Lisa and the Twins: Sat & Sun, June 14 &15, 2008

Saturday June 14:

Lisa and I both slept good through the night. Early in the morning a nurse and Dr came in to do an examination on Lisa's cervix. He said Lisa was dilated 2cm and Baby A's sac was hanging in the opening. This was not good news to hear after such a positive ultrasound yesterday.

Dr. Gianferrari came in to talk to us. She informed us that just because the membrane was bulging through the cervix, it did not necessarily mean that Lisa would be delivering the twins any time soon. She said there were several women within the hospital that had been sitting around for weeks at 2+cm dilated and bulging membranes.

Dr. Gianferrari and Lisa discussed utilizing a bed pan instead of getting up out of bed to use the toilet. Although awkward the first few times, Lisa got pretty good at it later.

About 2 hours later, another Dr. came in to perform an ultrasound. The cervix looked thin and dilated 1.9cm. There was no sign of Baby A's sac hanging through the cervix.

We had a lot of visitors in on Saturday. Lisa felt good and her contractions were slow during the day. Her contractions were even as low as 2 per hour.

11:30pm
As we were preparing for bed, Dr. Jackson and the nurse, Sara Fick, came in to check on us. Lisa told them everything was fine, but mentioned to Sara that she was feeling some moisture. Lisa told them that it was her inability to control her bladder. Dr. Jackson questioned this fluid leakage and decided to go ahead and test it for amniotic fluid. It tested positive. Although this is concerning, it isn't that big of an issue. It didn't really change anything regarding the treatment for Lisa. Women can carry babies for weeks with ruptured membranes (I read all about ruptured membranes back when we thought that was our case at St. Joes after the cerclage). As long as the membranes are not ruptured severely the baby can replenish amniotic fluid and in some cases the hole in the membrane can seal itself off.

Dr. Gianferrari, who was off work at this time, was called. She agreed that the treatment is the same.

About 5 minutes after Dr. Jackson left our room, Lisa abruptly leaned over, clinched the bed, and started crying. Her water broke! Half of the bed was soaked. Dr. Jackson came back in immediately to review the situation. She called Dr. Gianferrari again. Lisa's treatment didn't change except they decided to reinsert the catheter. As long as Lisa's vitals were ok, labour didn't start, babies vitals were ok, and no infection present, the babies could remain inside Lisa.

They moved us to the Taj Mahal of hospital rooms - #329.

Sunday June 15:

As we were getting settled into our new room, Dr. Jackson wanted to look at the cervix to see if anything had changed. She used a speculum and some cool space age looking helmet. Everything looked ok. Nothing had changed from the last ultrasound.

1:30am
Lisa started feeling contractions. These were bed shaking, body cringing contractions. I felt helpless. We weren't sure if the contractions she had been feeling all along were this same kind of pressure. Maybe without the amniotic fluid present, the pain is more severe. Her contractions had increased to every 7 minutes. Dr. Jackson and Sara discussed getting an epidural for Lisa. Lisa agreed. They monitored the babies' heart rates and everything was fine.

3:30am
Dr. Poston, Anesthesiologist, came in and performed the epidural with Sara. It was a lot more involved than what I had expected. Lisa felt better. She could still feel the contractions, but she wasn't in as much pain.

Dr. Gianferrari, who was still at home, had asked Sara to monitor the twins heart rates some more. Sara watched the heart rates and noticed that during the contractions, the babies heart rates were dropping from 150 to 100. After the contraction stopped, their heart rates would jump back up to 150. Dr. Jackson came in to review the situation......

I work in an environment where when a piece of manufacturing equipment goes down during post normal operating hours, it takes hours to get a hold of the appropriate people and tools to fix the issue. What unfolded next here at UK was absolutely remarkable.

Dr. Jackson (today was her last day, by the way) and staff worked calmly, quickly, and exact. She said the babies hearts are being affected by the contractions, and they must come out now. Within minutes there were teams of people in the halls and in motion. The NICU teams were present for the babies and so was the surgical staff for Lisa, led by Dr. Gianferrari who arrived within minutes. Calls were going over the loud speaker. People were walking briskly through the hall gathering their tools and confirming the order of direction. The team had morphed into a well oiled machine within minutes.

