January 30, 2008 – Feeling tired

The fight will be a long one.  Today I shared with several people one of my greatest fears that I battle with each day.  I am afraid to stay away too long from the hospital.  I know that the twins’ conditions can and will change, sometimes quickly.  My fear is that I will step away to run an errand or take care of Adam, and a crisis will happen.  I cannot imagine if one or both of the twins were to pass away and I was nowhere nearby to say goodbye.  I know that I cannot always be around, but in my dark times, I feel that I am working on borrowed time that is running out.  Many of the nurses seem to have an outlook that makes me feel that they believe things can improve over time, but maybe I am too afraid to believe it.

As for an update on the twins, Katelynn’s condition has not changed much.  She is still fighting the bacterial infection and gained a little weight.  We were told not to be fooled by this, as it may just be fluid increase.  Daria’s nurse informed us that she heard a heart murmur, which is not usual for a baby born this early.  Unfortunately, if the upcoming heart ultrasound confirms this, a potential course of treatment may be surgery to repair the defect.  Typically, in full-term babies, this type of issue self corrects, but the underdeveloped body of a twenty five week baby often cannot. 

Jenn-Jen is doing well,  considering the fact that she went through a vaginal and C-Section delivery only two days ago.  She is up on her feet more today and the pain is bearable with medication.  Jenn-Jen was able to take a shower today and I was given the ok to take her outside in a wheelchair for some fresh air.  It seems strange to tell you this, but Jenn-Jen has not seen the outside of Sutter Memorial Hospital since January 18, which was almost two weeks ago. 

We were also happy to have spent some time praying with Pastor Mike this afternoon when he came to visit us.  He read us Psalm 27 to provide encouragement in difficult times and listened as we unloaded our feelings, thoughts and fears on him.  It was quite therapeutic.

Each day has new battles.  Please continue to pray for Katelynn and Daria.  Please also pray for Jenn-Jen and me to keep our strength up.  We have a lot coming at us and the end is nowhere near.

January 29, 2008 – Results from Katelynn’s ultrasound and an update on Daria

Katelynn’s ultrasound came back and did indicate that there was some bleeding in the brain.  The good news was that the bleeding was not as severe as expected, and was assessed as a stage two bleed, one a scale of one to four.  The doctor said that the blood vessels affected are actually ones that normally go away as a baby is developing in the uterus.  The danger occurs if the bleeding spreads to the ventricles in the brain.  So we have some positive news during this rough day.  Katelynn is supposed to have another ultrasound tomorrow.

Katelynn is also fighting the ventilator by breathing against it, so unfortunately, they needed to sedate her.  It is a strange concept that we would normally expect Katelynn breathing on her own to be a positive thing, but if she doesn’t breath in sync with the ventilator, it creates stress on her little body.

Daria is doing as well as expected for a twenty five-weeker.  They needed to adjust the ventilator settings during the day, but we were happy to learn that they did not need to increase oxygen levels.  The rest of her vitals (heart rate, blood pressure, oxygen saturation) seemed to be in good shape.  It is nice to have some good news here.  Nonetheless, we were warned that the first 48-72 hours are very critical, and things can worsen very quickly and easily.

Jenn-Jen and I are going day by day with the goal of hoping and praying for the best, while we still try to prepare ourselves for the worst.  I know that I haven’t mentioned this recently, but our family is so grateful for all of the prayers, support and caring you have provided to us.  We sincerely can’t thank you enough and don’t know how we would be getting through this difficult time without you.

January 29, 2008 – The emotional roller coaster with no end in sight

Jenn-Jen and I woke up in the morning feeling quite exhausted.  I was anxious to see the girls and get an update from the neonatal doctor and nurses, so I headed over the the NICU to get a report to bring back to Jenn-Jen.  As I sat near Daria’s incubator, the doctor came over to tell me that Katelynn wasn’t doing so well. 

The news was painful and almost too much to bear.  Katelynn’s blood test showed that positive for gram-negative bacteria.  To give you a better understanding of the severity, examples of gram-negative bacteria include nasty pathogens like E. Coli and Salmonella.  While we don’t know which bacteria is infecting Katelynn, the doctor explained that this would be a difficult battle even for a full-term baby, let alone a twenty five week preemie. 

