An Actual Tip

It’s not inconceivable that part of the modest traffic that this blog manages to attract are new and expectant triplet parents. Maybe, like me years ago, you’re trawling the internet, looking for wisdom and advice about how to handle the task of having and raising three individuals at the same time. Well, today I’m going to try something I haven’t attempted in an awful long while: an actual tip, as it were, on triplets.

But since this is TipsOnTriplets and nothing’s easy-breezy, before I get to the advice, I’ll start with a story. I like to call it My Greatest Moment As A Triplet Parent.

Triplet pregnancies are fraught enough, but Carey’s had the added peril of Lupus, a condition she’s lived with since college. Every moment of our boys’ gestation would need close monitoring, which is what took us to Long Beach’s Magella Medical Group, specialists in high-risk pregnancies.

As you might expect, I had a jones to document everything with an eye toward eventually cutting together a highlight video of the pregnancy and eventual birth of the boys. I was on the lookout for odd moments, hopeful moments, important moments… anything that could communicate the nervous frenzy of the time, assuming we’d one day appreciate the look back.

So we arrived at Magella Medical Group for our initial consult and tests, a situation ripe for the video reel. And since the idea of producing a video had only occurred to me a few days prior, this was going to be one of the very first moments of the eventual edited piece. So I got to work grabbing b-roll of the building, the sign, the elevator ride up to the office. I imagined all of this cut together montage-style atop a heart-swelling music bed.

We entered and I was getting footage of everything, no matter how mundane. Carey signing in. Carey’s blood pressure being taken. No moment too small.

We entered an exam room and an office supervisor told us to have a seat. I pulled out my phone to grab a shot or two of Carey getting situated. The office supervisor said, “Just so you know, we unfortunately can’t allow any video taken here in the office.”

I said, “What do you mean?”

“Well, it’s one of our rules. I could explain all of the liabilities behind it, but suffice it to say it’s our policy here.”

“What about photos?”

She hesitated. “Photos are ok, maybe just a couple. It’s video we can’t allow. It looked like you were about to record with your phone, so I have to mention it.”

I thought about it for maybe two seconds. It made sense: an office specializing in high-risk pregnancies meant they’d likely seen quite a few pregnancies go badly. Failed pregnancies = angry parents = looking for someone to blame = “evidence” gathering, however legit, however spurious = legal battles = headaches the Magella Medical Group would just as soon avoid. I should also point out that the good people at Magella are as smart and conscientious as they come. It’s a wonderful place and we were lucky to be there. “I get it,” I said.

And that’s when My Greatest Moment As A Triplet Parent happened:

I lied.

“No problem, I won’t take any video. Maybe just a couple of photos.”

As reasonable as the Magella Medical Group’s policy on video capture was, it was a rule I just wasn’t going to follow. Sure, I thought, I could respect the wishes of the office. It’s their space, they get to decide what’s allowed. On the other hand, I pictured myself a decade in the future, me and three 9-year-olds huddled around a laptop. I would play the video their dad shot when they were still in the womb, showing how excited their parents were to meet them, how committed we were to taking every precaution to keep them safe and healthy.

Or I could tell them the story of why we didn’t have any video because we followed a lame f&%#ing liabilities rule.

The office manager left the room and I started shooting. And that’s how the rest of the morning went. I caught some great moments: The doctor telling us how the placentas work. Our hearing their heartbeats for the first time. Poring over ultrasound prints, relating to the camera what we’d just found out about our then-healthy three.

And stern looks from the staff. “Nope, just lining up a great photo moment,” I’d tell them, video rolling.

Of course, the video I really wanted to make was never made. But I did use the Magella footage in the memorial video I cut together after the boys passed. And you know? It’s not only my favorite moment in the whole memorial video, it’s footage I wouldn’t trade for all the riches in the whole wide world. While it was the postmortem footage of the boys (4:40) that caught the interest of The Daily Beast, BBC World Update and Good Morning America, it’s the Magella material (1:01) that makes my heart the happiest. Because there it is, in full-color, living, breathing, 24 fps shaky glory: two expectant parents who love their children more than anything, full to the eyeballs with excited, terrified, nervous anticipation. That’s the real stuff. That’s where life is.

Ok, that was quite a wind-up to get to the point of this post and the reason we’re all here: a Tip on Triplets. So here it is.

As a triplet parent, nature has already decided to chuck your special ideas about the traditional way of doing things right out the window. You have to wing it, you have to make it up as you go along. And the world is loaded with rules and philosophies about how you’re supposed to handle these three little aberrations.

These triplet children of yours are a messy, imperfect miracle. Listen to what the critics and the experts have to say. Take it in. Consider carefully. But keep in mind:

These children are yours. You make the rules.

