To the hospital in a hurry

Silly of us to think that Luka would spare us yet another medically-necessitated rapid departure from Dili following our first episode.  Instead, we found ourselves, once again, scrambling to pack in 20 minutes flat, while praying the Internet connection holds to book plane tickets.

Now, now, fortunately this one is much more par for the course and not nearly as exciting and scary as the previous one.  Turns out Luka has Bronchiolitis which is an infection of the small air passages (as opposed to the larger air ways, or the bronchials as was explained to me today). Whatever it is, it makes for one miserable little trooper.  With a fever spike of 40C yesterday, we listened to the poor guy wheezing all night long. At the doctor's this morning his O2 saturation levels (sats) were down to 92%, which is below the 93% that the doctor says is acceptable.  After a few minutes on the torture device known as the nebulizer he responded well - so we were sent home with a home kit to administer ventilin.

All the while we were planning to send Chris and Luka to Darwin tomorrow as a precaution - then it dawned on me, hang on, they're headed to Singapore on Tuesday anyway on their way to South Africa - why not just change that ticket and head up that way - ah right, because the plane leaves in TWO HOURS!  Unfortunately it was also lunch time in Dili, which on an island, is taken very seriously. So we had to wait until after 13h00 before Chris could go back to see the doctor.  By the time he called me to say that she still thinks as a precaution we should take him out, I had under 2 hours to change a ticket and pack for both of them and get them to the airport.  Mind you, it's not just packing for 4 days in Singapore, no, it's packing all the winter clothes Luka and Chris has to take to South Africa for the trip we were originally scheduled to go on next week.

Thanks to Michelle and Judith, we managed to get it all sorted, and off we went to the airport where the Air Timor guys were absolutely amazing and just checked us in right in the office, no line, no counter, no nothing (that is after we showed them the 'fit to fly' medical certificate' of course).

I was devastated to watch the two of them get on the plane, but with my boss out of the country (yes, this always happens when I'm in charge), and the election observation mission I am overseeing arriving in 4 days for the upcoming parliamentary election, I had to stay behind :(

Fortunately we know this is simply precautionary - and soon Chris and Luka will be hanging out at the Singapore Zoo, eating fabulous street cuisine.  We'd just rather he be eating street cuisine down the road from a world class hospital, than wake up tomorrow morning and be out of departing flights for two days.  Just the cost of doing business in our line of work I suppose.

Still sucked putting them on the plane though :(

Ita bele hablas Ingles?

Had one of those 'only as an aid worker in a developing country' experiences today....

Right before walking into a meeting with three consultants trying to reform the Ministry of Foreign Affairs in Timor-Leste, I get a call from Chris explaining that he thinks he found the reason why Luka has mysteriously been waking up at night for the pas three nights (I thought it was because I had just got used to the idea of sleeping 7pm-7am, so he obviously had to change the rules).  Turns out, we think he has his first ear infection.  Explains the swelling, spots, and yanking at the left lobe, accompanied by muchos crying.

Unfortunately, as you may recall if you have been reading this blog for some time, medical care is not exactly abundant on the island.  First call (of course) the (new, unknown, yet to be met) Australian doctor who replaced our Dr. Nichelle (purveyor of hope, steroids and visas in our premature state last year).  Unfortunately the new doctor is fully booked and not able to see us.  Okay, slight problem, seeing as how the very kind Portuguese doctor recently had his funding cut by the Portuguese government (European austerity anyone?) and now no longer sees anyone not-Portuguese - and despite all the nationalities and birth places between the three of us, Portugal is not one of them.

Okay, what to do.  UN doctor is out, neither one of us works for the UN, so, only option that is left (before braving the national hospital, that is) is a contact for a 'Cuban doctor with a Japanese assistant' at a clinic near my office.  I got the number from a friend who's friend had a good experience there recently when she needed care for some burn wounds...this friend obviously spoke more Spanish than I.

I dialed the number and a faint voice answered in Spanish.  "Is this Dr. Mileisy" I asked?  "Si" comes the response.  "Doctor, I think my son might have an ear infection, can we..."*a&^##sdoihbadsgxopaoihsadg" comes the response from the doctor who fires back in Spanish....

Hm...."ono momento" I offered....followed by: "Doctor Hola, pienso que mi hijo tiene una infección de oído. ¿Es su clínica abierta en el momento - ¿necesito una cita? ¿Dónde se localiza?"

That's right people - a few keyboard strokes on GoogleTranslate later, and I am fluent in Spanish to communicate with my son's new Cuban doctor in East Timor. 

When Chris pulled up outside my office with the patient, I grabbed my computer and 3G Internet connection, just in case we needed any more habla'ing in any more tongues, and we set of to find la clinica.  The clinic was a small pharmacia in the front with three consultation rooms in back.  The front was stacked to the brim with Chinese drugs, and believe it or not, a few pieces of (what I have to imagine is knock-off) TRX equipment, I kid you not (I only know this because we recently acquired a TRX setup, and it was not $70, not even close).  All I could think of the entire time was the recent BBC story about a few hundred people who died from defective heart medication in Pakistan, and the packet of Chinese condmns for sale at the Timor Plaza (which I am convinced has something to do with the high birth rate in Timor?), and suddenly I longed for the FDA.

When it was our turn to see the doctor, I remember standing in the consultation room thinking to myself that my friend who works as a lawyer in the health care industry in Los Angeles would have a heart attack when she saw the mangy examination bed (which I wouldn't let Luka touch), the messy desk, and best of all, the open waste disposal basket with used syringes and other medical supplies filling it to the brim.  And so came the time to communicate - seeing as how I spoke only enough Spanish to order two beers, and ask for the banos, and Dr. M spoke even less English than I Spanish, I asked whether she had a Timorese colleague that could translate - when she switched over into perfect Tetun.  So here we were, a South African, an American, and a Cuban, all discussing the health of an Australian-born baby, in Tetun, in a Chinese clinic in East Timor.  Seems par for the course no?

