>Seriously???? That’s All?

>So I am trying to solve the plugged duct in my left nipple. (Oh yeah, I should have warned about the TMI coming up….) And I go from the 24mm breastshields to the 27mm ones. I use those for a couple of days, pumping 8 times per day, and something happens. Pain. And swelling of areas you do not want to be swollen. And I can’t see because I am up close and personal. So I stand topless in the bathroom and call John in to see if he can see anything wrong. And he says, “Oh my God, Andrea, you’re bruised!” Yep, my girls are bruised. Actually bruised. And so I make a 9-1-1, code-blue trip to the Women’s Wellness Boutique at the hospital, which is where I buy all of my nursing paraphenalia (both because they either have anything I could possibly need, or can order it with just a phone call, and I get an employee discount). And they help me do some research. And we watch videos online of correctly fitting breastshields. And we realize that I have been using the wrong sizes all along.

So let’s recap: Pump In Style Advanced ($300), Freestyle ($400), Reglan, Fenugreek, Blessed Thistle, Alfalfa, pumping pumping pumping, Breastfeeding Medicine specialists, visits to lactation, different bras thinking that the ones I had were cutting into me and causing the plugged ducts and thus decrease in supply. Lab test to check my thyroid. Biting the bullet and buying the $2K hospital-grade pump…

And I spend $10 on a set of shields in the next size up and actually pump double my average pumping yield in the first time I used them.

You have got to be kidding me.

I feel like a moron. And am having flashbacks of the first time I spoke to a LC about the drop in my supply. When we were puzzled that despite Zach’s poor latch, my pumping with a good quality pump was not able to keep my supply up. And I started doing anything and everything to get it back up. And she aked me, “Andrea, do the flanges fit well?” And I said yes, thinking to myself, “Well duh!”. But they didn’t.

I found the solution. I’m glad it was such a simple one. I wish it had come sooner. I hope it isn’t too late to fix it.

>Packed Away

>FYI–I’m typing this one-handed as Zach snoozes in the crook of my left arm. He has fallen asleep somewhere in the middle of me wearing him moby’d and me feeding him a whopping 6 ounce bottle of breastmilk. He’s in this weird sort of limbo position, half in the carrier and half in the cradle hold in my arms. Actually, I was craving some Mommy-Baby time and so we were holed up in my bedroom jammin’out to the likes of the Stones and Aretha when he acted hungry. I told John to warm 2 ounces for more of a snack, but instead we got a whole meal. And 2 ounces in…..off to Dreamland. I would give anything to have a camera within arm’s reach right now.

So…back to the post at hand…Remember the previous post where I spoke on our cool weather, Zach’s seemingly exponential growth, and more? Well, today was a sad day for me in relation to that post. Today is the day that all of those bigger baby clothes emerged from my dryer smelling of Dreft and wholesome baby goodness. And I sorted, and hung, and organized into matching outfits. And I ran out of hangers. Now let me clarify: I purchased over 200 baby blue baby-sized hangers before Zach’s arrival. And I ran out. As in there are over 200 outfits in circulation. Not counting sleepers and onesies and gowns. Just. Outfits. Well, I need more hangers, so I am about to send John to the store for them when he throws a fit. And he’s right: Zachy doesn’t need more hangers, he needs less clothes. Which leaves me with the task I have been putting off for a while now.

I had to sort through his clothes, removing the outgrown, out of season items to make room for the fall/ winter stuff. A novice mom probably would have handled it better than me. I, on the other hand, broke down. And I was reminded once again of how it all goes so fast. And it seemed as if each item had a special meaning.

The solid white, plain, Baby Gap sleeper. I was about 12 weeks pregnant when we bought it. It was unisex because we didn’t know gender yet. And it was so tiny. The tag said “newborn” but it also said “up to 7 lbs.” And at a time when the idea of another baby was so fresh to me,I held it up in the air to show John, and we were both amazed that a human baby could fit into something so small. It had been so long for us. And at a time when it really was too soon to start buying clothes, we couldn’t help ourselves. It’s what Zach wore home from the hospital, and we were even further amazed when something so tiny was still so large on Zach: we could’ve tied the legs into a bow they were so long.

