Charlie has an umbilical hernia. This isn't an uncommon condition, though it's more common just like everything in premature babies. It occurs when the ring of abdominal muscles around the umbilical cord fails to close after the baby is born, and in most cases it resolves without treatment within a couple of years.
It's not serious and it's not harmful. It is also not so pretty.
Instead of a tidy and respectable innie, babies with an umbilical hernia have a protrusion that ranges in size from, I don't know, cat's-eye marble to basketball. What is it that causes this protrusion? What's sticking out through the opening in the abdominal wall? What in the name of all that's holy is that fucking thing?
Glad you asked! It's intestines, of course!
We knew about Charlie's hernia early on because, hey, it's the kind of thing you notice. In those weeks in the NICU we were concentrating on weightier matters than an unsightly navel, and I didn't give it much thought. It wasn't until Charlie's last appointment with the local neonatologist that the subject came up.
"Have you pressed on it?" the doctor asked us.
"Ummmm...no..." Paul and I stammered in unison, spooked by the very thought of poking that roiling little mound.
"Go on, mash it," she instructed gaily. And mash it I did. It sank abruptly into his abdomen with unnerving ease, then sprang immediately back out when I removed my finger. It felt like...like...well, exactly like you'd expect a protruding loop of intestine covered only by a couple of layers of membrane and skin to feel.
Since then I have found myself compelled to press on it every time I change his diaper. Though I want to, I don't actually do it. The one time I did, I was rewarded by an ominous rumble from deep within Charlie's belly, followed by a loud release of some of the foulest-smelling gas this side of the river Styx. This thing is like a goddamn Popomatic Bubble.
Oh, yes, we got Trouble. Right here.
Now, in the last several days he's found it difficult to empty his bowels, straining and turning a dark purple-red as he grunts with exertion. There are many things I can try to help him along. But rectal stimulation thermometer, ointment doesn't work. And a warm bath with gentle abdominal massage doesn't work. So naturally I keep thinking, What if I just pressed his navel...right...there?
In the hospital while Paul was changing a diaper, peering closely to make sure Charlie's tiny anus was left fresh as a daisy, Charlie let loose a gout of liquid excrement that shot out in a malodorous stream, making an arc no less impressive than the Gateway Arch. Paul responded with a loud announcement that made the nurses whoop with laughter: "Shit." I'm still not sure whether he was exclaiming or describing.
We know, therefore, that Charlie is capable of expelling his intestinal contents with all the force of a firehose under full pressure. (Riot cops, take note.) This knowledge is the only thing that keeps me from giving his navel a gentle poke when I know he'd like relief among all the plans I have for Charlie's room, chiseling solidified baby crap off the walls is not included.
Well, that and my grudging awareness that it's probably not a good idea to play with the kid's intestine every time I'm feeling lucky.
Too bad. I'll just have to satisfy myself with playing Operation on him. It'll come in handy if his hernia turns out to need surgical correction.
0 days adjusted
Charlie reaches his due date today.
When he was still in the hospital, I used that fact to protest every inequity, no matter how picayune. My indignation knew no bounds. "What do they mean, no turn on red?" I'd exclaim, shaking my fist righteously at a road sign. "Don't they know my kid's in the hospital?!"
Since then, I've cut him all kinds of slack after all, he was still technically early, even though we'd have had him at 36 weeks if everything had gone according to plan. "Well, of course he doesn't like being bathed!" I'd croon, getting all up in his face, scaring the tiny bejesus out of him. "He isn't even born yet!"
Now there are no more excuses. 40 weeks gestation today.
Nipple freakishly implacable antipathy
Whoever came up with the term "nipple confusion" is a fool. Charlie's not confused; he is a baby of rare discrimination who knows exactly what he wants. He doesn't have nipple confusion. He has nipple preference. Nipple aversion. Nipple seething white-hot hatred, if you really want the truth.
We dislike breastfeeding, Charlie and I.
We started out in the NICU with the make-a-nipple-sandwich method, which involves jamming a big fistful of areola into a defenseless baby's mouth, stuffing him into muteness as if you didn't want him squealin' to the cops, see?! With this method he'd latch briefly, give three strong sucks, then look bewildered. I'd remove my nipple from his mouth and start all over again. "He'll get it," promised the flaky hospital LC, in between fits of crooning, "There you go, mama. C'mon, baby. Mmmmmama," as if she were a white, female, sub-moronic Isaac Hayes.
When I told the local lactation consultant about this, she rolled her eyes so hard they clacked in their sockets. When they finally rolled to a halt, she broke out a nipple shield, a clear silicone sombrero that comes to a point so emphatic I feared I'd put out one of Charlie's eyes with it. It fits directly over your naked nipple and is used to make it easier for the baby to draw the nipple into his mouth; it's especially helpful for babies with a suboptimal latch or suck and for women with suboptimal anatomy. That would be Charlie, and that would be me.
We tried it, and it seemed to go well. The local consultant watched Charlie and me together and pronounced herself well pleased. "He'll get it," she declared, and sent us off to work on it together with instructions to try at every feeding with plenty of skin-to-skin contact.
And then I had houseguests for ten days straight.