Dr. M was great, she immediately confirmed the diagnosis, and didn't bat an eye when we hesitated to buy medication from the pharmacy, saying, without missing a beat, "bainhira sosa hosi Australia, bele haree informacion kona ba dosage" - essentially that, when we buy the Australian drugs, we just have to make sure we check the dosage.  Hm, simple enough - though, for reasons we won't go into, we were in fact not able to procure drugs from down under, so had to settle for the next best thing - antibiotics from India.  Turns out the instructions from the doctor who spoke no English, coupled with the pharmacist who spoke no English, coupled with the drugs that didn't make sense led to us accidentally overdosing Luka on Amoxiccillin (don't worry, not that much overdosed, just the dosage for a 7-year old kid, or the whole daily dosage for an infant in one sitting).  Needless to say we panicked, fortunately we were with our very level-headed Aussie friend who's mom happens to be a nurse - so a phone call to Australia and we were rest assured that he will be fine, just to watch him for any allergic reaction to Penicillin and we had to give him plenty of liquids.

Yowzer, and that was all before 10am....let's just say, my day did not get significantly better from there on - but happy to report that Luka was in amazing spirits (Gus can attest to the spunk back in our super-crawler) and he is currently fast asleep....which, at 11pm, is where mommy needs to head.

Ah, another day in Dili.

Good and sad day: Farewell Dr. Nichelle

Baby Security Council trying to draft a Resolution banning
Dr. Nichelle from leaving Dili

Today was one of those really happy and really sad days all at once.  It is a spectacularly happy day because our lovely little man turned eight months today.  But it was a similarly sad day because our beloved Dili Doctor, Nichelle Geary, departs post for new adventures elsewhere in Asia.

To say that she has touched the lives of many (okay, most) of the new Dili babies and their moms (and remember, we are close to a rugby team for Class of 2011) is an understatement.  For most of the moms, she was the healthcare professional that got to share the most wonderful news with each of us as we sat nervously in her trailer-cum-consultation room on the Australian Embassy living compound.  From there, she was the one who did our monthly check-ups (to the best of her ability with the limited resources here) which generally included talking the overly-controlling thirty/forty-somethings through so many of our fears and concerns.  She patiently weighed us, listened to the little bubs, checked our well-being, diet, vitamin intake, and monitored our progress diligently.

My visits to Nichelle was truly something to look forward to.  As anyone who has ever been pregnant can tell you - it is a weird and wonderful time all at once.  Consider that there is no sonar in her office, it was mostly an opportunity to visit and talk about how you feel, what you have been experiencing, and ask her any questions you have.  Which, for the longest time, as someone with a spectacularly uncomplicated pregnancy, was a special time I looked forward to.

So happy after the big scare.

Of course, my love and respect for Nichelle was irreversibly cemented in when things went wrong.  On that fateful Monday morning when I went from low-risk, uncomplicated, healthy and fit pregnancy, to 'you have to leave Dili now' pregnancy, it was Nichelle that shepherded me through the process and on to the plane (literally).  From monitoring my 'cramps' to finally deciding that I had to evacuate Dili ASAP, including arranging for my special medical visa through the Australian Embassy, and then, perhaps most importantly, communicating with the hospital in Darwin and administering the life altering (and I don't mean this lightly), steroids that allowed Luka's lungs to develop to give him a much, much, better start in life, she has touched Luka's and our lives forever.

And so it was that we hosted the wonderful Dr. Nichelle as she is known to us, for some coffee and treats at our home this afternoon.  Working moms came from the office, stay-at-home moms, dads and nannies all came to pay our respect to a fantastic doctor, and a beautiful person.  Seeing her surrounded by seven of her babies this afternoon was something to see.  Watching her listen to each mom's recollection of her impact on her pregnancy was amazing.   From breaking the news to one mommy that she did not in fact test positive for the Malaria she suspected, but rather for pregnancy - to reliving the experience of her checking my blood pressure one last time before I boarded the flight while in labor (not telling the airline of course) - it was a special few hours of reminiscing about some of the most significant moments in our lives, and she was central to so many of them.

Nichelle, you will be so sorely missed.  I thank you from the bottom of my heart, I salute your courage, your patience, and your most beautiful self for caring so much about each and every one of us.  Your new post is so lucky to have you.

With deepest gratitude Lovely Lady.

Hard to believe this is the 30-weeker Nichelle really
did not want to meet in Dili in March. 

When blue is bad

Had pretty much the most terrifying experience with Luka since his regular apneas and other arrests in the NICU seven months ago.  While feeding him his mushed carrots and pumpkin this afternoon (which, similar to the breastfeeding these days, pretty much resemble an MMA match) he suddenly choked.  Now obviously any new parent has the overwhelming fear that you will tumble down the steps while carrying your child and smash his head very graphically into the wall, or you will accidentally let your car drop off the particularly wobbly bit of embankment next to the big bazaar in town (okay, only for those living in third-world cities, but still), and of course, the fear of having to do CPR on your child.  Well, as I watched Luka choke, then cough, then turn a bright red, followed by purple'ish/blue today - I immediately kicked into fight/flight/freeze (and fortunately did not freeze).  I yanked him swiftly out of his Baby Bjorn rocker chair where he was happily munching away a second ago, and in one swell swoop, flipped him onto his stomach, lying face down on my left hand and started banging his back with the flat of my right hand.  Of course I am leaning over trying to watch his face for a reaction, and god willing a piece of food to come flying out followed by a relieved hack, cough and a cry - but none came - instead, in panic, not knowing exactly what I would do next if I didn't get him to breathe again, I flipped him up, and grabbed him around a waist and performed my best interpretation of a Heimlich maneuver.  Of course, through all this, Chris was not home - and I remember, in the seconds (that felt like hours) of manipulating Luka's airways, I briefly thought about calling Chris - what I would say to my husband carelessly shopping for Australian-style plugs and fruit, I am not sure - but it seemed like a good thought to have.

