Good news and bad news...and bad news and good news

"The good news is that I'm not in the hospital, and I still have a baby in my belly.  The bad news...well..."

 This is what I had begun to write last week before the move.  It's not entirely accurate now, but we'll start there.

Last Wednesday (June 11?) we went to the doctor for our last visit with the Louisville perinatalogists.  Itty Bitty had grown about 3/4 of an ounce, bringing her up to a not-so-whopping 12 ounces (330 grams).  But again, she had grown and she was hanging in there.  Unfortunately, though, when they checked the blood flow through the umbilical cord, they found some troubling patterns.  Apparently, when the baby's heart contracts, the blood flow is fine, but when it relaxes, the blood actually flows backwards, indicating that there is significant resistance in the placenta.  (It's kind of the same idea as high blood pressure in adults, if that makes sense.)  This is not a good sign.  The doctor (Dr. Fines, the first doctor we met at their office) said that if they saw this "reversal of flow" in a larger baby, it would be an indication to deliver immediately.  It may mean that the placenta is deteriorating further, or it may have been going on the whole time.  (This is the first time they've run this test because there's really nothing they can do about it except deliver, which wouldn't help her in her case, obviously.)  So that was bad news. 

We hung our there for another little while, talking with the doctor about details about the move and the logistics of switching doctors, etc.  Before we left, they took my blood pressure because it's been running a bit high.  The first reading was 158/105, which freaked the doctor out.  In her words, "Are you trying to kill me?"  Dr. Fines is adorable.  Anyway, they had me lie down for 15 minutes and retested; the reading was still high.  They sent me to L&D to be monitored and ran tests to check for preeclampsia.  They watched the baby's heart rate and periodically measured my pressure every 7 minutes.  (Amusingly, one of those intervals happened to fall exactly when they were inserting the catheter for the urine tests.  That reading was quite high.  Good times.)  The labs came back negative, and after a couple of hours my pressure dropped enough that they let me go home with instructions to monitor it at home.  So that was the good news.  Had they found any abnormalities in the labs, the doctor was prepared to deliver immediately (because delivery is the only cure for preeclampsia - more on that later).  They still didn't put me on bedrest, but they did emphasize that my role in the move was to be spectator.  I reminded them that my role was to be director, albeit from the couch.  I make a much better director than spectator.  But you already knew that. 

That was last week.  After a few furious days of packing (again, me directing and John packing), including some generously donated hard labor by my Aunt Joanne, cousin Katie, and several of the fabulous Christ Church young adults, the movers arrived on Saturday morning, and we were loaded and on the road by 2:00.  The movers (Two Men and a Truck - we highly recommend them) were scheduled to drive down that evening, spend the night, and then unpack on Sunday morning, but we got to Bethpage early enough to unload that night, which they finished around 9:30 Central Time.  All in all, the entire move took 13 hours - beautiful (especially compared to our nightmare move from Atlanta to Louisville - ugh).  My mom and dad drove in Sunday morning to help unpack and get us settled in.  By Monday evening, they (and John, of course) had unpacked 85% of the house.  The bedrooms (including Itty Bitty's nursery), bathrooms, living room, and kitchen are almost entirely set up.  The den needs some work still, mostly because all our church boxes and books are hanging out in there right now, along with a ton of decorative miscellany to be dealt with.  (Note:  the Hills need NO MORE candles, crosses, etc.  In fact, if you would like to decorate an entire house, we can probably spare enough for you and still have plenty for us.  Wow.)  The house looks awesome.  The church has gone above and beyond getting it ready for us, complete with meals for every night of our first week. 

Unfortunately, I am no longer staying in our lovely new parsonage.  Nor am I eating those lovely home-baked meals. 

On Monday night my pressures were still high, and I started experiencing some shortness of breath, which was a new symptom.  I called my doctor in Louisville, who suggested that we go on in to Vanderbilt to get checked out.  We drove 45 minutes to Vandy, then drove around for nearly 30 minutes trying to figure where to park.  Once we found our way to Labor and Delivery, they took us to a room immediately.  (A room with cable TV, I might add.  Sweet.  I've been in withdrawal since we left Louisville.)  Again, they hooked me up to the fetal heart rate monitor and the blood pressure machine.  After a while, they ordered a 24 hour urine collection (minus the catheter this time - thank GOD!) and sent us to an antepartum room (thus admitting me to the hospital pending the results of the urine screen). 

