Saving Sam (Chapter 1.23): Shit just got real

Our 2:00pm feeding was easily our biggest of Sam's entire journey so far.  We arrived, hopeful at his continued progress down the oxygen scale, and crossing our fingers that our assertive nurse would take the plunge and see if Sam was ready to breathe fully on his own.  We arrived, saw his great stats, and started getting him changed.  Almost without prompting, the nurse walked over, and removed the cannula (the thing that goes in his nose to give oxygen).  She wanted to see how he would do.  I remember thinking, as we were driving in, that this would be a very exciting moment.  I would be thrilled and would watch in awe as Sam kicked all sorts of ass.

Yet, that wasn't what happened.  Sure, Sam got off the oxygen.  But my heart started beating faster.  I started to sweat.  Elisa noticed that my leg didn't seem to want to settle down from it's up and down dance.  I was nervous.  It didn't help that Sam's feeding was a cacophony of beeps as, without the oxygen, he was toying dangerously with his oxygenation.  Every time it would beep, I'd try to adjust the oxygenation cord, thinking that somehow I could still control the situation.  Sam must just be having bad readings, right?  Eventually, he settled down, ate, and then we put him in his bed to rest.  The next three hours would be telling.  After all, it is critical how their oxygenation is when they are sleeping, not when they're awake.  Elisa and I walked away and headed for our car.  I said to Elisa "shit just got real".  Little did I know that three separate instances this evening would slap us into a very clear reality - indeed, things were starting to get real, and Sam's situation, current progress, and future arrival at home all held land mines that we might not have fully comprehended before.

90 minutes of heaven and hell
My goal today between the 2:00pm and 5:00pm feeding was to get a nap.  The late evenings are definitely taking their toll, and I thought that while the kids weren't at home, we could get a couple minutes of shut eye.  As we went home, we talked about how nervous we were with him off of oxygen.  Maybe it was just because it showed us how close we were.  I think it's more likely that we were starting to comprehend that Sam was sitting in NICU...and doing everything himself.  We came back, watched some Friends (hey, normalcy was definitely needed now!), and I fell asleep.  I'm pretty sure Elisa didn't.  When I woke, I got a call from our boys, and then a text from my Dad, who was visiting little Sam.  He sent a picture.  I don't think he knew that the oxygen had been removed, because he didn't mention it in his text.  And my heart sunk when the picture clearly showed that Sam's cannula was back in his nose.  Elisa and I adjusted, and I was slightly relieved that we found this out before the hospital.  It might have been more painful to see it while expecting great things.  When we got back to the NICU, the nurse (a new one, of course...not Mrs. Assertive from before) informed us that Sam had made it about 90 minutes before his oxygenation started settling in the 89-90-91 range.  While the alarm was set up to accept this, she informed us that the Doctor really wanted Sam's oxygenation to be 92+.  So back on the 10cc of oxygen.  Back to the cannula.  And a step away from home.  While she stated that if his saturations held up again, she'd try again, we couldn't help but feel deflated.  When the cannula was removed, I think we both saw our baby boy, free of NICU interventions.  The step back was a hard one to take.

Reality Training
But that was just the beginning of our night.  The boys were off to Grandma's for dinner because Elisa and I needed to check another box off our never ending list of "to do" items so that Sam could come home.  Tonight, we needed to attend an infant CPR class.  I can only imagine what that class might be like before you have a kid.  It's probably the like breastfeeding class.  The Dads sit and giggle that they have seen more breasts in a public setting than ever before in their lives.  The women are all business, thinking that breastfeeding looks very simple.  Then reality strikes.  The kid is here and men will never look at breasts the same way.  Women realize how difficult breastfeeding truly can be (hmmm...maybe that's why most do it for 3 months and quit).  An infant CPR class before a NICU baby would probably be the same.  Men would joke about the little mannequin and the plastic bag in their chest.  Women would take copious notes, thinking that they were ready for any situation.  When you have a NICU baby, however, the Infant CPR training just scares you.  Why?  Because you know you might actually need the skills.  You might be in the situation.  You could need to save your baby's life.  Elisa and I were quiet and focused during the training.  I remember thinking that I was careless to not know this with my other two boys.  Shit just got real...again.  I do have to thank the other couple for being in the class and giving us a brief period of levity.  After CPR training, we learned what to do with a choking baby.  As we were practicing, the trainer recommended that we stand.  I did.  Elisa didn't.  The other couple didn't.  As we started the process, I looked over at the other Dad.  He was certainly giving the choking steps his all.  He was just missing the key awareness that you probably shouldn't be letting the baby's head beat against the table.  Next time, stand up buddy.  Give yourself some room before you really do damage to a kid while trying to save it's life.  I wasn't surprised in the least when I saw the mannequin army crawling away from the guy in between videos.

Home is a scary place
Our final lesson of the night, however, made us realize that as much as we want Sam to be home and away from the NICU, there is a scary reality to that end result as well.  At the 8:00pm feeding, Elisa was alone, feeding Sam behind her nursing curtains.  Sam was happily eating away when he choked on the breast milk.  He arched his back.  His lips went a little purple.  And alarms started ringing throughout Level 2 NICU.   Elisa was a champ.  She sat him up, patted his back, and Sam recovered almost immediately.  By the time the nurse arrived, the alarms had settled and Elisa was simply informing her that he had choked a little and was okay.  The nurse left, clearly satisfied that Sam was okay.  But Elisa was shaken.  The reality of leaving NICU is that you give up the nurses, the monitors, and the beeping that tells you when something *could* be wrong.  You're on your own.  No beeping.  No warnings.  Just you, your actions, and a NICU baby that takes on a persona of a fragile porcelain doll, not a bouncing baby that will crash into walls without a scratch.  We want Sam home.  So badly.  But something like this makes us open our eyes - will we be fraught with worry at every cough?  Every deep or shallow breath?  Every pause before eating?  Indeed...shit just got real.

At 2:00pm today, Sam took his first major step to clearing Milestone #3.  He was off of oxygen for a full 90 minutes.  And instead of feeling invigorated, I felt scared.  In the moment, it was scared of a beep that showed that he wasn't quite ready for a world without the cannula.  By the end of the night, it is a building worry about Sam, Elisa, and me long after the NICU.  When we're home, alone, and trying to keep our little perfect baby boy safe.  I can only hope that we keep our wits about us to ensure that Sam is as safe at home as he is in the friendly confines of the NICU.

Yes, shit just got real.  Very real.  And very, very scary.

Brad