The whole ordeal came to an end when Chris walked through the door, me with Luka still face-down, looking up at him saying 'he's not BREATHING!' - he rushed over, I handed Luka to him, who was still a little choked up, but he let out a big cry and Chris just tried to convince me that 'if he's crying, he's fine' and telling me how great I did...

...let me tell you...worst experience EVER.

In hindsight, my Emergency First Responder (EFR) training definitely kicked in as I instinctively grabbed him, flipped him over and started smacking him in the right manner - but I know in Australia they don't recommend or teach the Heimlich for infants anymore, so of  course I was terrified that I had somehow done any damage to him in doing so...happy to report though that he is fine.  Mommy's nerves notwithstanding.  I am sure this is not the last time I'll get a scare, I mean, he hasn't even started riding a bike yet, but holy cow. If you've ever watched your little one turn blue, you'll know what I'm talking about - and if you haven't, count yourself lucky.

Seven Month Success

Luka turned seven months last week and five-months corrected (as in supposed-to-be) today.  Incidentally he had a visit to a pediatrician this week.  While we originally planned a visit to Darwin to catch up with all the lovely NICU nurses (and do some Thanksgiving shopping while there) we were fortunate to have a world-class pediatrician right here in Dili offer to see him instead.  And not just anyone, as far as 'small world' goes - she is also the owner of the lovely house we rented close to the Royal Darwin Hospital all those months ago for nearly five weeks - and just happen to actually run the NICU at RDH before moving back to Dili where she works in the local hospital now.

So we weren't really super concerned about anything today, instead we just wanted a pediatrician to look him over and tell us that Luka is progressing fine and there are no issues to be concerned about, and I think we got just that.  First of all seems our boy's penchant for all things tropical has bumped our boy from the 3rd centile for his age to above the 70th percentile for size and weight for a five-month old (which, if you know his parents, is a lot closer to expected than 3rd!)  He weighed in at nearly 7.5kg (16.5lbs) and measured 65.5cm (25.7inches) tall.  Developmentally he is right up there where he needs to be and we suspect he will be sitting any day now.  We discussed matters pertaining specifically to living in Timor-Leste, like the fact that he will probably get two measles vaccinations (even though it is not done in Australia for instance) due to the high prevalence of measles here.

He still has somewhat of a light heart murmur - but apparently it is very localized and not something to be concerned enough about to get a scan for.  We're scheduled to see Dr. Ingrid again in three months time, and I must say, I am rather relieved to think there is a highly qualified pediatrician just down the road ;) (even though of course we don't suspect and certainly hope, we won't have any real need for her).

So lucky us, we saved all that money by not having to fly all the way to Darwin to have a doctor tell us Luka is doing great - at the same time, I think I have had enough excitement and drama in the past few weeks to not have to walk the gangplank off the plane where I found myself in labor the last time I rushed through immigration, and to take the elevator up to the sixth floor at RDH.  Maybe next time.

Update: Luka out of surgery

Luka is recovering after the procedure, he came out of thater wailing, like Chris said that anaethetist has a 'soft touch'. He was only interested in one thing (okay, two) and is now lying peacefully in my arms. He is in some pain but cannot have any pain killers for another three hours unfortunately.

The doctor explained that all went well, but that this sack was almost as big as the last one, so good thing we fixed it now.

No word yet on whether we get to go home tonight or not, either way, hope this is it for a while.

Update: Daddy wheels Luka into OR

.

Here(nia) we go again - Luka goes back under the knife

Despite expecting this, it was with some disappointment that we confirmed via ultrasound yesterday that Luka does indeed have an inguinal hernia on the right side of his groin as well.   This means only one thing - back to hospital and under the knife tomorrow for yet another inguinal herniotomy.  Fortunately, unlike the last time this hernia is not strangulated, and is therefore a much less complicated surgery, but surgery under general anesthesia nonetheless.

We check in at 12pm tomorrow, but poor Luka is not allowed to eat after 8am - and guess who has to try and explain that to the growing little boy!  We are keeping our fingers crossed that he can be done shortly after 12pm and that there are no complications.  Unfortunately due to his premature birth it is highly  likely he will be kept overnight again, fortunately his parents do in fact learn from past experience and will be traveling with the requisite overnight attire this time.

Sorry little man - hopefully this is it for a while...

June 18 - Practicing my self-soothing techniques under daddy's
watchful eye.

All clear (with a small caveat)

After our eventful week at the Vincent Pallotti hospital last week, Luka returned to the pediatrician and surgeon today for a follow-up on his emergency inguinal herniotomy.  The good news is that the left side has healed wonderfully and he is clearly a much happier boy.  The other news is that the surgeon wants to do an ultrasound in about two weeks time to check the right-side for a similar hernia.  There is a small chance that it is present, but the good thing is if we identify it in the ultrasound we can do an elective surgery as an outpatient procedure (theoretically avoiding all the excitement of an emergency room run).

In other news, while we were at it, Luka also visited an ophthalmologist for the final 'all clear' on the Retinopathy of Prematurity (ROP), and the scan came back a-ok, so another one off the list.