On top of this, the doctor said that his initial assessment of Katelynn indicates that she may be showing potential signs of brain hemorrhaging.  He ordered an emergency brain ultrasound and told me that the results would be on a scale of one to four.  A three or a four assessment would mean severe bleeding that would most likely result in severe neurological disability, such as cerebral palsy.  His guess was that we were looking at such severity, but the ultrasound results would provide more information.  It was back to the waiting game…

I rushed back to Jenn-Jen’s room and broke the grave news.  We cried together for some time and felt knocked down again.  It seems that the small victories we have gained become so easily overshadowed by catastrophic news of life-threatening challenges.  My heart feels torn up, and all I feel that I can do is share the pain Jenn-Jen face with God in our prayers that He would will our daughters to beat the odds and grow to be strong and healthy. 

During a quiet time I had to myself, I thought about the account of Abraham and his son, Isaac, in the Bible.  Abraham’s trust in God allowed him to have enough faith to be obedient, even to the point of being willing to sacrifice his only son simply because God commanded him to do so.  As Abraham was preparing to take his son’s life, God intervened, stopped Abraham and provided a ram to be the sacrafice.  Every time I think about my tiny and fragile daughters, I try to tell myself that I should follow the example of Abraham and be willing to let God have Katelynn and Daria.  If this means that He takes them now or later, I want to be able to say that they are His and be at peace with His will for them.  It is so easy to wish to be that strong and so difficult to allow the heart to accept this.  I am not ready to let them go, even though I know that I need to prepare myself to be ready.

January 28, 2008 – Born too early

Jenn-Jen was moved into the operating room and I changed into scrubs to prepare for the birth(s).  The contractions were getting stronger and the cervix was dilating.  Active labor set on and everything went at a fairly quick pace.  Our first twin, whom we named Katelynn, was born at 4:24 PM.  She came in with a birth weight of 1 pound 7 ounces and measured 13.78 inches.  They immediately whisked her away to put her on a ventilator and keep her stable. 

The rest of the medical staff in the OR worked quickly to tie off the now separated umbilical cord and were now working keeping our other twin in the womb.  Jenn-Jen was given magnesium sulfate through her IV line to stop contractions.  We learned that her cervix was stabilizing and contracted down to three centimeters.  After a short while, they made the decision to bring Jenn-Jen back to her room in Labor and Delivery for observation.  The plan was to wait it out for twenty four hours, and if her cervix remained stable and the contractions ceased, Jenn-Jen would move again back to High-Risk Maternity.

During this time, I made a circuit of running between the OR to check on Jenn-Jen and the NICU to see the progress with Katelynn.  From what I observed, everything seemed to be going as expected with our new baby.  Her temperature seemed fine, as was her heart rate.  The NICU staff was now working on putting in a couple of catheters through her umbilical cord site to monitor blood pressure and provide her with nutrients. 

After Jenn-Jen was brought back into Labor and Delivery, there was a period of relative calm.  Although she was still having contractions, they were decreasing in severity, which was a sign that the magnesium was working.  After some discussion, we decided that I should go back home to gather a few things to prepare to spend the night at the hospital.  I felt happy that things went as well as they could and wanted to make sure that Adam was doing fine too.

I headed home around 8:15 PM and saw my mom and Adam there.  As I’ve mentioned before, I really wanted to make sure that Adam had as much of a normal life as possible while all of the events were unfolding.  I decided that I would wash him up for night, read him a bedtime story and tuck him in for the night.  It was comforting to know that my mom and my sister, Janet, would be spending the night with Adam.  Then my cell phone rang…

My dad called and said that Jenn-Jen’s nurse wanted me to come back to the hospital.  Not understanding what this was all about, I asked to speak to Jenn-Jen.  I learned that our other twin was experiencing some distress and her heart rate was going down.  They would need to immediately go back to the OR and have a C-section delivery.  I jumped in my car and raced back to the hospital.

Unfortunately, I arrived too late to be there for the operation.  Our daughter, Daria, was born at 9:13 PM, and by the time I was scrubbed up at the OR, they were stitching up Jenn-Jen’s incision.  Jenn-Jen was put under general anesthesia, as the epidural wasn’t working quickly enough to block the pain.  Daria weighed 1 pound 9 ounces and measured 13 inches at birth.

This was a very painful moment for me for a couple of reasons.  I was praying that Daria would able to stay in the womb much longer than four hours and forty nine minutes.  To make matters worse, everything happened so quickly when I really believed that Jenn-Jen’s condition stabilized.   I never would have thought that running home to pick up a few things for the night would mean that I would miss my daughter’s birth.  Since January 18th, we have had many emotional ups and downs, and unfortunately, this was another hope dashed.