That’s really it. You get to decide. If you need to go rogue, man, go rogue. This isn’t twin parenting and lord knows it sure as hell isn’t singleton parenting. It’s a whole other thing that demands reserves that John and Jane Q. Public don’t fully understand.

If you need to shoot the video, god’s sake, SHOOT THE VIDEO.

Go nuts. It’s up to you. The status quo was miles back, do your own thing.

That’s all.

(But, you know, within reason. Vaccinate your kids. I mean what are you, a bunch of toothless hill people?)

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Contractions

Very first of all, you should know that the whole reason for this blog has more to do with the comments section than anything I could possibly have to say.  We’ve been brought to tears again and again throughout yesterday and this morning by your wisdom, thoughtfulness, faithfulness and amazing autobios in the comments of previous entries (not to mention notes on Facebook and Twitter).  Carey was having a particularly difficult morning and it was your beautiful sentiments, read aloud to her by me, that carried her through.  Content yourself in knowing I used all my oral interp skills to represent you and I apologize for any mispronunciations.

I’ve said it before and I have to say it again: thank you.  We covet every message and I mean it. If we could reply to you individually right now, we surely would.

By way of updates, though:

Last night began on a positive note.  Carey was moved to a much nicer room, complete with windows and other amenities, which lightened the mood considerably.  The “Rain Man Suite”.  Dr. Chao stopped by with an ultrasound device and showed us Baby A.  To our delight, we saw that not only had he partially replenished some of his fluids, but he actually had enough room to move around a bit.  Carey was still losing water, but apparently not as fast as it was being replaced.  “He’s bouncing,” Chao told us.  “You can’t bounce without fluid.”

This was good news.

And the hits kept on coming.  We enjoyed a little dinner and a nurse brought in a cot for me, so that I wouldn’t need to ride a chair for the third night in a row.  Carey popped a sleeping pill and we began to drift off to dreamland.  We weren’t out of the woods, but, for the first time in days, things were looking a little better.

Matters took a turn, though, around 2:45 AM.

An uncomfortable itching and some cramps were keeping Carey awake and we called in a nurse.  She hooked up a monitor and confirmed it: some minor contractions.  Temperature was fine, fluid leakage was next to none… everything was looking good except for that little wavy line on the contraction printout.

Over the course of the next several hours, what began as a mild irritation turned int0 what appeared to be full-blown labor pains.  We ordered up the contraction medication and no effect.  Hours later, Carey wound up calling Dr. Chao on her personal cell to petition for a different contraction medication and Chao relented.  This one helped, but by no means fixed it.

Everyone was getting concerned that Carey might be going into labor.  The pain had intensified to a startling degree and even though it was the last thing anyone wanted, we were forced to order up Morphine.  It helped for a half hour or so, but wore off quickly.  We were doing our best to avoid being shipped off to Labor and Delivery.  Delivering these babies at 22 weeks (as of yesterday), as the doctors keep reminding us, more or less means Game Over.

A NICU doctor paid us a visit for a quick consult, wearing a “I lost the rock-paper-scissors tourney in the hall, so it looks like I have to break the bad news” expression the whole time.  He gave us a lot of odds and statistics and some genuinely helpful insights on our post-partum infants.  Most of it we’d heard before, but I suppose the medical community isn’t really doing their job if somebody doesn’t come in at some point each day and remind us our kids are a cough away from the Grim Reaper.  And likely brain damaged or disordered if they do happen to hang in there.

It wasn’t an all-bad-news day, though.  Fluid and blood leakage: next to none.  Blood work: good.  Temp: normal.

Dr. Chao eventually came in with a much-needed post game on the day.  The contractions are real, but it’s Baby A that’s amplifying them.  Specifically, his lack of a filled sac is causing him and the other two to apply pressure to the pelvic nerve and uterine ligaments, which is excruciating.  Also, the issue was keeping Carey from emptying her bladder.  A catheter meant more infection risk, but what had to be done had to be done.  After the catheter, she’s feeling significantly better.  And no, she doesn’t seem to be in labor.

So, we’re at 22 +1.  I wish I could say our odds are better than yesterday, but they’re not.  In fact, the only difference between our situation today and our situation yesterday is we’re a day closer to 24 weeks, without infection.  So far, anyway.

Which is something.

“We Can Hope”

Needless to say, we’ve been waiting in the eye of a mighty whirlwind since Carey’s water broke a couple of nights ago and she was admitted to the BirthCare unit at Long Beach Memorial.  We’ve spent all of our time in the hospital since then and, as you’d imagine, our OB warned us that we were in for a very long night and day to to follow.  And, of course, she was right.