Seems our boy is slowly swimming out of the deep waters, and is very much turning into a full-blown newborn now complete with changing moods, likes, dislikes and the cutest smiles (I don't care if they are not 'voluntary' yet!).

Along the road from Birthing Date to Due Date...

The family photographed near our house
May 2011

My 'Google Calendar' proudly announces 'DUE DATE' for today, May 27, 2011, just as I entered it all those months ago.  While we always anticipated this day with great excitement and joy to finally have our (back then still unknown) baby join our little family, little did we know that it would be a second homecoming.

That's right, in the spirit of auspicious dates*, Luka decided to give us a homecoming on his actual due date; only this time it was returning home from hospital where he had to undergo emergency surgery on Tuesday. After what seemed an eternal six weeks in a nursery in Australia, Chris and I both agree that the second time around in the neo-natal intensive care unit (NICU) was actually harder than those initial six weeks we spent in Darwin immediately following the birth.  Something about the optics of 'moving backwards', when we had just finally gotten comfortable with having Luka at home, away from the nursery in the first place.

Mom and Luka

The emotions of having another incubator assigned to us, hearing the friendly nurses introduce themselves "Hi, I am <such and such>, and I'll be taking care of Luka this evening...", the constant hand-washing, breast milk expressing, vitals, everything, was almost too much.  Yet, this time we were also thankful for the progress we have clearly made.  With one of the bigger babies in the nursery now, Chris and I were shocked at how tiny a four-day old prem in the corner was, only to realize he is 40g heavier than Luka was at birth.  Is it really possible that Luka was that tiny, fragile, skinny, jerky and pink?  How soon we forget, and how amazing the human race is at adapting when we have to. Looking at the tiny prem in the corner I was once again filled with empathy for the parents who lovingly, though cautiously, gaze and eventually cuddle their overwhelming little bundle.  Could I deal with that if I had to?  Then I snap back to reality and remember, but wait a minute, I have dealt with that...and I know that they too will be okay.  

There were many similarities between the NICU at the private Life Vincent Pallotti hospital just north of Cape Town, and the Special Care Nursery (SCN) at the Royal Darwin Hospital (RDH) in northern Australia.  Chief among them is the extraordinary people who work there.  I can't help but wonder about the true calling it takes to become a NICU nurse.  As mentioned in an earlier post, take anyone's most precious, most fragile possession, and choose to be the one to help them deal with it... just amazing.

Dad and Luka

There were, of course, also many differences between the public (state) hospital in a socio-economically challenged town in the Australian outback and an expensive, top-of-the-line private hospital in an affluent part of the metropolitan city of Cape Town.  From the emergency room entry we passed through in Darwin just over two months ago, flanked by the local population camping out on the sidewalks, inconspicuously taking swigs from bottles wrapped in brown paper, and less inconspicuously smoking under the 'no smoking' signs, to the 'camp like' lunches and dinners consisting of plastic mugs with pre-cooked instant oatmeal, white wonderbread and orange juice in foil-topped plastic cups ala coach class.  Compared to Cape Town with the comforter-clad beds, wicker furniture, white crockery and juice served in a glass with ice, along with the fact that you could actually turn off the lights in the room at night, and close the door (that it even had a door), connected by art-filled walls and overstuffed sofas for visitors and waiting patients.  Irrespective of the type of hospital environment though, perhaps of more importance is the fact that of the 22 weeks in 2011, we have now completed our seventh in hospital - or almost 1/3 of the year.  Not exactly the ratio we had in mind when planning a non-hospital delivery with a midwife only, but hey - what are plans for if not for breaking?

And so, our second stint in the NICU came to a ceremonious end when the most anticipated bowel movement of my life (and Luka's) finally occurred at 1800 last night, just in time for our pediatric surgeon, Professor Rob Brown, to witness during his rounds.  He agreed that with that performance, Luka and I could room in together (myself as a non-paying, non-eating, life-support only) boarder, and if all went well, we would be going home this morning.

Which brings me to perhaps one of the most telling lessons of the whole experience...the difference in a term and pre-term delivery.  Luka and I were assigned a bed opposite the NICU, sharing a large, comfortable room with en-suite facilities with a mom and baby girl delivered by C-section the day before.  The irony of spending my due-date night in a maternity ward 'rooming in' with Luka to 'establish' breastfeeding, after nearly ten weeks together, cannot be overstated.  For a few hours I had a window into what a "normal" delivery (in the temporal, not delivery method sense) is like.  Lying there in the dark of night, listening to the sweet, delicate whimpers of a newborn crying to communicate with her mother, echoed by the quiet cooing in a combination of Zulu and Afrikaans as a new mother cuddles, caresses and learns to independently care for her baby, brought back so many memories of the hours before we could hold Luka, and the weeks before I could independently care for him.  I recall how quiet Luka was for the first month of his life.  After his initial screams out of the womb, as with the majority of prems, we hardly ever heard him make a peep.  I empathize with this mother as she struggles to teach her infant to latch and feed, only to recall my two-hourly hand-expressing into tiny syringes, to be walked down the dull, institutional, artless walls of RDH to the Special Care Nursery, followed by the tens of liters of milk expressed by means of electric pump, while Luka matured and gained strength for nearly six weeks to get where this mother automatically found herself on Day 1 with her infant. 

Today, nearly ten weeks after we were blessed with a 1.777kg Luka, I am bouncing a 3.3kg ex-prem on my lap and am truly humbled and indescribably grateful to the opportunities awarded us by means of having had access to world-class medical care in both Australia and South Africa to enable Luka to progress as well as he has.  To all the nurses, the doctors, and other service-providers who have assisted us in some way or another, we cannot thank you enough.  For all the countless mothers and fathers of preemies, you too will find the strength and wisdom to get through, and to those unfortunate enough to birth premature babies every single day in places not equipped to deal with them, I pray that you too will some day experience the joy of holding a healthy, happy, hungry baby in your arms.

