NICU (Neonatal Intensive Care Unit)

My friend’s wife, Maria, was on bed-rest for the last few months of her twin pregnancy. They live in Cyprus. I’ve been checking in with them on Skype, every other Thursday. It gets down to numbers – be it weeks, days, weight, length, or contractions.

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“30 weeks. Woooo hooooo!”

“So far so good! Maria is doing well. Bored, but fine.” he replied.

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“32 weeks – great news! What’s the latest?”

“Doctor says all is good. We’re aiming for the 22nd of December; 36 weeks.”

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And last Thursday: “34 weeks, how’s it going?”

“We’re scheduled for a C-section in about 3 hours.” They were at the doctor’s clinic, waiting. “The smaller one has plateau’d at 1.7 kilo; the bigger one is 2.4 kilo. The smaller isn’t growing anymore.”

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Friday on the phone with my friend: The little one is doing well. It’s the bigger one though, he cried when he was born, and then suddenly stopped breathing. I was asked to leave the delivery room at that point. They held him upside down. He was blue…I panicked.

I remember the worry that gripped me every time I was asked to leave the NICU. Either Rahul had gone into yet another sleep apnea; for what seemed like a little too long, or they had to set, and then re-set an IV into an already rebellious Leila’s miniscule, 1.2kilo body-weight, hand or foot. The screaming, the suffering you hear from a creature as tiny as she was, through the thickest hospital walls, is heart-wrenching.

My friend and his wife seem to have their emotions under control. I clearly remember that it wasn’t easy to stay level. But I had to, no matter what. I seemed unemotional, distant, “strong”, because otherwise I would break down. That meant I barely spoke to anyone, other than minor, somewhat polite interaction with the medical staff and with my parents and mother-in-law, who had moved to Hong Kong to help me during those 6 weeks, and after. I managed it the best way that I could. That’s it.

I hated my phone more than ever before. I couldn’t stand to see Maher on his. It had to be off in the NICU. And if I wasn’t at the hospital, and it rang – it was one of 3 options: Maher, someone I didn’t really want to go into any detail with, or the NICU. Luckily for us, it was never the last option.

Regardless of the calm my friend has portrayed, I’m contacting him daily, but apprehensively. You never know with this: one day the milk feeds are up, the next day they’ve been stopped because it seems there is a fatal infection brewing in the intestines. One day Twin 1 is moved out of the NICU into the slightly bigger babies room, the next day the baby in the bed next to Twin 2 dies.

One of my initial, harder moments was on a Wednesday afternoon, the third day after the birth. It was the day I left the hospital. I walked out, free after months of bed-rest; but I was leaving my babies behind.

Maria will only see her babies on Sunday, after she is discharged. On Thursday, she gave birth at the clinic, and the babies were rushed off in an ambulance, to an NICU. I realized that what my doctors did, what seemed obvious then, makes much more sense – they put me in an ambulance at the private hospital where I’d spent the last two weeks of my pregnancy, waiting out contractions, so that I could give birth at 31 weeks, at a major, public hospital, that had a state of the art NICU on its 6th floor.  I didn’t see my babies until they were 17 hours old, but they were in boxes, safe, somewhere in the same building.

In the hour after I saw them for the first time, when I saw and heard Rahul cry out – in pain – and I couldn’t do anything, not even just pick him, I realized that I would have to find the deepest of my strengths, love, and compassion to get through this.

She was 2 weeks old when we saw Leila’s face for the first time; Maher and I happened to be next to her incubator when a nurse changed her sunglasses. Both babies had jaundice when they were born, which is quite normal. Leila’s dragged on for a while though. It is treated by phototherapy – a light that shines on the babies – front and back. The babies wear a white mask to protect their eyes. On most babies in this ward, the patches are as big as their faces.

I tried to spend every moment possible with my babies, visiting hours for parents only, were from 9am to 12:30pm, and then from 2pm to 8pm. I spoke to L and R, sang to them – out of tune, and during the week, when Maher was back in Chengdu I played an Mp3 of him singing for them. I caressed them, and when they were stable enough, I clumsily changed their diapers, and even attempted to breastfeed them.

The medical team of this hospital, The Queen Mary, HK, knows what it’s doing. From the moment we arrived – me contracting and making guided decisions in labour, Maher figuring out the administrative details, we knew we were in good hands.

But the NICU staff didn’t always explain a lot to us, nor were they particularly nice. Of course the team is very busy giving life to babies; giving them a second chance. They don’t have time for frantic, lurking parents; at least that’s how we felt at our NICU. They deal with immense fragility scientifically; they attach ventilator’s to tiny babies, insert IV’s, measure and inject milk feeds into a tube that goes straight into the baby’s stomach, and then suck out and measure the undigested material through the same tube, they monitor and record every minute change on a tight, 24-hour schedule. Not easy for any parent to handle. And oh yeah, they let the babies cry.