Yesterday morning, we met with Dr. Chan to “discuss options”.  Truthfully, we met with several doctors, but it was Dr. Chan who told us where everything stood.  (Apologies if I get some of these details wrong.  When you begin hearing terms like “viability” or “termination” or “sepsis” in relationship to your wife and three children, the world starts to strobe and details get fuzzy.)

Chan looked at our ultrasound and described what’s happening.  Baby A, who’s lowest, next to the cervix, is the baby whose sac ruptured.  By yesterday morning, the amniotic fluid had drained more or less completely, causing the sac to, in Chan’s words “shrink wrap” around him.  What fluid is left is in the pockets around his body and Carey continues to leak amniotic fluid throughout the day and night.

The biggest problem with this isn’t necessarily that Baby A has less fluid or that he’s all scrunched up in a ball (those things are big problems later down the line, but it’s not the immediate concern).  A fetus is able to survive in those conditions and A’s heart continues to beat just fine, but it’s the risk of infection that worries everyone here at Memorial.

Carey was experiencing minor contractions when she was admitted (so small that she couldn’t even feel them), but they put her on medicine to counteract it during the first night.  Eventually, Chan made the ruling to take her off the contraction-blocker, as it was only serving to mask infection.

The trouble with infection is that it begins as perfectly safe bacteria that’s either introduced into Carey’s body from the outside or already exists there to begin with.  Our bodies are accustomed to it and our immune systems keep everything in equilibrium, but the game changes during pregnancy.  Hormones make gestating fetuses extremely susceptible to any sort of infection and the barriers between our children and certain disaster are the cervix and the sacs.  At one centimeter dilated and the bottom most sac ruptured, that’s very bad news.

A lot of people have asked if it’s possible to save the other two if something happens to Baby A and Chan explained that, with infection, it doesn’t exactly work like that.  Any direct, invasive action taken to address the situation introduces more bacteria and increases risk of infection.  It’s not really a matter of taking one baby out to save the other two.  There are definite exceptions, but in most cases, if one becomes infected, it’s likely the infection will progress to the uterine lining and other placentas.  And if that happens, it becomes a matter of saving Carey’s life instead of the babies.

We asked what the chances are for all three to make it and Chan was straightforward: about 30%. And, of course, the likelihood of the kids living with motor-neuro deficiencies or spending their lives in wheelchairs due to CP is now extremely high.  I asked him if it was at all possible for us to have three healthy, fully-functioning  children at this point.  He shrugged: “we can hope.”

Now, I’m a realistic guy.  I know that “we can hope” is doctor-ese for “extremely doubtful and you need to prepare yourself for some very cold realities.”

He discussed Options with us.  He warned us that to continue down this path could make it very difficult for Carey to get pregnant in the future.  He said that the odds weren’t with us and there’s a strong possibility of handicapped children, even if things begin moving in a positive direction.  He mentioned that we’re still a couple of weeks away from 24 weeks, the Age of Viability, and that’s the point where he’s no longer allowed to treat termination as an option.  He asked if we would object to any termination discussions from here on out.

Carey and I weren’t exactly sure what to say.  We’re Pro Life people.  Carey in particular is a hard and fast believer in the sacredness of all life, including-but-not-limited-to human beings, born or unborn.  We’ve agreed that nature is better at deciding these sorts of things than we are.  But, like that annoying instigator who throws up his hand in the midst of every college Ethics course discussion and plays the devil’s advocate, life is testing what we believe by introducing an extreme scenario.

We finally said we want to wait and see.

“There’s a phenomenon,” Chan told us, “where a ruptured sac can seal itself back up.  It happens very rarely and we can’t explain it, but I’ve seen it.  The sac heals and fills again with amniotic fluid.  After a few days and weeks, well, we’re back in business.”

“How often does that happen?” we asked.

“I don’t want to get your hopes up for that.  It’s rare.  I’m tempted to say it’s a 1% chance, but even that is being too generous.”

“Have you ever seen it with multiples?”

“Ah… I’m not sure how to answer that.  I think probably only singletons, but I can’t recall.  It’s unexplainable.  A miracle.”

Later, Carey and I were discussing what we thought.  What should we be praying for?  Is there any hope left for our boys?

“What do you think?” Carey asked me.  “Be honest.”

I wasn’t sure what to say, so I just laid the truth on her, as I see it: “Well, less than 1% isn’t 0%.  And it’s got to happen to somebody.  So why not two people who are right now being prayed for by hundreds of people all over the world?”

She agreed.  So that’s our prayer.

