NICU, part something of several

The metaphor I've used for the way my liver transplant impacted my life describes a big bear ambling along and swiping me from his path--a flying, sudden change that took me from one life onto another. That image does not match my life experience over the past few years but more and more it seems necessary to find the words that do. I am. . .struggling. The blues. Lonely and feeling alone. Wanting so much to find an action to make myself feel better--a fix. Knowing in my mind that there is no fix. Is something even wrong? I can't tell. I'm in the thick of it--putting one foot in front of the other and feeling that, although that isn't enough, it's all there is.

Several weeks ago a friend of mine gave birth to her first son, very prematurely. She did an amazing thing--kept him safe and growing long enough for him to be born into the world and survive. Thrive, even. They're still in their NICU journey and though I imagined that I'd be someone to show up and help out. . .I've only talked to her once and haven't visited at all. It took me a week or so after his birth to put down the load I hadn't noticed I was carrying. Oh, I thought. This isn't my experience. I don't need to go there and tell her what to expect or find the right words to reassure them. I lived through this already and this is not me. Instead I planned to write a post about the NICU--what we learned, what we'd tell someone going through it. Before those words could come though I needed to tell Cyrus' story--a story I had been planning to write down in his journal, for him first. That didn't happen so it came out on the blog. Several people responded to me about those stories. The ones that meant the most to me came from my other NICU mamas--four ladies I know from the time we spent with Lily and Cyrus in the hospital.

Thank you.

I can't believe I didn't know that story.

I haven't written our story down yet. . .this pushes me to do it.

I'm crying. I cried. This made me cry. I'm crying.

They all said that. They cried because each one of them spent similar weeks and months at their babies' bedsides. Now we all have healthy toddlers and we're worried about how to brush their teeth rather than how often the monitors shriek to tell us they've momentarily stopped breathing.

Our first NICU was an open one. That means many of us were in the same big room rather than in private rooms like we had in our second NICU. Along with every other aspect of the experiences, it was interesting to be a consumer of NICU experiences, myself with a background in healthcare management and decision-making. How many times had I made a decision, thinking I was using the best information to create a better situation, but losing something vital in the process? On the surface I think most people would prefer a private room to an open NICU--with so much going on, so much emotion, so much out of your control, it can be nice to pull a curtain and close yourself off from everyone else.

An open NICU in the era of HIPAA (Health Insurance Portability and Accountability Act) is an other-worldly experience. HIPAA is responsible for the privacy paperwork I as a patient, and now the parent of patients, have signed approximately one billion times. Every time you go to a doctor's office for the first time you sign a paper saying you understand that they can't share your health information.

In an open NICU you are several feet away from another family--usually from a few families. You see them out of the corner of your eye. You hear them, talking to their babies, talking to their nurses, but you don't react because you are not meant to be listening. You know the names of their babies because the nurses make cute signs to hang on the front of the incubators. You don't know what the babies look like because you aren't supposed to look at them.You don't talk to the other parents, even when you might want to. You compare your babies against their babies--who is breathing better or eating better. You cheer them on, these other tiny babies, even as you feel the frustration and jealousy at hearing they might be getting out tomorrow when your son is still not eating. You create the illusion of privacy, even as you bump up against one another. It was only after doing it again in a different setting, with our own private room and absolute silence except for the beeping of our own babies, that I realized how glad I was that we had the open NICU experience first. To baptize us.

There was a tiny pumping room in the main NICU. To get there you walked past the front desk, past the first set of sinks, past four or five babies, into a dark hallway lined with laundry and into a small room with a couch and two chairs. A microwave where you sterilized your pump pieces in a special plastic bag. A ticking clock hanging on the wall that you watched as the twenty-minutes ran down. Stacks of magazines that you read through faster than you intended--a mix of women's issues and mom issues. The same Top 40 radio station playing over and over again, day or night. A sink. Stacks of bottles wrapped up in sterilized packaging. The pump room is where I met the other mamas.