As for our own journey from birth date to due date, despite the trials and tribulations of the past ten weeks, and no doubt of the future, I can honestly say...I don't think I would have it any other way...there is something humbling, empowering, and oh so full of grace in caring for a tiny premature baby that is perhaps part and parcel to the calling of those who choose to dedicate their lives to them.  Truly God's most special, and dare I say, perfect creation.

Happy original Birthing Day Luka - you are the sunshine in our days and the stars in our sleepless nights.

Our little angel

*   You may recall that out of 365 days, our boy popped out ten weeks early on his father's birthday


** All photographs courtesy of Brenda Wardall, Hearts in a Shutter

Luka's surgery: inguinal herniotomy

On Tuesday at 0400, Luka woke screaming inconsolably for the first time since his birth.  We tried everything to calm in, including the 5 S's of Happiest Baby on the Block fame, which seemed to help temporarily, allowing us a few more precious hours of sleep.  However, he awoke once again and was screaming terribly.  We figured this was indeed the next challenge in raising Luka, the 'colic' we have read are so prone in preemies.

To our horror, there was indeed a clear reason for his screaming - a bulging lump in his groin.  Having studied the essential guide for any parent of a preemie, we were at least partially prepared for the occasion insofar as we were pretty sure we knew what it was, and also, perhaps most importantly, that it would require what was indeed the most common surgery performed on preemies*.  So after calling the pediatrician and all that followed as explained here, we found ourselves once again in a NICU setting.

The little patient immediately after the operation. 

Of course, when your infant is in terrible pain, and you are rushing off to the hospital, one does not necessarily always stop to think and pack - and so, for the second time in ten weeks, we found ourselves under-packed for one of Luka's adventures.  Having reached the hospital and being passed on from our pediatrician, Dr. Carl Wicht, to the pediatric surgeon, Prof. Rob Brown, we knew we would be stuck over an hours' drive from home, at least overnight, but possibly longer - not a distance acceptable to us.  Unfortunately, Luka's surgery was an emergency, so there was little time to plan or adapt until after he came out of theater.  Prof. Brown explained that while a hernia is not necessarily an emergency, it is when the bowel is trapped in the connecting tube, causing a 'strangulated' hernia that requires immediate transport to the nearest emergency room.  After examining Luka, he informed us that his was indeed wedged in tight and would require immediate surgery to avoid permanent damage (read: removal of part of the bowel), then carefully sketched out the procedure for us on a pad and paper.  He immediately instructed his receptionist to book space in the OR, and started rescheduling his entire day to fit Luka's surgery in ASAP.

While waiting for an available operating room, we were booked into the nursery, Luka bathed and changed into a hospital t-shirt, and I administered a dose of caffeine done to assist the lungs in post-operating recovery (of course Chris and I were at this point still caffeine-less and almost demanded our own dose).  We were able to take Luka out to a waiting area with couches where we proceeded to wait for a few hours.  Eventually, the anesthesiologist Dr. Hanli van Dyk came out to the waiting area, introduced herself, pulled up a chair and proceeded to walk us through the entire process of putting our baby to sleep.   She explained that she would be using a general anesthetic, combined with a once-off regional anesthetic, which allows her to reduce the amount of general needed significantly (a good thing for someone born as prematurely as Luka).

Poor guy all swollen from the IV fluids...but so alert and happy
to see his daddy!

Once we got the green light that surgery would proceed, Luka was returned to the nursery where he had to board his incubator. The head nurse and a hospital porter then wheeled him to the operating room on the top floor, with Chris and I in tow.  At the operating ward, I was dressed in scrubs, shoe covers and a cap and followed the porter to a 'holding' area before surgery.  Here Luka was somewhat antsy, so I took him out of his incubator and soothed him. Dr. van Dyk came out and along with the porter pushed the incubator into a large operating room where Prof. Brown, two nurses and a young (presumably student) doctor was waiting.  I was able to hold Luka as Dr. van Dyk administered the gas, before laying him down on the bed, planting a big kiss on his forehead, and then being escorted all the way back out by Prof. Brown all the while explaining what he would be doing during the procedure.  At the door Chris and I went to get our much-needed coffee and a newspaper to try and occupy our minds for the hour we anticipated it would take.

Luka was not kind to the drips in his
arms I believe he went through five...

At roughly an hour and ten minutes Prof. Brown came out to explain that the bowel was so wedged in the sac that it was near impossible to pull it back through, he did manage, but it caused a minor tear in the bowel.  As such, it was not the 'uncomplicated' surgery we had hoped for (during which there was even talk of fixing a potential hernia on the right, should one exist), instead, now it would require an extended stay in hospital and nil per mouth (i.e, now milkies for our boy).  We followed the head nurse and porter back to the nursery with a now very distressed (read hungry) and groggy baby.

Kangaroo care - the only way to go!

The three days in hospital was not great, as we were once again thrown back into the lull of nursery-life, but at least we knew our departure there was rather imminent, unlike the newly arrived prems and their distressed parents.  Seeing Luka in pain, and discomfort the first two days was truly a challenge, but we knew he was being cared for well.  Probably the hardest thing for me was not being able to feed him for three days, since, despite the IV fluids, he was clearly hungry and smacking his lips for a feed - to try and mitigate this we had to revert to a dummy (pacifier), which our boy did not think was funny.

