Day 10: No free rides

Today was one heck of a day. I'm not sure if it is good or bad that my high point of today was changing my little girl's diaper for the very first time. It's impressive how much of something that gross can come out of a baby just over 2lbs. I was given a 2 min time limit and I'd like to think I made my time.

Dr. Hitesh wasn't in until Monday so no taking care of business there, but there was drama across the way at the NICU. It did start off well, and I had an awesome time this morning at bath time taking pics and tons of video. We'll start with finding Mr. Vivek all discombobulated at the bottom ofhis crib with his hat, as usual, cast off to the side.

First up for bathtime was Princess Tara. She splays herself out and waves her limbs around frenetically, but doesn't seem to cry or distress like Vivek does. I think she likes a good portion of bathtime actually. I took two excellent action shots of our princess.

Here is a video of Tara's spongebath adventures:

Vivek on the other hand during bathtime makes adorable squeaks of protest:

Post bath time Miss Tara is quite alert, but Vivek wanted to go back to bed after a quick snack.

But soon after bathtime problems arose. I could tell my little chipmunks were hungry because they were pushing their little tongues out and restless, making sucking and smacking noises.

But the problem was by 9:15, 15 min after feeding time there was no breastmilk.the nurse had told me. I offer to go to Manju's room to see what the hold up is. Several things become apparent:

1. Manju has no pump of her own because the hand pump is shared between her and the other surrogate. I learned later they alternate every two hours who pumps and it is sterilized in between. This gives them four hour gaps and more rest and enables the two of them to produce enough milk...usually. I quickly decide to bring my hand pump at the hotel that I had bought for plane travel and give it to Manju so this won't hold them up anymore.

2. Manju keeps talking in Gujarati expecting me to understand her, and I never want her on my team at charades. She does point to her chest and say something that makes me think she doesn't have enough. I ask about the 2nd surrogate and she points upstairs. I am ticked because I wonder what Nita has to do that is more important than pumping milk for my babies.

I explain the problem to the nurses and Suvarna, the most amazing nurse in the world who is getting a huge tip when we leave, happens to have a 6 mos old baby and assures me that she will provide milk herself if needed to add to whatever Nita brings. I go to the hotel and sterilize my hand pump.

When I return at the next feeding it is apparent some more discussion has occurred, but I'm not sure what. Suvarna tries to tell me something about it when I hand her the pump, but due to the thick accent I have some trouble understanding it. Suddenly both surrogates show up, and I realized Suvarna was trying to tell me she was about to play hardball and take matters into her own hands...literally. She had made my low production surrogate come down so that she could assist her and pump her herself to make sure it was done correctly. She got almost enough milk for both babies but was a few mL shy. Manju did not seem all that happy about being manhandled, but I would like to have seen her more concerned about the welfare of my tiny hungry babies than her modesty.

The other surrogate had a long discussion in front of me with another nurse Anju who speaks some English but not much, and I could tell it was a lively one. The other surrogate Nita had struck me as a little pushy and I had been wary of her. I become increasingly nervous about the content of that conversation as I held my son for the next hour. When Dr. Kothiala comes in later as I'm concluding kangaroo care with Vivek, she compliments my singing and asks me about it. Turns out her CD broke but she had been playing classical music in the NICU based on her music therapy research.

I not so gracefully segueway the conversation into the drama that had been going on with the surrogates and twice delayed feedings due to poor supply. A pow-wow occurs where Suvarna and Anju fill Dr. Kothiala on what had gone on and I finally find out the truth.

Nita is my hero. The reason she had been upstairs was that she was going to all the other surrogates trying to get enough milk for my babies! I am almost certain that this was not the first time she has done this to cover for Manju. She also explained that Manju had been "losing interest" in producing milk for my babies. Don't get me started on how angry that makes me. Either work hard to produce or go home to Ahmedabad, but there are no free rides here. You'll get no sympathy from me because I pump every 3 hrs day and night for the one mL I produce, and she gets a liesurely four hours with meals delivered and no babies to see.  I am not a rich woman and this is not a surrority house. (Punny right!?)