It’s Thursday morning, just before lunch, and Carey is still losing amniotic fluid.  Miracles are called miracles for a reason, though, and we’re taking Chan at his word: “we can hope.”

—

People have been absolutely astonishing with their prayers and encouragement.  To anyone who says blogging and social media is a waste of time, I say, respectfully, that Twitter, WordPress, Facebook and txt messaging have been our saving grace and anchor throughout this impossible time.  All over the world, we’ve received emails and txts, wall posts and blog comments, tweets and retweets from dearly loved family and friends and also Tweeters and Bloggers we’ve never met with encouragements, prayers and soothing words that have given us smiles and hopes in our darkest hours.

Several times a day I’ve pulled out my iphone and read Carey the latest, wishing we could reply to each person with hugs and heartfelt thanks.  “Good thoughts and vibes from me to you,” people have said.  “We’re praying.” “We know someone in a similar circumstance and they came out of it with a healthy baby.”  “We love you, we’re praying now and all through the day.”

“Praying.” “Praying.” “Praying.”

It would be impossible to describe all the encouragement we’ve received, but I want to mention one or two.

Marisa Palma: thank you for bringing meal after meal to the hospital.

Jerry and Pat Giles: thank you for getting out of bed at an ungodly hour to come and pray for us and give us a desperately-needed Psalm.

Mom, Dad, George, Shannon, Kelley, Erin, Lauren, Schwyzen, Danielle: thanks for crying with us on the phone and asking and listening.  It’s okay that you’re not sure what to say.  Being there for us is enough.

If you’ve txted us or posted something on your wall or commented or tweeted or retweeted: thank you.

If you’ve had a life long faith and are praying, or if you’ve told us, “I’m not a praying sort of person, but I’m praying for you,” or if you’ve simply wanted to send us good thoughts or vibrations or love or care or anything at all: thank you.

Thanks also for being understanding about what Carey and the boys need most.  It’s entirely possible that we’re unable at a given moment to take your call or receive an in-person visitor, particularly if you’re getting over a cold or something that could be dangerous.  Please don’t hesitate to ask if it’s an okay time, though.  If we’re able to talk or see you, we certainly would love to.

Most of all, please continue to lift us up.  It’s a difficult time and it’s far from over.  We’re trying our best to stay positive and get sleep when we can (I’ve gotten pretty used to this beside chair at this point).

I’ll continue to update Twitter when I can.

We’re going to keep hoping.  Hope with us, would you?

June 2, 2011

The envelope, please…

Nothing smacks you between the eyes quite like the sight of that positive pregnancy test and, from what I understand, the only moment to top it is the instant  your child–or, for us, children–are born.  But, thanks to ultrasound wizardry, contemporary parents get to enjoy a very specific pre-birth moment of adrenaline about midway through the 9 month journey.  And for Carey and me, that was today:

Today we found out what our children are.

For us, it wasn’t a question of whether or not we wanted to find out ahead of time.  We both agreed immediately: we need to know.  Life is loaded with enough surprises, particularly if you’re expecting triplets.  You’ll remember we calculated the odds and collected guesses from friends and acquaintances.  We had our secret druthers, but we knew that all the prayers and predictions in the world wouldn’t change any XXs or XYs in those little ones’ chromosomal soup.

Carey had her fingers crossed for two boys and a girl.  I didn’t really have a preference, as long as a boy was somewhere in the mix.

We headed back to Magella Medical Group today for the official anatomy scan.  They asked us up front: did we want to know?

Oh, yes.  We wanted to know.

So, the ultrasound tech did her thing and told us, one at a time, what we had.  Baby A was obvious, as was Baby B.  Baby C was a little more stubborn, but the kid finally moved the offending foot out the way and gave us a look.

Anyhow, enough wind-up.  Here’s the verdict:

I guess the Bear family name gets another go ’round.  And then some.

It’s true, the news hit Carey a little hard.  It’s difficult to resist the romance of a little girl… the cute outfits and the the perfume-y, sweet little moments that most every mom-to-be fantasizes about.  It’s difficult to trade dollhouses for action figures, dresses and hair ties for fart noises and broken furniture.  And she’ll probably need to mourn the daughter we’ll never have a little bit… and, I can’t lie, so will I.

But holy cow.  Check us out.  Three boys!  Three sons!  Can you beat that?

It’s time to get to work on the names, that’s for sure.  We’ve been putting it off, but the time for procrastination is over.  Truth be told, I think we’re fairly solid on two of the three.  So far, we’ve got two legitimate first name contenders and a middle name that now may need to be promoted to first name status.  But I suppose it’s all still up for grabs.