There was one nurse though, who made the difference. She always smiled. She not only encouraged me to breast-feed, but she also advised me and gave me pamphlets about it. She’s the nurse who organized a parent support group one Sunday afternoon. That meeting opened us up. Her kindness and compassion made my visits a little easier.

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At the NICU in Cyprus, my friends are only allowed to see their babies between 1 and 2 pm, and then again between 5 and 6pm.

A friend of mine had to send her 2 month old baby to an NICU in Chengdu, for pneumonia. No one was allowed in. Full stop.

On the other hand, a friend of mine in the UK would go in to see her baby in the middle of the night be it because she was gripped by anxiety or because she had a strong urge to stay close to her baby.

The NICU rules everywhere seem to differ. What was your NICU experience like? What were the visiting hours? Was the staff pleasant, and helpful towards the parents? Did they encourage breastfeeding? Who was allowed in?

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Medium and Happy

Rahul and Leila have come a long way since their birth at 31 weeks gestation. At 18 months they have caught up with other children their age physically, emotionally and developmentally.

Leila recently jumped from the 5th to the 10th percentile in weight, and Rahul is steady at the 10th. In height they are both at the 50th percentile. All in all, according to the charts (which might be slightly different that the US standard ones?), they are light weight children of average height. Not that it means much anymore. Last month I met a five month old baby who weighed as much as Leila. At their NICU there was a baby born at 24 weeks, much tinier than them. Now however, when I see them play amongst toddlers their own age, they merge right in, size-wise as well as ability-wise.

Since they were born a couple of months early it was normal, even necessary to closely monitor their weight gain. Thankfully we have had no serious problems since they left the NICU. They are both running, playing, and talking a lot. They are full of energy.

It’s time for me to let go of the obsessive monitoring. They need a break from being scrutinized and compared. They inevitably get a lot of it just for being twins. They don’t need any more, and especially not from me. In the big picture a little delay here or there is not a big deal. I have noticed that they are eating a little more than before, sleeping a little bit better, and enjoying each other.

I have found that comparing healthy babies growth and development is useless, and even silly. We all do it though. It’s natural. Parents often compare how soon their babies sit up, crawl, start sprouting teeth, walk, and talk in relation to others. Discussing these things with other mums and dads is important, especially for first time parents. It is necessary to follow-up on certain milestone achievements. If a real problem is caught soon enough it could be addressed more effectively.

There is a wide range of normal. I can see that just by having two babies. Leila crawled by 7 months, Rahul started after 9. They both had issues with digestion in the NICU. They digest differently. R has a strong reflux, Leila a poor appetite. Now L eats all the time and R eats only when he can feed himself! They both got their first teeth around the same time. According to Dr. Sear’s “The Baby Book”, when teeth come out is a genetic trait. Speech seems to be a big “issue”, and especially when there is more than one language spoken. We have 3 languages around us, and so far they are both saying words in all.

My brother didn’t speak until he was 2. My grandmother forced my parents to see doctors about this. Neither did he eat. What a catastrophe. My parents were easy-going enough to let him be. When he was ready he spoke and when he was hungry he ate. Now he talks a lot, and eats a lot. He is a professional sportsman, and a big guy. My brother-in-law spoke “late”, but apparently when he did it was in full grammatically correct sentences!

When asked, I usually responded to questions about my children’s age, weight, birth order etc. And then I asked similar questions back. Sometimes I even initiated such dialogues. I knew it was silly, but I needed to hear that Leila and Rahul are smaller than others to validate their experience of early birth, as well as mine being their primary care-giver. It has not been easy with their tiny milk feeds. After birth they wouldn’t drink more than 1 to 3 ml of milk at a time. By 1 year R could take 120ml. But because of his reflux he had to stop and burp every 30 ml. Each feed was drink, burp, drink, burp… Leila woke up every 2 to 3 hours to drink at night, and still does. Most babies around us sleep through the night and eat comfortably. I couldn’t help comparing.

I was listening to a studio talk by Richard Freeman, an inspiring senior Ashtanga teacher the other day. I am paraphrasing what I understood from it. He said as soon as we realise that our Asana posture is medium, that it could look better, and it could also look worse, there is a release. The pressure dissolves and the breathing starts. It is no longer about having the perfect posture. It is more intrinsic and personal. That’s when the suffering stops and the practice can deepen.

The same goes for size. As soon as we can acknowledge that we are medium, that we could be taller or shorter, fatter or thinner, there is a release. We can move on and think about other things. I once told a close friend that her son was tall. “No” she responded, “he is average height.” Her honesty struck me.

Rahul and Leila are changing all the time, as I am. When I am around them I want to be actually present. I want to encourage them to have fun, and to laugh. They have enough time to follow curriculae and perform in the future. We can all stack 4 blocks and order rings according to size. It makes no difference to me if they can do it now, or in a few months. They are full of love and energy and that is what really matters. I want them to be Medium and Happy.