Nita also had a surrogate in mind who would be interested in taking over for Manju so she can go home to her family. I make sure Suvarna and Dr. Kothiala know that I am not paying for someone who is not dedicated and productive in providing for my babies. Dr. Kothiala says I should go to see Dr. Patel's assistant and insist that Manju be cut off and sent home, and today or tomorrow morning they will resolve getting another surrogate to pump for me. Her assitant was very professional and confident and spoke superior English, and I felt instantly at ease. Dr. Kothiala assured me she would also contact Dr. Patel about the matter post haste.

In talking to Dr Kothiala during the whole wet nurse drama, I learn some other good info. In about two weeks we will start using my preemie formula (Similac Neosure) that I brought. She uses breastmilk only until gestational week 32, which should be the end of this month. She does that to avoid NEC (necrolyzing colitis I spoke about in a previous post) but the breastmilk is not as calorie dense and they don't put on weight and grow as fast as they do when you add formula to the mix. She is using some fortifier but explained she has maxed out on that for now. She will also try bottles and breastfeeding at the switchover point because the sucking burns so many calories, she would rather have them on a calorie dense regimen to ensure continual weight gain. I also learn that preemies at this stage in her experience take 3 weeks to gain back birthweight, so all my concerns about Vivek dissipate as he is getting close.

After all the drama I decided I needed to get away for a while and go for a jaunt about town for lunch. I dropped by to see my new friends from NY, and told them I was headed to Subway and they joined me. It was a hilarious ride in a Tuk-tuk. Seeing a guy the size of a middle linebacker cram into one is comical, and when you add two women and the driver...  It's not all that impressive to locals though cause I have seen about 7 folks crammed into one, and even more children on their way to or from school. The sandwiches and cookie were yummy and the second best meal I've had here so far. The place is as tightly in line with the Subway standard operating procedures and appearance as humanly possible in India, and the only main difference aside from localized menu selections were one side is vegetarian and the other isn't. It is a little further away, but worth the trip.

Tomorrow we do Alpha for lunch and will bring some back for my friend with her twins at the hotel, so I'm excited that I'll eat well tomorrow too and help them out again. But mostly, I'm excited for bathtime. And maybe now with having earned trust changing diapers I can look forward to another one tomorrow. How soon will it be before I no longer look forward to changing a dirty diaper, I don't know...

Day 5: 18 days old!

My babies are 18 days old!

I am quite proud that I withstood over 3 hours today in “the chair” doing and hour and a half each of kangaroo care with my babies. After this is over I vow never ever to purchase, own, or sit in one of those white plastic lawn chairs ever again.

Vivek is still gaining slowly and is at 1025, which is under his birthweight. Tara is gaining faster, but has more de-sats (about one an hour that is not that bad only to the upper 70’s and usually self corrects) but has GERD. This is essentially reflux, and I expected both to have it since it is fairly common among preemies. I think I’ve only seen Vivek de-sat once. I’m trying not to obsess about weight, but given all other factors that appear stable it is the one significant sign of progress I can focus on.

They are both as adorable as can be, and today are both wearing hats I brought. Of course they had to tape them over themselves to fit, but they’ll grow into them sooner or later. When feeding time comes every two hours they start to coo and throw their arms around and clench their hands, and make darling little sucking motions with their mouths.

The cardiologist only comes once every 30 days to check on them unless needed, and hasn’t been here yet. I asked today if he had been by because I wanted to know if either of them had a small hole in their hearts. This is common for preemies and the hole tends to close on it’s own without a problem. Dr. Kothiala said from what she can see it doesn’t look like they do, but when the cardiologist comes he can confirm that.

Since I’ve been here I’ve collected a variety of opinions on the NICU here. Some are positive, some more negative. My impression so far is positive, but I also have babies that are faring pretty well and I am taking a laid-back and trusting approach to this in order to stay positive and sane. When you walk into the NICU, there is the sense that the forces of fear and faith are at constant war inside your head. To one or the other you must surrender.  My friend who is here is a doctor and speaks some of the language, and I trust her opinion that the care here is comparable to a U.S. NICU even if the facility lacks the poshness of more modern facilities. Ya’ know…posh things like real chairs that don’t inflict pain upon the person sitting in them.  Something about being a parent makes you worry more than you know you should, and all you have to do to find something to worry about is be awake and have your eyes open. I try my best to stay in a relaxed and positive state for the entire time I’m holding them, but that can be hard to do for long stretches of time…especially in the middle of a de-sat.