While he lay recovering, slightly sedated, and absolutely starving!  I managed to find a guesthouse nearby thanks to a recommendation from one of the nurses, while Chris ran to Woolies (JC Pennys) to get a packet of underwear and a clean t-shirt for each of us.

Luka being examined on Chris' chest by his pediatrician
Dr. Carl Wicht

For the next three days, we kangaroo cared Luka again for close to ten hours a day in the NICU while we waited for the pediatrician and surgeon to do the rounds to see whether we would be spending another night in hospital - from where we would quickly phone the guest house back to reserve our room for that night again.  Each day Luka was more wakeful, and clearly in less distress than the day before - but we were still waiting patiently for the all-changing bowel movement to manifest!  Imagine a a gaggle of nurses and two doting parents all rooting for the same thing - a big poo!  Well, it eventually happened on the second night, the 26th - which set the ball in motion for us to leave.

And so it were that we were once again released from hospital (after settling the bill of course!) on Luka's due date.  For some thoughts and ponderings on that, please see the next post, From Birth Date to Due Date.

For now, it is nearing sunset here in Scarborough on a gorgeous winters day on the southern point of Cape Town.  Luka is peacefully resting on my lap after his umpteenth feed for the day, and following two fabulous poos - we are closely monitoring him for pain and discomfort and administer Panadol-based seppositories as needed.

The backside of Table Mountain as we drive away
from the hospital this morning.

We are due back for a follow-up with the pediatrician, the surgeon, and at the same time his final ophthalmologic examination next week.  During the visit with the surgeon he may do an ultrasound on the right side of the groin to determine whether there is any need to mitigate that side in an elective surgery as well before it too becomes strangulated, risking another emergency surgery in the future.

Note: I can safely say infant surgery is one of the tougher things of the whole experience so far, but thanks to the amazing staff, we felt confident and calm most of the time.

* 3-5% of healthy, full-term babies can suffer from hernias, this number increases up to 30% for preemies.  Source

Snack time!

After another long day with no feeds for the little guy, the surgeon agreed we could give him a 5-7minute 'snack feed' at the breast lunchtime today.  He was SO grateful as was I!  Now we wait and see whether his bowels have woken up enough and are able to process without vomits or worse.

Keeping our fingers crossed, and thank you so much for the good wishes from around the world!

We hope to be able to take him home tomorrow...get this, on his actual DUE DATE. 

Update: Luka in Hospital for Emergency Surgery

"Hello NICU my old friend...."

Alright, not exactly the post I was hoping to write today, but seems our boy needed to have one more bit of excitement before his due date this coming Friday.  On Tuesday morning he cried uncontrolably for the first time in the nine weeks he has blessed our lives.  We thought the dreaded 'colic' may have finally set in, but were corrected in our thinking when we changed his nappy to find a very enlarged groin.  Seems our boy managed to get a pretty inflamed hernia in the groin area.

We called his paediatrician who told us to be there in 45minutes (we live nearly an hour away considering the road, traffic and ancient car).  Long story short, he examined him then whisked us to the paediatric surgeon.  Must say, we were rather relieved to see 'Professor Rob Brown' on the door, with lots of degrees cum laude against the wall...I mean, if you are going to have your baby operated on...

Long story short, Luka went in for an emergency herniotomy at 1500 on Tuesday afternoon at the Life Vincent Pallotti hospital in Pinelands outside of Cape Town (incidentally exactly nine weeks after he was born at 1500 in Darwin).  After over an hour in surgery, we were told that unfortunately the bowel was extremely constricted through the hernia, when it was pulled back through it acquired a small tear. 

The good part is that we caught it early enough to avoide a 'incarcerated hernia' that would have required removal of part of the bowel.  The bad part is that the bowel did tear and we now have to wait for the bowels to function again before he can have something to eat.  He is currently on pretty hectic pain medication in addition to flagyl for the infection.  In addition he is on a drip with electrolytes, sugars and fluids - think living on gatorade for a few days when you are used to lobster and steak.  And mom, I'm feeding the electric pump again.

He is doing well, stable, slightly sedated.  Mom and dad are okay - the NICU is strangely familiar...more on that later.

In the past 24-hours we have not had any bowel action as of yet, we will follow up when the surgeon does rounds again tonight to see whether he is ready to be fed or not.  Either way, Chris and I have once again booked into a guest house five minutes away from hospital and surviving just fine on our new undies, toothbrush and socks we acquired yesterday.

Help needed: Baby vitamins

Alright, I realize the "Internets" should be able to answer just about every question I have concerning baby-wellbeing, rearing, clothing, educating, and everything in between.  I have, I believe, however exhausted my own ideas for administering what I am quickly beginning to consider a terrible menace - baby VITAMINS!  Known as 'vomit medicine' according to Luka's new paediatrician in Cape Town, I am amazed that some smart folks in white coats with thick glasses have not yet come up with a better solution than foul tasting, foul smelling liquid vitamins.  From the neon yellow pineapple Australian varietal known as Pentavite to the less fruity South African Vi-Daylin version that more closely resembles molasses in consistency and color.  Either which way, I cannot get Luka to hold down a meaningful amount of the mere 0.6mls he is required to receive daily for the next four months due to his early arrival.

I assume the fact that he is required to take the vitamins and iron, means it is important - hence, my interest in ensuring he actually retains some (most?) of it, some of the time.  Therefore, my request for any special ideas other mommy/doctor/nurse-readers on this blog has come up with for administering.  So far I have tried:

1. Administering it on its own
2. Administering mixed with EBM (Expressed breast milk)
3. Administering on an empty stomach
4. Administering on a full stomach
5. Administering half-way through a feed
6. Using a small syringe
7. Using the dropper that comes with the vitamins
8. Using a bottle (which I was not crazy about, seeing as how we did practice for six weeks how to breast feed, I would prefer we avoid 'nipple confusion' at this point)
9. Administering lying down (not good)
10. Administering at a slight incline
11. Burping frequently during the administration and subsequent feed
12. Not burping

I welcome any clever ideas from anyone that I may be missing...otherwise, I suppose we will just power on.

