Little Breen part 3 — Day 2

Erin woke up looking more like a human. She was ravenous and ate two breakfasts!

I was told at the end of Day 1 that I or Erin could go to the NICU rounds any weekday at 9:30am. During rounds, Dr. L. and the entire NICU floor discussed care for every tiny patient, and if I hung around Breen’s incubator, I could sit in to listen to their strategy for his care, and even chime in with questions or thoughts.

As I entered the NICU for rounds, I saw Dr. S. starting to leave. We stopped and talked for a while. She was there to check on Breen, and told me that she had put his vitals on her doctor phone so she could check on him. She started talking about the cut and began to break down. I had heard earlier that day from a nurse that several of the other OBs had reached out to her throughout the day to console her, and that she was devastated that she had cut Breen so badly.

I expressed to her that from our perspective, she saved our son’s life in many ways: First of all, had she not had been closely monitoring Breen’s heart rate from home, no one else would’ve read into those variables that it was time for him to come out. Secondly, she had prepared Dr. L. and his team to be there at the moment of birth to provide intensive care, which Breen obviously needed. Thirdly, she paused. As I already discussed in a previous blog, that pause was all Breen needed. Anyone would’ve made the first cut, and even if you’ve done a million C-Sections, they most likely would’ve never done one with a 23 week old preemie inside a womb that had ruptured four weeks prior, and had sustained significant structural damage from days and days of contractions. It’s such an easy thing to imagine doing, but the pause was masterful. The intuition to know that something was amiss, and to take the time to figure that out during an emergency. What an amazing person, what a fantastic doctor, what a brilliant woman.

She started crying and asked for a hug, which I gladly gave. We love her so much, and will be forever thankful that she got us to the NICU. Apparently after she left me, she went to Erin’s room to check on her, and they similarly had an emotional heart to heart.

Dr. L. had been a gem of a person on Breen’s first day, a terrible and brutal day that somehow ended on a good note. I was so moved by his grace as the ship started to go down, and impressed by his flexibility as this tiny warrior impressed him with a recovery.

The doctor regaled his team with the drama of the previous day, and expressed his admiration for Breen’s recovery and stability overnight and into the morning. He also warned me, and reminded his team, that micro preemies often experience some kind of “honeymoon” period during their first 48–72 hours of life where things looks good and number improve just before a crash. The crash often happens because much of the intensive care that they give these little guys are traumatic to their bodies, and at some point, inflammation and bruising starts to catch up to the care, and can be too much to overcome for such a small life.

What’s more, like most infants, preemies start to immediately digest their fat storage in order to survive life off of a placenta, and can rapidly lose weight, fluids, and strength right before this crash happens, giving them less reserves to fight it. What’s even more, their immature digestive and endocrine systems aren’t able to process food effectively, so it can take them a long time to pull nutrients out of their food and into their bodies.

Dr. L. said that on day 2, the primary concern was Breen’s nutrition, and that his blood sugar levels, which were astronomic. A healthy reading would be somewhere in the mid 100s, his was 380. This was due to a number of things including his immature system, plus the steroids, plus the hydrocortisone, plus his body’s response to the trauma to his back, plus the heightened sodium levels due to his immature kidneys, plus…plus…

His plan was to institute an insulin therapy, something that he said he rarely does because it’s very dangerous and can often cause death in preemies. But if they allowed the blood sugar levels to remain that high, Breen’s body would shut down sometime soon. He was at toxic levels.

He said they would start out at .03 ml per hour on the drip, and take a blood sample every couple hours since it would take so long for it to start to take effect. He would tolerate up to .1 ml per hour if it wasn’t working at first, but after that they would have to either hold or come back down. This is because if they kept the insulin too high, Breen could come crashing down and get hypoglycemic, a death sentence for such a small guy.

He did say that he was also impressed with Breen’s skin, which had dealt well with the lung tube being taken out, and that the wound on his back was healing very nicely. Also, Breen’s skin had shown a little less bruising than he had anticipated, and thought that was good news moving forward.

So here we go again with a radical and rare treatment that has a side effect of death, but is the last resort in order to jump start one of Breen’s involuntary systems online so that he can maintain those gains as the radical treatment gets weaned. I think this might be our new normal.

Erin and I came back later that afternoon to talk and sing to Breen, which was a beautiful time. I love being with Erin and Breen, what a great way to spend time. We wish desperately for Nora to meet him, but siblings aren’t allowed on the NICU floor (understandably), so we have a long way to go before that would be possible. While we were there, I inquired about his new blood sugar reading. 372. Damn.

I came back later that day and asked again. 350. damn.

Towards the end of the night, I came back late and hung next to Breen. I told him stories, told him about his family, recited names of his extended family and a little bit about each of them. I brought some paper and wrote about everything that had happened to his young and tiny body. And I celebrated his 48th hour on the planet.

What a warrior.