The power went out today several times at the hotel, and then twice while I was at the NICU. As I expected, the essential machines were all on a uninterruptible power system run by generator backup, and the only reaction by the nurses was to hurriedly reset all the machines when the power came back on.  I did see a nurse run into the other room once today, but I couldn’t decipher why because I didn’t detect any noises beforehand. I am curious, but I do try to mind my own business about other people’s babies for the most part because I’m trying to be a fly on the wall and stay on everyone’s good side. I have only said something a few times to get a nurse to attend to a baby while I did kangaroo care because a baby had thrashed themselves over to the side of the isolette and had a face smashed against the plastic side and an alarm had not gone off yet, or they had twisted their hat around and it was covering their mouth and nose. I had no idea such premature babies could move and shake so much…and with most of them sleeping on an incline because of reflux, gravity plays a supporting role in getting them all discombobulated in their isolettes.

I finally got to video chat with my husband today, and it gave me the huge boost I needed. I wish I had a faster feed because I got a blurry shot of his face every 20 sec or so. My in-laws also called and it was nice to talk to them too. I feel a little less alone now, and as much as I want them to relax and not worry…knowing that my husband and father-in-law are not sleeping so great helps me to know I’m not the only one feeling the emotional upheaval.  It does hit you at a certain point in a situation like this that you have to be the strong one. Everyone is leaning on you for strength and leadership in this tough situation, and you will not be able to lean on them more than they will lean on you. I am strong enough to do this, but I find myself so worn out emotionally that it seems to translate into physical exhaustion as well. Though my husband did point out that trying to stay motionless in “the chair” for 3 hours for my babies does take some physical fortitude.

Once again today I took a ‘nap’ and got my schedule off and neglected to pump. It is frustrating, but at some point I’ll establish a routine of NICU visitation, pumping, sleeping, and the anything else here of life in Anand.

Flying Solo

So here I sit at the Dallas Fort Worth International airport. It has been a rush getting here and now everything has slowed down while I wait at the gate for two days of traveling. I paid $200 for a bag that was 3 lbs overweight, but every diaper and can of formula counts until my mother in law can arrive with the 2^nd bag full in a month. I pre-paid without complaint and was impressed with myself that my guess that my bag would be just over 50 lbs was deadly accurate. The TSA agent on the Xray machine didn’t blink an eye at my breast pump that I left inside my 2^nd carry on, so I guess that won’t raise eyebrows at Mumbai…..I hope.

I cried loudly enough to attract attention when I said goodbye to my husband, and I think he was trying not to get choked up too. I’m more worried about him than me. I’ve only gone about a week away from him since we’ve been married 8 years ago. Now I’ll go at least 2 months without seeing him!  It is very hard to say goodbye, but I know it is the smart thing to do. His VISA arrived this morning, so that is one thing off the list. I’ve left a critical “Honey Do” list so I’ll have to check in on his progress.  I’ve asked family not to call me at the hotel until the evening time on the 8^th so that all day I can focus on my babies and not missed calls and reporting back status to my family.

My mother-in-law’s wonderful sister Guddi Aunti has gifted us lots of baby clothes, which I can’t wait to see until I got back. Three more gifts were given my last night at work, and though I had frantically finished all the thank you notes from my shower I didn’t have time to get thank you cards to those generous three and I hope that an email will be okay.

A million thoughts and emotions run through my brain as I sip what will be my last Starbucks coffee for some time. I can’t wait to meet my babies. I’m worried about my babies. I’m worried I’m a bad mother because maybe I’m worrying too much about my babies. All indicators tell us that they are doing spectacular but still I fear they are waiting to tell me anything bad until I get there. Stop worrying. Stay positive. Quit thinking about your to do list when you get home and the fact that the nursery is still not painted. Babies don’t care what color the walls are. Quit worrying that there is one critical thing you forgot to pack. I look at the three new pictures of my babies, especially my little girl chilling under the bili-lights, and I follow her example to relax and live in the moment. I still can’t believe I finally am a mother. I have a son and a daughter.  A family of four forever. 

