A Fond Farewell

To my co-workers at Plano 911:

I vowed to myself and everyone around me all night long that I wouldn’t send “the final email.” I lied. Whether it be the gift basket and nummy food or the outpouring of support, I find myself surrendering to sentimentality.

While I’m sad to be leaving Plano 911, it couldn’t be for two better reasons. I want to extend a huge thank you to everyone who has helped me and worked alongside me these 12 years, though many have moved on as well in that time.  I’m so proud of what we all accomplish as a team on the floor and on staff, and will leave with many fond memories. I hope to someday work on a team as capable, dedicated, and innovative as Samantha Baumgartner and Sheila Powell again. I’m proud to have worked with so many amazing people, who labor in obscurity in a basement and no one they serve will ever really see or appreciate the sheer difficulty of what they do.  We are very tough on ourselves and regimented and push hard to be better. And I’ve seen enough of other agencies by now to realize that even if we aren’t perfect, it makes us among the best in the country at what we do.

Working at Plano 911 has made me a stronger and smarter person in so many ways, through experience and training you just can’t get in any other profession and even at any other agency. I am a lot tougher of a gal than the nervous young woman that started here in 2001. I am a better person.

I’m not sure if many other workplaces would have given me the encouragement and understanding Plano PSC has. I thank everyone for that support. I’d like in particular to thank Susan Carr, who helped make it possible to take the opportunity back in September of 2011 and has offered continual support along the way. Had I not worked here, I don’t know if I would have endured the trials that these past 5 months as well as I have.

But something I do know is that my daughter would not be alive if I hadn’t worked here.

The day I gave her CPR will be forever in my mind. It was like I was outside of myself watching,  calmer than I think would be possible in that situation for anyone who hasn’t been on the other end of a 911 call for so many years. I knew her breathing was agonal the second I saw and heard it. I’d been watching her breathing religiously for  months, and there was very obviously no air moving. That meant I had to act because there were minutes left, and the paramedics would be there too late if I didn’t do something. I knew that because her 20 second apnea alarm had never gone off that there was still oxygen in her blood and so I started with compressions first. I remember thinking how she seemed so much like one of those plastic dolls I’ve practiced on over the years, just as limp but heavier.

I told my mother to call 911 and put it on speaker, double verifying my address and phone number then stating “baby not breathing” and answering the EMD questions in order and telling the poor Carrollton Calltaker to go to card 9 and protocol A. I was careful to speak slowly and clearly despite the urgency of the situation. She was a little stupefied, but she recovered well and coached me through the rest and converted me over to ventilations and compressions.  I was grateful she was there for me, and promised myself if we made it through this I would thank her personally and introduce her to my daughter.

I made sure her head was tilted back, covered her mouth and nose with my mouth, and blew the two puffs of air in and saw her chest rise and deflate. I made sure I didn’t waste time switching back and forth between compressions and ventilations.  I made sure to press down far enough and come all the way up between pumps. I told the Calltaker to use the compressions monitor, but I was already singing the “Staying Alive” song in my head so I already knew I was going fast enough.

I knew even in the moment I was doing everything right, but I also knew that in 12 years I’ve never had a documented life save that we know of because CPR so often is not enough. I remember having the “it’s not working!” reaction I used to teach about in ETC class, then consciously realize I was having it and continued CPR telling myself “this is helping her even if I don’t see a response.” But the truth is as much as I didn’t want it to be, I really thought it was the end. But 5-7 minutes later the paramedics arrived and laid her on the bed and told me she had a pulse of 120. Then I thought there was a chance after all.  The first few hours it looked grim, but then the most talented doctor I’ve ever met threw a hail Mary treatment at her and it began to work. For the week after that, she clung to life on a ventilator in one of the best NICU’s in the country and they could have lost her at any moment. But now three months later she is alive and recovered. Within a year the health problems from her prematurity that led up to that awful day should resolve completely. And the Calltaker that took that call has no idea that she even lived, and went on to the next phone call. Just like Georjon did a few minutes ago, and Jenn S. may have saved a guy a little while before that. All in just one regular night at Plano 911. There is a whole other end to that story that they’ll never know, so we all just move on and will never realize the true impact we have each had on so many lives.

