Batman born

On November 27, Charlie was born. Read Tertia's updates to get the story as it happened — my own account doesn't pick up until several days after the birth.

First lines

Every time I try to find words to write about this, what comes out is simply wrong:

It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a child.

Nope. Paul's not single, his fortune is largely depleted by my ruinously expensive Gonal-F habit, and I'm pretty sure Elizabeth Bennet didn't do it on the first date.

Under certain circumstances there are few hours in life more agreeable than the hour dedicated to the ceremony known as the first postpartum bowel movement.

Vulgar, contrived, and a great big goddamn lie.

Lochia, light of my life, fire of my loins. My sin, my soul. Lo-chi-a.

If Humbert Humbert ever knew the pleasure of having his hospital-issue slipper socks splashed with blood when he finally rose for his first post-surgical shower, I'll eat an inch-thick maxi.

It was a bright cold day in November, and the clocks were striking thirteen.

Nuh-uh. Altogether too many rats strapped to the face. Besides, it wasn't cold, it wasn't bright, and I lost all sense of time.

Once upon a time there were four little Rabbits, and their names were Flopsy, Mopsy, Cotton-tail, and Peter.

What the fucking fuck? That might well be the Percosets talking.

You can see the problem I'm having. Okay, one more try:

Everything is different now forever.

For now, that'll do.

Charlie. 3 pounds, 11 ounces. November 27, 2004, 10:22 PM.

Everything is different now forever.

A funny thing happened on the way home from Connecticut (part 1)

While I am sure he will eventually become a pain in my ass, Charlie's entry into the world began instead with a pain in my abdomen.

The Tuesday before Thanksgiving, I had a stomach ache, bad enough to make me fractious and bad enough to make me call the doctor's office to ask whether I could have something a little more potent than Maalox or Tums, though not bad enough to make me casually request a snifter of Demerol. The answer, alas, was no — if over-the-counter antacids weren't working, I'd have to go in for an appointment before they'd okay anything stronger. ("Don't eat anything," the nurse helpfully suggested, an intriguing piece of medical advice when given to a gestational diabetic.) I made an appointment for late the next day, after we'd planned to leave for Thanksgiving in Connecticut with Paul's family, and hoped the pain would magically vanish before our plans were compromised.

And it did. Around 5 o'clock that evening, I suddenly felt quite normal again. Since I was perfectly well the next morning, too, I cancelled my appointment and we headed down the road.

(Here is where the sirens should be going off, howling, "PLOT POINT! PLOT POINT! FATAL ERROR! TRAGIC FLAW!")

Now it was Wednesday, the day before Thanksgiving. We stopped for dinner — a glycemically virtuous affair involving a cheeseburger with no bun, some lackluster steamed broccoli, and a carefully calibrated handful of French fries. Six hours later we were in our hotel, Paul was in bed, and I was stretched out on the bathroom floor, thinking I was going to die, grateful only that the tile was cleaner than mine at home after 9 weeks without housework privileges. My stomach hurt terribly, with a dull constant pain, and my right shoulder felt like it had been wrenched. I assumed I'd strained it as I held myself above the toilet, trying very hard (but unproductively) to retch myself into good health again.

("AOOGAH! AOOGAH! UNEXPLAINED SHOULDER PAIN! REFERRED! REFERRED! CALL THE DOCTOR, YOU STUPID HOLE.")

And by 10 AM on Thanksgiving, once again I was fine. I don't mean I was feeling suddenly less bad; I mean I was feeling perfectly normal, shoulder included. I ate what made me happy, and was quietly elated when I saw that my blood glucose stayed well within normal limits. Maybe Thanksgiving wasn't a total wash, I thought, carrying away a plate of pie to serve as my mandated bedtime snack.

Friday morning, Paul went out to his aunt's house with his sister, leaving the car for me so that I could follow later. I ate a normal breakfast, noodled around online a bit, and dawdled over hair and makeup as long as I could before leaving. I suspected a family baby shower was in the works based on some huddled conversations I'd pretended not to notice, so I wanted to give them time to make everything nice before I arrived, and I wanted to look especially nice for the pictures.

("OH, CHRIST, SHE'S GOT HUBRIS, TOO! SMACK THE SHIT OUT OF THIS GIRL, STAT.")

Before I even made it out to the car, the stomach pain had set in again. But I was determined to get there, and I was sure I could handle the drive. Through unfamiliar territory. With directions by Mapquest. And crippling abdominal pain.

Yeah.

Suffice it to say that between the pain in my stomach and the fiendish machinations of the sadists who programmed Mapquest, I have no idea where I drove during the next two hours, despite stopping thrice to ask where I was. I saw an awful lot of Connecticut, though I never got anywhere near Paul's aunt's house. I ended up beached outside a Costco, dialing my cell phone with fumbling thumbs, asking for directions. "We'll come get you," said Paul's cousin instead. I tilted my seat back and waited.

When they arrived, Paul took the wheel. I vomited quietly down my sweater, onto my jeans, into my jacket. I don't remember what we laughed about, but we did. Must have been really fucking funny.

I went immediately into Paul's aunt's room, where I would spend the next eight hours throwing up bile and trying to rest. Paul's cousins were so kind to me, rubbing my feet, offering tea, stroking my forehead as I lay in state, and yet I was happiest when they'd gone, when I could lie quietly, alone, without worrying that I smelled like vomit.

Time passed. That's all I know.

I can't really explain why we hadn't called a doctor or gone to the hospital, because it was bad enough that we should have. I will always regret that decision. Even if we hadn't been able to keep Charlie inside a single minute longer, a steroid shot as late as Friday night could have made a big difference to the health of his lungs. I can only say that I felt the baby was absolutely well — he was moving as much as ever, vigorously but not frantically, enough to make me resent the kicks he was merrily delivering to places that were hurting already.

But by 9 PM I was fine.

Back at the hotel, we sprawled across the bed and lay quietly watching TV. We shared a Diet Pepsi. We slept. Paul patted me in the night, as he often does. I thought it would all be okay.

Saturday morning, I was all right until about half an hour after eating a banana and drinking some water. At last I called my doctor, who okayed a dose of Zantac. "I can't prescribe anything over the phone," she pointed out, "so if the pain is really that bad, you should go to a hospital where they'll be able to check you out. Oh, and go to a pharmacy and use their blood pressure machine. If it's high, you should get looked at."

Paul drove us to the big grocery store down the street from our hotel. We made straight for the antacids, where I ripped open a box of Zantac and took one as I stood in the middle of the aisle. I went to the store's pharmacy then and strapped myself into the cuff. 145/90, especially high for me.

Between dry heaves into the balled-up sweater I'd removed, I paged my doctor again and waited for her to call back. 15 minutes passed. Half an hour. 45. She didn't call. I finally said to Paul, "Please go ask the pharmacist where the hospital is. I think we need to go."

You'll feel like you're falling, but you're not

There's a lot I don't remember from the day Charlie was born. Part of that is because of the pain, which left me foggy a lot of the time; part of it is because I let myself drop out, knowing I could count on Paul. Here is what I do remember:

As we waited in ER triage, I first sat quietly in a single chair, then slumped across two, then lay full-out across three or four. I debated whether sliding silently to the floor would finally convince the nurses this was serious, but then decided that the floor was too filthy even for me. And I am not fastidious.

I knew I was in trouble when I started to hate a baby. A couple arrived with their sleeping newborn, who needed phototherapy for jaundice. Because it was the weekend, their doctor had sent them to the ER. "If that baby gets seen before I do," I thought, "I am gonna be pissed." I rehearsed a little snit just in case.

When the nurse finally called my name, I struggled into the office and sat in a chair. "Severe abdominal pain," I told her. "Any other medical problems?" she asked. "30 weeks pregnant, placenta previa, gestational diabetes," I recited. "You should have gone to labor and delivery!" she said, in a more accusing tone than I really cared to hear. That's when I lost it: I burst into tears. Sobbing immoderately with snot glazing my face, I choked out, "We've been waiting...for an hour! Why didn't...anyone...tell us?" A wheelchair was produced with indecent haste, probably to speed me away before I upset the other patients. I cried the whole way up to L&D, when I wasn't vomiting into another sweater. (By now I had an entire wardrobe of vomit-christened attire.)

The room in L&D — which I would occupy for the next 48 hours, when I wasn't having a babyectomy — was sunny and peaceful. I couldn't wait to change into a gown and get in bed. I wasn't surprised when the fetal activity monitor showed that the baby was frisky and fine, and I knew I'd been having no contractions. "I'm not in labor," I told anyone and everyone, but I knew they had to check.

I lay on my side and tried whimpering to see if that would help distract me from the pain. It didn't, but it was kind of fun, so I kept it up for a while, trying to sound as much like a puppy as possible.