I went over to the Recovery Room to wait over my unconscious wife until she came to.  The nurse said that Jenn-Jen would probably be out for at least another forty five minutes, so I decided to run up to the NICU to see Daria.  She was just as small and fragile as her sister, and I tried hard to not break down when I saw her being prepared for the upcoming fight to survive.  I said a quick prayer for Daria, went across the way to see Katelynn, prayed for her, and went back to Recovery to see Jenn-Jen.  She was still unconscious, so I decided to try to eat a little something.

Jenn-Jen slowly came to and we waited until she was coherent enough be transported back to the High-Risk Maternity.  We wheeled Jenn-Jen in her gurney to the NICU so she could finally see Katelynn and Daria.  It was another heavy moment on our hearts, seeing our daughters connected with tubes to keep them alive.  We stayed a little longer, realized that it was well past midnight, and felt our bodies tell us that it was time to rest in preparation for the very long days ahead.  I tried to sleep, but the emotional drain kept me tossing and turning through the night.  Jenn-Jen had it worse, with nurses coming in every other hour with medication.

January 28, 2008 – Emergency!

I received a call from Jenn-Jen around 9:30 AM.  Our hopes turned into our greatest fears when the ultrasound this morning showed that the twin that had a decreased level of amniotic fluid was now showing no fluid in the sac at all.  I dropped everything, called for my parents to come take Adam, and rushed to the hospital.  When I arrived I learned that the ultrasound could not show the sac membrane anymore, confirming that one of our twins was now in heading into distress.  Jenn-Jen was experiencing increasing contractions, as her body was telling her that it is time to deliver.  Without the bag of water around the twin, she was now feeling the force of the contractions, and this was causing her heart rate to go down periodically.  The way that it was explained to me as that the twin is feeling a squeezing sensation that was putting pressure on the umbilical cord, which supplies oxygen to her.

From here, the doctors said that we would no longer try to stop contractions and delivery would be imminent.  The distressed twin was in the correct position for us to move forward with the plan to do a vaginal delivery of the first twin and attempt to keep the other in the womb.  There were some cases of this working, but we had no reassurances that we would have success.  Jenn-Jen was transported from her room in High-Risk Maternity over to Labor and Delivery, and the staff was now preparing an operating room.  In case the procedure does not go as planned and we need to deliver our second twin, the operating room would provide the right environment for a Caesarean Section (C-Section) delivery.

Jenn-Jen’s IV line was changed back to a heavier gauge to prepare for any emergencies where large amounts of fluid need to be pumped in.  My poor wife has already endured at least two previous IV site changes, with approximately six or seven failed attempts at getting the line in.  She apparently has deep veins and the nurses and two IV Therapy specialists were having quite a bit of trouble putting in previous lines.  An anesthesiologist was able to put in a previous line, and this current one took the nurse anesthesiologist two attempts to get it in successfully.  She still had the epidural to go, and Jenn-Jen was getting very nervous.  Thankfully it went in fine.

Now we wait and pray.

January 27, 2008 – We are praying for a miracle

Dear Friends and Family,

First off, I wanted to take a little time to thank you for all of your acts of generosity, continued prayers and thoughtfulness as we go through this time of uncertainty.  I know that reading all of my previous posts may have given you a little glimpse of what we have been going through, but my words simply can’t tell you enough of the thoughts that go through my mind each day.  My heart has been heavy and I am doing my best to adjust to a lifestyle that I can only imagine what single parents go through.  Again, I count my blessings to call you my friends and family.  Your generous acts of support have meant the world to us, and your prayers have helped us stay optimistic and faithful. 

As I mentioned in my previous post about our latest ultrasound, one of our twins has a what looks like a rupture in her amniotic sac.  Jenn-Jen is going to have another ultrasound done tomorrow and we are praying for a miracle.  The perinatologist (high-risk pregnancy doctor) that is overseeing the pregnancies tells us that she suspects that the rupture may be higher up in the sac, which is why we aren’t seeing any fluid leak out.  There is a possibility that our baby will be producing enough fluid to keep the two centimeters of existing fluid in equilibrium, and the rupture may seal.