The one time I have a known life save…it’s my own daughter. It’s like every 911 call I’ve ever taken was a rehearsal for the most important and terrifying moment of my life. The paramedics played a critical role, as did the responding officers and of course all the hospital staff. But 911 is the true first responder that all the rest of them depend on.

This job is like no other. What we do is important and changes and saves lives. It is  interesting and scary and fun and exciting and boring and annoying all at the same time. PD and NCIC and FD and Calltaking are all valuable and challenging in their own way. But I’m only going to leave you one bit of advice.

Nothing we do is more life critical than being an Emergency Medical Dispatcher. So even if you don’t always like that part of your job, keep your skills up and be a damn good one.

I hope to never be a stranger.

Pros and Cons and Myths about Surrogacy in India

So this afternoon I get a call from CBS News, who are working on a news story about surrogacy in India. As expected, they are fishing for stuff that could go wrong, though I guess if they didn't it wouldn't be a news story. So they went surfing the net and sure enough they found folks like me, though with everything that went wrong I still consider us a case gone right. 

I worry because I have seen so many poorly researched news stories that sensationalize a few well known problem situations or clinics without telling the whole story and being balanced. Recent isolated cases of DNA tests not matching the intended parents are indeed very concerning, but still isolated and could conceivably happen in other countries as well. Some other "gone wrong" cases have more to do with a couple going to a clinic without making sure they were established and well reputed, or not being careful about legal conflicts (and the laws of the home country were the problem instead of India to my recollection). I don't think rare and extreme examples should be the basis of a decision like this. You can find a horror story about any potential infertility solution, so take them with a grain of salt and use reasonable precautions. Nothing is guaranteed, especially when it comes to infertility.

While India could use some better regulation on surrogacy, I hope they never become over-regulated to the point places like England are where it becomes nigh on impossible to do surrogacy. See: http://oneinsix.com/  I find that the biggest roadblock to surrogacy is not only the cost, but the lack of legal recognition that it is a legitimate path to parenthood in so called "developed" countries. India was our land of opportunity partly because the regulations were not overbearing.

There are plenty of pros and cons to any solution to infertility, and surrogacy in India surely as any has a unique set. I hope that my blog and online presence has helped to educate others in their decisions. But the bottom line: I would do it all over again and recommend it to others. But you must DO YOUR RESEARCH and prepare yourself. Above all find a reputable clinic. Clinics and surrogates have been deceptive and taken advantage in many countries, and regulation can't always keep you safe. Be prepared for what could go wrong. But also be prepared to finally have your dream come true and become a parent 9 months later! (Our in our case 6 months!) I will try to give a brief summary, insomuch as someone like me can ever be brief!