Time passed. It was dark outside. The doctor came in and told me bluntly, "We have to take the baby out." I asked her if there was time for steroid shots before delivery. She was definite as she told me no. "Okay," I said. She wouldn't be doing it if it weren't absolutely necessary. 29-weekers usually do fine. "Okay," I said again.

While I was being prepped for surgery, I fumbled with my cell phone, trying to send a message to Tertia. My hands were clumsy so I handed the phone to Paul, who finished the note and sent it.

I remember the kindness of the anesthesiology nurse, the one closest to my head during the C-section. As I was to be moved from one gurney to another, he told me, "You'll feel like you're falling, but you're not."

I was grateful for the banter of the several people circulating around the operating room. I was happier knowing they were relaxed than if they'd been tense and quiet. I knew my situation was serious, but I don't think I felt it was grave.

I heard the baby cry, a pissed-off squawl that had some vigor to it. "APGAR 9 and 9," someone said, and I thought, Thank God, thank God, the God I don't believe in.

During the entire surgery, Paul sat beside me and stroked my head. He could only see what was happening if he stood. When my uterus was being removed so that everyone could admire it, he reported, "They're doing what you blogged about." "AGGH," I think I said.

Very briefly, I was shown the baby — I saw him for no more than three seconds before he was taken to the NICU. Paul followed, my incision was closed, and I wouldn't see the baby again for more than 24 hours.

And that is what I remember.

A funny thing happened on the way home from Connecticut (part...um, whatever)

Something was making me itch all over. I suspect it was the magnesium sulfate, a bag of which dangled over my bed like a pinata (if, in fact, pinatas prevent seizures — note to self: sift through journal articles). My mouth was parched and I felt jittery but exhausted. A blood pressure cuff clenched the flesh above my right elbow, taking its measurements automatically every ten minutes or so. I had a hep lock in my left hand. My calves, ankles, and feet were encased in pulsating boots to discourage the formation of blood clots. A Foley catheter drained my bladder into a bag hanging at the foot of my bed.

When he came in from the NICU, Paul, still uncomfortably jumpsuited, brought two Polaroids of the baby, a tiny creature sprawled on his back, skinny arms and legs splayed, face inscrutable behind the tubes, head mostly obscured by a tacky knitted hat. Now I have a confession to make, and I hope it won't upset my friends here who've had babies earlier than I did: I was relieved to the point of tears to see that he wasn't very red. Early babies can have a dark and angry red color to their skin, a fact I've always found distressing. As a rule, I admit I don't find preemies beautiful. Ours was no different. I couldn't make sense of the photos — couldn't yet make sense of the day that had passed — and I didn't look for long.

Somewhere along the line we named the baby Charlie. It had been near the top of the list for the few weeks we'd allowed ourselves to discuss names; it was Paul's favorite, a family name on his side. In the moment I was so grateful to him for his steadfast sanity that it seemed like the most obvious, fitting choice. His middle name comes from my side of the family — my grandmother's maiden name, my aunt's middle — and is awfully close to Batman.

I asked about seeing the baby in person, a request that was summarily denied. I wasn't allowed to get up, not even to get in a wheelchair — some boring business about seizures again, which made me feel very impatient. When I wasn't clawing at my own flesh in an attempt to neutralize the itch, or shifting fitfully to make sure the catheter was still firmly plugged in, I was impotently trying to get my dry mouth to mutter a string of profanity.

I'm pretty sure I was delightful.

The nurse brought me a basin and a toothbrush. After brushing, I felt closer to human than I had all day. She brought a set of scrubs for Paul to wear, and extra pillows and sheets for the pull-out chair next to my bed. I know how I managed to sleep; I was doped to the cottony gills with pain medication and what the nurses affectionately called "the mag." I don't know how Paul did it. I know he didn't sleep much, because every time I woke, my face damp from crying as I slept, he was ready to pat my outstretched, hep-locked hand.

I didn't dream at all.

And miles to go before I sleep

Charlie's two weeks old.

Friday the doctor said Charlie might be moved as soon as Monday to a hospital closer to home. He'd spent more than 24 hours off CPAP without incident, and seemed to be going strong — the main measure of stability for what's called a back-transfer. It sounded too good to be true, and it was. Friday night as we held him, we could see that Charlie's breathing was more labored than it should have been. His blood oxygen level kept dropping as we held him, and we knew that didn't bode well. Saturday morning, he was back on CPAP. It was a disappointment but not a surprise. "He's not sick," the nurse hurried to reassure us, "he's just tired."

That's how I feel, too.

For the first few days after Charlie's birth, I was sick. I was also weak and weepy, but the presence of my mother kept me from spending much time thinking about our situation. Then I was running on adrenaline and joy — the baby was doing so well, and I was still so surprised to hear myself saying on the phone to the nurses, "Hi, it's Julie, Charlie's mother," that I felt a jolt of energy every time I thought of him.

But now I'm slowing down. I knew we could expect setbacks as Charlie gets older, bigger, and stronger. This is the first thing anyone who's had a child in the NICU will tell you — two steps forward, one step back is the name of the game. (I am sorry to dash your hopes when I tell you that, no, the name of the game is not slamball. Fewer trampolines, more IQ points, significantly lower blood alcohol level.)

I'm tired. I have a hard time staying awake in the afternoons, a harder time getting up in the mornings. I'm only really starting to understand the long way we have to go, and it is daunting. The enormity of it hit me yesterday when we approached Charlie's isolette and I heard the telltale bubbling of his CPAP rig, the one I'd been so giddily thrilled not to see at his bedside Friday morning. I have earned a quiet little breakdown, but can't afford one until we're all safe at home. Six weeks from now? Eight? Who knows? Just like everything else, that will take place on a "wait and see" basis.

We have a long way to go, and I am already tired.

Time does funny things. Funny-depressing, not funny-ha-ha.

During the first few day of Charlie's life, I learned he would soon have twin roommates. Their mother was hospitalized on bed rest for preterm labor, and was expected to deliver within a matter of weeks, if not days. Her due date was mere days away from mine. I was more excited to hear this than I should have been — twins! of the same gestational age! expected any day now! every bit as premature! — and thought that if they arrived soon, I could covertly observe them, creeping up to their isolettes to make visual confirmation of their inferiority to Charlie.

On Monday the twins arrived at last. (IVF twins, we learned, since one of the nurses asked, in what should have been her outside voice. The mother answered in what should have been her Washington-rallying-the-miserable-frostbitten-troops-at-Valley-Forge voice, so we couldn't help but hear.)

Paul and I were there to visit Charlie during what we've come to refer to as baby-bugging time. Because premature babies need uninterrupted sleep, their care is clustered — here they're disturbed only every three hours, when the nurses change diapers, take vital signs, and deliver a payload of breast milk as needed. Baby-bugging time, when Charlie's already being antagonized, is when we're able to hold him.

We didn't hold Charlie that day. The arrival of the twins involved every nurse in the NICU, two doctors, and two physician's assistants. They weren't frantic, but they were purposeful and focused, working in impressive concert to examine and settle the newest babies quickly. I love holding our baby, watching him blink at me, seeing his mouth move in sucking motions as he sleeps on Paul's lap, but that day it seemed slightly less urgent than, you know, making sure two smaller newborns were actually getting enough oxygen.

And I thought again, I'm so glad we didn't have twins. Having one baby prematurely has been agonizing enough. How much more grueling to worry about two?

The next evening the mother of the twins was in the NICU, along with her husband and her parents. The longer I stood watching Charlie, overhearing their conversation, the more envious I felt — not that they had two babies, but that they apparently didn't feel worried, or that their joy was so strong that doubt couldn't intrude. That the mother was immediately able to visit them and hold them. That she instantly found them adorable. But mostly that she got two more weeks than I did.

I've mentioned before how critical two weeks can be in the development of a baby. In babies on the edge of viability, two extra weeks mean the difference between a chance at life and a certain death shortly after birth. At Charlie's age, the survival rates don't increase appreciably with increasing gestation because they're already so high. But even so, a couple of additional weeks in the womb can mean a much shorter stay in the NICU. In Charlie's case, two extra weeks would have left his lungs in much better shape — and would have found us safely at home for his delivery.

There's no point dwelling on what might have been, because, after all, it wasn't. But it's impossible not to wish. Two weeks. That's not long. But for a baby, it's practically forever. It could have made such a difference.

...

