IMR: 1998: January: 31

IMR: 1998: January: 31 -- Saturday, 6:10 p.m.
Carter Dillingham Pediatric Ward, Kapi`olani Medical Center, Hawai`i

After only two days at home, Katie was readmitted to the hospital yesterday. Jen and I have remained with her, and are now heading into our second night as reluctant residents of 1319 Punchbowl St.
The day started out normally enough. It was my second groggy day back in school. I got up at 5 a.m., made the long, rush-hour trip into town, blinked through my 7:30 a.m. Hawaiian class and Magazine Writing, and headed back home.
Mom was on the phone when I walked in the door, and gave me that "don't get comfortable" look.
Turns out she and Jen had noticed that Katie was sleeping more than usual that morning, and her stools were mostly water. I remembered it had been runny during the night. Jen called Straub, and they said to bring her to the emergency room at Kapi`olani.
We scrambled to pack a bag and moved the car seat into grandma Henderson's Olds. We strapped Katie in and drove carefully but swiftly into town.
Only upon arriving in the emergency room did we realize our diaper bag was missing two things: diapers, and Jen's insurance card. The overworked desk staff sighed at us.
They put Katie through triage, and promptly moved us to a little curtained room in back. Her weight was 5 pounds, 1.1 ounces... a loss of more than a pound in four days (which was well over the 10 percent loss usually expected in the first week).
The nurses started checking her reflexes and other vitals, so she started screaming. While I held her and tried to keep her calm, Jen started crying.
If there is one moment that I will vividly remember until I'm old and gray, it would be that instant. Both my wife and daughter -- the two most important women and people in my life -- scared and wailing together. I've never felt so helpless, wishing there were two of me to hold them both. My insides were crumpled into a knot.
God. It still hurts to think of it now.
Finally, the doctor -- a bear of a man by the name of Boychuk -- came in and checked Katie out. He asked some questions and called for more tests. With Katie's listlessness and runny stool, along with Jen's extended post-rupture labor and mild fever at the time of delivery, Boychuk concluded that Katie could have some kind of infection.
He said only two out of a hundred infants who are symptomatic are actually ill, but it was standard procedure to do a set battery of tests to be sure.
Blood test. Urine test. Chest X-ray. Spinal tap.
We were sent back into the emergency room lobby to wait. Jen was distraught. She was convinced it was her fault, an illness brought down as punishment for not being enthusiastic enough -- even occasionally doubtful -- about being a mother a few months ago.
I assured her everything was going to be fine. I hugged her, kept my spirits up, joked a little. When she calmed down, I insisted she eat something.
It was only when I was walking to the cafeteria that I really cried. People in the hallways gave sympathetic, understanding looks. Tears in a hospital, I suppose, are hardly anything new.
I brought back a couple of sandwiches and drinks, which we finished slowly. When the nurse poked her head out to call us, Jen literally sprinted from her seat. As I caught up to her at the door, the nurse said, "Wow, she left you in the dust!"
Boychuk explained what the tests were and what they were looking for, and reassured us that except for a few symptoms, Katie seemed perfectly healthy. The problem at hand was dehydration, which was being rectified with an electrolyte IV drip.
As Boychuk disappeared to call Dr. Boyens, the nurse explained that standard procedure also included a 72 hour stay for monitoring.
We waited in the E.R. examination room for a while, as assorted nurses griped to each other over their failure to find Dr. Boyens. Finally, they decided to go ahead and move Katie into the pediatrics ward on the second floor.
Katie was bundled up and handed to Jen. The nurse grabbed the IV pole and wheeled it along, and Jen and baby followed close behind.
For an instant I saw us from a distance... Jen cradling a baby in a blanket from which wound a thin plastic tube that ran to a blinking blue box. Rolling out of the elevator and down the hall, there were more of those sympathetic looks.
We were led to room that was two-thirds the size of Jen's post-partum accommodations. It was clear the place was meant to house someone considerably smaller than an adult. Against the far wall was an Isolette -- an utterly frightening contraption consisting mostly of a plexiglass box with round, spaceship-like hatches on all sides.
It is in this contraption where Katie has spent most of her fifth and sixth days of life.
Jen, firm in her breastfeeding resolution, decided he would stay in the room with Katie, and with that, I decided I'd stay too. I headed out at the peak of a Friday afternoon rush hour to get clothes and other supplies from mom's, and didn't get back until two hours later.
Then we were trained in the ways of the Isolette: how to change diapers by sticking one arm each through the hatches, how to open it and take Katie out for a feeding (watch that IV tube!), and how to respond to assorted over- and under-heat alarms.
We got settled in as best we could, Jen resting on the vinyl-covered, convertible armchair while I pretended to be comfortable slouching on a metal folding chair. Jen went to get dinner, only to find the hospital cafeteria closed. We feasted on a humble meal of pizza-flavored Combos from the vending machine.
I familiarized myself with the floor, finding the kitchenette, nurse's station and shortcuts to elevators and the dining room. Walking down its halls -- past doors with big red warning signs and family members in breathing masks -- made me realize that things could be much worse.
The wide variety of nurses' -- from blonde and easily confused to short and fast-talking -- continued in this ward, but with the welcome addition of male nurses. I'm probably just a sexist bastard, but I found the male attendants far more pleasant and willing to help.
One made change for a twenty, another gave us six cans of juice (even though we're -- or rather Katie -- only entitled to one). The only small talk I've made all day was with our overnight nurse, a friendly guy who helped us get set up with a breast pump so he could feed Katie for a feeding or two while Jen and I slept.
It helped. Sure, it only stretched our two-hour morning nap into four-hour nap, but it helped.