I was able to slip away to pump; at the beginning of the visit I was discreet, disappearing without warning, but by the end I was bellowing, "Gotta pump!" as I trudged up the stairs yet again. Although the guests were family members, I was too uncomfortable to spend time with them naked from the waist up, coaxing a
screaming reluctant baby onto my sombreroed nipple.
They weren't even out of the driveway before I'd stripped and presented my plastic prosthetic once again to Charlie. But by that time, his initial goodwill had turned to rancor. He'd open obediently and allow me to draw him aggressively onto my breast, and he'd take a few experimental sucks. But when no milk was immediately forthcoming, he would scream.
I'd wait for him to calm down, give him a few milliliters from a bottle, and then try again. And he would scream the scream of the thwarted, the betrayed, the milkless, the pissed.
Now here is where we talk about the letdown reflex, or milk ejection reflex. It's this that causes some women's breasts to leak when they hear their baby cry, and what some women feel as a tingling that precedes a gush of milk. Apparently it's a conditioned reflex that can be inhibited by pain, anxiety, or negative feedback. You know, like the pain of sore nipples being relentlessly hoovered into a mechanical pump, or the anxiety of watching your supply diminish, or the negative feedback of, oh, I don't know, a baby yelling in fury when you're not delivering the goods fast enough.
My letdown, friends, is for shit. So Charlie would give a few healthy pulls, get no milk, and then scream. I can't entirely blame him. Having been bottle-fed for the first ten weeks of his life, he had no patience whatsoever for meals served in a less expeditious fashion. If the nipple of a bottle even a slow-flow nipple is a McDonald's drinking straw, my nipples are those whisper-thin coffee stirrers. Now how would you rather drink your milkshake?
A classic case of nipple confusion. But Charlie is not confused. He simply hates my breasts.
I called the local lactation consultant, a mother of a preemie herself, and explained the situation. She sighed. She said, "Well, you can work on it. You can do more skin-to-skin, and you can continue to try. Or" and here is where I burst into grateful tears "you can just enjoy your baby."
I needed that permission, thinking, If a hardcore breastfeeding advocate says it's okay to stop, it must really be okay to stop. I've been working very hard for the last ten weeks. I am ready for something to be easy, for feedings to be pleasant and amicable. I'm tired of trying, and desperate to stop being a special case, to stop having to work so much harder than almost everyone at something that should come more or less naturally. I am not going to try anymore.
That said, I'm still pumping. In fact, I'm committed to doing so at least until Charlie hits twelve weeks. I've heard that at twelve weeks a baby has received about 60% of his mother's antibodies, with the rest accruing only gradually thereafter. (I was not able to find a citation for that figure, but it pleases me so I embrace it.) It's important to me to give him that much, especially during RSV season.
Beyond that arbitrary milestone, I don't know how long I'll keep it up; a lot depends on how well I'm able to build and maintain my waning milk supply. To that end, I'm already pumping so frequently I don't know night from day, guzzling so much Guinness I smell like a brewery, and popping so much fenugreek I smell like a mapley brewery. I've also ordered domperidone without a prescription from a shady overseas pharmacy, and will frantically swallow it in giant handfuls immediately upon its arrival.
After that, we shall see. I will report back, unless I'm too busy enjoying my baby. Or slowly decomposing in a drawer in the morgue, a sad cautionary tale against ingesting controlled substances acquired from fly-by-night charlatans somewhere in the South Pacific.
The happiest baby on the block
Charlie welcomes in the weekend.
Boppy courtesy of Abby. Blanket courtesy of Layla. Milk-drunk stupor courtesy of Julie.
Move over, Iron Eyes Cody
I did not know this until I had one: babies aren't born with the ability to cry tears. Although from birth they make moisture enough to keep their eyes wet and healthy, what we commonly think of as tears the kind that slide down a fat satiny cheek reddened by frustration or pain don't come until later.
As we undressed him this morning at his neonatologist's appointment, a hungry, pissed-off Charlie cried his very first tear. He is one month adjusted today.
Some days (not today, thank goodness) you just can't win. Charlie starts crying, so you pick him up and he starts crying louder. Offer him a pacifier, he screams. Offer him a bottle, and he screams while arching his back into a semicircle while whipping his head from side to side like the lead in some devil-baby slasher flick.
Swaddle him, rock him, sling him, shush him and all you get is more evidence that his lungs have recovered from RDS just fine. And why did you spend all that money on the NICU when you were just going to murder him anyway, he asks in tones that might well reach downtown.
So rather than throwing him across the room or tearing him limb from limb like he says you're doing, you put him down and step into the next room just to get away from the screaming.
You step back in, very softly, and there he is lying on the changing table or the couch, gurgling quietly and looking up at ceiling. Waving his arms and legs a little. In that mood the books call "quietly alert". What he really wanted wasn't food or a return to the white-noise confines of the womb or "non-nutritive sucking", it was for you to stop goddam bugging him.
Our local doctor once commented that ICSI babies tend to be developmentally delayed, because their parents never put them down. If that were really anywhere near true, it would be a wonder that any survive...
