Memories Unstoppable

I have a slideshow that plays in my head.
It's personal,
Intense,
Drives sadness,
Incites triumph,
But mostly, it's just mine.
I suppose that this is probably normal.
I hope it is, at least.
That trauma survivors replay events.
And I assume that it is normal for it to intensify as anniversaries approach.

Anniversaries are approaching.
And I feel in some ways like I am on a train.
The course is chosen,
The tickets bought.
I can't get off,
Even if I feel we are going too fast,
Or not fast enough.
The control of this journey is not mine.
I know I'm going to pass every stop,
See every sight,
And eventually get to some destination.
I hope that destination is fulfilling and peaceful.

Don't get me wrong.
I am grateful.
Tremendously so.
I had some terrifying months.
Yet those months also brought great joy.
And I know that I am blessed.
That a few months are but a blip on the radar for the lifetime I get to spend with my daughter.

But still,
The train goes on,
Passes through many emotions.
Often unexpected,
Unstoppable.

This week last year we had a significant snowstorm.
I also turned 36.
And though we were stuck in the house for a week,
I remember it as a magical time.
I had just learned my baby was to be my first daughter.
Ephram and Charlie were so excited about the snow.
I felt that all was perfect.
I was secure in my marriage, my health and my family.
I was safe.
I also remember that it was at my appointment a week later that it all started to change.

Tonight as I rocked Macie to sleep,
I watched the snow fall outside.
And again the pictures cascaded in my head.
Memories so dear,
Intense,
Mine.

One year past... this is where it starts.
The stream of anniversaries will soon hit.
First appointment that resulted in modified bed rest.
First hospital stint with a husband half a world away.
Restrictive bed rest while caring for an autistic son and a toddler.
Warning of hospitalization.
The hospitalization itself
The day I got the headache to end all headaches.
The day that ended with a beautiful girl.
The heartbreak in learning of her double collapsed lungs,
The pain of seeing my baby suffering.
The triumph of her speedy turnaround.
The day that she started to eat.
The day that she was tube- and wire-free.
Her homecoming.
Watching the bond develop with her brothers.
The night we had to call 911.
The day that she first completed a feeding without any supplements.
The day she finally hit the growth charts.

I hope I can live through these months remembering all that I have,
And not dwelling on all that could have been.

So, my apologies if I wax nostalgic too much in the next few months,
If I seem teary,
Or if I talk too much about something that doesn't seem as huge to everyone else as it is to me.
This is a glimpse of the pictures that play in my head.
They fly by when I'm falling asleep,
Getting ready for the day,
Watching my sleeping daughter,
Or just at a random moment of no extraordinary consequence.
This, the unstoppable stream.

 

Six Months Past

Bear with me as I take a short break from the chronological order of this blog to recognize the importance of today.

Six months ago today...
I did not have a stroke,
I did not have a seizure,
My liver did not erupt,
My kidneys did not fail,
And I did not start hemorrhaging.

And while this may sound very dramatic,
Unfortunately all of these things were possible.
Likely, even.
Because I did have a serious condition named HELLP.

Which is why - 
Six months ago today,
Macie Drew came two months early.
And suddenly turned a scary situation into
The best and brightest
Miracle
In my life.

Six months ago today,
I escaped death...
And I have learned a thousand lessons since.

Delivering Macie Drew

This story should go: I had a spinal, it went beautifully.  They pulled my daughter out and sewed me up and sent us all on our way.  But that's not how it went.

When they started my magnesium in my room, I told them that it hurt badly.  I had a little problem with IV's while I was in the hospital; especially after I started the lasix.  So to put my third IV of my hospital stay in, they had to try four sites.  The only site that worked was in the top of my left hand.  But when they started to use it it not only burned, but actually hurt.  I had already had magnesium and it hadn't felt that way.  But the nurses told me that it probably hurt more because it was in the top of my hand.  So I tried to ignore the pain.

When we got into the OR, I stepped up to the operating table and sat with my back to the student anesthesiologist.  She started scrubbing my back when Andy walked in.  I felt her pushing on my spine to identify the correct injection spot.  At that same time the nurse realized that my IV fluids were no longer flowing.  Right after the anesthesiologist injected the numbing stuff, the nurse came over to inspect my IV. It had failed.  The staff anesthesiologist, came over to try to start a new IV.  Meanwhile the student anesthesiologist kept poking at my back.  It took the staff anesthesiologist three sites to find a working vein.  The good news on the IV that he put in is that it was the best IV I had the whole time I was in the hospital.  It didn't hurt a bit, was attached perfectly, and functioned for the two days that I needed it.