The “Little Brother” onesie. Right after Evan found out we were having another boy, he was so upset and actually kind of angry at me. He had gone all afternoon without speaking to me as if it were all my fault that Zach was a boy. And then we were at Macy’s, eager to buy clothes now that we knew gender, and Evan found the tiny onesie and brought it to me, saying, “Mama, I want to buy this for my baby brother.” And I knew he would be okay. Zach is actually wearing that in several of the photos from the hospital.

There’s more. The outfit my home health nurse brought me when she came to see Zach and to officially discharge me from their service. She was the one who hugged me 2 days before my amnio as she told me it would all be okay, that I would have a beautiful healthy baby and it would all be worth it. And she was right. Or what about the little romper I bought at Target? It was the one I was reaching for when I wrecked the scooter into the rack of baby clothes. (Hey, shopping while on bedrest proved to be quite the adventure. albeit an illegal one by my doctors’ standards.) Or there was the little overall outfit. So cute. And the very first time Zach wore it was the day I learned a valuable lesson about breastfed babies–that they poop on their own schedule, even if that is only every other day. But that when they poop, they poop. Even if you are in the mall. And so I lifted the lift gate of my car and used an entire package of wipes to clean Zach up as he lay on a blanket in the cargo area of my car- the only area large enough for the operation at hand. And we made the intrepid journey to the nearest garbage can to throw the whole mess away, unwilling to be caught being the ones who stank the place up to be damned. And I thought to myself that the outfit would never come clean, which led me to another lesson about breastfed-baby poop–it really doesn’t stain.

So there they all were: tangible memories. And I could remember all of it. And it was all folded up and packed away into plastic bins. And before I could bring myself to place the lids on, I just stared. They were so much more than clothes to me just then. They were memories of my pregnancy, before it got crazy and riddled with pain and complications. They were family bonding and evidence of my toughness to survive what I did. They were late nights spent learning to nurse. First smiles. When 3 became 4.

So Zach’s first summer on Earth was packed away today. And since this was not my first go-’round, I know how this goes. This starts the March of the Seasons, passing with a blur. Time you will always remember and never, ever get back. And just like I did with Evan, I’ll hold onto them for years, reluctant to let go. Until one day John will lament the amount of unneeded junk in the basement and try to find stuff to get rid of. And he’ll ask, “What about all of these baby clothes?” And I’ll have to let go. Just not right now.

>Breaking My Pledge

>The girls at work have been teasing me lately because I have an addiction: baby clothes. I realized I may have a problem on my last trip to Babies’ R’Us. I went in the monster store for pacifiers, not only because they seem to be as disposable in this house as the Pampers we wrap Zach’s little butt in, but also because we need the next size up since Zach is growing. I did well at first, making a beeline to the appropriate section of the store and avoiding the pitfall that is the middle section, full of racks of sweet baby togs. And bonus for me when the brand I buy was BOGO! But then I made the mistake of straying once they were in the cart. The “Let’s Just Look Around” mistake.

Oh Look! Carter’s stuff is almost half off! And the BRU brand is BOGO! And before I knew what was happening, I had 10 new outfits for Zach in the cart and was rounding the corner to the shoes.
Of course this seems harmless to the layperson. The kid needs clothes, right? And after all, it is getting cold out, so there is a whole new season for which to shop! But the problem is that my coworkers were awesome to me once my baby emerged from me with a penis. Nobody else was having boys, and so the two who have had boys in the past year hooked me up! Bins upon bins of like-new baby boy clothes of appropriate sizes for the seasons. And one of them has a wife who managed a Gymboree and so there were scads of Gymboree clothes with the tags still on them. So I seperated them by size/ season, and had them stored and waiting for Zach to grow into them. I wouldn’t need more baby clothes for Zach’s first year of life!

So here we are again, with my newly-discovered problem. The first 3 months of Zach’s life left me changing his clothes 3 and 4 times a day just so he could have an opportunity to wear the tiny outfits at least once before they were packed away as outgrown or passed on to someone else. And I vowed to myself and to my coworkers that I would refrain and use some serious self-restraint in the future. And I was being good. For a few weeks.