Pros:
1. The baby: You could finally become a parent! Finally having a child outweighs all the other pros by a mile, but you can't let it cloud your decision so that you don't do proper research and preparation or examine other reasonable/affordable alternatives for your unique situation.
2. The cost: A lot closer to $30K than the $100K+ you would pay in America. It takes 2.5 tries on average before successful implantation, so the cost for attempts is something to take into consideration.
3. The chances of success: If you are looking into surrogacy in India, you have likely looked at and tried other options but they have either failed, have low odds of success, or have cons that you are uncomfortable with. A proven gestational carrier combined with modern fertility medicine and the best prenatal care give you odds of success that other options may not have offered you. You could have equal chances of success for surrogacy elsewhere, so likely you are looking to India for the cost.
4. The betterment of many lives: The impact you will have on the surrogate and her family is beyond measure. The surrogate, her children, and her children's children will live a totally different life than they would have otherwise, with a home and education and life lifted out of poverty. Our clinic offered financial counseling and set up a trust in the surrogate's name to help them make sure to manage their windfall well for long term benefit.
5. Having the full experience: As a general pro to surrogacy anywhere, you get to to participate in a pregnancy, though in a limited sense when it is in India.  A big reason I chose surrogacy was that you get a child from their first day of life and experience infancy and all stages of development. Low cost adoption of older or challenged children, fostering to adopt where you can lose the child, or international adoption of an older infant or toddler were the only affordable options for us. While we intend to do that someday, each had an understandable downside with a process and paperwork that in my perception is a lot more intensive than surrogacy in India. If you can be a genetic donor, then you can also have the experience of a child that you are related to. It is not selfish to want that, anymore than it is selfish to want a healthy newborn that is lower risk for medical, developmental, and attachment problems.
6. Return on investment: While you can have failed attempts, you will be out a lot less money than you could potentially be from a failed adoption from what I understand. From my research I've seen more horror stories about failed adoptions and tremendous emotional pain and  loss of investment than I was comfortable with. I know an adoptive mother whose birth mother changed her mind in the several day waiting period after birth, and devastating does not even begin to describe it. An Indian surrogate not only does not want the baby, but they bear no relation or right to it. As long as your home country's regulations are also on board and you do the proper contract through a reputed clinic, this is YOUR child and it cannot be taken away from you.
7. Prenatal care: In India they will most likely choose to stay at communal surrogate housing, and you can choose that as a condition for your surrogate, though it could limit your selection. Some folks look at pics and see a room of cots and make negative judgements, but they have clearly never been to India. Trust me...a surrogate house is Shangri-la compared to other alternatives or where they have been living. Healthy food is prepared and educational classes are offered. There is air conditioning and on site medical care and close prenatal monitoring. They don't have to work and clean and endure the strain of caring for their own children during the pregnancy, though their families can visit frequently. These surrogates are not only happy about how their life and their family's lives are changing for the better and their comfortable accommodations, but many of them say the lifelong friendships they formed with other surrogates are the best part and lead them to do it again.
8. You have a greater chance of having twins. It's risky, but it is also AWESOME! This is a pro for surrogacy in general, and not exclusive to India.