The pump room was also the first place I felt mom competition--didn't take long for that to kick in. It was hard not to feel like a failure when the mom next to me produced so much more milk than I did. That other mom looked so cute, put together with make-up and thin already. I might have brought out similar feelings in some of them, for who knows what reasons. It learned quickly that I had to shut that shit down in myself--I couldn't drown  in the inadequacy of my milk production, kicking my own ass for not waking up often enough during the night to sit alone in my dark hospital room pumping for my tiny babies.

I spent many hours alone in the pump room but I looked forward to hearing the door open and seeing another mama come in. Sometimes we talked, often we did not. Sometimes I eavesdropped on a conversation between two others; sometimes I was the one talking and being eavesdropped upon. I saw a couple other women hit their breaking points. . or one of several breaking points. Whether it was a not-helpful nurse, a setback with the kids, a change in expectations, adjusting to a new doctor with a different style or just the overall exhaustion and overwhelm of being a parent who doesn't get to be the one who takes care of your own kid. We bore witness for one another.

Yesterday I walked six miles with my four kids for the March of Dimes fundraiser. With us walked Stephanie my friend and the world's best baby-sitter, along with her two daughters, her friend and her older daughter's boyfriend. We met up with two of the families I know from the NICU. Last year a group of them did the walk and I really wanted to be there with all of them but a bad cold, another twin pregnancy and my sister-in-law's bachelorette kept me from walking. I was determined to walk with them this year.

"Walking together" with four double strollers, six toddlers, seven adults, two teenagers and a ten-year-old looks more like folding in, around, behind, and on top of ourselves like a confused snake. Luckily it was a straight course so, even after separating, we'd all manage to meet up again, talk for awhile, admire the children.

How bizarre and amazing to realize that I'd only seen each one of these other mamas twice out of the hospital. And that the two of them hadn't even met while in the NICU--they met afterwards in a mama yoga class and made the connection that they'd overlapped in the hospital. Most of us are Facebook friends and most of us got together once last year for a holiday cookie party. We email from time to time. We like each other's pictures And we are somehow forever bonded because of that alternate universe in which we met or almost met.

Many of the walkers yesterday wore shirts In Memory of a baby who didn't live long. At the end of the walk we came to a huge, bright purple inflated arch with white lettering proclaiming FINISH. We proudly walked under it, having long lost track of our NICU friends. Cyrus pointed at all the photos decorating the arch, saying "Baby. Baby." Yes, those are babies, I told him.

Because this walk is for babies like you who were so teeny, tiny when you were born. But now you're big and strong.

Scale of 1-10

My grandmother died when I was eighteen. She was and still is one of the people I love the most in the world and when she died it was Christmas vacation of my first year of college. I had just spent the most homesick few months of my life and all I wanted was to get home and see my friends. After she died I walked around feeling like someone had chopped off my arm, dimly wondering why everyone was still treating me as though everything was ok. Couldn't they see I was missing an arm?

My mom and my sister went to a grief support group in San Francisco--I was back in Boston for school, I'm not sure why my brother didn't go with them. I didn't hear much about the group though I know it was very helpful for them. I do remember them telling me about how other people in the group would talk about the death of a dog or something else that seemed less important, less painful. The facilitator taught the group that grief is grief. It's not comparable--my grief is worse and sadder than yours. I've thought of this often since then.

After my liver transplant people would stop themselves whiling complaining to me about something and say "Oh, I can't even complain. This is nothing compared to what you've gone through."

I would reply that yes, of course they could complain. My getting sick did not close the door on all other future suffering and complaining. When you're in it, feeling the pain of whatever is hurting at the moment, that is as real as it gets. All of that and yes, there were times when I'd want to shout Are you kidding me with this?? THIS is the problem? Shake it off homie.

All of that and I'm one of the few who got the transplant. Lots of people don't get that lucky. Who am I to complain?

In the hospital the nurses ask you "On a scale of 1-10 how much pain are you in?" The pictures show a row of faces--the ten has stenciled tears running down its cheeks, the one is smiling. I'd be half-focused on my pain and half-wondering "Well hmm, how bad IS my pain? I bet 'x' would hurt more than this. . ."