But then….
It got cold. Really cold and really suddenly. And I had to dig through the bins and cut the tags off of the clothes I have purchaed for fall. And I realized something: Zach can wear most all of them now! Of course the pants are a little long and some of the sleeves need to be rolled up because my baby has short arms and legs. But they fit, and I have gone through all of the bins. There is still a litle more, but not much at all. And it dawned on me what it is that this means:
I need to buy more baby clothes!!! I get to buy more baby clothes without feeling guilty about it! I have an excuse to break my pledge. Thank you, Zach, for being so pudgy and giving Mommy an excuse to shop! Woo Hoooooo!

>Missing

>I have been working too much, and I hate it. I know why I do it. $$$$$. But I feel like I am missing from my own life. From Zach’s, Evan’s, and John’s life. And I’m sad.

John and I came to an agreement when I went back to work. I felt bad about having to return to work so soon and leaving Zach, but I had to do it. And John has done a stellar job taking care of our baby. Zach is clean and fed and happy. He’s now on target with his milestones. But John didn’t uphold his end of the agreement. Here’s why:

I have worked 55 hours in the past 4 days. Gross, I know. But true. And I am so tired and weary that my bones are aching. And this means I am away a lot. John promised that when Zachary started doing something new, instead of presenting it to me in a way that left me feeling even worse, he would let me discover it on my own as if it were the first time Zach did it. So Saturday morning, I get out of work and my boys are waiting for me in the car outside of the hospital. And as soon as I get in the car, John is bursting with excitement. Zach finally did it! He rolled over. Up until that point, he had been doing his weird but funny thing where he would balance on his belly with arms and legs up in the air and rock back and forth, trying his hardest to roll over. It reminded me of a turtle stuck on his back, honestly, only in reverse with Zach on his ventral side. Hilarious, actually. But he finally did it. Of course I was sad because I missed it.

So today, I am trying to get Zach to do some tummy time. Despite my best efforts, he will not usually tolerate it more than 5 minutes. We have to get him off of his back in other ways, like his Jumperoo (even though he is a little too young), the Bumbo (which he hates), or the Moby Wrap. Whatever works, really, since his head is getting a little flat area on it. Anyhow, he is there on his tummy and getting seriously pissed off about it when he learns that he has a new manner to escape: he just flips over. Just like that, arms extended and a look of surprise on his face that was priceless as it dawned on him that he was no longer in the dreaded belly-down position. And so a new era has begun in our house.

Zach is no longer stuck where we put him. More caution is warranted in such things as changing his diaper on the changing table, casually laying him next to us on the sofa, and more. And before I know it, he will be crawling and nothing from the knee-height and down will be sacred any more in our house. And there will be more he will do that I will miss.

>2/3rd’s, The Shots, Scheduling Woes, and More

>Today Zachy got his 4-Month immunizations. We couldn’t have them done at his 4-month well-child appointment because it hadn’t been exactly 2 months since his last round. He really is such an awesome baby. He cried a bit for the last ones, then did fine at home. No fussines or crankiness, no fever. I had the same expectations for these, and he did not disappoint. Though John said it was my turn to hold him for these. Neither of us like to be the bad guy, holding him down while pain is inflicted upon him. So I did. Fair is fair. But I cried right along with him, and both of us were instantly calmed when it as all over and I could pick him up and cuddle with him. My sweet, sweet baby boy.