That night we saw an OB resident, a nurse anesthetist student, and a neonatalogist.  The visit with the neonatalogist was awesome.  He didn't paint us a pretty picture, but he did seem considerably more optimistic.  All the other doctors have said that she really needs to be 500 grams to be viable, as I said before.  Dr. Reese, though, basically indicated that at 330 grams, which her chances would be very, very, very slim, there was a chance, and they would do everything they could for her.  There are kids in the world who were born between 300 and 400 grams and survived.  The biggest question initially would be whether or not they could intubate her.  Generally speaking, we just don't have the technology to make tubes small enough for most babies under 500 grams.  But sometimes it works.  (This is important because almost all babies born at 27 weeks, especially ones sizing smaller, need to intubated.)  After that, the biggest risk would be bleeding on the brain, likely caused by the trauma of birth and her immediate care.  They are just so fragile at her size.  If she does develop a brain bleed, the injury can range from relatively minor disabilities (either physical or mental) to something fatal, depending on the severity and locality of the bleed.  After that, of course, she'd still have high risks for other general preemie complications.  So, again, it's not a rosy picture at all, but it's actually more encouraging than we had expected. 

We are SO thankful to be here a Vandy.  Even though the hospital and doctors in Louisville are great, a preemie's chance on survival is very much dependent on the quality of the NICU - and you just don't get better than Vanderbilt in the southeast.  In fact, U.S. News & World Report recently ranked Vandy's NICU 13th in the country.  Wow.  I could be wrong, but we would not have gotten the same report from the specialists at Suburban.  It's just the nature of being at a major medical research university.  And we are SO grateful that all of the crazy changes in our lives this year have brought us to this place.  Of course, we would have preferred to avoid this road completely, but life is what it is.  But, as Marcus Hummon wrote, God has "blessed this broken road."  I just can't wait to see where it leads.

So we spent Monday night hanging out, measuring pee, and eventually (and for just a couple hours) catching some sleep.  Tuesday morning we met our team of doctors: Dr. Lenzi, a perinatalogist; Dr. Barrett, a resident (who finishes her training this Friday!); Dr. Browning, another resident; and a random med student whose name I don't remember.  They were great, though they really didn't have much information for us.  Hospitals being what they are, though, they had to wake us up at 6 am to meet us and listen to my heart.  Ah, hospitals.  We were to be worked in for an ultrasound sometime that morning so that they could check her growth and develop a plan of care.  So we waited.  And waited.  And waited.  Thankfully, several of our favorite people in the world came to visit, which, along with the periodic checks of my blood pressure and the baby's heartbeat, helped pass the time.  Lunch came and went.  The afternoon came and went.  They never came to get us.  Ah, hospitals.  Apparently they never had a chance to get us in.  That was frustrating.  We were already scheduled for our (outpatient) ultrasound Wednesday morning, so they just kept us in that slot. 

I sent John home for the night so that he could take care of our sweet puppies (who are doubtless very confused now with the move, a stranger (the fabulous administrator at Bethpage UMC) taking care of them Tuesday morning, 10 hours alone in their crate, and their MIA mother) and get a good night's rest (because who knows what the next few days will bring!).  I took an Ambien, turned on Letterman, and drifted off to a very peaceful sleep.  Beautiful. 

This morning the doctors (or maybe the nurse - I don't remember) woke me again at 6 without much of a report.  A couple of hours or so later they came back with the rest of the team (the same as yesterday, but with a different med student).  They had gotten my urine collection tests results back, which did confirm that I do have preeclampsia.  So that they can monitor my condition closely (which is not great, but not too dangerous, as long as it doesn't worsen), along with Itty's condition (as much as they can - basically just keeping an eye out for signs that she is in distress), they are going to keep me here until delivery.  We really have no idea how long that will be.  They again stated that we would know more about our plan once we had the ultrasound.

While they were in the room, which was about 2 hours before my appointment, the transport people came to get me to wheel me down to the clinic for the ultrasound.  John was still not back from home, so I called him and told him to hit the road.  We should have figured that he had plenty of time.  This is a hospital, after all.  Again...ah, hospitals.  I waited for an hour or so before John got there.  Then we waited forever together.  Turns out those hospital-issue wheelchairs are not meant for sitting in for hours.  At least not comfortably.  Finally, a while after our scheduled appointment, they took us back. 