While we keep our hopes high, the reality is that Jenn-Jen may need to deliver in the short-term.  Since being admitted on the 18th, the doctors did put her on antibiotics to fight off any potential infection with a ruptured amniotic sac.  She also had a couple of steroid injections to give the twins a boost in lung development to prepare for early delivery.  The anti-contraction medications seem to have reduced the frequency of Jenn-Jen’s contractions, but they still show up every once in a while.  The medical staff is doing the best that they can to help keep Jenn-Jen pregnant as long as possible. 

Even so, with all of the steps they’ve taken, the perinatologist tells us that if we can get another three weeks, that would be wonderful.  Three more weeks means that Jenn-Jen would deliver at twenty seven weeks gestation, or thirteen weeks premature.  For those of you that journeyed with us through Adam’s birth, you may remember that we has born at thirty two weeks, or eight weeks premature.  He ended up spending the first three weeks of his life in the NICU at Sutter Memorial Hospital. 

At this stage of Jenn-Jen’s pregnancy, every day counts and each week is a milestone to look forward to.  If she can get to twenty five weeks, which is in a couple of days, the chances of the twins survival moves up to about fifty percent.  If they do survive, we have no more than a twenty percent chance that each twin will lead a life free of major disabilities, such as cerebral palsy, blindness, deafness or major learning disabilities.  My heart aches every time I look at that chart that shows the statistics.  Yet I continue to pray that God will provide a miracle.

January 27, 2008 – Still no fun being sick

All went well after I left the hospital yesterday.  My Uncle Alan, Uncle Tim and his wife, Cassandra, came in from the Bay Area for dinner.  It was nice to see Adam happy from spending some good times with the rest of the family.  As straining as it has been since the 18th, I count my blessings when I see so many family and friends stepping in to help us out.  As I mentioned in an early post, my goal has been to keep life as normal as possible for Adam while his mom is away.  It’s really a tough balance to make sure everyone in the family is getting all the attention the possible.  Jenn-Jen has been remarkable in keeping up her spirits and being concerned for Adam’s emotional well-being.  God has really provided me with the best family.

As for the illness update, Jenn-Jen’s blood-work and x-ray came back negative, which means that there is no infection.  Her cough ebbed as well after taking the new medication.  This was really good news because the coughing became so bad that she was beginning to feel cramps in her abdominal muscles.  The congestion is still there, and the Trandelenburg position is only aggravating the situation. 

After church services, Adam said that he was really tired.  We went home and I let him take a little nap, thinking he would feel more refreshed.  Unfortunately, Adam came down with a temperature that hit 101.7.  I gave him some Tylenol and called Jenn-Jen to tell her that we probably wouldn’t be visiting today.  My mom came by later in the evening to watch Adam, so I was grateful to be able to get out and see Jenn-Jen.  We continue to pray for a healthy family, and the condition of the twins are on our minds constantly.   

January 26, 2008 – No fun being sick and our date night

Since Wednesday, Jenn-Jen’s congestion has progressively worsened and she is now coughing heavily.   I keep thinking if she picked up my head cold, but the symptoms seem quite different.  Jenn-Jen also picked up a temperature of 102.8, so new treatment included a strong cough suppressant, and a combination of medication and cooling pads to break the fever.  The doctors ordered a complete blood count (CBC) to see if there was any indication of infection.  The next step is a chest x-ray in the morning to check for pneumonia.  We are praying that neither Jenn-Jen or the babies are infected and we’ll have to wait and see.

I finally feel the symptoms of my head cold are completely gone, which is a big relief.  For the past week, I have been careful in not coming to the hospital while I was contagious, and it was during these times that were the toughest on the family.  Now that Adam and I are better, I made the plan to spend last night (Friday) in the hospital room with Jenn-Jen while Adam camped out with Aunt Janet and Uncle Stan.  I guess you could call this one of our strangest date nights.  We ended up watching the Women’s Final of the Australian Open and ate our dinner in bed.  I imagine we might do something similar for Valentines Day and Jenn-Jen’s birthday, if we can get that far. 

January 23, 2008 – A painful visit and the second ultrasound

Between the worsening discomfort Jenn-Jen was experiencing and the horrible episodes of illness Adam and I were going through, we kept praying and trusting the Lord that another day that Jenn-Jen remains pregnant in the hospital is another answered prayer.  All of us felt tired and we missed each other terribly, but our hopes were up that we were in this for the long haul. 