Some people say that the hardest part of having a premature baby is leaving the hospital once they've been released while their babies stay behind. For me, that wasn't hard. First, the overall feeling of unreality that surrounded the entire experience was still intact — I could hardly believe I'd even been pregnant to begin with, much less that I'd gotten so sick, had a baby, and was miraculously well within the space of a few short days. Second, Charlie so obviously needed medical care that I couldn't regret leaving him in hands more capable than mine. Finally, I thought there'd surely be so much more that was harder.

A couple of days ago my suspicion was confirmed. There was something harder for me.

Since Charlie arrived at the NICU, several babies have come and gone. Most are in the NICU for no more than a couple of days. They might be ill, but not seriously. The ones I've seen aren't early or small. They're 7 or 8 pounds, and they get sent home fast. If they're in an open bed, if the handmade sign taped to the side of their cot says they weigh twice what Charlie does, I hardly register their presence — they make almost no impression as I trip all over myself in my hurry to get to Charlie's nook. They're not there long enough to inspire my curiosity.

But other babies make a deeper impression. They're the ones who've been there longer — say, a week, ten days — but who arrived after Charlie did. I've seen their parents there with them, learning to bathe and feed them. I've nodded pleasantly to the parents as I make my beeline for the isolette at the quiet end of the room. And I've seen those babies strapped securely into their infant carriers. The nurses hug the tearful parents, wish them luck, and make them promise to return with photos and updates. And then the babies go home.

That'll be Charlie one day, I know, and that'll be me leaking grateful snot onto the scrubs of a hapless nurse. It won't even be that long from now in absolute terms. Weeks, only weeks. But when the days blur together as they currently do, with the hours punctuated by trips to the hospital, bouts with the breast pump, and phone calls from anxious friends wondering whether no news is good news, it feels like fucking forever.

WWMFITCD?*

Yesterday we were told that we had a couple of choices: Charlie could go via ambulance to the hospital close to home this week, or he could stay in the hospital in Connecticut for about another week, then go directly home — to our house, in our car — with us.

Charlie is 34 weeks' gestation today, and weighs just a hair less than 5 pounds.  He's being fed by bottle and requires no breathing assistance.  He's finishing a course of antibiotics after last week's infection, and is in an open crib regulating his own temperature nicely.

Now, I'm not asking for advice, because we've already made our choice.  But there were about a million factors to consider, and I'm interested in what my friends inside the computer would decide.  In our situation, what would you do, and why?

________________

* What Would My Friends Inside the Computer Do?

You were right. Whatever you said.

It turns out you were all absolutely right. Each and every one of you.

We decided to have Charlie taken by ambulance to the hospital closer to home. The biggest factor in this decision was our bone-deep terror of taking a 35-weeker — tiny and floppy — on a six-hour drive in a New England midwinter the very first time he's given into our care. (Either we'd leave straight from the hospital, or we'd have to bring him here to our hotel. And I don't even want to touch the bedspread, as long as we're discussing the perils of introducing a baby to exotic new flora. You think I want him licking it? And I'm not quibbling about a few semen stains between friends. No, I am reasonably certain this particular bedspread has served, in the past, as a makeshift shroud for someone who died of flesh-eating bacteria. Good thing the court ordered that exhumation, or this hotel would have been short a perfectly good bedspread.)

Other factors included logistical issues, like having absolutely nothing set up at home. (A quick glance at the registry Tertia and boulder set up for me, which many, many of you generously picked clean, soothed that anxiety — so much so that I'm leaking grateful snot all over the keyboard just thinking of it. I will post about that at very great length soon, and will include pictures of the Alpine mounds of largesse. I have not yet seen it but in my mind's eye it is a magnificent trove indeed, an Aladdin's cave of bountiful goodwill, a twnemfndos kleam id jne — wait, too much snot of gratitude. Fingers slipping. Moving on.)

Aaaaand, the temperature in the house is set to, you know, tundra. I have not yet met Charlie's pediatrician-to-be. And we do not have a car seat. And all I know about infant CPR is that you have to cover a baby's nose and mouth when inflating his lungs, because how can you help it when it's such a wee tiny face, with an infinitesimal button nose and a chin the size of, well, a slightly larger button, and an incomparably adorable mouth that firms up in an obstinate pucker when you try to shove a nipple in when he doesn't want it? And I DO NOT KNOW HOW TO TAKE CARE OF A BABY, much less one who only a week ago had a snorkel on his face.

But aside from those minor concerns, we think that taking him home ourselves on Monday is a great idea. Good thing, because that's what we're doing.

A few weeks back, we thought Charlie would be going to the hospital near home. We did all the necessary legwork, talking to the doctors there, wheeling and dealing — because I am nothing if not a big-time silver-tongued cheap-suited wheeler-dealer, my friends, right here in River City — with the insurance company to get the cost of the transport (which hovers around $5000) covered.

As an aside, in case there is any doubt, I am feeling a little bit manic just now.

Anyway, the insurance company agreed that they would foot the bill. Charlie, however, opposed our plan to move closer to home, so emphatically that he required resnorkeling, so the earlier transport was scuttled.

Fast forward three weeks in the NICU, or several geologic ages, whichever feels longer. Include several phone calls to the insurance company to assure that Charlie is indeed covered, despite the fact that they haven't gotten around to actually processing the paperwork I sent in weeks ago; a trip to City Hall to acquire several impressive-looking copies of his birth certificate; and a few harried sessions laboring over the breast pump, just for comedy. I am told the transparent hooter cones are hilarious.

So so so so so (still manic, hang in there) our plan was to tell Charlie goodbye yesterday, then drive home in the evening. We'd meet him at the local hospital on his arrival. We'd packed the car, made arrangements to reassume pet care, and used up every last hotel towel in a shocking spree of profligacy. We drove to the hospital, sat to feed Charlie, and patiently awaited the next bombshell. By now we should have learned that when it comes to matters reproductive, there is always another bombshell.

In the movie of my life, the next scene would involve a doctor, a nurse, the hospital's social worker, Paul, Charlie, me, and a lactation consultant. While the doctor and the social worker soberly explain that the insurance company has refused to authorize the upcoming transport, the lactation consultant, the nurse, Charlie, and I are trying to breastfeed for the first time. Paul is staring in horror as my enormous rack threatens to engulf the tiny head of his heir. Music: something dark and Wagnerian, corresponding to close-up cuts of Charlie's flaring nostrils and my wobbling flesh encroaching ever closer with increasing menace. SFX: wailing of several other, lesser babies (billed in the credits as Crying Baby #1, Crying Baby #2, and Baby The Nurses Call "Irritable" But You Would Be Too If That Braying Jackass Were Your Mother).

And why would the movie of my life include such a zany scene? Because that is how it pretty much happened. Needless to say, the breastfeeding was not a success, though Charlie's cranium emerged battered but uncrushed; the transfer was cancelled outright; and Paul and I were once again knocked for a loop. Another plan that has fallen through, another abrupt reversal.

It seems that the insurance company won't pay for the ambulance unless the transfer is medically necessary (meaning Charlie's moving from a less sophisticated hospital to a more advanced facility) or unless the doctors can certify that Charlie will need to be hospitalized for at least another two weeks. Neither is the case. This is the kind of problem you want to have: our kid is too well to require the transfer. So here we stay until Monday, his expected date of discharge, when he will go straight home with us at 35 weeks' gestation.

I'll believe it when Charlie's bucked safely into his car seat and I am hyperventilating in panic as we appoach the highway entrance ramp. Not a single second sooner.

Circ du no-way

I've been reading the comments about circumcision over at Tertia's with great interest. It all reminds me of a conversation that took place during our childbirth classes. The teacher asked our class — eight couples, all having a boy — whether we planned to circumcise. Seven out of eight planned to cut. Paul and I were the sole dissenters.

The most popular reason was the belief that father and son should have matching parts. The teacher listened to this and then asked, in a sensible tone, "...And how much time did you spend naked with your father?"

"Enough," I asked Paul sotto voce, "or not enough?"

"None," Paul muttered repressively, "and therefore exactly enough."

So you see that father-son Garanimal tackle isn't really a priority for us.

The second most popular reason was the belief that an uncircumcised boy might be ridiculed during the inevitable locker room comparisons. This is apparently a sacred ritual, this adolescent scrutiny. What, you didn't know that teenage boys love to be caught staring at each other's kickstands in the shower? Just good clean schoolboy fun. In fact, I like to think of it as wholesome and stylized, perhaps something like a schoolwide spelldown — a penis bee, if you will.

I'm thinking that if Charlie's peers have to look that hard for a reason to make fun of him, he's probably doing okay.

Cited third were concerns about cleanliness. Of course this forced me to imagine my male classmates in varying stages of cloacal rot, and to conclude that they've never heard of that magical substance, rarer than ambergris, more precious than civet, more exotic than the frankinest of frankincense: soap.