How it all Happened Part II: Preparing for our Preemie

Continued from Part I here...

...as our flight proceeded southbound to Darwin, I was still trying to find some answers for the why, and most importantly, any positives on a prognosis for a baby born at this early of a gestation.  Unfortunately my natural birthing books emphasize the 'normal' in birthing (which is what I loved about it) and less so the 'what can go wrong' bits - so we were stuck worrying and wondering.  Midway through the flight Chris thought it a good idea to request we be let off the plane first when arriving, I quickly grabbed him and told him not to say anything until we were on short-final for fear the pilot might be mandated to turn the plane around if someone was in labor (which of course, we were still praying we weren't).

At the Darwin airport Chris and I disembarked the plane along with an elderly lady with a short connection.  We tried patiently to stay with her and the ground staffer, until we reached the gangplank into the terminal when we sped up our pace.  Armed with nothing but hand luggage and a freshly adhered visa in our passport we stood sheepishly in front of the passport control agent who asked for our arrivals cards.  Of course, we completely forgot to fill them in.  He was about to tell us to step aside and come back when they were complete when I suddenly blurted out "I might be in labor" - I have never seen an immigration officer complete two arrivals cards on behalf of passengers so quickly - within 15 seconds we were stamped and on our way to customs.  Again, they looked at us, I pointed to my belly, and they waved us right through (which is unusual for Australian customs agents!)

In the arrivals hall Chris grabbed cash, I hailed a taxi.  "Darwin hospital please" and off we went...

Sitting in the back of the taxi watching the sites of a foreign city we had only visited once before, go by as the last of the sun starts to dip, I was still praying and tearful, yet survival mode was starting to kick in.  "When should we call our parents, which ones do we wake up?"  I wondered out loud which entrance it was again that my doctor in Dili told me to go to when we pulled up outside the Emergency Entrance of the Royal Darwin Hospital.  At this time my courage sank into my shoes.  Having planned a tranquil all-natural HypnoBirth at my lovely home in Scarborough overlooking the Atlantic ocean, arriving at a state hospital in a strange place, where most of the visitors sat cross-legged on the pavement smoking a variety of legal and illegal substances under the no-smoking signs while drinking beverages from brown paper bags, was not my idea of a good compromise.

We rushed in the door to the window where we were immediately directed to go to the 6th floor.  Ascending the elevator to the 'pink' floor, how could I have known that I would be riding the same elevator for the next six-plus weeks, every single day.  We were slightly surprised that the wards were all behind strict security gates with cameras and buzzers, rather resembling a prison than a hospital.  We proceeded to the 'maternity' ward, where we were sent immediately over to the 'birthing center' to which I objected profusely explaining that 'no one is actually in labor here!'   At the birthing side of things were were shown to a room and interviewed by a young man in slacks and a white shirt with no identification.  He could have been a vacuum salesman for all I know, apart from the stethoscope around his neck.  The conversation centered largely around our family health histories.  We went through the drill of how I felt, what had happened, and what my symptoms were.  He said he would return with the doctor in charge, a young female named Dr. Koh, a more-efficient-than-bed-side-manner-oriented type.   This time the conversation went more along the lines of 'hm, interesting' from her side, to 'excuse me, how bad is it' from mine.

Things quickly progressed to include a vaginal examination and other vital signs being checked.  My world started spinning when she said that I was in fact 1cm dilated and that my cervix had started effacing (or thinning).  To confuse matters more, two separate tests for amniotic fluid came back with conflicting results, so we were still not sure whether or not I was leaking.  She had to leave to attend to another woman in labor and I was left trying to keep things together and remain calm, until we met Dr. Andreas. The nice German  had actually participated in the Tour de Timor the year before and we made some small-talk about the island we lived on. It was when he introduced himself as the pediatrician on duty that I panicked and realized that yes, there is a high possibility now that there is a baby in our very near future.  He was also the first one to explain to us not only the risks involved, but also that should it be the case that we have the baby in the coming hours/days, it is very likely that he/she will have to remain in hospital until the due date - that was almost ten weeks away!

When he left, Chris and I had a few minutes to try and grapple with the reality we were possibly about to become parents.  I started crying again, Chris tried to comfort me and we started making a list of all the questions we needed to ask.  Then we turned our attention to the first matter at hand, birthing this baby, if it turned out to be the case that the Bun was in such a hurry.

As it turns out, Australia, much like the UK, has a very strong midwife culture therefore all the nurses on staff in the birthing center, are also midwives.  Having planned a midwife-only assisted birth in Cape Town, we quickly turned our attention to the young midwife assigned to take care of me after admission.  Not only did she bring us dinner (which, at the RDH at 1900 on a Monday evening consisted of a vending machine sandwich), she also tried to make us as comfortable as possible (which, in a birthing room with a single bed and one chair was not easy).  We immediately started talking to her about the perfect pregnancy we had experienced up until 24-hours before, and the equally perfect birth we had been training and hoping for, and whether or not, in the event I did go into labor, I would be able to have the baby naturally.  She comforted us and said that unless something was wrong (cord, breech, low vitals etc) there should be no reason I could not.

