Friday, January 16, 2009

Evening Update (Friday 1/16)

Just like on airplanes, you're not allowed to use wireless devices in the NICU. As a matter of principle I'll follow any policy the NICU dictates. This evening, however, Carolyn and I conducted a serious debate via text message; to hold up my end I had to tap away surreptitiously, when the nurses weren't looking. We were discussing the color of Max's eyes while I was staring directly into them. I don't see how there could be serious debate when I was looking at them and Carolyn was four miles awa,y, feeding Felix dinner. My position is that Max's eyes are greenish-hazel; Carolyn thinks they're blue. We'll try to gather and present photographic evidence tomorrow.

Also, while I was with Max, he and the nurses showed me the present he's working on for Carolyn's birthday tomorrow. In case she doesn't like it, I got chocolates and flowers too.

Here in Washington we've got a four-day weekend coming up, and they're really serious about not letting anyone over the bridges on Monday, not even doctors and nurses. Thus, the whole NICU team that we've gotten used to are leaving tonight and not returning until Wednesday morning. Carolyn sat down with the sainted Dr. B. and talked over the plan for the next few days. Dr. B. assured Carolyn that she had written detailed instructions for Max's care and that she's sure that the attendings who make their way to the hospital in coming days will follow the plan. Max's digestive holiday is slated to end on Sunday, when he returns to "compressed feeds". At the moment he is being fed continuously at an ultra slow rate. Max gets the volume that babies are expected to eat in, at most, 30 minutes spread out over three hours. And because babies have to be fed every three hours this means that he is continuously being fed. Starting on Sunday his feedings will be compressed into...two hours. (Carolyn asked about started at 2.5 hours, but the NICU team thinks that would be just the same as his current schedule.) So Max's feeds won't be compressed by much, at least at first.

The NICU team put Max on the slow drip feeding schedule to give him time to get his nervous system a little more organized and to give his lungs a rest. Carolyn and I have both noticed that Max's breathing is quite easy and stable; far better than we've ever seen it. Indeed, when I was with him today I picked him up and, unthinkingly, put him up on my shoulder like I would a normal baby. Max was fine (he kind of enjoyed the view), but he's still trailing as many wires as an astronaut so I had to carefully untangle the lines I messed up. I think he's ready for the next challenge.

The doctors told Carolyn that Max's recent head growth is normal and that his head feels good. Max's skull is a little mis-shapen now, the result of spending too much time on the same side. Max prefers to look out at the NICU, so they've reversed the direction of the crib so he can look out at the world while lying on his other side.

Max had a session with physical therapist A. today. A. told Carolyn that a big part of physical therapy is helping a baby learn "state control". Some babies, when distressed, can freak themselves out and spiral into uncontrollable, self-perpetuating, crying. State control is the art of realizing that a small disturbance such as a loud noise, a dirty diaper or getting tangled up in monitor wires while your dad swears continuously does not mean the end of the world, that there's no need to panic because things will get better.