One day I'll write something that is not about Oz. That is not today. The good news is, me dragging my feet doing this means that you are getting spared many a couple of the gory details that I originally wrote out. Also: this post is really super long because I'm cramming the whole ordeal into just this one, so as not to do an epic series of posts on this one thing that you may not care about.
"Opstipal" is, as you may guess, the GNG's term for hospital. (Caution: I may use the word "pus" repeatedly below.)
I brought Oz into the ER around 11 on a Saturday night 2 weeks after he was born, thinking I would get the usual paranoid-mom hand-holding and sending-homing. (As I've told all of you many times, the only time I took Eva to the ER in her first year was because I couldn't wake her up when she was only a few weeks old. Their diagnosis: she was really tired and, uh, needed to keep sleeping.) Instead, a pediatrician was called in and he was admitted to the ICU.
His belly button has been slightly dramatic from the beginning. His umbilical cord fell off when he was only 4 days old (as Eva's did...my kids are so developmentally advanced!). But his had an umbilical granuloma--basically, a "thingy in there"--and the doctor gave us silver nitrate to get rid of it. Eventually all appeared normal and healthy. But on that Friday and Saturday I felt like something just wasn't right with him. I did my best to chalk it up to my favorite postpartum (and anytime, really) emotional problem, anxiety, because he didn't have a fever and there was really nothing specific other than he wasn't eating well--he kept falling asleep while nursing. The thing about a newborn is that you don't really know him yet. His body and brain are changing ridiculously fast, and as anyone who has had a kid knows, every day can bring a new challenge or trait or development. So it's hard to tell if a 14-day-old is acting "normal" (since I've only dealt with a 14-day-old one other time in my life). But I digress. On Saturday morning his belly button was definitely swollen. The google machine told me that, absent any other symptoms, it was probably an umbilical hernia and could wait until his 2-week appointment on Monday. He was ambiguously fussy all day, and around 9 that night a decent dollop of pus showed up on his onesie. At that point my heart stopped a little, because in reading about umbilical granulomas and how to use silver nitrate I had come across something on omphalitis, a rare but serious infection of the umbilical cord stump. But he still didn't have any truly worrying signs of infection. The doctor advice line told us to take him in only to be on the very, very safe side. So at around 10:30 Saturday night he and I headed to the ER. The Pater Familias showered me with things I secretly considered unnecessary, like extra diapers and snacks and my boppy pillow (that's a nursing prop for those who don't know) and electronics chargers. The snacks were mostly gone by the time I got to the ER. The man knows me well.
After the usual puzzlingly long wait surrounded by the sick and injured*--with me desperately trying to keep Oz away from the sick--we saw the doctor, who called in a pediatrician (sorry about your Saturday night, Dr Goode, but thanks for maybe saving my baby's life!). By this time, only a couple of hours after the pinkness appeared, the area around his belly button was getting more red. The doctor got a culture started on his belly button discharge and called down a couple of NICU nurses to start an IV and draw blood. This part was absolutely awful, and let's just say that Oz felt it was the worst thing that had happened to him since that whole birth thing. (Even worse than that time his sister tried to pick him up, got caught by mom, and in terror dropped him back into the swing...) And I agreed.
The nurses blew out three veins--that was the saddest part, thinking that they'd finally succeeded then seeing the little blue explosion under his skin that meant failure--before giving up and retreating upstairs to their non-squirmy 3-pound babes. They were able to finally draw blood for cultures and an inflammation test.** We all figured he'd get his first dose of antibiotics intramuscularly and they'd try again in the morning to place the IV.
The pediatrician we saw figured it was either cellulitis (a relatively minor skin infection, not to be confused with what all of us moms seem to catch on our thighs) or the beginnings of omphalitis. Around 2 AM we moved up to the ICU and around 4 another NICU nurse found success in an arm vein. (I don't want to admit this out loud lest I incur angry jealousy, but the night was extra hard because Oz had already started sleeping pretty solidly from 10 or 11pm to 4 or 5 am by this point, so he was painfully tired.) They made a makeshift arm board out of tongue depressors to keep it in place, which is what the whole getup below is. The purple circle showed the spread of infection when we left the ER.
He responded well to the two antibiotics they put him on. Sunday evening we moved down to the regular ol' inpatient floor, and he was unhooked from the constant heart and oxygen monitors, which made taking care of him a lot easier. Although it was a tradeoff--every few hours, day and night, a corpsman would have to come in and check his vitals. Sometimes he dealt with it fine and sometimes he gave'em the old pain-scream treatment. He freaked out several staff members with that trick until I figured out that he was just really peeved and nothing was hurting him. After that our stay was more or less uneventful. We settled into a certain grinding routine of feeding*** (still dealing with some new-nursing problems, fun!), soothing by walking the 4-step half moon that was all that would fit in my room, vital checking, half-hour antibiotic pump, and naps.