On the breastfeeding front, things are going better and worse. I have managed to increase my supply a bit and am now producing about 2/3rds of his total intake. I now leave for work with more breastmilk in the fridge than he can eat in one night, and have a few days’ worth built up in my freezer. Of course this progress comes at the cost of me being attached to a pump for what seems like all day. But in truth,I could be a lot better about it. I keep making plans to spend all of my off-time pumping at least every three hours and after feedings, but it seems like things always come up. Truly, I blame it all on my work schedule. We do self-scheduling, and we are currently working on the schedule I completed about 2 weeks after my big return to work after the 5-month hiatus. Instead of scheduling my days in a row, I scheduled myself for every other day. I did this not only because I had been off so long that I started to atrophy and didn’t think I could physically handle long stretches of 12-hr. shifts, but also because I figured I would get no real sleep with a newborn who is breastfeeding. It turned out to be a mistake. Not only does Zach sleep like a champ, but I feel like I am never off of work and get even less sleep. Take today for example. I worked last night and had today off. By the time I got home and tried to sleep, most of the day was over. I really only got this evening off. And I spent that time doing things I needed to do. Plus the sleep I get is broken because I wake every few hours to nurse Zach or pump. Now it is 3:15 AM, my family is asleep and I am wide awake. I’ll get more broken sleep tomorrow because I am back at it tomorrow night. Well, the next four nights, actually. I picked up 24 hours of overtime this weekend. For this next schedule that will be starting soon, I did the opposite: scheduled for three days at the beginning of one week and three days at the end of the following week, which means I have long 6-day stretches off in-between to rest and regroup and nurse and pump. My goal is to use this time to get Zach totally off of all formula supplements by the time he is 6 months old and ready to start solids. That seems lofty to me at this point but it really isn’t when you do the math. For a baby eating solids, the average formula/ milk intake is about 24 oz. daily in addition to other foods. If I can pump just half an ounce more at each pumping session, that will put me way over that mark for daily output! And I will have all of those days off to do it! Ha! Finally!

On another Milk Maid note: It happened finally. I got a plugged duct. But not just any plugged duct. This is in a bad place. A very bad place. I had noticed I was a little more tender than normal. The LC has me hand-expressing after I pump because even the hospital-grade pump is leaving enough milk in there that it literally sprays out after a pumping session. So I do and it has become habit. But when I was doing my little ritual yesterday……oh bloody HELL!!! It hurt. Badly. Because I can’t be normal and get a plugged duct on the side or something. Nooooooo! I get one actually inside of my nipple. And weirdest of the weird, you can actually feel the milk passages in there because there is about a 2-inch section of inflamed duct that feels all ropy and knotty. So tonight I waited and waited for Ev to go to bed so I could sit in my living room with a hot wet washcloth on my…well, you get the picture. It is still there. If it isn’t gone in a couple of days, I am to see my doctor, according to the LC. Gah! I’m sure this all the result of my sucky schedule, business at work, and erratic pumping/ nursing schedule. I think I have come up with a solution: I bought that damned Freestyle that has the rechargeable battery. I might as well use it. I think I’m going to make its permanent home be my car, so when I am running errands or am out and can’t nurse Zach, I can use it. No more excuses. And much handier than, say, lugging around the big pump of Herculean proportions. I don’t een have an excuse to take it out of the car since I have a standard power outlet in my car’s console and can just plug it in when the batt is dead. There!

So there you have the low-down on my issues once again. Now back to work.

>On Coming Back and Letting Go

>Work has been so strange lately. It’s not even Hell Season yet. For those of you who don’t realize what that is, Hell Season usually hits around November and lasts through March or April–in other words, flu season. In other words, the best of times and worst of times to for a respiratory therapist. The best because I will earn about 3 times more than I usually do in the off season because the hospital is usually full of respiratory patients and the overtime is there for the taking. And I am opportunistic. Sick people need our care, staffing has to be up to accomodate them, and I am all about more moola! On the downside, I have not yet maneuvered Hell Season as a Nursing Mom. I had another night last night where I went 8 hours without pumping because I was just too busy, and this is way before it is supposed to be as such. Will my boobs survive? I don’t know. We shall see. But you can expect more posts about work.

So anyway…

Last night I got a call from an RN friend from the SICU, warning me that I should start heading that way, that my patient was getting ready to code. I get there and he is off of his ventilator and the nurse is bagging him. I take over and am bagging him when we lose his pulse. The big blue button is pressed to alert the troops, and the rest of the code team arrives. We resuscitate this patient for over 50 minutes. During that time, we get his pulse back only to lose it again. His wife is brought in to say her goodbyes and also to see that we are doing everything. She is obviously very distressed and calls his daughters. And we call it: Time of Death 04:46. The rest of the team leaves the room except for me and his assigned nurse. I tell the nurse to turn the oxygen off from the connection on the wall and the loud hiss of it stops and there is silence. I detach the bag from his endotracheal tube and lay it on his chest. And then I hear it: noisy breathing. I look down and he is spontaneously breathing. And not the agonal, uncoordinated breathing of the dying. No, this man is breathing. So I try to discreetly get the nurse’s attention, who calls the resident back in. And they check him. Good pulse, good blood prssure. Just like that. He came back. The Lazarus Syndrome. I’ve heard of it happening may times. This was just the first time it happened to me. So we hook him back up to the ventilator and tuck the blankets back around him and leave the room with out resuscitation equipment. Just like that, as if nothing had happend. Totally bizzare.