My son the doctor
Dr. Batman to the rescue
[...] It is still a rarity when someone adopts Batman as their legal name.
[Norwegian] medical student Anders Mjelle, 22, is studying to become a pediatrician, and prefers Batman to more supernaturally powerful heroes like Spiderman or Superman, newspaper Nordlys reports.
Mjelle, now Anders Batman Mjelle, told the paper that the idea came to him while he was practicing his signature during a prescription class.
"It just wasn't as cool as doctor signatures usually are. So I tried signing with the name to my old hero of heroes, Batman. That was much better," Mjelle told Nordlys.
"I have naturally assessed the risk of being called Dr. Batman if I want to be taken seriously as a physician. But my goal is to become a pediatrician. In this case I believe being called Batman can definitely be something positive," Mjelle said.
(Full story at http://www.aftenposten.no/english/local/article967931.ece.)
I've got a secret
There's something I've been keeping from you.
First, the background. I am beginning to suspect, to my dismay but not my surprise, that Charlie has colic. The yelling has diminished now that the Prevacid has taken hold, but there are still three or four nights a week when he howls for no apparent reason, for a few toe-curling, jaw-clenching, sphincter-twitching hours at a time.
Since we've gotten the reflux more or less under control and he's no longer arching in pain, the screaming is easier to take. Instead of sobbing along with him, I march around the room with him tightly slung, singing loud enough that I can't hear his cries, or I bounce him on my knee emphatically enough to surprise him into silence for a moment, or pat my hand gently over his mouth while he shrieks so that it makes a "bah-bah-bah-bah-bah" noise. (It amuses at least one of us.) The goal is diversion, to distract him from yelling for even a blessed moment so that Paul can hear me when I ask for a motherfucking drink.
This is how I discovered the shameful secret I am about to reveal. Charlie, I found, can latch.
A few days ago, in yet another creative attempt to divert him, I unbuttoned my shirt, yanked loose the cup of my nursing bra, unceremoniously flung Charlie across his Boppy, and presented him with a fleshy ultimatum, ramming him onto my nipple with an authority I had not known I possessed. And he latched like he'd been born to it as, in fact, he was.
I did it again tonight. And he did it again tonight. He suckled for a good five minutes, swallowing diligently, until he remembered he was supposed to be screaming and I swear I could see the tiny Christmas tree light-sized light bulb go on above his head and geared up again into full voice.
Here is what I plan to do with this information: absolutely nothing.
I was surprised by how I felt about his latecoming aptitude specifically, not much. I'd have expected to feel elated, or relieved, or even, if I'm honest, chagrined. Instead I feel neutral, as if he'd done a trick I'd seen before that didn't impress me then. Big deal, you can latch. Come back when you can photosynthesize.
Giving up breastfeeding was a decision I made with no small degree of grief. A month later I'm over it, and have even grown to appreciate certain advantages of bottle feeding. (Those certain advantages are called sleeping through the 2 AM feeding, nonchalantly sashaying out to the spa for a massage and exfoliation, and never, ever letting my father get even the quickest, most accidental glimpse of my tits.)
I can't imagine retracing those painful plodding steps between anguish and acceptance, much less setting myself up for several weeks of sore nipples, patient positioning, and making myself available for every single one of Charlie's evening clusterpaloozas just when I've started enjoying him.
Will I regret it? Doubt it. I'm a little apprehensive since I know there's no turning back once I stop lactating. But I'm looking forward with indecent pleasure to throwing out my pumping gear, having regretfully concluded I cannot lawfully burn it under current EPA regulations a clue that I won't be sorry to see the end of this mammalian phase of motherhood.
Smile, grunt, snort
Charlie finally smiles.
He also coos, grunts, and snorts like a pig (QuickTime, 1 MB).
In my head, Charlie's life is full of clocks: a clock starts ticking when he finishes his meal, so I'll have an idea when he might be hungry again, when he goes to sleep -- count every second gratefully -- or when he fills his diaper, so that I have some idea when he might be angry and straining again. Even when he's in his gym kicking at the toys, or watching his mobile, there's a little timer in the back of my mind ticking off the minutes till he starts getting those overstimulated shakes.
I try to think more in terms of chess clocks than of the blinking LEDs that grace every made-for-TV bomb ever created. You know, the bombs with all the booby traps so that they'll go off the moment you try to move or disarm them.
Which brings me to the longest half hour in Charlie's day: the time between when he gets a dropper full of Prevacid to control his reflux and when he can start sucking down his next bottle. (It took us a few days of complaining that his new medicine wasn't working worth a damn to read the warnings not to give milk less than 60 minutes before or 30 minutes after a dose.) But if you're Charlie waking up hungry and swallowing a nice gulp of what tastes like yummy food, only to be told the next gulp is in forever, package inserts are slim comfort.
How long is 30 minutes? Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi Mississippi is a minute, and don't think he's not potentially alert and ready to blow for every one of them. We change him, we make him stare at his mobile, we give him a bath, today I slung him and took him for a nice sedative walk in the park. Tomorrow, who knows?
Perhaps I shall get him a watch and just explain calmly and reasonably that he can't eat until the requisite time has gone by. Do you think I should get him a digital watch or analog?