We just couldn’t stand being away any longer, so I brought Adam in to see Jenn-Jen.  It broke my heart when I brought Adam in today.  He was a little groggy from the nap he took in the car, so I carried him into Jenn-Jen’s room.  Right when he woke up, he went over to the corner and started crying.  Initially I was really angry that he wasn’t going over to Jenn-Jen to give her a hug and tell her how much he missed her.  Adam gets a little emotional after naps, but it really hurt Jenn-Jen to see him not wanting to come near her.  He eventually told us that he misses mom, and we don’t blame him.  As much as Jenn-Jen and I have hoped to make life seem normal for Adam, the reality is that around-the-clock bed rest in the hospital is really a modified version of being in jail.  The main difference is that, during our visits, we don’t have to talk between plate glass or bars. 

To make things even more heavy on our hearts, the results of our second ultrasound came…

We learned that Baby A, which is the twin that is lower in position in the uterus, seemed to have less amniotic fluid in her sac.  The difference was substantial, as the ultrasound showed the level to be around two centimeters, as compared to six for her sister.  The strange thing was that there were no outward signs that the water broke, as Jenn-Jen was not leaking any fluid.  The doctor’s assessment was that there was a rupture, perhaps higher up in the sac, and any fluid that was leaking may have simply drained when Jenn-Jen urinated. 

The news stunned us, and we immediately had a barrage of questions go through our mind.  Does this mean that we would have to deliver soon?  Will our baby be infected, as a ruptured sac eliminates the sterile, protected environment? Are Jenn-Jen’s infrequent, but still existent contractions only going to squeeze more fluid out of the bag?  Does the fluid get replaced and will the rupture seal?  All the doctor could do was tell us that time will tell, but they have taken all measures to keep Jenn-Jen from going into labor and prepare the babies for the worst-case scenario.

We prayed like we never have before that day, and asked many of you to do the same. 

January 20, 2008 – Unexpected complications

While Jenn-Jen was staying in bed, a few complications arose.  One of the courses of treatment was to have Jenn-Jen stay in the Trendelenburg position in bed (please see http://en.wikipedia.org/wiki/Trendelenburg_position). The fancy name simply means that she was to lay in bed on a tilt so that her head is lower than her legs.  The goal was to help the twins fight the forces of gravity and move away from the cervix.  Unfortunately, this created some problems, as Jenn-Jen began to experience severe congestion, dizziness and nausea.   The symptoms became worse a couple of days later on Tuesday, to the point where Jenn-Jen vomited.  As a result, the medical staff changed the position around so that only the feet were elevated.

To make matters worse, I picked up one of the worst head colds I ever experienced, and Adam contracted a nasty stomach virus.  That night Adam threw up twice and I must have slept a couple of hours at most.  The next morning was filled with fatigue for both my son and me, and thankfully there was only one more vomiting episode.  As you can imagine, I phoned Jenn-Jen to let her know that we would not be visiting her in person for the next few days until we stopped being contagious.  All the while, Jenn-Jen was becoming more congested, dizzy and nauseated.

January 18, 2008 – Hospital admission

Dear Friends and Family,

I have set up this blog to provide you the latest news regarding our family.   As many of you are already aware, Jenn-Jen and I were excited to be blessed with news that we would become the parents of twin girls.  With an expected due date of May 12, 2008, we had many plans an aspirations for the new additions to our family.  Our son, Adam, was also very excited to learn that he would become a big brother.

Our excitement soon turned into  fear, as Jenn-Jen was admitted to Sutter Memorial Hospital (http://babies.sutterhealth.org/delivering/delivery_smcs.html) on Monday, January 18, 2008 for pre-term labor.  She was experiencing strong contractions about every seven minutes and triage immediately set her up in the high-risk pregnancy wing.  The maternal-fetal doctors put Jenn-Jen on strict 24/7 bed rest and the initial prognosis was that she would be hospitalized for the remainder of her pregnancy.  We remained hopeful at the time, even after initial ultrasound results were inconclusive about a potential rupture of the amniotic sac of one of the twins.  Many of the nurses were cheering us on with success stories of mothers coming in and remaining in the hospital while their babies continued to grow in the womb to a healthy gestational age.  I left my wife in with faith in good hands of Sutter Memorial, an institution well known for its neonatal intensive care unit (NICU), but prayed that the twins would stay in the womb to full-term and never need to visit that unit we became so familiar with five years ago when Adam was born eight weeks premature.