Next up was the small matter of logistics.  Here we were, in a hospital at the far northern side of a town where all the hotels were located in the southern end of town.  We had no friends or family, no reservation, no local phone, no internet access, no car, no place to go.  It was nearly 9pm and I may or may not be in labor.  The most important thing for us was to be together and I could not even bare the thought of staying behind in hospital alone, which is exactly where they wanted to keep me for observation overnight.  So we did what every insured person would do -  inquired about a 'private room'.  (Note: At this point, we did not even know whether my insurance would cover any of this, I mean - does one get pre-approval for this sort of thing? who knew?)  Unfortunately we were told, the maternity ward is completely full, so there was no way Chris could stay.  The midwife must have seen the panic on my face because she promised to try one more thing.  When she returned she informed us that we could spend the night in Birthing Room 6 down the hall, unless at some point, someone actually needed to birth in it.  We thanked her and watched them drag a mattress in for Chris to sleep on the floor. Looking over at the bed, I thought to myself there is no way I am sleeping on a hospital bed, since in my mind, I was not exactly 'sick'.  Instead, we removed the couch cushions and created a makeshift bed on the floor for both of us.

In my haste to pack and make the flight, I managed to pack every book on labor and child birth I could carry, as well as a number of other items like my iPod, camera, and a handful of Balance bars.  What I did not pack, were hospital necessities like pajamas, so in addition to the t-shirt I wore over on the flight, I changed into a pair of Chris' boxer shorts.  At this point we knew we had to let our families know what was going on. Due to the timezones we decided not to wake Chris' family at this time until we knew what was going to happen, but opted to call Susan's dad in South Africa - who, months later, told us that when he saw the phone ring from my Timor number so early on that Tuesday morning, he knew that something was wrong.  We explained to him what was going on and promised to keep them updated along the way, explaining that we were going to spend the night in hospital, but that the midwives were still hopeful that the labor would be delayed thanks to the nifidapine I was receiving.  

The midwives who took care of us that night were in a word, angels.  They dragged a lamp into the room so that they could turn the lights off, encouraging us to get some sleep between the two-hourly vitals checks I was receiving.  So once we had brushed our teeth (I did manage to pack toothbrushes), we curled up in each others arms on the floor of a cold birthing room at the end of the corridor in a hospital in a strange city in a strange country far away from anyone we knew, and everything familiar, and we prayed together that this baby please remain inside of me for a few more weeks, or even days.  Tears ran down my face pretty much permanently at this point as we vowed to each other that we would try and get some sleep because whatever tomorrow might bring, it was bound to be exhausting.  I listened as Chris drifted off to sleep and then turned on my back and resumed praying, the constant stream of tears soaking the pillow behind my ears...

Stay tuned for Part III, our birth. 

Another one off the list: Retinopathy of Prematurity (ROP)

As can be expected, when a baby is born prematurely, he/she has not had the luxury of having all the little bits and pieces developed fully in the uterus (note to Luka from his mommy: take it from personal experience, it is better to wait than rush some things!).  One of these bits include the eyes.  As the blood vessels in the unborn baby's eyes continue to develop until about 34 weeks' gestation, this growth can be interrupted and altered, leading to potential damage of the retina.  The disease is called Retinopathy of Prematurity (ROP) and is one of the leading cause for childhood blindness.

Luka being screened for Retinopathy of Prematurity (ROP)

Since Luka was born at 30 weeks, he was screened for ROP to ensure the blood vessels are growing normally, and not too fast or otherwise altered that could damage his retina.  The test requires eye drops be administered 30 minutes before hand to dilate the pupils (an awful feeling if you have ever had these drops during an eye exam).  According to the technician Luka's blood vessels are progressing normally.  While they have not yet fully developed (i.e., completed the distance from the center to the periphery of the eye) there is no indication of ROP.  As a precaution, he recommended a follow-up at 40 weeks to ensure the vessels completed their growth normally.    

Luka passes his hearing test

Neborn Hearing Screen test kit on wheels

As part of routine screenings for babies born in Australian hospitals, Luka had his hearing screened by a technician here in the special care nursery.  The screen involves a pretty 'spacey'-looking headset that plays a set of 15,000 'clicks' in both ears.  Small electrodes are attached to the forehead and the back of the neck to read the brainwaves as he processes the clicks.  A progress bar for each ear shows the brain activity. In order to pass, the bars for each of the ears have to be completely filled before he runs out of clicks.  What made the event rather special for everyone is that Luka's profoundly deaf grandmother, or Ouma, was here to hold him during the procedure.

Luka having his hearing screened while being held
by his deaf Ouma Estelle

Susan's mother, Estelle, was born profoundly deaf in Pretoria, South Africa, the youngest of four siblings.  Her deafness however was not discovered until the age of four and a half, at which time she had already taught herself how to lipread to understand her family.  By the age of six she received her first hearing aid and recalls the fright of her life when she heard an airplane overhead for the first time.  Today, she is an accomplished professional academic researcher with a PhD in Information Sciences.  She speaks four languages (Afrikaans, English, French and German), managed her own aerobics exercise club for 20+ years, and recently founded and presently chairs the largest chapter of the Ret Hat Society in South Africa. Today Estelle is a frequent speaker at events, is often featured in publications including national magazines and recently on a national talk show program on television.  She was selected for the South African national field hockey team in the 1970s, but was unable to accept as she moved to the US with Susan's dad to pursue his Masters in Engineering in Seattle. She is an avid player of the organ, has a larger music collection on her iPod than Susan, and loves painting and drawing South African wildlife.

Needless to say...if there was something wrong with Luka's hearing, we were not concerned that it would 'hold him back'.  We are happy to report however that despite a first 'inconclusive,' he passed the second round with flying colors.  Next up, eye exam...no accomplished blind family members to report on that we know of...though Chris did have a blind dog that was quite cool.