5:00am
They wheeled Lisa into the operating area, and I got sent to a quarantined room to get dressed for the surgery. I was scared to death. It was way too early for the twins to come out. They hadn't even reached the 24 week viability target. The twins were at 23 weeks and 5 days gestation. I made a phone call to Lisa's mom, and quickly sent out a text message.

When I entered the operating room, they were already cutting on Lisa for the c-section delivery. I was only allowed to stay behind a curtain next to Lisa's head and next to the Anesthesiologist, Dr. Poston. Lisa did great. She felt pressure at times but was not in pain. She was amazingly calm. I heard everything the Drs and staff were saying. Everyone was very professional. Baby A was removed first and handed over to the first NICU team. The staff said he was wiggling and made a little cry. Baby B came out just a few minutes later and was handed over to the second NICU team. The staff said he was wiggling also.

A few minutes passed and Dr. Gianferrari came over to talk to me. She said both babies were intubated. This is very important considering how small the babies are. She asked if I wanted to see Baby A. I got up and walked to the other side of the room where baby A was completely wrapped except for his head. He was so tiny. Baby B had already been transported upstairs to the NICU area. I had no idea what to expect of a micro-preemie. If Baby A was so tiny, I couldn't imagine seeing Baby B.

I walked back to my stool on the other side of the curtain. I saw Lisa cut open on the operating table, and the staff working on her. I didn't pass out, but I couldn't hold back the tears. Everything happened so fast. I was exhausted. It was way too early for those babies. Dr. Poston was there to console me, and I certainly needed it.

They continued to work on Lisa. I stayed there with her until they asked me to leave. The Drs said that the C-section went well.

What just happened? Less than 8 hours ago, everything seemed fine. Lisa and I had been discussing our 36 week gestation target. We didn't even make it to 24.

The next hours were filled with family support. Looking back, I think I was pretty numb to the whole event. For some reason, I was now relieved. Lisa was doing well in recovery with the help of pain medication.

I didn't get to go see the babies until around 2:00pm. Dr Q (my brother) went with me. I didn't get a good look at Baby A in the operating room because he was mainly wrapped up. In the NICU, the babies were not wrapped. They were in incubators and had tubes and wires all over them. They were so tiny. Baby A was born weighing 1 lb - 8 oz. Baby B was born weighing 14 oz. (Yes, Lisa and I still haven't named them yet). There was one NICU nurse dedicated for Baby A and another nurse for Baby B. They were very knowledgeable about all of the equipment and the status of the babies. They rattled off all kinds of information that just went in one ear and out the other, because I could not get over how small the babies were. I kept my composure for a little while until I reached into Baby A's incubator, and I touched his fingers. When he felt me touch him, his fingers reached out and partially wrapped around my finger. The tears came rolling. They were my boys. They were alive, moving, and breathing. They were my early Fathers Day present.

Dr. Shook, from the NICU, gave us a rundown on the grim statistics for survival and normalcy for both babies. She also began to prepare us for decisions in escalation of care that may have a chance to improve the condition and viability of the baby. It could also lead to prolonging the inevitable or lead to disabilities for the babies. These will be the tough decisions ahead of us.

So far Baby A seems to be doing pretty good. Baby B is also doing good considering his size, but he is definitely requiring a lot more attention from the NICU nurses. He was originally labored in his breathing and required a change in the orientation of the ventilator tube.

Lisa got to go see the Babies around 6:15pm today. She did really well and enjoyed seeing her little twin boys.

We got transferred to another room ~ #309.

We were very fortunate to be here at UK. The staff has been excellent. The boys are in good hands. As tough as this pregnancy has been, Lisa and I are in for tougher months ahead. Just like taking one day at a time while in the womb, we will focus on one day at a time in the NICU. If everything goes really well (which is unlikely), the boys would be in the NICU until September.