The Pater Familias was completely amazing during his week as a stay-at-home dad, taking care of Eva with a little help from friends and bringing me stuff that I needed every day as the visit stretched on. He even bought me a fancy speaker for music and rented a 3G hotspot so I didn't have to wheel**** baby-O down the hall to the convenient but completely frigid patient lounge where there was wifi. And said friends were completely amazing, taking care of Eva and visiting us and bringing treats and so on.
One of the things we were waiting on during our stay was for the pediatric radiologist and pediatric infectious disease doctor in Hawaii (the bigger military hospital in the region) to weigh in. And they were waiting on being able to see images taken during Oz's ultrasound. They never got to see them, for a reason that remains unknown. A tech support person was on vacation, we all suspect. The radiologist did see a lower-quality image emailed directly to her by our pediatrician, so that helped. Yay communist healthcare. Other than that, I have to say that every staff member we encountered was wonderful. Yay people doing their jobs well!
(His IV got switched from his arm to his leg, which was actually considerably easier to deal with. They got it first try, too! Which is good because that time, thinking I knew what was ahead, I started crying before they even started poking him.)
On Friday morning we discovered that his IV had given out. Apparently the things do that and then you have to place a new one. The NICU nurses were on their way down when the doctor walked in and told us that we could switch to an oral antibiotic--at home! I'm sort of a leisurely person, and I hadn't even finished my coffee yet, and people who know me would have been shocked at how fast we split out of there.
The final diagnosis (thanks to the ultrasound) is that Oz had neither cellulitis nor omphalitis but an infected urachal remnant, which is inconvenient mostly in that it's really hard to explain quickly in a passing conversation infections like this can happen. When babies are developing in the womb, they have an open channel between the bladder and umbilical cord. It's supposed to close by the end of the second trimester, but *apparently* 41 weeks of gestation wasn't long enough for this little procrastinator--do you think he's my son?--so his didn't completely close. Assuming it doesn't get infected again, he'll have another screamapalooza ultrasound at about 6 months, then if needed around 1 year, and if it hasn't closed by then surgery will be considered. And coming full circle, he also has a very small umbilical hernia (adding insult to injury, but ignorable for now). Interestingly and probably unrelatedly, when he was born his umbilical cord was all spiralled up like an old-school telephone cord; the midwives said that happens when the baby is very active and spinning round and round in there. Dramatic from the start, like I said.
It's been almost 2 weeks since he was discharged. I don't want to say that God proved Himself good or faithful by this, because God is always those things, even when situations don't work out the way we want them to. But I know He is good, faithful, and sovereign, and there have been many visible benefits to come out of this situation. One, as a friend pointed out, was that how many second children get 6 days of alone-time with their moms at the beginning? Another is that how many moms get 6 days to just get to know their second kid and work on this whole nursing thing? (Which is going pretty well at this point. 1 month in, good weight, no formula and no crazy-person mom.) I have a lot more sermonizing up my sleeve but really this is outrageously long, and if you're still here, thank you for reading thus far.
*Pro tip: If you're a Marine on Okinawa who needs to get facial injuries fixed on a Saturday night, be sure to throw on some dirty cleats before you show up at the ER. Looks less suspicious that way.
**Lab person: Uh, we only do those tests on Wednesdays. Pediatrician: Uh actually, you're going to do this test tonight. Score another point for Dr Goode in the face of communist medicine.
***Amazingly, a staff member managed to walk in without knocking during about 75% of feedings. It was downright uncanny.
***The same rules about not carrying your baby in the halls apply here as in the postpartum hall. Had to keep him in that bassinet if we were on the move.
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Wow. That's a lot to deal with, new baby style... Freakier.
I like doctors that act all doctors an take charge- can you imagine waiting around til Wednesday, just cause.
And, my guess, they made a game out of nursing intrusions! Like frat guys with their chalkboards!! Points vary by privacy intrusion level; people get bored.
Posted by: Cadena | 13 December 2012 at 20:49
So glad to have four next door again. :)
Posted by: Emily | 13 December 2012 at 21:29
Oh Martha - that is so scary and so much for you all to have to go thru. I am so thankful that the doctors were able to treat the infection and he is doing just fine. Praying for him to continue doing well. Miss you guys! Will send a present soon. I promise!!
Posted by: Danielle | 13 December 2012 at 22:32
I just think you're awesome. And yay for being able to nurse this little guy. Wish we were closer...
Posted by: V | 14 December 2012 at 15:11
Yeah, Ozzie! You just wanted your mommy to have to spell "urachal"...
Posted by: Leslie | 15 December 2012 at 11:58