Hah.  “The Bear Fellows.”  I can honestly say that, of all the combos, it might be the one I expected the least.  But I guess that’s par for the course at this point.  Because, brother, who knew, I’m now a modern-day Steve Douglas (the TV one, not the guy Lincoln beat).

And I can hardly wait to meet these gentlemen.

Jumping Beans

Tuesday, for the first time, I heard their heartbeats. But let me get back to that.

Last week, Dr. Chao, our OB, had told me, in no uncertain terms, “you need to be at the first high-risk-pregnancy-specialist appointment with your wife. If your work won’t let you go, you need to call in sick.  It’s important.” Fortunately, work was amenable, so, Tuesday morning, we headed to the Magella Medical Group in Long Beach.

It’s where you go when you’re pregnant with a disease or a disorder that puts you at risk.  Or pregnant with a child with a disease or disorder that puts him/herself at risk.  Or if there’s anything non-standard about anything having to do with your pregnancy.  Like, say, you’re 53 and find out you’re carrying a litter of pumas.

Or, say, 34, with Lupus, carrying triplets.

It’s tricky how they set these appointments up.  They spend the first 40 minutes or so filling you in on the 1,000 Reasons You Need To Worry.  Doctor Tith was extremely warm and helpful, but she didn’t shy away from the truth.  Fact is, any or all of our children could have CP.  Or Down Syndrome. Or some sort of mental handicap.  Or they could be sharing placentas and starving each other.  Or choking each other.  And, of course, for many of these issues, there are tests.  The tests can tell you within a 60% certainty whether your child has an 8% chance of having some disorder that’s 28% fatal.  Of course, you can take a more invasive test, which will give you 85% certainty, but you’ll increase your chances of miscarrying or delivering early by 13%, but only so early that your chances of it being fatally early are 38%.  Or some ridiculous combo thereof.

So, great.  Thanks everyone.  Consider us informed.  We feel way better.

Needless to say, halfway through this consult, I was convinced that at least one kid has some sort of fatal disease, the second one is going to be born with roughly half the organs it needs to sustain itself , and the third?  Oh, the third one’s fine, but s/he’s probably going to wind up a vampire when s/he’s 21.

I know my wife did way better than I did, but my swimming brain did at least take away a handful of important pieces of information.  Among them:

• Strong heartbeats= good
• 3 sacs = good
• 3 placentas = good
• The fact that these triplets are spontaneous, as opposed to IVF babies = moderately safer

So they took us in for the big ultrasound.  Triplets meant we’d already hit the fertility jackpot.  It was time to yank the lever again and find out what was heretofore unknown: are any of these goofballs sharing a placenta?  If so, that doesn”t necessarily spell disaster, but Tith was straight with us: we  should be hoping for 3 placentas.

Ultrasound began and we asked the tech, whose name is Michelle.  Michelle confirmed it: “Yes, I see three placentas.”

Finally, some friggin’ good news for a change.

And it was strange.  Here, only 11 weeks in, and they already seem to have different personalities.  Onscreen, Baby A swatted something in front of its little alien head.  Baby B kicked and flipped and did what it could to kung fu my wife’s innards. Baby C (who Chao calls The Lazy One) lounged up top in its amniotic hammock, irritated to have been bothered.

Jumping beans.

Michelle hit the vox and, out of nowhere, a very fast, very strong heartbeat filled the room, overpowering Love and Rockets’ So Alive, which had been playing on muzak. Baby A: 173 bpm.  Looking good.

Baby B: 173 bpm.  Very strong and looking good.

Baby C: 173 bpm. Everybody’s looking good.  Our kids have heartbeats.

In the space of a few moments, the majority of Tith’s concerns turned out to be just fine, or at least as fine as they can be.  And who knows, all of our children may end up with all of their organs. Maybe we wouldn’t miscarry.  Maybe they’ll all be (sh-shudder) healthy.

We talked about my wife’s job and her diet and her at-the-moment woefully inadequate calorie intake.  We found out later that, apparently, our case had been the talk of the office that morning.  A 34-year-old vegan with Lupus who’s carrying spontaneous triplets?  It’s odd.  Throughout the appointment, different doctors and other staffers kept poking their heads in and smiling at us: “Hiiii!  Sorry to interrupt, but I’m ___.  We heard everything’s looking good.  Congratulations!”  Then they’d disappear.  My wife is, it seems, medical journal case study fodder.

And it occurred to me that, as upset as we were when we found out we were having triplets, I now really want them all to be healthy and strong.  In fact, I think I want it very badly.  Maybe I’d even move heaven and earth if I have to to make sure they’re all right.

Good god.  When did I turn into a father all of a sudden?