We saw an ultrasonographer, Dr. Barrett (the resident from our team), and another med student.  (Turns out there are a lot of them at Vandy.  Go figure.)  After a bit, Dr. Wenstrom (??) joined us and gave her two cents about what they were seeing.  Apparently Dr. Wenstrom literally wrote the textbook on maternal-fetal medicine.  Amazing.  They gave Itty Bitty a thorough once over to confirm everything in the records from the Louisville doctors and confirmed that structurally, everything looks great (excepting a non-descript finding about her bowels, but they didn't seem very worried about it).  It seems she's tiny, but well-formed. 

But she's not quite as tiny as we thought.  And that's the GREAT news.  She weighed in at 400 grams!  Of course, that's still tiny, but it's a lot more growth than we expected.  Some of the difference could be chalked up the difference between machines, but I can only think that we would have gone to an even more accurate machine down here.  So whether she literally grew 70 grams in the past week or not, we're THRILLED to say that her estimated weight is now right at 14 ounces.  Again, she could REALLY use another 2-4 ounces, but that's definitely a move in the right direction.  She's getting so close!  Even though we haven't talked to the neonate folks again, the perinatalogist (who works closely with the NICU) said that they have had 400 gram babies that they have been able to intubate here at Vandy.  So she's got a better chance than we tought this morning.  Hooray!

Now I'm basically here trying to keep her growing as long as possible.  I'll be here until delivery, which will likely be precipitated by a worsening in my condition (likely indicated by an even higher sustained blood pressure), an indication that Itty is in distress (that we would hopefully see in her heart screening or through my noting a decrease in her movement), or an occurance of placental abruption.  The doctors seemed to have recently learned that babies with growth restriction linked to placental insufficiency (i.e. babies like Itty) are more likely to have their placenta detach from the uterus, which is really bad.  We would know immediately when it happened (because I'd bleed and have severe pain), and she would have to be delivered IMMEDIATELY.  That's another reason they are keeping us here.  I am basically on relatively lax bedrest, meaning that I can get up to go to the bathroom, hang out in the chairs in the room, and go for a wheelchair ride once a day, as long as we stay within 10 minutes of the floor (in case something goes wrong).  I know those don't sound like exciting privileges, but, trust me, after only 2 days here, I know that they are a big deal mentally.  It may even mean that some day (if we're here a while) John or his mom (who is here now and helping out with the dogs, logistics, keeping John sane, etc.) could bring the puppies up to campus for me to see in the courtyard!  I miss those puppies like crazy and wish they could be lounging in the bed with me.  They like to snuggle under the covers, and Buster in particular likes to lie right up next to the baby (which of course he understands, right?).  John and their Nana Dana are home with them tonight, and I gave him strict instructions as to how to play with them tonight (like he needs instructions).  I'm having to live vicariously through him, so he's humoring me.  He's been humoring me beautifully all day (and yesterday and the day before), by the way.  He's really the best husband ever.  Ever.  I'm so glad that if I have to go through mess, he's right there with me.  Marrying him was probably the smartest thing I've ever done in my life!  So make sure you say a prayer for him and his sanity when you're thinking of us.  Think about how frustrating it must be to be stuck at the hospital feeling helpless at the same time that you're preparing to start at a new church.  His first day is (and my first day was supposed to be) Sunday, so somehow in the middle of all of this, he's got to write a bang up sermon and gear up for officially beginning.  He'll knock it out of the park, of course...but he's certainly carrying a lot right now.  I at least am officially out of the work picture for a while, so I just get to work on carrying Itty. 

I think that about catches you up.  Sorry that I didn't write earlier, but, um, we've been a little busy lately.  If you're in Nashville, we love visitors, but it would be helpful if you could call on my cell beforehand so that we can make sure I'm getting some breaks for some rest (especially since I'm waking up at 6 am these days!).  I've got the same number as always.  Just e-mail me if you need it.  Thanks for all your thoughts, prayers, and support!  We'll try to keep you posted, which may actually be easier now because we've got wireless at the hospital but no official internet access at home.  If something dramatic happens, we'll try to get someone to post in our stead so you can know what's happening.  Hopefully we won't have much to say over the next few days - looks like boring is what we're going for for a while!  But don't let me be too bored - entertain me with your comments!  I'll be looking for your time-wasting website suggestions!