t eaten all day.  This was my first meal since having surgery.  I ate the food, not really tasting it.  I remember thinking it was strange that I didn’t feel hungry, but I ate it all anyway.  The nurses reminded me to “keep pumping!” in voices that sounded far too chipper.  I did.  I even dutifully washed and sanitized my pumping parts between every session, killing the time by running hot water over everything.  They brought me toiletries so I could have a shower.  They removed my IV and catheter, and checked on me every hour.  They told me that I would be discharged early the next morning, smiling, “You’ll have one of the shortest stays ever after a c-section!  That’s so great!”  They asked repeatedly if I wanted anything for the pain.  I didn’t know which pain they meant.  So I just said no.

The nurses had me fill out my discharge paperwork that evening.  They wanted to make sure that all I had to do in the morning was get the doctor’s approval and leave.  While signing the papers, someone from the Special Care Nursery appeared at the door.  She was hesitant.  She had Maddie’s ankle bracelet in her hand.  “I didn’t know if you wanted to keep this.  A lot of moms want to keep it for their scrapbooks and baby books.”  She handed it to me.  She had been able to slip it off Maddie’s too-thin foot without cutting it.  It was complete, but empty.  It froze me.  I held the small bracelet in my hand, trying to keep it warm, trying to keep it feeling alive and still connected to a hot, panting little body.  I rubbed my hands together, willing my nerves to remember the feeling of her soft, soft, loose skin, her bony grip. My hands shook as I held the bracelet.  I don’t remember asking them all to leave—I don’t remember being able to—but soon I was alone in my room, crying, sobbing, panting.  My breath came in fits and starts.  I couldn’t catch it. Couldn’t catch my breath.  I couldn’t fill my lungs.  I stared down at the bracelet. “I love you.  Mommy loves you.”

I said it over and over.

Maddies_bracelet

Eventually, the respiratory nurse called to let me know that Maddie was set up in a private room in the NICU, and that she had tolerated the helicopter ride well.  My husband also called, his voice hopeful.  “She looks so good.  Really.  She looks better already. I’m serious, baby. She looks so good.  They already have her looking better.”  I could tell by his voice that he wasn’t placating me.  And I was happy that he was there, along with his mother, and my parents, who stopped in Indy on their way down to see us.  Three of her grandparents were with her (my father-in-law was watching our older daughter), and her father.  That’s what I wanted for her.  To be overwhelmed with love.  To be full to the point of bursting with care and concern.  I turned on the television in my room, and watched HGTV until regular programming switched over to infomercials sometime around 4am.  By 7, I was showered, packed, wearing my street clothes, and seated in the rocking chair in my room, waiting to be discharged.  I was in the hospital 32 hours total, and when my husband arrived at 7:30, we didn’t even stop to pick up a change of clothes.  By 9am, I was once again running my hands through Maddie’s dark, dark hair, still matted with afterbirth.

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