In our house, we are clean people who happen to enjoy handling our genitals. I have no worries as far as hygiene goes.

So, really, none of the top three reasons seemed compelling to us. And while God seems quite avidly interested in what Jews and Muslims do in the dingus department, I've received no word on how pale and WASPy agnostics should handle the situation, though I have an intuitive certainty that whatever we're supposed to do surely involves liquor and a handwritten thank-you note on engraved stationery. Beyond that, God is either silent or passed out drunk after cocktails at the club, one.

Without any strong justification for doing it, then, we decided not to circumcise a boy long before Charlie was born. But until I actually became custodian of a newborn penis — like a regency, I guess, only more, you know, scrotal — I didn't feel particularly invested in the decision, an impartial arbiter on an issue that remained mostly theoretical.

Now things are different. I see the equipment in question. Friends, I am here to tell you: that-there is one tiny penis. You know how in Chinatown you can get your name carved into a grain of rice? It would be like that. You'd need a goddamn jeweler's loupe to perform the procedure. And the steady hands and steely nerve of a neurosurgeon. And nanobots. With lasers.

And, look, I know the baby who'd be affected. In his very short life, Charlie has experienced so much pain and fear that I can't imagine intentionally causing more without a damned good reason. Even if it's not especially painful for a newborn, as some assert, it would hurt me to subject him to a medical procedure that's ultimately cosmetic and elective. Really, we've had about enough.

And if my insurance company wouldn't spring for a lousy freakin' ambulance, I'm pretty sure they won't cover the nanobots, either. So Charlie remains uncut. If the boys in the locker room have a problem with that, they can take it up with me.

Why we are not in the car right now

When you give birth in a hospital under ordinary circumstances, you usually have the opportunity to room in with the baby during your stay so you can get used to taking care of him under the helpful supervision of the nurses. At this hospital, the baby stays in your hospital room in a convenient wheeled cart. (I assume this is so you can imperiously bark, "Whisk him away! Off with his fuzzy round head!" when you and he have a difference of opinion about just how much noise one tiny person should be allowed to make.)

When you have a child in the NICU, you don't have the same chance. But many NICUs, including this one, have made provisions for new parents who need that support. Here there's a parents' room within the unit, complete with full bath, Murphy bed, and an "occupied" sign on the door that everyone from the janitor up pointedly ignores. If anyone has been scarred for life by the sight of me laboring pendulously over the breast pump, they deserve what they get for not knocking before entry, and I do not apologize. You hear me, man-from-building-engineering-who-came-to-change-the-light-bulbs?! I do not apologize.

So Paul and I loaded the car, moved out of the hotel, and took over the parents' room on Saturday. Charlie's little cart was wheeled in with us. At last his monitors were disconnected and we became the thrilled and terrified caretakers of a wireless baby boy.

It was wonderful.

We woke, fed, and diapered Charlie on schedule. (The warning, "Never wake a sleeping baby," doesn't apply to premature babies — since their hunger doesn't reliably awaken them, you have to do it for them to be sure they don't miss a feeding.) We got up a thousand times when he gurgled to peer anxiously into his sleeping face. We watched him make comfortable sucking motions in his sleep. He did well. He slept and he ate and he grunted and squeaked, making very little fuss except during grievous indignity of a bath. In short, we were normal parents — I know what you're thinking, Tertia, you asshole, so wipe that smirk off your face right now, young lady — and he was a normal newborn.

Yesterday the nurse came in wheeling a monitor — or as my friend T. would say, wheeling in a PLOT DEVICE — just like the one he'd been attached to out in the main area. He should have been plugged in the whole time, the nurse explained, instead of being allowed to go without monitoring — hospital policy, since he was still, after all, a patient on the unit. So after several hours of being a cordless rechargeable baby, Charlie was plugged back in.

It is almost impossible not to watch a monitor when it's giving you feedback of that nature. But I was determined not to: Charlie was fine, breathing well, pink and well-oxygenated. I mostly ignored the screen; there's no need to watch the moment-by-moment numbers, especially since these monitors are equipped with enough alarms and flashing lights that you think you're in Las Vegas hitting the motherfucking jackpot when one of them detects an anomaly. The moment one goes off I start swiveling around on my stool looking for a leggy waitress to bring me a free but watery (but free!) drink.

Charlie's didn't go off, and hadn't in any meaningful way since December 24.

Last night, while I stayed with Charlie, Paul went back to the hotel, finished loading the car, checked out, picked up dinner, and filled up the car with gas. He got back in time for the 8 o'clock weighing and feeding, after which we tucked Charlie in and settled in for the night, Paul behind his dinner and I behind the breast pump.

And then the monitor alarm began to sound. Motherfucking jackpot.

The flashing indicator on the monitor went from "slowed heart rate" to "severe bradycardia" almost instantly. Bradycardia is a slowing of the heart rate, generally defined in premature babies as a rate of fewer than 80 beats per minute. Charlie's breathing had slowed dramatically and his heart rate had dropped. Paul jumped up and stimulated Charlie, which brought his heart rate and breathing back to normal very quickly. Charlie's heart rate is normally in the 130s and 140s; at his slowest, he was down to 58 beats per minute.

Bradys (and they are so endearing that they need an affectionate nickname) go hand in hand with apnea and are common in premature babies due to immature respiratory centers in the brain. They usually occur simply because of this immaturity, but can have other causes, too — scary things like illness, infection, and seizures, in addition to less alarming and transient causes like the strain of a bowel movement, or reflux, which Charlie has.

Bradys will also fuck up your plans but good. For the most part, a hospital won't discharge a premature baby until he's gone a certain number of days without any spells of apnea or bradycardia. There are exceptions, and then the baby will go home on a monitor. Charlie is not one of these exceptions. His episode last night reset the clock, buying him at least another five days in the hospital.

Once we'd spoken to the doctor, we said good night to Charlie, gathered our belongings from the parents' room, and retucked the Murphy bed back into its cabinet. We trudged out to the car carrying Charlie's car seat and the bag of clothes I'd packed for him to wear home. We came back to our hotel — where Paul had checked out only a couple of hours before — and moved back into the very same room, before it had even been cleaned.

Cats

Charlie got a cat when he was a few days old.

Because we were in limbo, in a hotel with few of our belongings around, we weren't able to furnish Charlie's isolette with any of the personal touches parents like to add — photos of home, a special blanket, a CD of favorite lullabyes. I'd read that premature babies shouldn't be stimulated too much, so I didn't worry that Charlie's plastic box wasn't very cozy. I was surprised one day to see that one of the nurses had taped up a picture of a dog, a black and white graphic, the kind infants are supposed to see earliest. She'd written on it in black marker, "Charlie's dog!"

The next time I saw the nurse, whose name was Carol, I thanked her. "Well, a boy needs a dog," she said in mock indignation.

I told her we had cats instead. The next time I went in after she'd taken care of Charlie, I saw she'd taped a new picture up on the other side of the isolette. It was a cat, in the same high contrast style, helpfully labeled, "Charlie's cat!"

I swear to God Charlie preferred to look at the cat. When he was put to sleep on his back, he'd turn his head toward the cat. When he was placed on his side facing the dog, he would inevitably end up on his back, head turned toward the cat. He'd look at it, eyes wide, brow furrowed, clearly seeing something.

Charlie liked that cat.

...

Because Charlie's lungs were in such bad shape, I worried about bringing him home to a house with pets in it. The preemie book I'd read, which I highly recommend but hope to God you'll never need, cautioned against it, citing possible irritation from dander and pet hair. I asked one of the neonatologists (which I can never pronounce, so I usually say "the wee tiny baby doctor" instead) about the cats: would it be safe for Charlie to be around them?

"Don't get rid of them!" he said in alarm. But I wasn't proposing to; I'd thought of something less drastic like having them shaved and dressing them in fetching little velour suits, perhaps with "JUICY" emblazoned across the ass, just above the tail-hole.

...

The cats spent the first couple of days avoiding the bedroom. They would creep in silently when Charlie was asleep, slinking low to the floor, ready to back away hastily at his first gurgle. The younger one, the one I fondly call Nutless, was brave enough to sit up on his haunches and peer through the mesh of Charlie's bed, but still chicken enough to flee, claws skidding spastically on the hardwood floor, when Charlie made a noise.

A few nights ago when everything was quiet, I was sitting in the den feeding Charlie. Nutless crept in, hopped warily onto the sofa, and advanced far enough to sniff the back of Charlie's fuzzy head.

Sniff.

Sniff sniff.

And then...

Lick lick lick lick.

Since then, the cats have been largely unconcerned by Charlie's presence. I can only conclude that Nutless tasted baby, and found him unobjectionable.

...