Cons:
1. Culture shock: If you haven't traveled, been to a third world country, and aren't familiar with Indian culture you are in for a shock. But if you open up your mind and prepare yourself it can be an amazing trip and a wonderfully life changing experience. I married into an Indian family and had spent a month there 8 years before we tried surrogacy so it was a lot easier for me and I knew what to expect. If you are borderline OCD and like everything antiseptically clean and hate crowds and traffic, India may not be for you. In my personal opinion things are much cleaner than they appear, but Westerners are used to everything being new and bright and shiny.
2. Communication: The language barrier, cultural differences, and time zone will pose definite challenges. As someone who has suffered from the pain of infertility, you are likely to have some control freakishness going on so the lack of clear communication will be hard to handle but can be well worth the frustration when the baby is finally in your arms.
3. Emotional connection: There will not be much of one, either with the surrogate or your baby. You are having a baby by email, and it may not feel like this is actually happening until there is a screaming infant being handed to you. You may connect with the surrogate, but since you don't have ether lifestyle or language in common it isn't likely. You will have the baby in common, and that is enough. It is primarily a business arrangement, and there is really nothing wrong with that. It's great if you can have a local surrogate in your home country and ya'll become besties and can share in every moment of the pregnancy, but it's not somehow morally wrong if that isn't your reality.
4. Medical standards: They do a great job at Indian NICU's. Don't get me wrong. But having experienced both I can confidently say that they cannot compete with American medical care, even if it is simply because of the available technology and not the doctor's skill level. Availability of experienced specialists is more limited. You have to hope you won't wind up in this boat, but you can do everything right and it can't always be prevented. They may be able to treat the symptoms pretty well but not give a solid diagnosis, and advanced therapies may not be available.  I've felt guilty that my daughter needed more medical care and expertise than was available, but the fact is my guilt is misguided because I would have done surrogacy in America if I could have afforded it and I've done everything in my power to give her the best care I can possibly provide.
5. Baby born premature or with medical problems: This can happen anywhere, even if you have a well screened egg or sperm donor and your surrogate does everything right and has no complications. But since this baby is in another country where you don't live, you could be in for a long and expensive ride. Your insurance may not cover out of country care or put up a fight about coverage, even though it is far less expensive there. You might have to live in India for many months, or wait to join your baby until they are discharged from the NICU. You may have to medivac your child out. (Check out the Rasta Less Traveled blog for what this can be like). This part of the journey did indeed suck, but we made it through to the other side and have two beautiful babies and have our happily ever after.
6. Death of the surrogate: Though not a risk exclusive to India it bears mentioning. I only know of this happening once, and it couldn't have been prevented or anticipated. It was an educated risk the surrogate or any woman takes on in a pregnancy, so your clinic should offer life insurance. In the case I know of the family was paid several times what she would have earned, and the baby did survive.
7. Surrogate risking their reputation: Education and scientific understanding is lacking in India, so many folks can't understand how surrogacy works without infidelity or genetic links to the offspring to the surrogate. This is one reason why surrogates travel from smaller villages and often choose to isolate themselves in communal surrogate housing, though often it is for the comfort and camaraderie. They just tell people it was for a job opportunity, which is very common and an easily believable ruse .An Indian woman takes on this risk, though they do it in part because they understand far better than most women in the world the pain and stigma of infertility because of how it is viewed in their culture. Our clinic helped local women at lower costs, and helped fake a pregnancy so the family will never judge the woman for not being able to bear a child.
8. You have a greater chance of having twins. It's awesome, but it is also risky no matter where you do surrogacy. You may have to do a reduction procedure if more than two implant. You stand a greater chance of loss of the pregnancy or one twin, complications, or prematurity. It will be more expensive to have twins in any country, but if done in India while you live elsewhere you could find yourself paying for double the extended NICU and exit fees like we did.
9. You won't know gender: It's annoying because gender neutral clothing is a myth in my experience. But if you really care about this so much then you probably shouldn't be having a child in the first place.

Myths:
Please read my previous posts to see the many misconceptions about surrogacy in India. http://www.10milesuphillinthesnow.blogspot.com/2012/06/ignorance.html  and  http://www.10milesuphillinthesnow.blogspot.com/2012/05/surrogacy-faq.html.  
A couple of things I'd like to re-emphasize.

1. Indian surrogates are being exploited: Why is it assumed that they won't understand what they are doing but an American surrogate will? Do you have to have money in order to make a responsible decision for yourself? You don't have to be educated to be smart, and the tough lives these women have lived make me seem ignorant in comparison. They are perfectly capable adults who are counseled and aware of what they are doing, and selective reduction if necessary is done to ensure the health of the surrogate.  They have all been pregnant before, so that understanding of what it entails is a given.  Yes...being poor sucks in many ways. But it doesn't automatically make you less of a human being or less capable of making good decisions for yourself. And it doesn't mean that two women reaching across the world to help each other are engaging in exploitation just because one of them lives by what the other defines as poverty. Why is it that if you do it in America it is okay, but if you do it in a poorer country it is exploitation?

2. Isn’t there a risk of wealthy Americans ‘outsourcing’ pregnancy and birth to the third world to avoid stretch marks?”

Fears like this are extrapolated using a logical fallacy call the slippery slope. The pundits latch on to this one because sensationalism sells. It’s like saying that by allowing gays to legally marry pretty soon we’ll wind up allowing people to marry their dogs or inanimate objects. Sigh. Anyone who has been through the process could never imagine someone doing this as an “easy solution” because it is anything but. Having been through it, I cannot fathom any way where someone foolish enough to try this could even get through a beginning phase of the process.  It would be far costlier, but much easier to abuse surrogacy in the U.S. than to go overseas in my personal opinion.