Meanwhile, in an adjacent unit of the hospital, there is a patient who is breaking my heart. An elderly gentleman who knows he is dying and has signed a DNR order. And he begged me and begged me to help him die, and all I could offer him was treatment to prolong his life. I have to tell him both sides: that it could be considered life-saving treatment, but that it also could be short-term to help him through until he can breathe a little easier. And bless him, he doesn’t want it and I can see that, but I think he is worried about what I want to hear more than he is about how he wants to die. And it breaks my heart. He keeps asking the nurse and I to just make it go quicker, and I can’t. We ask if he wants us to call in his family and he says no. “I’ve been married for 64 years to the love of my life,” he says, “and I don’t want her to go through this. Just call her when I’m gone.” True selflessness. He wasn’t worried about her being there to hold his hand. Instead he took the hands of a young nurse and a respiratory therapist, both strangers to him, and that was enough for him. I had to stand there and do nothing while he started to slowly slip away. I couldn’t call a code or intubate or breathe for him. There were no chest compressions or life-saving cardioactive drugs. And now I can’t get him out of my mind.

We spend years of our lives learning how to save a life. That’s what I do. Well, the biggest part of what I do, anyway. I’m sorry if that sounds like the swagger of a cocky healthcare provider with a God complex. It really is just the fact of my occupation. And they teach us of the legalities of our role: what constitutes extraordinary measures, medical futility and more. But then there is the side of this for which they do not prepare us: standing by and doing nothing. Holding a hand as our patient dies when we are trained and geared toward doing anything and everything to prevent it. And in that moment, just like my patient, I have to let go. One would think that the resuscitations and other life-saving moments would be the greatest challenge, but they really aren’t for me. What happened with this guy–well that is the hardest part. Having the ability to keep him breathing an his heart beating and not doing it. Letting go.

>The Bane of My Existence

>Or Why I Can’t Sleep. Or Why I Have No Time. Or Breastfeeding Kinda Sucks. Or This is Bullsh*t. Yeah, I could come up with quite a few titles for this post. Because after a busy night-one busy night– at work, my supply dropped back down again. So I am back to pumping every 3 hours around the clock. Again. And after just a few days of being back at it, I feel like a zombie. But what sucks is that I’ll work and work at getting my supply back up, then go to work one night and it will be guarunteed to go back down. I am constantly attached to a breastpump, and I fricken hate it. But just when I am about to say “screw it” and give up, I have one of those warm fuzzy nursing moments with Zach, and I instantly know I won’t be giving it up anytime soon. Because every drop of my milk he gets is my way of giving myself over to him.

One of my fave OB nurses from work put it into perspective for me. She knows all I have tried to be able to exclusively breastfeed Zach. (I mean, c’mon, who buys a $2000 pump??????) So when I was feeling down about it and cursing the lactation consultant who first had me give him damned formula in the hospital, she cleared my head by telling me that they were secretly talking about keeping Zach in the hospital. In fact, if he would have lost 2 more ounces of his birth weight, he wouldn’t have come home with me. And that was with him getting formula. I can only imagine what would have happened if he would have just been nursing and getting colostrum those first few days. I didn’t know any of this until she told me. And then she reminded me that I have been at least 50% of his food source for 4 months, which is a lot more than a lot of babies get, and that I managed to do that with a preemie who couldn’t latch. And during the emotional aftermath of my pregnancy, which was enough to dry up the fricken Atlantic. So yeah, she picked me up a bit.

So no, I won’t give up. But it still sucks.