Then the student anesthesiologist reinjected a numbing agent to start the process on the spinal.  She told me that she was going to insert the needle, and she did.  And it hurt.  And it wasn't in the right spot.  She tried two more times and kept hitting bones.  Finally the staff anesthesiologist stepped in and got the spinal done on the fourth try.  Two weeks later I still have four healing scars on my back.  (Not to mention the seven small scars from the different IV's and IV attempts in the hospital... and my bruised inner elbows from all of the blood draws.)

I don't really know how I stayed calm through the IV fails and the spinal fails.  It took them about 20 minutes to get through all of it.  I did have the same determination at that point that I had with Ephram.  I knew that the surgery was just something that I had to do, and so panicking wasn't going to serve any purpose.  But in my first c-section, my IV worked great and my spinal went in on the first attempt ... and didn't hurt.  So once again, my daughter and my pregnancy with her proved to be more complex.

They quickly laid me down on the table and set to work prepping me and putting up the curtains.  The anesthesiologist I'd met with in my room covered me with a warm blanket because I had told her about the horrible shaking I had after Ephram's birth.  It was a nice thought, and made me more comfortable.  Operating rooms are so cold to begin with.  They checked to make sure the spinal was working appropriately.  With Ephram it had climbed a little too high.  This time it was perfect.  It stopped right around my breast bone and I felt like I had control of my breathing.  Not feeling that area with Ephram's c-section had been alarming to me and I was glad to not repeat it.

The surgical pause started before I knew it.  There were so many people in the room.  Two anesthesiologists, two nurses for me, two doctors to do the surgery, the neonatologist, two nurses for the baby, and a respiratory specialist.  They all introduced themselves to me and then the surgery began.

Ephram had been a breech baby.  He was transverse and took some time to get out.  My daughter did better in this area.  She was head down, just as she should be.  They didn't have to struggle as much with her, and before I knew it I felt the intense pressure that preceded her birth.  It was more intense than it had been with Ephram and I had to breathe through it for a couple of minutes.  The staff anesthesiologist came over and asked me if I wanted to see.  I said yes and he opened the window.  My OB, Dr. Schocket, held my little girl right up by the window.

She cried and it was the best sound I have ever heard.

Macie Drew Kovar was born at 5:35pm.  She was 3lb, 14 oz and 16.9 inches long.  Her head was 32 cm.

Andy left my side and went to be with Macie.  My biggest concern for my children is that I want them to know that they are loved and I want them to feel safe.  I knew that the first hours would be complex for Macie, and I felt that it was much more important for one of her parents to be there than for Andy to stay with me.

I had a pretty clear view of the table where they were examining Macie.  She cried the entire time.  I heard them call out the Apgar scores of 8 and 8, and I was happy that they were that high for being born at 33 weeks.

Then they brought her to my side.  When they touched her to my shoulder she cried.  And when I spoke to her she looked at me and stopped.  I had time to touch her head and to give her a kiss.

And then they left.  Andy said goodbye and told me that he loved me.  I knew that he would stay with Macie and make the right decisions if needed.  And I was alone.

With the remainder of the surgical team.

My c-section with Ephram was extremely long.  It went over two hours because I had two cysts that needed to be removed at the same time.  The entire time that I was pregnant with Macie, I kept telling myself that at least this c-section would be shorter.  It could be a normal c-section.

I was a little right.  And a little wrong.  It was shorter, but not much.  It turns out that I scar very aggressively.  The doctors had a lot of scar tissue to remove in order to finish the operation.  I believe that my surgery started around 5:15 and I didn't get back to my room until 6:40.

For the remainder of the operation I took deep breaths to remain calm.  I fell in and out of sleep.  And I listened intently to the conversation taking place between the two anesthesiologists behind me.  Apparently I was a great case for a student.

Meanwhile, Andy was with Macie.  They got her into a room and put her in a giraffe bed.  The respiratory specialist noted that she was working very hard to breathe.  At 33 weeks, and with the steroid shots, we were all hoping that her lungs would be mature.  So he used a technique called blow-by where an oxygen mask is placed increasingly closer to the baby's mouth until their blood oxygen saturation levels normalize.  That did not work with Macie, so she was eventually placed on a CPAP which provides continuous positive pressure to the lungs.

