“Malia Mei: A Courageous Birth” is a memoir by Michael Moline, a college instructor, loving husband and devoted father, that includes his recollection of the joy, fear, and hardships leading up to and following the unexpected premature birth of his daughter. Jelly Bean Journals is honored to share their story in this multi-part, bi-weekly series.
MALIA MEI: A Courageous Birth
by Michael Moline
The phone call:
We were told Monday evening that we were welcome to call the NICU and speak with Malia’s nurse at any time, day or night. They did not routinely make phone calls to parents so the onus was on us, which made complete sense to me. They told us that they would, however, call if something drastic were to happen with Malia. This also made perfect sense to me.
Sometime between the point that we ordered our celebratory dinner and its arrival, Cherry was in the little bathroom and the rest of us were sitting/ standing around the hospital room. The phone in the hospital room rang.
Assuming that the medical staff in the NICU did not yet have our cell phone numbers, my heart jolted. Nothing drastic would happen with Malia in terms of recovery. That was not possible; it would be long and slow progress, which meant something wrong has happened. I jumped across the room (about 2 feet from me to the phone, but there was a bed in my way). I answered with a nervous “hello.” The response: “High, this is room service. We wanted to know if you were aware that we offer a celebratory dinner and if you would like to order it.”
Apparently, they had lost our order over those 15 minutes and didn’t realize we already were on top of it. They took a few years off my life for no good reason. Well, I went ahead and reordered the food to the best of my knowledge, only getting one item on the entire list incorrect. I asked for white rice as our fourth side, when mixed vegetables is actually what Cherry had told them. And, when we got the dinner 15 minutes later, which item was included as the fourth side? The mixed vegetables. I suppose they didn’t lose our original order after all… or they accidentally gave us mixed vegetables instead of rice.
Cherry had slept relatively well Monday night, but I was up all night thinking, praying, worrying that the phone might ring. I couldn’t shut my mind off. Tuesday night ended up being the opposite. Perhaps Monday night, Cherry was too exhausted from pushing a baby out of her (“butt” according to Ariah). Perhaps Tuesday night, I was too exhausted from being up all night Monday. Regardless, we each got about 1 night of sleep over the previous 2 nights and Wednesday morning we were anxious to call the medical staff to inquire about Malia, quite happy that we had not received a phone call during the night.
When we called the medical staff Wednesday morning, we were met with some encouraging news. Malia was off her blood pressure medication and responded well with a steady BP and great urine output. Her oxygen continued to improve as they weaned the settings. Upon visiting her in the NICU, the nurses told us Malia would likely move from the oscillator to a ventilator later that day. But a short while later, the physician told us that would likely occur the next day. Interestingly, a couple of days later, the physician said Malia would likely go home with some supplemental oxygen and a nurse flat out disagreed with him after he left, telling us she would play the contrarian and optimistically believe Malia would go home without needing supplemental oxygen.
The nurses were right. Wednesday afternoon, the physicians decided Malia was doing well enough to move from the oscillator to the ventilator. Although I was assured that this was a very natural progression after continually weaning the settings on the oscillator, it was still a nerve racking process for me to watch. I had earlier told Cherry that I would not want to be around during the transition, but later changed my mind. While the respiratory therapist changed out one machine for the other and switched some tubes around, the nurse provided bag valve ventilations. Although I knew this was temporary and would only be necessary for a minute, it still broke my heart to watch. This was the second time in about 48 hours that I had to watch my daughter get bag valve ventilations. I would not wish that site on anybody.
After a couple minutes of work from the respiratory therapist, Malia was officially on the ventilator. Among other things, this meant that she was receiving 30 breaths per minute from the machine, as opposed to 600 (which sounds like a random exaggeration, but I assure you, that is what an oscillator does). Although it would take the next several hours to determine whether or not the ventilator was working effectively (and whereso Malia would not have to go back to the oscillator) she showed positive immediate results. She also showed those positive results over the next few hours.