As we were leaving, one of the nurses saw me removing the dog and cat from Charlie's crib to take home as a souvenir. She brought over a new book of pictures, including the dog, the cat, and several abstract patterns, so I could show them to him at home. As soon as we'd settled Charlie in for his first nap at home, I pinned a new cat to the side of his bed.

He likes it very much.

Crybaby

I smile when Charlie cries.

He doesn't cry much. When we change his diaper and the cold air hits his bottom, he yowls. When we haven't anticipated his hunger in enough time to speedily deliver the goods, he grunts, frets, and makes little stuttery noises that make him sound like a tiny pissed-off sheep. When we bathe him, he sounds the alarm and people all over town anxiously scan the skies for a glimpse of the Luftwaffe, clutching their ration coupons in a white-knuckled fist as they file into the goddamn bomb shelters.

And I'm right there smiling.

When Charlie had his infection in the NICU, the sign the nurses noticed was that he wasn't protesting vigorously when they checked his vital signs — which were normal — or changed his diaper. "He's normally downright pissy about it," one of them told me later, "so I could tell he wasn't himself."

And indeed he was not. Charlie had sepsis, a blood infection caused by Enterobacter, a strain of bacteria that live in the intestine. The mortality rate among low birth weight infants infected with Gram-negative bacteria like Enterobacter is in the neighborhood of 36%.

Without a fever, without much else to go on, his decreased activity was the only real sign that he was ill. The NICU nurses are generally assigned to the babies they've worked with and know well, a practice called primary nursing. They knew Charlie normally yells, and noticed when he didn't. This knowledge of our son, the knowledge that he dislikes being inconvenienced and registers his displeasure accordingly, quite possibly saved his life.

The day before we left the hospital, the doctor who was treating Charlie during his infection stopped by to say goodbye. We reminisced a bit about the good times — "Hey, remember when you told us you didn't have a crystal ball?...Yeah. You remember. Fucker." Yes, we sighed with nostalgia over those golden moments, those halcyon days. And then he said to us, in a tone of some wonder, "You know, Charlie was really knocking on the pearly gates."

Knocking. On the fucking. Pearly gates.

I love to hear our baby cry. It fills me with relief and joy to know he's unhappy with his bottom exposed, to watch him wind up for a yell as I pour warm water over his naked chest, to hear his cranky lamb sounds as he "eh eh eh"s before his bottle. I'm grateful for every mutter, thrilled by every snit, because they're normal. He's normal. In these moments he is very much himself, and I am very much in love.

Even cow girls get the blues

Man, this guilt thing starts early.

I don't think any parent is immune, but mothers of premature babies have some fairly specific reasons for it. Some, for example, feel guilty because they fear they did something — cheating on bed rest, moving that heavy laundry basket — that brought about birth too soon. Others feel guilty because they don't immediately bond with that scrawny creature in the isolette who doesn't yet look like a baby. Still others feel guilty because they can't give their babies breast milk when they need it so very badly.

And others, selfish others, feel guilty because they don't want to.

Well, this other does, anyway.

I've been feeding Charlie expressed breast milk because he's yet to get the hang of getting it straight from the source. I pump at least seven times a day, hunched over a machine that makes a rhythmic wheeze as it pulls my nipples (normally the shy, retiring sort) into alarming purple torpedoes. When I'm not actively pumping, I'm guzzling water before or cleaning the pump parts after. I pump while I'm on the phone, and I pump while I'm online. In fact, I'm pumping right now while Paul feeds Charlie lunch.

Yes. While I am expressing milk, Paul is helping Charlie knock back the previous batch.

This does not seem especially efficient. It offends my sense of order, which is born out of a laziness so profound that it's a wonder my cells haven't hired a service to do the dividing for them. But more than that, it feels deeply fucked up to hand Paul the baby, the baby I'd been enjoying, saying, "Can you take him now? I have to go pump."

Can you take Charlie, whose head fuzz I've been dreamily rubbing with my cheek, so I can go do something I hate?

Plus, for me, pumping hurts. You know what they tell breastfeeding mothers who have sore nipples, fissures, infections? "Check the latch." You know what they tell pumping mothers, whose latch is robotically impeccable? "Huh. Weird. Well, it shouldn't hurt..."

Yeah. Hey! Thanks for the help!

My nipples hurt all the time. It's gone on for twenty-four hours a day for the last seven weeks. "Imagine, if you will," I said to Paul today, and described the situation to him with relish.

"I'd rather not," he said resentfully, "but now I can't help it."

Feel the love, people, feel the love.

So you'd think the desire to eliminate the middleman would motivate me to get Charlie established in breastfeeding. But I have to confess I'm not too eager to do that, either. Every time I put him to my breast it ends in screaming. He screams because he's frustrated and hungry, and I scream because while his mouth is refusing one nipple, the other is invariably being buffetted by some angrily flailing body part of his.

Besides the pain, I'm tired. I don't mean I'm physically tired, although I am, God, I am; I mean I'm weary in my soul. After everything that's happened, I am ready for something to be easy, a no-brainer, a gimme. Breastfeeding won't be, since Charlie apparently has a colorful assortment of mental blocks — either that, or he has inherited my laziness. (Note to self: next time consider donor eggs. Oh. Wait.)

Switching to formula? Now that would be easy. I think of it a thousand times a day, most wistfully when Paul is asleep between the midnight and 8 AM feedings, when I'm up to pump, feed Charlie, then pump again. Yesterday Paul said, "I wish I could do more to help." Yet he balked when I made a simple suggestion. Suuuure, he wants to help.

I can't give up, though — not yet, and probably not soon. How can I? I understand the importance of breast milk for any baby, and I know it's even more advantageous to premature babies who need an extra boost when it comes to immunities and brain development. If Charlie hadn't had such a shaky start, if he'd been full term, if my milk supply were no longer equal to his needs, I might feel differently. But given the circumstances, I believe if I can give him milk, I should. And I can. So at least for now, I will.

Parts of me don't want to (specifically, my freakishly distended nipples). But pumping won't kill me. Neither will being patient while Charlie learns. I can tell myself I'm doing it for him, and I am, but I'm also doing it for me: I can't subject myself to the guilt of not doing it. The guilt of not wanting to is bad enough.

Snot-nosed brat

I am the worst mother ever and here is why.

You know how people go on about how sweet a new baby smells, how satiny-smooth their pink cheeks are, how adorable their clean little outfits are? Not my baby.

Right now Charlie is tucked snugly into his co-sleeper, wearing a damp sleeper with spit-up on its feet, lying under a blanket stained with vitamin drops, on a sheet that's splattered with coffee stains. (Mine, not his. He's more careful with his sippy cup than his clumsy and bleary-eyed mom. And, no, I did not spill it in his bed while he was in it, so if you were picking up the phone to dial child protective services you can hang it right back up, yo.)

He has a crusty line of dried milk in the crease between his lower lip and his chin, and I would bet good money his diaper was full before I put him down to sleep. He is filthy, our boy, but will not have a bath today. My baby kind of smells.

Worst. Mother. Ever.

You would think that someone who worked so hard to have a baby would take better care of the one she finally got. People who have children after infertility are often regarded, at least by themselves, as more concerned, more attentive, and more appreciative parents than those who conceived without heroic measures. So you'd think I'd at least be after him with a wipe every now and then.

But I am finding the parenting strategy that works best for me is this: If it's not bugging him, it's not bugging me. The collar of his suit may be sodden with milk, but if it's not touching his skin and causing irritation, it's more trouble than it's worth to change it. He may have just mustered a diaperload so massive it's awaiting designation as a Superfund site, but if he's nodding off to sleep I'll be damned if I'll wake him up to change it. He may carry the whiff of sour milk and baby shit, but if it doesn't stop me from burying my nose in his neck — and it doesn't — I'll attack that soft, smelly flesh with kisses instead of a washcloth. If it's not bugging him, it's not bugging me. (Dressing him in a pink suit yesterday, however, did seem to bother him, so I will regretfully be returning the tutu that I got on crazy mega-sale.)

It's more important to me that he be tranquil than that he be pristine. When a bath still makes him squawk, he need not have one every day. When a diaper change wakes him up from a milky stupor and makes him yowl, he can go a few hours without one. I like him clean, freaked out and damp after a bath, but I like him peaceful more.

And we get along well this way. Look, he doesn't complain about my unwashed hair, my lanolin-stained bra worn at saggy half-mast, my chipping pedicure, my rank flannel bathrobe — we'd rather be peaceful, Charlie and I, in these first disordered days.