How do we respond to the pain and suffering of others? Some people force you to look at the positive--yes, but look at how great it is that you HAVE four healthy children. You are so blessed. Some people bring up something worse, to try to help you have perspective--you aren't going to eat that food? There are children starving in Africa who would love to eat that steamed spinach! Some people--the ones who have the energy and the awareness or the training or the natural leanings or whatever else goes into it--sit there and make space for you and what you're feeling. They don't judge or Polly Anna you. They sit with you in your grief and your discomfort and let you know that you are not alone. Which is probably what most of us want--that person and to know that we're not alone.

As a patient, when I finish reeling off all of the shit in my medical chart to a new practitioner, more often than not I am met with a blank stare. Whoa. Just. Whoa. That is a lot. Ulcerative colitis at eleven. Infertility at sixteen. Liver failure at twenty-three. IVF at thirty-five. A premature twin pregnancy with eight weeks in the NICU at thirty-six. A spontaneous twin pregnancy at thirty-seven. Holy shit woman.

As a parent, I am often met with a similar blank stare. From strangers at the park who yell out to me as I pass "We've heard about you!! We haven't met you but we've heard about you and all the kids. How old are they again?" From other twin parents who look at me practically with tears in their eyes as they send a quick prayer up to whoever they believe in, asking that they please, please do not get pregnant with another set of twins. I often have people say things like "Oh man, you make me feel like an asshole for ever complaining. I only have one! How do you do it?" or "I can't complain to you! I don't know how you do it."

And I respond with "Parenting is hard no matter what. I think your kids know just how much energy you have to give. . .and they push you past that and take more." I've never had one kid--I have no idea how hard it is. I'd imagine that going from no kids to any kids is hard as hell--I know it was for us. My husband looked at me after we'd had the older twins home for a month or so, haggard, and said "People lied! No one told us how hard this is." It's hard. Does it matter who has it harder? Also, how insufferable would I be if I trumped everyone else's complaints? You think that's hard? Try this on for size! I'd be left alone, searching for that other mom of two sets of twins to come listen and share complaints.

I am so incredibly lucky. These beautiful, healthy, lively children call me mama. Or at least look at me with smiles that say "Oh hey, mama" until they're able to say the words. I get attention and often admiration everywhere I go. That can feel good. I don't even have to do anything other than survive to have people think I'm cool. I would not trade one thing in my life. The transplant saved my life and changed it forever and I would never go back and undo any of it, even if I could. The years of infertility and being told I would never have kids sliced my heart open over and over. I got through that. I wouldn't want to go through it again but it made me who I am as a mother and as a woman. There were many times I held back tears in the face of the joy of people sharing the news of a pregnancy with me. I know how lucky I am.

All of that is true and yet. It is 9:26 in the morning. I'm sitting here writing, trying to ignore the cries of one child is is wailing "Mama! Mama!" in a heartbroken voice. I have already watched as that same child rubbed peanut butter into her hair, not once but twice--the second time looking me straight in the eye with a "What are you going to do about it?" look in her eyes. I held her head over the sink and washed it out as she cried. I scared her and I feel ashamed of myself.

I sometimes think my mere existence can make other mothers feel like failures. How did she get all four of those kids into the car to drive into the city? That's a good question. How the hell did I do that? It is ridiculously fucking hard. I do it by pushing calm into every edge of myself so that I have the space to try and acknowledge four separate little people and each of their needs. It is hard and I fail, over and over again. No amount of acknowledgement or comparison or kudos make it less hard. And the really really hard times when I wonder how I will make it through the next five minutes usually happen when I'm alone, unseen. Those aren't the stories that I call up when I meet an expectant mom of twins. I'm not going to tell her "Holy shit it is so hard! Watch out!" What would be the point of that? Plus, I mostly forget the details when we've passed through them. PTSD maybe or mom brain. Or just having no space to recall them or dwell on them.
I joke that the key to it all is having low expectations. Or I say that I let my kids eat sticks and don't brush their hair and let them fall and hurt themselves. All true.

Is it harder than what you're doing? Who knows. Who cares? Does it matter?