Andy talked to the doctor and respiratory specialist a lot, and they explained the different things that could happen with immature lungs.  At this point, it was clear that Macie's lungs were less developed than we'd all hoped.  After she had settled down and seemed comfortable, he eventually made his way to my room.  I was still on the antepartum floor and just down the hall from the NICU.  I was so tired and the magnesium had been re-started, which makes me feel fuzzy and confused.  I remember listening to what Andy told me and being impressed at all of the knowledge that he'd already acquired.

But mostly, I just wanted my daughter.

I noted that my body was still mostly numb and decided that the best thing I could do was go to sleep.  I had about six hours until all feeling should return.  And then I'd be able to go meet my daughter.  During this time Andy went back and forth between our rooms.  I am sure he was torn about which place he should be in.

Macie's delivery was not what we would have planned.  Ideally, we'd like to have been several weeks further along.  I'd like to have had her and Andy stay by my side as the surgery finished.  We would have come back to the room together.  I would have held her and tried to do an initial feeding as soon as possible.

None of that happened, and I'm learning to accept that.  What I do find comfort in, is that I knew without a doubt that we were in the best place we could be.  I knew that the decision for her to come was necessary, even if not wanted.  I was grateful to live in this time, when we could be saved.  I was thankful that all the nurses at the hospital were so warm and caring, and I knew that they would help Macie feel safe in my absence.  And I did have trust in the doctors that they would help my Macie.

And that is how I came to have a daughter.  But our journey was about to get more difficult...

Meeting Ephram

For the past two weeks since Ephram's arrival, I have been meaning to better document the story of his birth. I want to remember every piece of it that I can... so here is my attempt to write it down. It will probably be long. It will probably be boring to most people outside of my immediate family. Maybe it will even be boring to them. But at least it will be written - for me and for Ephram.

As you probably know, the creation of Ephram was a big surprise, (a really good one at that!) I spent the majority of the pregnancy worried that something would go wrong. But I was pleasantly surprised as day after day, week after week, and month after month passed by without complication. But, Ephram had to throw us for one big loop. At 34 weeks, he decided to flip over so that he was in a breech position. In the two weeks following, he managed to completely wedge himself in a transverse position at the top of the womb... it was clear that he was not going to come out on his own. We eagerly scheduled a c-section a couple of weeks later, and were pleased to learn that our baby boy would have a very special birthday - New Year's Eve. For the week that the date was known, we hastily prepared for our trip to the hospital and the arrival of Ephram. But nobody was more surprised and anxious when December 30th finally arrived. I spent every hour of that day realizing that I would never experience it again without my baby. It was a very odd feeling - exciting and scary at once.

Andy and I got a lot done that day. We finished cleaning the house, doing the laundry and preparing everything so that it would be like new when we returned home. We spent some special time with Charlie before taking him over to his friend's house to spend the night... and Andy delivered our dog to our next door neighbor's house. Finally it was just Andy and me, and a growing baby inside. Waiting for the right hour to arrive. We decided to take a couple of "before" pictures.



It was hard, but I went to bed around midnight. I slept for all of two hours and then I was wide awake! I found some more things to clean and some television to watch. I knew that I should be in bed, relishing the last few hours of sleep before the baby's arrival. But I had so many nerves bundled up inside that I just couldn't do it! Finally it was 5:30am and time for us to start getting ready to go. Our c-section was scheduled for 8:15am and we were to arrive at the hospital no later than 6:45am. We showered, dressed and loaded the car. As we got in and rolled down the driveway, I remember thinking about how things were about to change. I don't remember much about the drive to the hospital that morning, but I do remember getting out of the car and walking up to the reception desk at the family maternity center.

This was the year of the swine flu. Because of the expected spread of the virus, hospitals across the country were taking preventative measures to keep germs away from labor and delivery centers. While we were in the hospital we would only be permitted visitors over the age of 12 that had no signs of the flu. We could have Charlie visit Ephram only if he had no signs of the flu as well, and because he is a sibling. When we entered the maternity center that morning we too were screened for the flu. Every day, Andy had to get a new sticker if he left the maternity area. He ended up with three different color dots. I only got this one:


We sat down and waited for our nurse to come out. Her name was Kirsten and she was the best, most comforting nurse ever. She showed us back to our room, I was glad that one was already set up so that we would not have to go to the triage area. We had a white board in our room that the nurses used to keep us informed of their names throughout our stay. They added Charlie to the board so that he would know that he was part of the family too when he came to visit.