I am setting a terrible example, adopting a dangerous pattern, no doubt. Today it's spit-up on his feet. Tomorrow it's a river of drool. Next, a runny nose that he's forever wiping on the sleeve of his grubby T-shirt. Beyond, who knows? Spinach in his teeth? Scotch tape repairs on his aviator glasses? Halitosis so staggering it makes people think he's been snacking at an all-you-can-eat gala buffet of corpses? I am afraid my kid is destined to be one of those unkempt Kool-Aid-stained children who make neater parents shake their heads and cluck in pity. At the moment, I simply don't care.

So in that way I'm a bad mother, probably. My baby is occasionally smelly. Together we scare the bejesus out of the UPS man when he's foolhardy enough to ring. And we're happy. Dirty, peaceful, and happy.

And they say there's no health care crisis in America

RSV — respiratory syncitial virus — is the most common respiratory virus in babies and young children. It's highly contagious; virtually all children get it before age 2. Most of the time, it causes an illness no more serious than the garden variety cold, but in premature babies, it can be life-threatening. 125,000 kids are hospitalized yearly with RSV, put on ventilators, returned to an ICU. And about 2500 infants die yearly from it.

There's no vaccine for RSV, but there is a drug that can keep the illness from becoming so severe if a baby contracts it. It's called Synagis, and it's given every 28 days during RSV season to babies who meet certain criteria — premature birth, chronic lung disease, or both.

It also costs the motherfucking earth.

The dose is calculated by weight, so the cost increases monthly. The total cost of Synagis during a single RSV season can exceed $6000 per child.

Charlie's first dose was administered in the hospital in Connecticut. His second was delivered to our house to be given by a visiting nurse. The dispensing pharmacy called a few days before shipping to let us know the package was on its way, and to alert us that our insurance company was agreeing to pay only 40% of the cost for the injection.

There must be some mistake, I thought. It's a prescription drug, just like any other, covered with a reasonable co-pay. Someone's made a mistake.

Ah, but after several phone calls we have determined that there was no mistake at all. Charlie's Synagis — a drug so effective that his doctor said, "I can't tell you how many lives it's saved" — is covered on the same schedule as drugs that enhance erection.

Imagine my delight.

It turns out that there's a bit of controversy surrounding Synagis. While it's been proven to be remarkably potent against RSV, it's not thought to be cost-effective as a prophylaxis.

Follow me? It is cheaper to hospitalize a kid when he's sick than it is to prevent the illness to begin with. So the insurance company's taking its chances. Taking its chances with my kid's health.

I know this is what insurance companies do. I know they're a business. I know each company must minimize its own risk to maximize its profit. And I think it's fucking unconscionable.

Look, we're lucky. I know that. No matter what, Charlie will get his shots. We can afford to make up the difference in cost. And even if we couldn't, we'd have to find a way. We're parents who love a child, a flesh and blood being, after all, not a corporation that answers only to its shareholders.

And to think I was miffed when the company wouldn't pay for fertility treatment.

WWM throwdown

Tertia claims she's the world's worst mother. But the crown is not uncontested: I contend that I, too, am in the running. See, I'm so bad at keeping Charlie's nails from turning into razor-sharp talons that the poor kid looks like he was in a goddamn bar fight from scratching his own face. I am imagining a gang of pissed-off babies whacking their bottles against the edge of the bar to make a jagged edge for menacing their tiny enemies. I am fashioning a teeny bandana for him in his gang's colors, in fact.

I haven't the heart to tell him that tiny ducks scattered on a background of butter yellow won't exactly strike mortal terror into the hearts of his arch-rivals.

I clip his nails frequently, but always forget to use a junior-sized emery board to round off the sharp corners. Even so, at ten weeks old — ten weeks old tomorrow! — he has a nicer-looking manicure than I do. We will not talk about the haircut I was due to have two days after his birth and never rescheduled, or the lizardy dry patches of skin I can't be bothered to moisturize, or the appalling state of my toenails, pedicured five days postpartum and neglected ever since. (Talk about razor-sharp talons, to say nothing of the giant flakes of Essie's Scarlett O'Hara that trail behind me everytime I go barefoot.) I shower every day, but until I do, I shuffle around the house in a saggy plaid bathrobe and a lanolin-stained nursing bra pulled up over my breasts but not fastened, with my scaly, hairy legs as awkwardly naked as if I were poultry.

So not only does my infant son bear more picturesque facial scarring than a Barbary corsair, I have officially let myself go. Not only am I negligent, I'm ugly to boot. Top that, Tertia, you asshole.

It happened one night

Usually Paul tends Charlie around midnight. I take the 4 AM feeding because I need to be up to pump anyway. This generally allows each of us to get a short stretch of unbroken sleep, although it's imperfect; pumping every two to three hours plays hell with a girl's slumber. I'm philosophical about that, since I know that if Charlie were nursing I'd be up then, anyway.

I say "usually" and "generally" because we've been known to switch off when one of us needs to crash. Last night Paul was in dire straits, so I volunteered to be on duty all night.

I started feeding Charlie at 10:30, confident that he'd be finished and sleeping peacefully by the time I needed to pump at 11:30. Somewhere along the line, though, he started getting pissy. He'd suck on his bottle, but a few pulls in he'd start arching back, making a terribly angry face, and screaming. After a few rounds of this, I concluded that he wanted to suck but had a full stomach, so I put his pacifier in his mouth. He'd suck on that for a while, then repeat the same routine of angry contortions. I tried to pretend we were playing a game of charades at a sophisticated '30s house party, but he remained unamused by my guesses: swaddling? No. Rocking? No. Jiggling? No. Swing? No. Shushing loudly into his ear to drown out his angry yowls? No, and quit that, goddamn it.

Inconsolaboy.

Nothing was working, so as a last-ditch effort I shucked off what little clothing I was wearing and put him to breast, sans nipple shield, sans ceremony. I thought he might find some comfort noodling around with my nipple, smelling my scent. (Because the fenugreek has apparently infiltrated my every gland, I smell like the unwashed nether folds of Mrs. Butterworth, thanks for asking.)

My friends, he nursed like a motherfucking champ.

He latched. He sucked. He gulped and swallowed and practically chewed with his mouth open and drank the contents of his finger bowl. When I switched him to the other breast once he'd seemed to slow down, he took to it like, um, like a mammal to milk.

That boy can nurse.

However, since I'd managed to get in some pumping while he howled unhappily in the swing, I knew my breasts weren't full, so when he dropped off my breast a while later and still looked hungry, I investigated the bottle I'd been trying to give him when our peaceful mealtime went to hell. I thought maybe the milk had gone sour, so — I can't believe I did this, much less that I am confessing it — I put the nipple in my mouth and gave it an experimental suck.

Nothing happened. No milk, though the bottle was half full.

A few more sucks and...something...worked its way free. The holes in the nipple had been blocked, and all of Charlie's formidable sucking power could not dislodge that...something.

My boy was yelling, and my boy nursed at last because he was practically starving.

We finally slept, with Charlie dropping off exhausted and me eventually drifting off after making grand plans to sweep into the lactation consultant's office, Charlie nursing contentedly in his sling, modestly declaring that it was really nothing, after all. Just a little patience was all it took! (It goes without saying that in my vision, I was svelte, Charlie was cherubic, and the sling had an impeccable cut, making me look fashionable and maternal all at once.)

This morning I pumped a bit first to get my letdown going, and put him to breast again, eager to hold the ground we'd gained last night.

And he would have none of it.

None.

He screamed. He wailed. He would not latch. He would not suck. He hated my breasts again, or still.

I'm fucked. As long as I lactate, I hope. As long as I hope, I'll try. And as long as I try, I suspect he will scream. I am fucked, my friends. Just fucked.

Next time I'm sticking with 160-Pound Tumor

The problem with TiVo is that it makes it impossible to claim, "I was just flipping past, and I happened to see..." No, I explicitly requested the Discovery Health program, Babies: Special Delivery, the episode slugged, "Crisis Mode: Pre-eclampsia at 31 weeks." (It is irrelevant but interesting to note that the same channel offers such edifying fare as 160-Pound Tumor and 14 Kids and Pregnant Again! — exclamation point theirs, not mine.)

A pregnant woman with chronic hypertension is admitted to the hospital when her blood pressure spikes and she begins to spill protein into her urine. Her condition is worsening, so the delivery cannot be postponed, and in short order she gives birth to a baby boy weighing 3 pounds 14 ounces at 31 weeks. The baby shows immediate signs of respiratory distress syndrome. He does not respond well to the first course of surfactant.

Now, um, why did I think it was a good idea to watch this?

I watched it as I cradled Charlie against my chest, rubbing my cheek against his fuzzy head while he slept. I kept thinking, I could have lost you. I could have lost you. That's when I wasn't thinking, Good Christ, she's bloated.

...