New India Surrogacy Regulations Article

I simply cannot understand why so many countries do not recognize surrogacy as a legitimate way to become a parent. Even gestational surrogacy where there is a clear genetic donor! I feel so bad for folks in Austrailia, and don't get me started on the backwards regulations in England! At least America it is more possible, but prohibitively expensive. It is hard enough to be infertile, but to live in a country where they create barriers to non-traditional pathways to parenthood must be infuriating!

http://www.abc.net.au/am/content/2013/s3669598.htm

India cuts off commercial surrogacy to many Australians

Nance Haxton reported this story on Tuesday, January 15, 2013 08:12:00

Listen to MP3 of this story ( minutes)

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TONY EASTLEY: Changes to commercial surrogacy arrangements in India, introduced just before Christmas, have cut off one of the more popular avenues for Australians wanting to become surrogate parents.

While going overseas for commercial surrogacy is illegal in Queensland, New South Wales and the ACT, hundreds of Australians still fly to India every year to become parents.

However, the Indian government has now issued a directive that only couples who have been married for more than two years can enter into commercial surrogacy arrangements, and only if it is legal in their home country.

Nance Haxton reports.

NANCE HAXTON: Queensland lawyer Stephen Page is a surrogacy specialist who has represented many Australian surrogate parents. He says the policy changes in India have already had a huge impact.

STEPHEN PAGE: Essentially, if you want to go to India in future for surrogacy, you've got to be married for a minimum of two years - gay marriage is excluded - and surrogacy must be legal back home.

And the only place where commercial surrogacy can occur in Australia is the Northern Territory. So unless you're in a heterosexual, married relationship for two years and you're living in the Northern Territory, you can forget about going to India.

NANCE HAXTON: So there was effectively a loophole before this where many Australians were able to go to India to engage in commercial surrogacy arrangements.

STEPHEN PAGE: Anyone could undertake it in India, anyone. So... and the majority of people from Australia who went weren't married. So they were either living in a de facto relationship or they're in a same sex relationship or they were singles.

I believe instead of about 200 children a year being born to Australian intended parents a year, it will be down to five or 10.

NANCE HAXTON: He says the rule change won't stop Australians entering into commercial surrogacy arrangements overseas. They will simply look elsewhere.

STEPHEN PAGE: See the strange thing is, it's outlawed at the state level but at the federal level it's not. At the federal level, you can go overseas and all that you need to establish is that the child is yours and then the child is entitled to Australian citizenship.

NANCE HAXTON: Surrogacy Australia president Sam Everingham says many Australians with incomplete commercial surrogacy deals in India are now in limbo. He says it would be far preferable for Australia to regulate commercial surrogacy at home.

SAM EVERINGHAM: It's become a legal headache for many courts in Australia dealing with the unintended consequences of surrogacy. And I think you know if we had arrangements in Australia where commercial arrangements were possible, it would make it much easier for the kids that are born, as well as the parents.

NANCE HAXTON: What about for people who have ethical concerns about exchanging money for children in that way?

SAM EVERINGHAM: Look, I think there's a lot to be said for keeping these arrangements all happening in the same country. You avoid issues like accusations of exploitation of families from less well off backgrounds, and it's been clear from systems in place in US states like California and Minnesota that commercial systems can operate very well, with really positive outcomes for the children, the surrogates and the intending parents.

So I think we need to look really closely at that as a wider community. I mean, despite the laws we've had against surrogacy, a lot of families go overseas and ignore those laws. So I think it will be a much better outcome if we could get those sorts of arrangements and much better access to surrogates in Australia.

I mean, even if it's not commercial, even if it's just surrogates being able to advertise that they're willing to carry in Australia it would be a start.

TONY EASTLEY: The president of Surrogacy Australia, Sam Everingham, speaking there with Nance Haxton.

