He Who Remains Unvanquished — Day 10

This little guy.

This beautiful boy.

Today was a better day today for Breen, highlighted by an incredible achievement: Nurse C the Brave, the Wise, the Great, got his picc line installed!! (cue trumpets!)

This is a massive step, not least of which because a different nurse was unable to get it in yesterday. From our conversations with Dr. O and other nurses prior to the successful installation, we learned that a picc line is a tricky thing to install on any preemie, but Breen was an even more difficult case due to how small he and his veins are.

Adding to the difficulty is that it apparently takes an hour or more to complete the procedure! In order to get it done right, you got to have someone with a steady hand, a brave heart, and zen-like constitution. Enter Nurse C. What courage she has. What a badass.

After the installation, Erin peppered Nurse C with questions regarding her preferences for treats, and finally got it out of her that she likes chocolate and strawberry shortcake. Oh man. We’re gonna get her enough chocolate strawberry shortcake to build a house with. We are so grateful. Nurse C the valiant.

There are other reasons why this is a monumental step for little Breenie. He had previously been receiving medicine and IV fluids through a line into his belly button. This line apparently starts to dry up and becomes an infection risk starting around day 9 or 10. Also, it seemed that they will only try to install a picc line a few times before needing to pursue more invasive and severe measures to get a preemie these essentials. We were one strike down, and it was nice to get this done on the second attempt.

Also, having a secure and steady line for medicine and IV sustenance will allow Drs. O and L more patience as they slowly work towards ramping up Breen’s feeding. Food intolerance is very common for these micro preemies, and Breen had a bout of regurgitation a few days ago, causing Dr. O to indefinitely pause his feedings as well as his probiotics (which need to be taken with food). The other concern is Breen’s intestines, which are super immature and if you push them too hard you can get ruptures or blockages which puts you on the road to sepsis and all sorts of bad times.

With the picc line in there, Dr. O can be confident that if Breen has setbacks with food tolerance, she can pause feedings and rely on the IV calories to sustain him before trying to feed again. It’s a wonderful safety net for these next few weeks as Drs. O and L artfully coax Breen’s digestive system online.

Speaking of which, Dr. O decided to keep Breen’s feeding volume (1.5 ml) despite a return of some regurgitation. She came up with a creative solution to help alleviate Breen’s food intolerance by slowing the feedings so they occurred over the course of 30 minutes. This brilliant idea has so far worked! Breen is tolerating his slowly delivered measly feast, and we hope to build on that with more volume in the coming days.

Erin has been incredible at pumping, and we have a huge amount of breast milk in storage here and at the NICU. I continue to be in awe of my incredible wife. She is such a great mother to Breen. The little guy who lives because his mother did so much to bring him here. When Erin’s water broke at 19 weeks 5 days gestation, it felt like Breen was stranded on the moon, and the scientists told us there’d be no way to get to him. “Well, unless you were somehow able to build a ladder to the moon!”, they joked.

But then over four weeks, Erin built a ladder out of tooth picks, popsicle sticks, twigs from the back yard, and anything else she could find. She kept building that ladder until it reached the moon, and she went and got Breen and carried him to earth. What power. What faith. What beauty.

Everything else went fairly well for our little warrior today. His kidney numbers were stagnant, but not worrying, as he continued to pee throughout the day. He blew good O2 blood tests. He stayed pretty steady with his O2 interventions throughout the day (dating back to yesterday evening as well). Also his back wound continues to heal nicely. He’ll have a gnarly scar, but it’s looking all the more likely that this insane and traumatic wound won’t impede his future quality of life.

Also, his skin is shedding like a little lizard, but that’s good as the new skin will be thicker and more tolerant. This alone is a very good thing because he has been so intolerant of touch and care from his nurses. Every time they feed him, move him, or change his diaper he desats and they have to significantly increase his O2 intervention until he calms down. This is because touch for a micro preemie with thin skin and an under baked nervous system is agony. Between him sloughing off old skin and his nervous system maturing, we hope he’ll be more resilient with these cares.

It’s difficult to not get emotionally caught up in the results of any given day. Yesterday was frustrating and demoralizing as we got absorbed by the frustrations, pessimism, and stress of a couple of Breen’s nurses. At the end of yesterday, I could feel the gravity of the remaining distance to go for this little guy and it seemed too far. An impossible distance to travel for such a small traveler. An impossible weight to carry for such tiny shoulders. Then today gives a number of positive developments, it’s difficult to not feel too euphoric.

We’re in for a long stay in the NICU, and Erin and I can’t be bouncing around like a pinball based on events that are totally outside of our control. If we do, we’ll be wrung out in no time. There’s going to be several days in the future like yesterday, and several days like today.

We’re on a small leaky barge out at sea, and we have a long way to travel. Storms and swells will occur, but we have to keep the nose of the boat pointed north, our hands steady on the wheel, and our eyes have to stay on the horizon. It’s going to be a rocky and rough journey, but we’ve got a chance to make it to port even on this barely sea-worthy vessel.

The only thing to add to the above analogy is that we’re not steering the boat. Erin, Breen, and I (and Nora. And, well probably you dear reader) are in the hull. We can hear all of the commands being shouted across the decks, but at the most, maybe we’ll bail water a few times during some rough seas. Drs. O and L are in command. The nurses and techs work the sails. We are simply passengers on this journey. This undeniable fact makes for significant anxiety, the only cure being resignation to those in charge, and faith in the structural integrity of the ship.

Breen’s last name is Armstrong, which comes from Scotland. As my father and Aunt C have learned from research, the Armstrongs were a nasty border clan who developed a reputation for stealing sheep and angering the English monarchy. (they probably did some other things as well, but most likely nothing more significant). The family crest shows three flexed arms with the motto: “Invictus maneo”, which translates to: “I Remain Unvanquished”.

Our tiny warrior has faced so many battles, with such long odds. His demise has been predicted on innumerable occasions. Erin and I have said goodbye to him multiple times. Several medical professionals have given us pained looks over his fate, and yet he remains unvanquished. So many things have attempted to vanquish this little dude, but all have failed to defeat him thoroughly.

I love the motto because it’s different than saying: “I am undefeated”, or: “I win all the time”, or: “I am unstoppable”. No, there’s a humility in “I Remain Unvanquished”. It tells a story of pain, trauma, and hardship. It infers that the person who recites this motto has seen many battles, some of which they have lost. But they haven’t been vanquished dammit. They’ve been beaten up, bruised, left for dead, underestimated, abandoned, and maybe even defeated. But not vanquished.

That’s our beautiful boy. Beat up, cut deep, feeling raw, and unable to breathe. Yet here he remains, heart beating strong. The smallest Armstrong and newest member of the clan has done his ancestors proud I tell you.

This tiny warrior remains unvanquished, and we will continue to fight like hell at his side.