I got e-mail a couple of weeks ago from a woman who also had HELLP syndrome. She wrote,

I'm having a really hard time coming to grips with what happened, and what COULD have happened.  I could have lost my baby.  I could have lost my life.  I could have lost my life AND my baby's life.  I could have left my older child without a mother, and my husband without a wife. My older child probably would never have remembered me.  I think about that a lot.

I've had three doctors tell me now that I shouldn't have any more children.  It's hard to hear that I can't have more children if I wished to try again.

I'm wondering how you dealt with your HELLP. Did you have a hard time coming to terms with it and has it gotten better as time has gone on?

I'm astonished to say this, but I hardly think about it at all.

When I was discharged from the hospital, leaving Charlie behind for the night as we'd do for the next forty days, it was almost impossible to believe it had happened. I couldn't grasp the enormity of it at the time — the fact that I'd gone in pregnant, come out not, not far from death but now quite well, a scant fast four days later.

I had a lot of time to think about it over the next six weeks, especially as Charlie's condition changed from day to day. And yet I rarely did. I thought about him, of course, all the time, and I occasionally resented the slow pace of my recuperation from surgery as I regained my stamina, but I didn't dwell on the danger I'd been in myself.

When Paul and I talked about those first few frightening days — and we did, a lot, at my obsessive insistence — I learned that he'd been scared for me. Strange; I never was. When my abdominal pain was at its most severe, I knew I was ill but was sure that it couldn't be serious. And when the obstetrician on call told me they needed to deliver the baby, I was certain it was on Charlie's behalf; it didn't occur to me at the time that it was necessary for my safety.

Behold the awesome power of denial.

I can't really account for any of this because, hey, I'm as self-absorbed as the next person. (Okay, I'm as self-absorbed as the next ten people.) All I can conclude is that my mind was full of Charlie. I had to think of someone else. I had to keep moving.

Even now that things have settled down and Charlie and I are perfectly well, I can't really accept it, can't honestly confront how sick I was. Did I have a hard time coming to terms with having had HELLP, with having been so desperately ill? You tell me.

Is it hard to hear that I shouldn't have more children? If I'd been asked this while Charlie was still in intensive care, I'd have said no — in fact, I did. Now my answer's different. Now I have a newborn, and I feel a pleasure close to intoxication as I watch him change from day to day, on the cusp of new awareness with every single blink. I can say now with conviction that I want another baby, and I'm sorry I won't be having one.

...

It could be much worse. I'm here and well and so is Charlie, and that should truly be enough. Beyond that, I could have been the patient I mentioned before, the one on the show who delivered at 31 weeks; her son was on a ventilator for 20 days. I could have been another patient on the same show who extruded a second set of spontaneous twins through her artfully pixellated vagina. (Tertia, take note: two sets of twins at home. Two. You piker.) Or I could have been still another patient, one who had a severely abscessed tooth, requiring delivery before she went septic — the camera zoomed in on her mouth, and as God is my witness I swear to you I'd rather be barren than have a luminescent throbbing oral pus-pocket like hers.

Congratulations

When Charlie was born, everyone in my family said, "Congratulations!"

No one said, "You must have been really sick," or "What a scary time for you," or "Is he going to be okay?" No one acknowledged the seriousness of the situation. Now, it is a thoroughly documented fact that in my family we don't talk about unpleasant things, so it wasn't a surprise, but it added to the unreality of the experience to be warmly congratulated on the dramatically early arrival of a baby who might not make it.

A few weeks after Charlie's birth, I told my friend T. with some indignation that a well loved relative on Paul's side "didn't even call to say congratulations." T. said, "You know, it's funny — when Paul called to tell me about it, it didn't even occur to me to congratulate you. I thought to say, 'What can I do to help?' and 'Is Julie okay?' but 'Congratulations!' was the farthest thing from my mind."

No one said the right thing because there is no one right thing to say. If I was confused about my own feelings — and I was, and still am — and if even I didn't know what I needed to hear, I couldn't hold it against the people who care for me when they were unable to voice precisely the right combination of validation and optimism. You can't really expect people to blurt, "I'm worried about you. I'm worried about your baby. I'm shocked and sad at how it came about. I'm apprehensive about what the future might hold. But amid all this I feel a thrill of joy to think you have a baby at last. Hang in. I'm here for you."

Kind of a mouthful, really.

It's this same complexity of emotion that sometimes makes it hard for infertile women to accept congratulations when they're pregnant at last. The knowledge that that positive pregnancy test could eventually bring anything from joy to desolation is tough to reconcile. It's what makes us say, "Well, we're cautiously optimistic" when we're twenty weeks along, or tack on, "...if everything goes okay, fingers crossed," when strangers wish us well.

Charlie's twelve weeks old. I've reached my goal of pumping until we'd reached that milestone. Coincidentally, today we are using the very last of the frozen milk I'd stockpiled while he was in the hospital. I'm tremendously ambivalent about both the prospect of stopping and the possibility of continuing. I've done right by him so far, and I'm proud of that. Now as I enter uncharted territory — the place where I have no concrete goal and assume a "one day at a time" approach — I don't know what I need to hear. I don't know if I need encouragement to continue or reassurance that I can stop. I'm not sure what would make me feel good. I don't think there's any one right thing to say, when my feelings are so complex and often contradictory.

But I think "congratulations" would be a good start.

: )

I had a rare and pleasant conversation with Tertia yesterday. Unusually, we were each able to type with both hands instead of conversing in the kind of abbreviations Prince would use if he ever had cause to refer to lactation — "u pumpn rt now? know how u luv it." "i h8 2 pump, a-hole." "hor." "anus." "shut ^." "no U shut ^!" Et cetera.

I could type with both hands because Paul was taking care of Charlie. She could type with both hands because she'd sent Adam out for a pack of smokes or something. I told her how hard the early morning had been. I believe I referred to my well-loved small son as an asshole.

Yeah, he was that bad.

I told her that his reflux has been especially acute lately, and that during feedings he cries and arches away in pain, making it very difficult for him to eat even though he's ravenously hungry. I told her that he'd screamed for much of the night, wanting to feed but hurting when he tried. I described the way I'd felt, that night would never end. I repeated what I'd crooned to Charlie in soothing, motherly tones, directly into his shell-pink ear: "Whaaaaat. The fuuuuuuck. Is wrong, my boy?" I told her why I had finally snapped and gone to wake Paul — it happened while I was changing a terrible diaper. I'd carefully moved his clothes out of the way so they wouldn't get smeared, and was holding his tiny ankles in an iron claw to keep his feet from kicking against his poo-slick bottom as I went through wipe after sullied wipe. I was so careful, and was doing brilliantly, until the little asshole — yes, I said asshole — decided it was time to pee, drenching the footie sleeper and onesie I'd tried so hard to protect, and my nightshirt that he'd already spoiled several spit-ups ago.

"Did you spank him?" Tertia wanted to know.

"Well, his pants were conveniently down at the time..." I admitted.

That's when I went to get Paul.

...

Watching Charlie struggle with reflux makes me feel better about not nursing.

Every time I put him to breast, he'd end up screaming and wriggling away. I took it hard, feeling that if only I'd built a better milk supply, or put him to breast more often, or taken the time to shave my armpits, or had a nice-looking rack like Ashley Judd instead of the terrifying mammarian shelf that threatened to overwhelm his fuzzy little head...if only I'd done something different.

I felt better once I'd given up trying. I felt better about pumping, too, easy in my mind that by not trying yet again, I wasn't missing out on some idyllic interlude — Their eyes met across a crowded bra — but instead was avoiding yet another painful confrontation. And lately, I'm feeling even better: watching him struggle against the bottle makes it clear that it's his own body he's fighting, not me.

...

It's hard taking care of a newborn under the best of circumstances. In many ways, we have those best circumstances: Paul and I are both around most of the time, since we work at home. We can switch off when one of us has had enough; we can nap during the day as the situation permits. And we love Charlie deeply, always aware of how fortunate we are that he's here and he's healthy. That knowledge makes it easy to be patient most of the time. Most of the time. But it's still very hard. It's relentless.

In other ways, we have the worst of circumstances. The parents of a typical newborn face the same challenges, the lack of sleep, the constant demands, the arc of pee in the dark of night. But one day they wake up after yet another night of broken sleep, and their baby smiles at them. Here we are still waiting.

By all outward appearances, Charlie doesn't like things yet. Parents I know will say things like, "Oh, she loves her bath!" or "He's so happy in his bouncy seat." Paul and I say things like, "Hey, he doesn't scream as much when you change his diaper now." He doesn't like; he tolerates. At worst, he hates things; at best, he seems fairly neutral.