Photo FAILS

As I said in my last post, sometimes it takes 50 photos to get one good one...especially when they are together and you have double the lack of cooperation. Some of my favorite photos wind up being the outtakes sometimes. 

It was almost perfect but Vivek photobombs this one

It almost looks like they did this on purpose together

I like to call this her "stank face"

All drama, all the time

Tired of picture taking

Sneezy the elf

Vivek is not impressed

Smooshy the elf

Sleepy the elf

"Whatchu talkin' bout Willis?"

This is just wierd. He doesn't even look like that.


AND MY MOST FAVORITE OF ALL:



FLASHBACK TO 'NAM



And they lived happily ever after...most of the time.

They tell you how they grow up so fast. They truly do. I look at my two new favorite pictures below and see how much their faces have changed and are full of personality.

Is it just me, or in some photos does it look like he has a 5 O'clock shadow?

I look at the pic taken of (almost) all the grandkids at Christmas and realize how grown up the rest of them are now.  It makes me feel old!

We have truly adjusted to life with twins at this point, despite all the complications. Even our dog Ralph has adjusted. He has laid claim to a broken baby swing seat, but otherwise knows his place.

"The dumpster. I think not! It's mine. You can't have it back."

I told my husband that in so many ways I can't wait to see them grow up and walk and talk to us. But then I want a switch that for just a few minutes would turn them back into tiny 6lb babies every now and then. As it is Tara is now 11lbs and Vivek is almost 12lbs. They now fit perfectly into 3 mos size clothes just like their corrected age, but I'm sure it will become snug on him soon.  

Today for a big change I took my son in for a doctor's appointment instead of my daughter. He had to visit the urologist for his circumcision consultation. I was wracked with guilt because we had postponed it due to our daughter's hospitalization, not knowing that when he reached 10 lbs they would no longer do the "ring" and instead it would be an inpatient or possibly outpatient procedure requiring anesthesia. But the urologist told me that since he has a slightly curved situation going on down there it would have had to be done at 8 1/2 months as an outpatient procedure anyway to correct that at the same time. So once again my Mommy guilt is alleviated. Turns out only 1 out of 150 boys has it, so my son apparently wanted to be a medical rarity as well.

I must say it is weird filling out the piles of medical paperwork as the parent/guardian. I have to remember to fill it out for the patient instead of myself and be sure to put single instead of married. Some things strike me as very funny because they are so small, such as marital and veteran status. Medical history gives me some chuckles too. Symptoms: Vomiting. Check. Uncontrolled bowel movements. Check. Frequent urination. Check. Difficulty speaking. Check.

Vivek and Tara both smile like sunshine all the time now, and she has finally started cooing more. We are working on tummy time progress and charting it everyday now to make sure we are more consistent. If the plagiocephaly continues to improve by us forcing their position with rolled up burp cloths, then hopefully no one will need a lovely foam helmet made for them when our pediatrician assesses them at their next appointment in two weeks. The incredible pulmonologist spent an entire hour discussing her case with me in great detail, even calling my husband and sending a detailed summary of our discussion and conclusions to our pediatrician who raved about his thoroughness! Thank you Dr. Sah from Pediatric Pulmonology and Sleep Specialists! In the end we have decided not to change anything regarding the diuretic/24cal/sodium chloride to keep her lungs dry, but can add lactolose to help with her constipation that has her screaming for 30-45 minutes at 10:30am every day. You could set your watch to it. 

Sleepy little angel...for now.



"I like Dadoo. He's funny! But why does Dadima keep calling me Conner?"

