Monday, December 15, 2008

Evening Update (Monday 12/15)

I've decided that it's not realistic to swear off keeping a poop journal, at least for the near future. I'm reminded of an episode from Felix's early life that we called "The Great Bowel Movement Crisis of 2006." Sure, it was funny and sort of gross, but it was also actually kind of scary. So, be forewarned that detailed descriptions of Max's intestinal function will continue to feature prominently.

Carolyn spent all day with Max, and I took over after work. They're supposed to kick parents out from 7:00 to 7:45 (AM and PM) every day for the shift change, but for NICU pros like me they'll relax the rule. As a result I got to hold Max for two hours. I think he was extremely hungry before his 6:00 PM feeding began.

While I was holding him, he twisted his mouth to one side and stuck his tongue out like he was expecting to find something to suck on. Then he found his fingers and began sucking enthusiastically on them. Felix did both of these things in his very early days; I had completely forgotten about them until now. (Indeed, I feel like I'm going to need a class on remedial infant care because I seem to have forgotten everything about taking care of little babies.) I think I'm watching the formation of the rooting reflex. Most babies arrive in this world with a fully formed set of reflexes, but they must have developed in utero; after all, fetuses don't have these reflexes at conception, right? My crackpot theory is that I'm getting to watch development that would normally have been hidden from view.

For the most part, Max was quiet and comfortable while I held him. However, he would sometimes visibly struggle to pass stool. During these struggles his sats would dip, setting off one of the many NICU alarms. Indeed, Max's labile oxygen saturation is one of our current major concerns, and they seems to be related to his difficulty passing stool. You'll be happy to know that Nurse S. reports that Max had a couple of blowouts and appears more comfortable. I have another crackpot theory to expain this. When Felix was very young he had trouble passing stool because he couldn't coordinate his muscles: the trick is to relax the sphincter while tensing the belly. The easier thing to do is to tense both at the same time, which does no good. Max's whole story has been of slow development: slow to get his CSF system in order, slow to get his digestive system working, slow to root. So why shouldn't he be slow to learn the trick to emptying his bowels? It is a bit counterintuitive if you think about it.

So let's list our current set of worries:
  1. Max's CSF system might get out of kilter again, bringing back his hydrocephalus and a grinning bunch of phrenologists.
  2. Max has continued oedema of his lower extremities and groin. That's going to have to clear up sooner or later, right?
  3. Max is not kidding anyone that he's figured out how to poop stress-free.
  4. Finally, a constant nagging worry: What if Max falls victim to one of the many disasters that seem to float around the NICU, looking for victims?
Those of us with mild, sub-clinical OCD find making lists to be soothing.

In other news, the NICU continues to lose business, on net. Even with the step-down NICU patients and a couple of new admissions today, the place is feeling pretty empty. Also, I have the distinct impression that the NICU docs don't find Max that interesting anymore. They just don't come by as often as they used to, and when they do they can't keep their eyes from straying to the monitors over nearby isolettes. For the first time in my life I'm happy not to have my kid be the center of attention.