Charlie doesn't smile. And of course he will. But so far, Paul and I have been enduring the difficult parts of being a parent without the payoff. Parents of full-term babies endure maybe six weeks or so of toil before they get the feedback and the feelgoods of a big gummy grin. At this point I am desperate for there to be something that obviously gives him pleasure — I need to know from him that we're doing something right.

We're coming up on fourteen weeks, and I sure could use a smile.

Reflux redux

Last night was a bad night. There was an awful lot of crying: uncontrolled sobbing, ear-splitting wailing, inconsolable heaving, and a long stream of crystalline snot quivering from the tip of a gem of a nose.

And when I woke up today, boy, were my eyes swollen and bloodshot.

Charlie has been having a rough time with reflux. He left the NICU armed with Zantac; we adjusted the dosage upward as he grew. After a while, he reached the maximum dose, at which point the medication lost its efficacy. A pediatric gastroenterologist switched him to Prevacid, which initially helped and made us almost comically optimistic: one day of two-hour naps and we were sure we had this thing licked.

Not so fucking fast.

Last night Charlie was in pain once again as the acid rose from his stomach up into his esophagus, causing a burning feeling bad enough to make him scream as he tried to drink. He'd shriek, arch his entire body away from the bottle, and twist his neck as far to the side as it would go, emphatically rejecting his milk. Yet because he was ravenous, once the worst of the burn had subsided he'd cry out of hunger. As he screamed, he'd stiffen; there was simply no cuddling him into comfort, not that there ever has been.

It'll get to you after a while. Let's leave aside the knowledge that your helpless baby is in pain and there's nothing that makes him feel better, because that's just plain unspeakable. Instead let's consider the relentlessness of it, the screaming at every feed, the feeling that there's no end in sight: "Reflux usually clears up before the baby is a year old," the books cheerfully promise, not all that reassuring when the baby in question is a mere five weeks adjusted.

Or how about the way it disturbs a baby's sleep, with the pain yanking him from a sound slumber into an abrupt howling cry? Mind you, we don't expect much to begin with, especially considering the following passage from Preemies: The Essential Guide for Parents of Premature Babies:

Sleeping. Healthy premature babies are expected to wake up and fuss about every two hours until they're three to four months corrected age. (A long time, if you ask us!) By about six to eight months corrected age, they will have settled into longer periods of sleep, to everybody's understandable relief.

So let's discount that and focus on the sad possibility that even when Charlie might reasonably be expected to settle down for longer than two hours at a stretch — a possibility that seems fairly distant — he could still be jerked back into agonized consciousness by a simple ill-timed gurgle.

Or we could talk about how beaten I feel when I see his face redden just as he starts to scream. How angry and how cheated, when I remember the hopes I'd had that we might be granted an infancy that was only ordinarily hellish. How endless it seems, this just another twist that stops me from enjoying a pregnancy, a birth, and a babyhood that will only come once.

It'll get to you after a while. After a while, it's all too fucking much.

Last night I cried and cried. I was agitated and upset about everything I've just said, but it was the most absurd thought that finally brought the tears: Charlie doesn't like me.

It's absurd because I understand that for infants his age, liking isn't at issue. Infants his age need and recognize and bond; liking doesn't enter into it. Inasmuch as he can love, I suppose he does, but that blind devotion driven by hunger and a desire for warmth is a far cry from a smile, a face lighting up when I enter the room, a small body relaxing into mine with a sigh of contentment.

As crazy as my thought was, there's a kernel of disturbing truth to it, and that truth is that I'm finding it hard to bond with him at this stage. When he rejects every comfort I try to give him, it's difficult not to be discouraged. When I stay still as he sleeps because I dread waking him rather than because I'm relishing his weight on my chest, it's almost impossible not to feel disgusted with myself. At the moment I'm seeing each day and each feeding and each ten-minute nap as something to be gotten through rather than something to look forward to, and it's deeply distressing to acknowledge that.

Charlie doesn't like me yet. I know he surely will, but every day of screaming makes it harder to believe.

WWM: Woman wastes medication

Ladies and gentlemen, we have another entry in the World's Worst Mother contest!

The Prevacid we give Charlie comes in what they call solutabs — tablets that are supposed to dissolve instantly on the tongue. Because an infant can't be trusted to wait compliantly while producing the necessary tide of saliva, we're supposed to dissolve the tablet in water, then give the whole watery mess to Charlie by bottle or dropper.

When the tab is dissolved, most of it disintegrates, leaving the water spiked with what I am told is a delectable strawberry sweetness. The active ingredients remain visible, tiny orange beads that sink to the bottom of the mixing vessel. It is those we must get into Charlie.

So we use the medicine dropper, carefully positioning it to suck up as many beads as possible with as little water ditto. We hold the dropper vertically, waiting for the beads to sink down to the business end, and insinuate said business end into Charlie's mouth, which he has obligingly opened like a hungry baby bird. He sucks on the dropper, we squeeze the bulb, and the medicine is gradually introduced into his mouth and thereafter his gullet.

With me so far?

Today Paul took apart the dropper to wash it thoroughly. I usually just give the open end a wash in hot water; he, more fastidious, removed the bulb. And what do you think he found?

An orange muck of medicine beads, beads Charlie should have gotten, left instead in the dropper.

If you incline the dropper while it's full — say, to keep it from dripping out while you wait for the ravenous baby bird to open his tiny pink maw — the medicine runs into the bulb..and does not run out again.

Our baby was hurting because I'd held the dropper wrong.

World's. Worst. Mother. Winnah and champeen!

I may be some time

When I feel I'm failing — and I do, all the time, in a thousand different ways — I don't worry I'm shortchanging Charlie. It's Paul who gets the shaft, over and over again.

When I'm napping alongside Charlie and get jerked awake by his sudden cries, I call down the stairs to Paul, "Can you come take him, please?" so that I can get more sleep. "Sure," he says invariably, ready and goodnatured. Later I go down to the kitchen and find Paul's dinner halfway made, abandoned when he came to take the baby.

When it's time to pump, I come into my office, shut the door, and sit at my desk. I pump for twenty minutes, then relax in my chair for another fifteen. When Charlie's being captivating, I push the pumping off for a while, eager to spend more time with him. When he's howling, I claim asylum, leaving the screaming baby with Paul while I retreat to my quiet room. I don't think Paul has checked his e-mail in the last seventeen weeks — seventeen weeks today — but I regularly have time to visit blogs, make my own posts, and chat with friends.

Sometimes at night when Charlie begins to make fretful peeping sounds, I lie beside him and will him to go back to sleep, hoping for just a few more minutes of peace. Of course he does not, but I let his noises escalate until there's no ignoring them, which is usually long enough for them to wake Paul as well.

Now and then when Charlie's having a rough night, I sit in the den with him patting him as he cries. Sometimes Paul wakes, despite the distance between our bedroom and the den, and comes to see if there's anything he can do. I know in his place I would lie in bed and hope that the crying will stop.

At least I don't tell him yes, there is something he can do: Will you take the baby for two seconds? I am just going outside. I may be some time.

I always tell him to go back to bed. But before you take that as proof that I'm not as unfair to him as I might be, consider this: why don't I ever close the two doors between bedroom and den before the baby howls?

No one ever said on her deathbed, "I wish I'd spent more time with my tit in a plastic cone."

This is not my last pump, but it's close.

Over the last couple of weeks I've dropped the domperidone and have gradually increased the time between sessions, thereby reducing the number of pumps in a day little by little. I'm down to two.

It's almost the end of the line. My supply has been dwindling noticeably and drastically. It's never been plentiful; I topped out at around 24 ounces a day. After fourteen hours without pumping, last night I pulled an ounce and a half. I'm not sure I need to today, but I will because it feels too strange not to. If the yield's like last night's, the milk will be thin, mostly just water and useless.

I am deeply ambivalent about stopping, as much as I was about continuing. I can accept the various risks associated with discontinuing breast milk, mostly. The single place I get stuck? Antibodies. Before Charlie's six months adjusted, he's not making many of his own. Now, I can tell myself that we'll limit his exposure by keeping him away from crowds and sick people, something easily done where we live. I can pretend that because he wasn't especially sick in the NICU, he won't be in the same kind of jeopardy that other preemies might if he were to come down with an illness. I can give him bottle after bottle of the milk I've frozen, knowing that although it's not as rich in infection-fighting properties as fresh, it's better than nothing.

But it's all just rationalization, and not especially effective at that. The bottom line is that I'm willingly giving up, intentionally cutting Charlie off from something he probably needs.

For me, pumping is an inconvenience and not an impossibility: because Paul works at home and happily takes on child care, I'm able to find time to do it. My desire to stop is simple selfishness — not because it's been a rough eighteen weeks, although i