I was really starting to get nervous by the time we got to the room... about meeting my son, having surgery, needing pain medications, and a litany of other things. It seemed like everything happened so fast from this point forward. Before I knew it, I was in a hospital gown. I'd had one last ultrasound to confirm that Ephram was still breech. Suddenly my doula had arrived, an IV was inserted, and the anesthesiologist was talking to me about what to expect. Our anesthesiologist was Matt, a resident that was nearly finished. He grew up near where I lived in Missouri, so we spent some time talking about that. We had another anesthesiologist supervising him as well - they did an excellent job. Our doula and Andy put on their scrubs... Andy looked as nervous and excited as I felt!

My doctor arrived and explained that they had decided to remove my ovarian cyst during the surgery to help avoid torsion post-pregnancy. It was a scenario that we had discussed many times during the pregnancy, and seemed like a sound decision to me.

Suddenly it was 8:15 and I was walking. Down one hallway, around a corner and down another. Through double doors. Then Andy and my doula went a separate direction so that they could prepare to enter the OR, and I was walking alone with my nurse and my doctor, through the final set of doors into the OR. Up on the table I anxiously awaited the spinal. It was the part of the surgery that I had most worried about. I am so thankful for how patient all of the staff were as they explained every step of what was happening. I am also grateful that Andy walked in just before I received the spinal so that I could look in his eyes for reassurance. Although I was pretty scared, I knew that this was all necessary and all would lead to Ephram's birth. The spinal went in and the numb feeling was immediate. My feet began to tingle and the staff helped me lay on the table. I was introduced to all of the people in the room - the two doctors, two anesthesiologists, and four nurses. I was asked if a student anesthesiologist could observe, and gave my permission. I started to feel queasy and so Matt delivered some anti-nausea medication through my IV, which immediately made me feel extremely drowsy.

Before I knew it, they were doing the "surgical pause" and announcing my name and the purpose of the surgery. For a moment I wanted to tell them all that I had changed my mind. That surely, we could find a way to get Ephram to flip back to the traditional position. But I knew that was nerves and that it was silly. So I kept my mouth shut and tried to focus on fighting the medications to stay awake. Andy's hand was on my shoulder and my head as I felt them start reaching for Ephram. I heard them say, "Here he comes!" Then I heard someone say that they could see his behind. It seemed like quite awhile after this that he came out, and it was... because he was so stuck that they really had to fight to get him out! I couldn't see him or hear him, but I heard them say, "8:45am." And then I heard them say, "He's pooping!" Andy ran around the curtain and to the warmer to be with Ephram as we had discussed. I really had to fight to keep my eyes open, as I wanted to hear his first cry. It seemed like it took forever. Later I learned that he had swallowed a lot of amniotic fluid because he was so high up in the womb, and had to be suctioned before he took his first breath. Finally I heard his cry, and then there was no way that I was going to go to sleep! I still couldn't see him around the poles used to hold up the surgical drapes, but I knew that Andy was with him and I could hear his little cry. So I did the only thing I could do, I lay there in wait of Andy to return to my side with our new baby boy.

Meanwhile, Ephram weighed in at 6 pounds and 6 ounces, much smaller than we'd anticipated! He was 19.75 inches long, and ... like most of the Boyce family ... had a head that was large in proportion to the rest of his body.


Finally Andy was back. I have no idea how long it took, but in my drug-induced state, it seemed like an eternity. Meanwhile, they had started work to remove the dermoid cyst from my ovary and I could feel all of the tugging and pressure for that. But I quickly forgot it when Andy gave me a first look at my little boy. What hit me the hardest was actually the look that Andy was carrying. He clearly was already in love with our little boy. It was written all over his face and contained in his posture and the way he was handling Ephram.

At first I just looked at him. Honestly, I had spent the last month of my pregnancy convinced that something would be wrong with him at birth. So I couldn't help but stare at his perfect little body. I was amazed that he appeared to be fine. Andy explained to me that he had bruising on different parts of his body because they had to work so hard to get him out. But the bruise on his chin was attributed to the placement of his hand while he was inside of me.