Though it's upsetting to be back here not five days after my daughter was born, I guess I'm happy we actually did make it home on Wednesday to spend some quality time with her first.
Her homecoming... I guess her first homecoming, now -- was pleasant and quiet.
That day, Jen got lunch over an hour late. The kitchen had assumed we were gone already, and I expected the same. The only thing was, Dr. Boyens didn't show until the afternoon.
Eventually, I tracked down a cooperative nurse to handle the ordeal of discharge paperwork. We slipped Katie's tiny body into the car seat, putting in makeshift bumpers to keep her head from wobbling too much. I drove very carefully to Mililani. I went no faster than 47 miles an hour and left five car lengths ahead for the whole 23 mile trip.
Katie slept the whole way, and didn't make a sound 'til she was in the crib.
It was then that I noticed my jaw was aching. I gritted my teeth the whole way home and hadn't realized it.
Jen and I took up residence in Todd's room, and -- whether or not we were ready -- dove headfirst into the sleepless world of infant care.
We recorded every wet diaper, bowel movement and feeding, right down to noting which breast was used last.
Katie stuck to her two-to-three hour nap schedule, which allowed some budgeting of parental snoozing. Still, it was rough... especially on Jen. She got frustrated when Katie would get hungry quickly, which she did once in a while (every twenty minutes at one point) during what the literature describes as "growth spurts."
My adaptation was hardly smooth, either. While awake, I was fine changing diapers, bringing Jen juice, helping with the occasionally clumsy nursing process. But once I'd had a taste of sleep, it was hard -- almost painfully hard -- to get up again.
Mom was great. Cool-headed and attentive. The whole time, she was always quick to spring into action. She'd often hear Katie crying from her bedroom before we would, and if it was a dirty diaper, she'd insist we sleep and change her for us.
She'd put Katie to sleep after feedings (to save us a few precious minutes of shut eye), she set up all the diaper supplies and even nabbed our dirty laundry and washed it when I wasn't looking.
Of course, she wasn't trying to do everything for us, and was careful to make sure she wasn't stepping on our toes. By our second day, she held to the background, helping with little things whenever she could.
Even though she gets just as little sleep as we do, mom still takes the time to unfold diapers, fold blankets, and a dozen little things that make child rearing just a little more manageable.
Her assistance means more to us than we could ever say. Just her calm approach to it all -- possible only after raising two brats of her own -- gives us strength.
Todd isn't exactly excited, but he's trying to be accommodating. He gave us his room, after all, and surrenders the family room when Jen or I want to sit on the old rocking chair and play Mozart for our daughter. He even cooked dinner for the family on Wednesday.
Since he also recoiled at our ultrasound pictures last month, I think he's just not entirely comfortable with the whole baby experience.
Meanwhile, grandma Henderson -- recognizing that the three of us needed time to adjust -- pretty much kept to herself. Still, mom hinted that she was itching to hold Katie, so on Thursday we brought her downstairs for a trans-generational cuddle.
Now that we're back at Kapi`olani, the house is quiet again.
Even though Katie was a boarder for all of 48 hours, Mom says all three of them miss her a lot. Grandma stayed up until midnight last night waiting for mom to get home, hoping that Jen, Katie and I would miraculously return with her.
We'll be home again soon. Maybe even tomorrow.