As a funny side note, I saw a posting on a Yahoo Group for Indian surrogacy the other day asking about the pros and cons of doing surrogacy in India. I was too busy to reply at the time, but planned on writing something later to mention my blog so they could hear our crazy tale. Funnily enough, before I could someone else replied and named my blog as an example of "what could go wrong" to help them consider the con side of it. Ha! I'm glad my blog exists to help folks out there consider everything that could go wrong so that they are prepared for what can happen, but I hope it doesn't discourage anyone completely because we would still do it all over again.  My advice: Think about what you will do if you have twins. Think about what you will do if they are premature and have to have an extended NICU stay. Think about what you would do if they had to be medi-vaced out to your home country. And to my gay and single friends out there, research the impact of the newer regulations India is putting out there as well as your home country's most current rules to be sure what risks you are taking on so that your children won't be without a country or without a recognized parent.

And while our situation was tougher than most, it could have been tougher with even more severe medical problems like our wonderful Bernadette and her family have had to deal with. But the true worst case scenarios to me would be failed attempts, loss of the pregnancy, surrogate health being affected, and worst of all stillbirth or infant death. But the fact is these same things can happen anywhere you do surrogacy and you can't control them beyond taking reasonable precautions. So as long as you find a reputable clinic (Ex: Akanksha/Dr. Patel, SCI, Rotunda)  I say go for it. But if you can afford alternatives in the US or a more developed country for goodness sakes do it there! The reason I say that is because the NICU care in India cannot compete with the U.S. at the highest level of care in more complex medical situations, and that is the only reason that would have mattered to me in the end if I had any other choice.

A lot of things are uncertain about the future, particularly when and where I'll be working full time again. But amazingly I'm not worried about it and am able to adapt and be flexible about whatever happens next. Fortunately there are plenty of opportunities out there for me due to my training and experience, and I've had some response already from some jobs that might work better for our current schedule of medical care for our daughter and our in laws helping out. That is truly a gift that my children have given me, because those that know me will recognize that not being obsessed with how to get a crystal ball is a major step for me.

One thing is for sure, I know I wake up everyday and look at the two of them and still can't believe I finally got my happily ever after!

It took about 50 photos to get this one with both of them looking at the camera and not thrashing into wierd positions.

Worth

In these past two weeks since she's been home, I come to the opinion that having twins with one requiring medical care must be like having triplets. It's not that the routine care Tara requires is terribly complicated (though recognizing signs/symptoms of problems and discussing modifications to care with her doctors is), but that it is time intensive. I've got them sleeping through the night. I've got them sleeping at the same times during the day for the most part. Finally having continuity of care has her health as stable as it has ever been. But it doesn't matter. Because every 1-2 hours something has to get done except for one 4 hour gap from 4am-8am. Here is a short list:

1. 6 different medications delivered on a  strict schedule
2. Breathing treatments every 6 hours
3. Chest physical therapy every 6 hours
4. 2-3 bottle feeds per day for 15 minutes, requiring the feeding pump to be turned off for an hour beforehand. Her oral feeds will be upped gradually in frequency and duration to get her to 100% oral feeds, hopefully before she starts solids in 4 1/2 months.This will make things much more time intensive.
5. 2-3 doctor appointments or lab tests per week
6. About 2-3 calls about doctor appointments or from doctor's offices, nurses, case managers, social workers, or insurance compaly representatives per day
7. Rinse and replace the formula in the feeding bag/pump every 4 hours
8. Replace the feeding bag in the pump daily.
9. Replace the BARD button tube weekly
10. Wound care at least two times per day.
11. Tummy time for both babies for 15 minutes daily
12. Baths for both babies every other day
13. Sterilize bottles and pacifiers daily.
14. Mix 24 cal formula pitcher daily
15. 3 medications daily for my son

In between all that you have to cram in around 14 diaper changes per day and then 7 bottle feeds for my son. Then throw in all their laundry. When they are awake you need to be awake and playing with them and stimulating their development, especially given their prematurity and risk for delays. Then sometimes they cry for gas pains or no reason at all and you need to hold and soothe them. She has a big temper and it can take a half hour to get her calmed down. Oh yeah...and I have to eat and sleep occasionally.