After several minutes my nurse came over and suggested that Andy prop Ephram up on my shoulder. This was huge for me. The only thing that I truly was sad about in the need to have a c-section was that I would not get to feel the weight of my baby on my chest just after he was born. To have them let me feel him, touch him and kiss him took away a lot of that regret. He couldn't completely rest on me because there was not much of my shoulder on that side of the curtain, but I still got to feel the warmth of his little body.


It was about this time that I overheard something about two cysts. It turned out that I had not one dermoid cyst on my left ovary, but two. The surgery was about to go longer. I suddenly started shaking severely and Andy took Ephram back as I tried to relax and gain control. Soon Matt was by my side explaining that he had to administer more medication because the surgery was going longer than anticipated. Maybe that contributed to the shakes, maybe not. The clock told me that I had already been in the ER for over an hour at that point. The only thing I could do was wait and try to ignore what was happening, so I turned my attention back to my little boy. He was trying out his lungs...


And showing us his best pouty face...


And then Andy put him back on my shoulder. And he stayed there for most of the remaining surgery, which went about two hours in total. (If you aren't familiar with c-sections, they usually go from 30-45 minutes, so 2 hours is very long!) I really tried to ignore them when I heard the anesthesiologist asking the doctors about too much blood loss. Thankfully I avoided the need for extra blood, but it was a narrow escape. I found it was much more fulfilling to look at Ephram than to listen to the tidbits of medical conversation.

Finally the surgery was over and I was being wheeled back to my room on a stretcher. I could hear Andy carrying our little boy back through the hallways. I was still completely numb when we got back to the room. They lifted me onto my bed and I watched as everyone congratulated us and took a last look at Ephram.

Our doctor took a moment to pose with Andy and the baby, although she did complain that she would probably have "hat head". Dr. Schocket was amazing throughout the pregnancy. She, along with Dr. Hill who was assisting, did an excellent job delivering our little boy.

I watched as Andy continued to ogle over Ephram. I was a little bit jealous and ready for the numbness to subside so that I could really get to know my new little boy. Ephram was put on my chest pretty quickly in our room, but it was at least an hour before I had sensation in my whole body and could sit up and properly meet him.

After an initial attempt at breastfeeding, Ephram was taken from me again for his first bath. Because I was stuck in bed, Andy had the privilege of bathing him with the nurses help. I watched as I continued to fight off sleep. Ephram did not much care for the bath and protested loudly. Andy found very quickly that Ephram would calm down if he was given Andy's finger to hold onto. We were very impressed with the control that Ephram had over his hands from the beginning. It was more than we'd expected.

Later, when the nurses had left to give us our space and our doula had departed. Andy and I were left alone in our room with our new little miracle. We couldn't get enough of him! We watched him sleep, breathe and move around. We could not believe that this little guy had grown so long inside of me and finally made his appearance. It is definitely the best New Year's present we have ever received. We spent the night marveling at him and looking forward to a good year in 2010.

Introducing Ephram William Kovar

Ephram William Kovar was born on New Year's Eve at 8:45 in the morning. He weighed 6 pounds, 6 ounces and wa 19.75 inches long. He was delivered via cesarean section, which went about twice as long as 'normal' because I had some other surgical things to be done. Ephram has to be delivered by c-section because he was in a breech position, and was actually laying transverse at the very top of his space... it is unlikely that the pregnancy would have progressed if left alone. He was really wedged in and required some extra manipulation to come out. As a result he had some extra bruising!

Ephram had some difficulty breathing at first and had to be vacuumed after birth, and then again on his birthday in the NICU. (Don't worry he was only up there for observation for less than an hour and Andy was right there with him! We are all adjusting to life at home now. It has been fun for me to watch both Andy and Charlie develop their relationships with Ephram. Andy is truly amazing with our little boy and has had a lot of extra responsibility as I am recovering from the surgery.

Ephram mostly sleeps, eats and cries still - but we are learning that he is very expressive with his eyes. We really enjoy his alert periods because he makes some of the most adorable faces.

Here are some pictures from his first moments of life in the operatig room.

Andy with our OB - this is actually in our room, I was still numb and stuck in bed!

Just after birth - proud dad!

They let me have my hands free and put Ephram on the corner of my chest. I was so grateful to be able to touch and kiss him during the larger part of my sugery.

Ephram is really good at crying.

On the scale... yes, he winks a lot too.

First photo with Mom and Dad