Breast pumps, though. Now there's a fascinating technology.
We forgot our own electric pump in Mililani, so our favorite nurse (not on tonight, sadly) brought in a disposable, manual one.
The suction is created with a fat syringe-type thing, much like a short bicycle tire pump. It takes about 250 pulls to fill a short, narrow bottle. If it wasn't for the standard steering on my car, I probably would've pooped out in no time. Instead, I just got a pretty good workout.
Eventually the electric adapter for the pump became available, and it was wheeled into the room. I was surprised to see the device simply connected to the manual syringe, and pumped it back and forth just like a mechanical hand.
We're collecting and freezing milk between daytime feedings, hoping to again use bottles for alternating feedings overnight so we can get more sleep.
Unfortunately, Katie has demonstrated a distinct preference for the real thing. Once, when Jen had Katie on her lap and put the bottle in her mouth, she only sucked a dozen or so times, then popped it out with her tongue.
Then -- and this was the neat part -- she started rocking and wobbling her head until it slowly started sliding, turning toward Jen. She started rooting with her mouth, and the movement pressed her face further down Jen's breast. If it wasn't for the fact that Jen was wearing a sweater, she probably would've latched on all by herself.
I was delighted. It was the most intelligent, deliberate thing I've seen her do yet. It isn't a symphony, but it's a good start.
Some babies don't take to breastfeeding too well. They don't have the rooting instinct, or don't latch on right. Katie's a natural.

So far, everything looks good.
Katie's getting her color back, and I think she's plumped up a bit. She's putting out perfectly thick, perfectly mustard-colored poop and urinating frequently.
The nurse says all the tests so far have come back negative. Blood, urine, stool... no sign of infection. Only the final report from the spinal tap -- the test that makes this a 72-hour stay -- is left.
Dr. Boyens, during a frustratingly short visit this afternoon, figures that if she does have a bug, she got it during late labor in the birth canal. With that, Jen's upset that the hospital staff waited so long -- about five hours -- after we came in to start antibiotics.
See, Jen's bag of waters didn't break so much as tear. Since it was a small rupture, they had to test Jen twice to find amniotic fluid. If they didn't, they were itching to kick her out of the birthing center. Only after a walk around the ward did enough fluid pool to show up on a slide, so only then was Jen officially admitted and the IV set up.
And that was seven hours after the membrane tore. In all, there was a twelve hour window for nasties to get into Katie's bubble.
If there is no infection, that Katie's bout with diarrhea may have been viral in nature. A cold bug picked up in the halls of this hospital or, less likely, from my family.
She'll get better. If only I could convince Jen of that.
Jen keeps fearing the worst -- keeps suspecting that Dr. Boyens and the nurses are lying, that they're keeping some awful piece of news from us. She even visited the chapel here and prayed her heart out. She cries if Katie cries too long, and cries if Katie sleeps too long. No thermometer reading, no vital sign is normal enough.
Part of it is 'post-partum depression,' I suppose; the hormone hurricane that's often intensified by breastfeeding. On the other hand, my own moments of free-falling fear make it clear that no matter how healthy Katie is getting, the fact that she's in the hospital is not insignificant.

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