If it was just two healthy twins with the requisite bottles and diapers our original plan would have worked. If our insurance had approved private duty nursing (which babies with less medical need get approved all the time I'm told by our Home Health Nurse), our plan would work. (We are now attempting to get it covered through my husband's insurance or other social service programs, but that will take time and there are wait lists.) If I made a bunch more money than the skilled assistive care she would require per month, it would work. If I didn't have debt to pay off from surrogacy, infertility, and previous medical expenses that insurance didn't cover and a car that needs replacing next year, it would have worked.

But as it is, there is just no way physically or financially I can continue to work full time and give Tara the care she needs and get enough sleep...even with all the help my in-laws have given us and having refinanced our house on Monday for substantial monthly savings. I'm severely sleep deprived even while I've taken two weeks off of work and had our in laws come in and help! My husband's job evaluates him solely on his speed in a call center environment, and him going it alone while I work at night has him so tired that it slows him down at work and can put his job under threat if it continues.

Fortunately I have a retirement account that I can use a portion of to resolve financial concerns we have and to make it possible for me to take some time off to care for her. With careful investment and savings moving forward in our future I can restore and double that account in half the time. In a short time we'll be in a much better situation for me to return to work at either my old job or a new one.  Not only will Tara's medical regimen reduce dramatically and some of her health care issues improve, but we will  then be able to afford skilled care even if we can't get coverage for private duty nursing. In general, a lot of things get easier for babies the older they get, and Tara will outgrow her need for the G-tube and meds and breathing treatments, and eventually her lung disease entirely.

As much as I love my current workplace, I am at peace and much more relaxed since I've made this decision because I know it is the right one for my family. Having a family means making some hard decisions, but somehow it is so much easier to make them than before.

There were times in my darkest days I wondered if maybe the pain of infertilty was too much of my own making. That perhaps finally having children wouldn't actually offer me the glorious bounty of happiness that I had imagined and mourned for daily.

Nope. It is even better than I ever imagined. Even when I haven't showered or shaved and am wearing the same formula covered clothes for a number of days I'm not even sure of, and am so tired the world is blurry around the edges.

Notice that I'm not saying "those eight years of infertility were all worth it." I won't minimize or rewrite the past. The present does not erase it. I won't say "I wouldn't change a thing" because it brought me to where I am now. Call me cynical, but I don't think those eight years are somehow worthwhile now because it makes me appreciate my babies more, I'm a stronger person, it has taught me so many life lessons, or it is the cause to my current effect. Sorry, but I'd still rather not have gone through it and popped out a these kids on my own years ago and my biggest problem be my stretch marks and what to cook for dinner. On the same note despite how extraordinary the entire experience has all been, I'd still rather my babies have been born full term and healthy right here in the Texas and not have had to go fight their way through 3 NICU's in 5 months in 2 countries.

It is really hard, and my life sure seems overwhelming when I look at it as written above.

But after a few days of adjustment to our whirlwind routine, it doesn't really feel that way most of the time.  I may have a bad hour or two or even a bad day, but the thing is....every time I reach down to pick them up they smile at me. They even laugh now too! That moment in time makes me happier than anything else has ever made me. And it happens dozens of times a day. I've come to the realization that it's not about making the bad stuff "worth it." It's just that there is so much amazing, fun, beautiful, happy, and incredibly good stuff.

So if anyone out there reading this is wondering if it will all be "worth it" one day when it is all "over," I can't promise that. The best laid plans... But I can assure you, your child will make you more happy than you ever dared to dream of and it pervades every part of you. It's the biggest and best kind of love there is. The time you spent worrying about this child feeling like it was less yours because of an egg/sperm donor, adoption, being an older child, or growing in someone else's belly will seem wasted. So if you are out there struggling with the decisons surrounding making your dream of parenthood come true and trying to make the optimum choice and control every aspect of the outcome like I did, my only advice is  that in the end the "when" will matter so much more than the "how."

Tara and Mommy in the same dress circa 1977!