Also during the afternoon, Malia was able to receive her first feeding of breast milk. However, it was not from the breast. And it was not from a bottle. And she did not get to taste it. But, instead of receiving IV fluids only, she did get a little bit of breast milk through a feeding tube that went through her mouth, directly into her stomach. I later found out that this is less comfortable for her than the tube that goes through her nose, directly to her stomach, oddly enough. But they had to do it this way as she had too many other devices utilizing her nasal passages
One last point of interested from Wednesday afternoon was that Ariah got to see her little sister for the second time. Because she was not allowed in the NICU, it wasn’t exactly the same as the face to face she got Monday afternoon, but while she was with Grandma, we did a Facebook Messenger video chat which allowed her to see Malia on the phone screen.
I learned a lot about respiratory therapy during Malia’s stay in the NICU. While an oscillator provides upwards of 600 breaths per minute, a ventilator provides much less, and interestingly enough, only provides breaths if needed. One of the ventilator settings provided Malia with 30 breaths minutes, but only if she needed it. In other words, if Malia took at least 30 breaths per minute, the ventilator would not provide any additional breaths. By the evening, that was nearly the case. The monitor was color coded to show whether each breath was provided by the machine, or taken by Malia. It was refreshing to learn this as most of the breaths were yellow; that is, most breaths were taken by Malia and the ventilator was hardly providing any support at all.
Because Malia was taking most breaths on her own and her O2 saturation levels were healthy, the medical staff was already weaning the ventilator settings, providing even less support. We were told that night that Malia could be moved to a cpap (the next step down in the weaning process) in the next day or two.
The walk outside:
We left Malia’s room around 8:15 that night. Cherry had not had much of a chance to get outside over the past couple of days, so as we reached the main lobby on the long walk back to her room in the mother deliver section, she asked that we step outside for a moment. Knowing it was cold, we agreed it would be adequate to exit the lobby doors, walk the 100 or so steps to the next set of doors (and mostly on the way to her room) and get back inside quickly. Cherry and I sure got our fresh air.
As a security measure, at 8:00 pm every night, most of the hospital doors lock. They don’t lock anyone in; you can exit the building with no problem. But they do prevent entry. So, Cherry and I exited the lobby, walked in the brisk, cold air to the next set of doors and, ready to get back inside right away, found the doors to be locked and we were unable to enter. “Shoot, I forgot about that” I said, recalling my first entrance into the building the day Cherry’s water broke. “No problem though; we exited the main entrance and those doors are sure to be the ones that open” I continued. Cherry agreed so back we went. Upon arriving back at those doors, we were greeted with more locked doors. Evidently, the only doors anyone (except staff of course) can access are those to the emergency room, located at approximately the furthest point away from where we were.
As we departed on our cold walk around the hospital, Cherry joked “well, now we can get some more of this Colorado ‘fresh’ air,” referring to the fact that marijuana was legal in Colorado. Funny enough, on the walk around the hospital, we indeed saw (and smelled) a couple of folks smoking marijuana.
Several minutes later, we were at the emergency room where we were let in, we described our situation, and were given directions back to Cherry’s room. A couple minutes after that, we were right where we began (next to the NICU). My goal each day was to attain 10,000 steps (measured by the pedometer on my phone). I believe I reached my goal that day.
Thursday morning- Sunbathes, sugar, and setbacks:
To be fair, there were not sunbathes, sugar, and setbacks. The setbacks were what I am calling sunbathes and sugar. Specifically, Malia’s labs showed that she had high bilirubin levels. Because of this, she had to “sunbathe” under ultraviolet light, which somehow helps remove the bilirubin. I was assured that this is very common in premature babies and it is even common for term infants. The high bilirubin levels results in jaundice, which I had known is relatively common in infants. I was glad to know it was a common problem, and typically a very minor one, but it was a setback nevertheless. At least Malia got to look super cool with her black “sunglasses” protecting her eyes from the light.
Of more concern Thursday morning was that Malia’s blood sugar dropped significantly. It had been stable over the previous couple of days, but all of her nutrients were provided via IV fluid. Because she started receiving breast milk the day before, the nutrients provided via IV fluids were slightly reduced. Apparently she was not ready for this transition. The blood sugar had dropped in the middle of the night and when checked again in the early morning, they were even lower, enough to cause concern. This issue was not as threatening as any potential infection or lung/ breathing problem, but it had the medical staff a little concerned, and subsequently had me very worried. She was moved back off of foods for the time being and once again strictly on an IV fluid diet with glucose supplementation.
Come back in two weeks to pick up on the next part of Malia Mei: A Courageous Birth.
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