I know I must talk to Dr. Hitesh and Dr. Patel the day I arrive too in order to meet our surrogate (if she is still there and the one providing our breastmilk) and in order to settle payments, but I tell myself that can wait for a few hours and to meet my babies first and take my time.  That reminds me…I forgot to pack Kleenex and I’m going to cry. A lot. 

I read The Premature Baby Book by Dr. Sears at my side, partly because it is the one thing I could not fit in either of my two carry-ons. It is great preparatory reading and so far I’m feeling a little more confident in how I’ll handle myself and knowing what to expect.  I plan on taking the advice to not read the chapters of bad things that can happen unless they actually happen. I read some preemie blogs of 28 weekers and some born sooner at my last night of work, and mostly found encouragement but things that went wrong with some scared me. For the most part it seems like the ones that had problems of some sort it was apparent from birth or there were more delivery complications or they were born sooner or smaller than mine. The fact that mine were never on a ventilator and are now breathing on their own is the biggest reassurance of all. I just hope my little girl gets chunky soon because 2 lbs is pretty tiny and 2 ½ sounds a lot better. Plus I promised my mother at least two chubby rolls on their thighs for her to pinch on.

So here I still sit waiting at the DFW gate. I’m watching the drug dog make a 2^nd pass at my suitcase. I have a bag of fenugreek seed and a bag of fennel seed that look a lot like drugs and have a strong scent, but are just galactologue herbal supplements. Fortunately Rover seems to know the difference. (His actual name is Uno, because I can hear the handler calling his name and telling him “Good boy!”)  For a moment I watch him play with his rubber toy reward with pure elation, and it makes me miss my dog but also be grateful now that I finally know such joy in my own heart too.

I’d decided when I got to Newark I’m using the 3 hour layover to eat a steak. Hopefully it will tide me over enough that I don’t rush out into the street and go after one of the cows that wander loose. Mmmmm….sacred.  

So here I sit at the gate in Newark. It turns out when these Yankees think mighty highly of their steaks and charge twice as much for half the size as I can get in Texas. I have a bleu cheese burger instead, and it ain’t that great. I’m already missing Texas.

It takes me half an hour to get my saree on in the tiny bathroom. I’d forgotten one element of the Gujarati style of wrapping since I’m used to wrapping Punjabi style excepting my trip to Anand a year ago, but it comes to me in a flash after four attempts and I finally get it on.  The saree I had on top of my suitcase didn’t fit because I’d forgotten about the whole lactation thing and my chest is too large. So instead I select a very comfy pink one with a stretchy top. I befriend a young Indian gal who has been stuck at the airport for a day and compliments my saree, and she wishes me luck. Once I freshen up and brush my teeth I realize there is no electrical outlet to use my breast pump. Guess once I get on the plane I’ll turn to the side in my window seat and use the hand pump and hand expression like I did on the first flight.

The main reason I selected the window seat was to allow for some privacy for that purpose. And fortunately being in the last row and seated next to one old lady who didn’t speak English and minded her own business helped that effort. However I love window seats for other reasons. Mainly because you can look out upon the universe with sky and clouds and the magnificence and grandeur of God is overwhelming. It baffles me that everyone else I see has the window closed and is sleeping, reading, or watching the TV they charge you 7.99 to view. I just can’t fathom how you can’t even open your window a crack just once on the flight to see and enjoy the amazing scenery that brings on such a sense of wonder. It makes me ponder miracles, and feel an intense gratitude for the two miracles I’ve been granted.

So here I sit in the Mumbai airport during a 7 hour overnight layover, just like I did a year ago on my first trip to Anand to attempt surrogacy. I am calmer to some degree because the locations and signs are familiar and I am less worried that I’m going to the wrong place and know I have 7 hours to correct any navigational errors. I mostly worry envisioning my mother doing this on her own in a few months and I plan how to explain what to expect to her. The only snags so far are the bus guy pushing me hard for a tip. I don’t feel bad not tipping him because:

1. I can handle my own damn luggage but you wouldn’t let me. I’m stronger than I look.
2. I don’t have anything less than a 500 rupee bill and am not about to ask for change with a line of folks behind me.
3. He didn’t ask anyone else for a tip for picking up a piece of luggage and putting it in the bus directly next to him