Untitled

Those who know me or us know that Cyrus is fine. It was scary in the beginning--very scary. A week or nine days after the birth of these twins the doctors told us they would be taking him down to get a CT of his brain. His birth was very traumatic and his blood pressure was low for a while. Very low. The kind of low that makes doctors worry about the hit his brain took.

In those days he didn't move. He was hooked up to so many machines, his head turned to the left all day, every day. No one held my boy for the first week or more of his life. I hate that so much. My arms ached to hold him but more than that I just wanted, needed, for him to be held. Loved. By someone, anyone, it didn't have to be me. What did it feel like to be born and then put into a box and left there?

The day before the scan our favorite doctor talked to us on rounds. "Have you discussed what the results of this scan might mean?" she asked gravely.

No.

We decided not to discuss it. I think we decided that together, my husband and I. I should ask him to see how he remembers it.

The doctors were very serious that day. They didn't like that he wasn't moving, wasn't showing signs of life. I felt him in there, in his body. Felt his life when I touched him. But then I'd worry that maybe I just wanted him so badly that I was fooling myself.

I called my mom early the day of the scan and asked her to bring Bill, her sweetheart, to see us. Bill is an artist--a sculptor and a painter and a calligrapher. He is a gentleman and a gentle man. When I was sick with liver failure he would lay his hands on me, on my feet or my head, and reiki me. He sent healing energy into my sick body. Later, after I was better, he wrote me a beautiful letter about what a powerful experience it was for him to be alongside me throughout that experience because even when I was so sick, not moving or opening my eyes or talking, he felt me in there. My strong self, inside my sick body.

He and my mom came, early in the morning, Bill dressed up in a navy, wool blazer and carrying a brown paper-wrapped frame of his work. He had somewhere to be for work soon but he came anyway and put his big hands on my little boy. I wanted his healing energy but more than that I wanted someone other than me to touch him and know whether he was in there or not. I didn't ask him what he felt and he didn't tell me.

Later that morning they took Cyrus down, a team of people walking beside his little covered bed. Tubes and machines everywhere. My baby would be taken out of his incubator and put into the scanner, not even needing any sedation because he was so still. We waited upstairs for him.

For some reason I think we waited a day for the results, though that doesn't make much sense. It wouldn't take that long. I'm probably confused but what I know is that I spent a lonely, terrified night laying awake in my hospital bed, no longer a patient myself, praying and praying that these people wouldn't tell us that our son was not able to breathe on his own and would need to be disconnected from the ventilator. Was it the night before the CT? Or the night after? I don't know. I wasn't alone--my husband was asleep on his cot next to me. I didn't wake him--I didn't want company or conversation. I cried and cried as terror and grief seeped out of me.

I also wasn't alone because I had put an update on Facebook earlier in the day, asking for prayers and energy for our little lion. Why was he a lion? I think because my friend had given us two stuffed animals after our babies were born--a lion and a crocodile. For some reason they'd become stand-ins for the babies for me. I held that soft, stuffed lion, wrapped in sharp hospital sheets, and read through people's well wishes. Over and over again. A friend from another life, someone I met through an old love, wrote "Laser beams of positivity" and that was the image I held in my head. My son surrounded by love, by light, by laser beams. Please be ok, please be ok, please be ok.

The CT scan showed some bleeding in his brain. Grade I intracranial hemorrhage as well as some other little bleeds. They couldn't tell us what that might mean for him in the future.

My husband had his hard day and night after those results. I was so relieved it was like my whole body had been drained of feeling and was left as a numb vibration. Anything would be ok, could be dealt with, now that I knew he would live.

He started getting better that day.

Recognition

I'm not a nurse but I play one one TV, I used to say. Or I'd reference my fake RN degree. A decade into my organ donation career I was more than familiar with certain lab values and vitals signs. Blood pressure, heart rate, oxygen saturation. I knew just enough to be dangerous, to myself. I'd seen patients like my son before. . .but they were dead patients who went on to be organ donors. To my eye he met all the signs and I started to be afraid that they just weren't telling us what they already knew.