The 2^nd snag is that when I go to get my new boarding pass since the one issued in the US must be exchanged for a local one. I also check in my luggage, and a 3 person debate in Hindi ensues for 30 minutes concerning it. Concerned about what is happening I show her a picture of my preemie girl and tell her “sick baby” and point to the bags and say “medical equipment.”  She seems to get the importance of what I’m trying to communicate and assures me the baggage can go but they are just debating what payment is due. I luckily had a printed receipt that I had paid for my overweight and extra bag already, and the think tank pores over and discusses it extensively. But the restrictions on Jet Airways for my connecting flight to Vadodora domestically are different than United that I used to get here, and the real problem becomes my 2^nd carry on. I neglected to research that in advance. My 2^nd carry on is 14 kg and only 7kg is allowed. She sees the look of panic on my face as I consider my options:

1. Dump half my clothes in a garbage can. My two large bags are all baby stuff, and my small carry on is my stuff only. I could always buy more clothes for me here, but baby stuff is harder to come buy.
2. See if I can refund my ticket and take a train or car to Anand. I’d really have to kick my resourcefulness into high gear, but it is an option though it might delay me. I really only considered this option when I thought that the baby luggage might not be allowed to go.

She tells me I can check it instead as a 3^rd bag and pay. I agree to do so. It is almost 3,000 rupees, or around $60. I figured if I’d bought new clothes that is about the same price so I pay willingly with a smile on my face. Kill ‘em with kindness and getting them to pity you is a better way to go here than being a demanding, self-entitled, stereotypical American.  

I get through the security screening at the final gate just fine, though they have to unpack my entire bag because I wasn’t clear than anything and everything metal needed to be separated out into a container. They expect my ignorance due to my overwhelmingly pale and obviously foreign appearance. The saree and mangalsutra necklace only go so far and people find it more charming that I wear them than an effective disguise. He did question my fenugreek seed, but I tell him “fenugreek herbal supplement” and he seems satisfied, thank goodness. If that didn’t work I wasn’t sure where we would go from there because galactologue doesn’t translate well.

I am starting to feel engorged and am now worried because my hand pump lost a part at some point from when I got off the plane that it may not work properly without. I decide to brave the bathroom and hope I can find an outlet with a bit of privacy. I find the working outlet, but have to unplug the hand dryer to do it.  As far as privacy goes, my semi-sheer saree draping across my front will have to do. I am pleased to find that I actually pump enough that it could probably be fed to a baby in a single spoon. This is progress to be proud of at this early stage. About 10 women come and go as I pump, most looking at me curiously. One custodian asks me what I am doing. I just say “breast pump” and point each index finger towards each breast. The look on her face is still confusion but she seems satisfied with that explanation. They probably only use babies or hand pumps for that purpose here, and $2000 electric double breast pumps are not something you see everyday.

I’m not sure how much I slept on the flight to Mumbai but it could have been around 10 solid hours. I slept at least an hour in this waiting room, though I’m not sure how because it was dreadfully uncomfortable. Some coffee wakes me up a bit, and I’m rather sure I’ll find the will and strength to get through an entire day before I sleep again as night falls. The sun will be up in a few hours, and I’m about to have one of the most important and happiest days of my life. It is odd to know that beforehand and have to wait for it consciously.

I read some more of my preemie book to help prepare myself. I know the hardest part of the day will be arriving at the hotel and unpacking and pumping first and forcing myself to wait a few more minutes to meet my children who are but a 2 minute walk away. Who are we kidding? It will be 1 minute cause I’m gonna speed walk. But I want to make sure I’m clean and showered for the NICU so I don’t bring in germs, and I want to organize the baby stuff and bring in a few items I know they need immediately. I plan to write the names on their diapers since I know the Huggies are better for boys and Pampers better for girls. This is the one think Dr. Kothiala did say on the phone I needed to bring, though she probably doesn’t realize I knew that already and have been systematically prepping for months to know in advance what is necessary to bring. I also want to walk in looking like the most prepared mother every to make a good impression upon these nurses I will depend on so heavily. I mustn’t forget to tie my hair back, and will wear something that is easily adapted to Kangaroo care in the hope I can hold them today. Waiting a week until they are more stabilized and developed will hopefully pay off in that respect.