Dopamine. Dobutamine. Epinephrine. These were some of the drugs streaming into his little body through needle-thin IV lines. I recognized these drugs as donor drugs--the ones that kept a heart beating and the blood pumping after the brain and the body were capable of maintaining these basic systems on their own. (Note: these drugs are also very normal drugs to give to sick patients in the ICU--so don't start diagnosing on your own please)

When I was an ICU patient my family started keeping a detailed notebook of all the things the doctors and nurses said, as well as all of my vital signs and important labs. This ended up saving my life at one point when my mom used it to question a decision a new doctor almost made and kept them from giving me massive steroids when I turned out to have an infection. It can be helpful as a non-medical person in a hospital environment to write things down. It's harder than you think to remember--you're under stress, things change quickly, you don't totally understand everything people are telling you. There are also a lot of shift changes in a hospital stay--nurses changing every eight to twelve hours, doctors changing at night and then every couple days or weeks. They strive for continuity of care and give one another detailed reports but everyone is different and has a different styles of care so it's good to be your own advocate and pay attention --the patient and the patient's family are one of the few constants.

I tried to do the same--starting writing down Cyrus' vital signs each time we went to the NICU. Looked up at that fucking monitor and transferred all the green and white numbers into a little journal. I did it a few times and then, back in my room after a NICU visit, I sat on my single hospital bed, shoulders hunched, looking down on those scribbles and I knew this could not continue. I had started to hear the name of my company,  the donor network, whispered in the unit. At least I thought I heard it. I was convinced that we, the donor people, were following my son as a potential donor. Writing down his numbers was like being at work, jotting down a referred patient's vitals as we tracked them to see how they trended. It was filling me with fear and a sickness in my belly. I even logged into our database looking for his name. More than once.

In that moment I became a mother. I think they were two or three days old. As I sat there on my bed I realized that the only thing I could do, the best thing I could do, was love that baby with all my heart. Pour my love into him, even if it broke me open and left me unable to recover.

The thing was, I felt him in there. In his body. As the doctors grew graver about how little he was responding, how motionless he was, I held my hand on his little body and I knew my son was alive. Not just hanging on to life but alive, in there, working hard.

There were many times in my career where we worked with families to come to terms with the fact that their son or daughter, father or wife, was dead. Yes, we'd explain. They look alive because the machines are breathing for them. Brain death is actual, legal death. When the doctors do their exams and write those notes, that time of death written in the chart is the person's actual time of death even though he is still laying in bed, chest rising and falling, skin warm. Some people tell us they knew the moment their loved one left their body. They'd say they knew he or she wasn't there anymore. Other people could not accept it. Did not believe it.

I thought of those families with so much more understanding. As I stood by my son's bed, talking to him, singing to him, feeling his warmth, feeling his spirit under my hand, I wondered if it was just the strength of my hope that was telling me he was ok.

I called my friend Nikole and told her I needed her to come. Nikole is a doctor--a transplant surgeon. She is also the medical director of the organ procurement organization I worked for at the time. She is also a mother of twins--they were two months old at that time Lily and Cyrus were born.

"I need you to come look at him and tell me what it going on. I need you to talk to the doctors and look at his vitals and tell me what happened and what is happening. I know too much and not enough."

So she came.

there was a little girl and a little boy

It took two hours for the doctors to come see us. The Benadryl they gave me for the itching made me sleepy and mellow. I didn't feel like a mom. Was I afraid? I can't really remember. I was in a state of waiting and the drugs and numbness definitely helped with that. When the doctor finally came it was a woman we hadn't met yet: another perinatologist. She started updating us, saying your daughter this, and your daughter that. . .she asked us if they had names and then switched to Lily is doing this and Lily is doing that.

That's when I got really scared. What is happening with my son? Why are you not telling us anything about Cyrus?

Things were not looking good for Cyrus. He was very sick--the sickest baby they had. His lungs had been full of blood when he was born and he wasn't breathing. He hadn't taken any breaths on his own before they intubated him and hooked him up to the ventilator. He was on lots of medication to keep his blood pressure up--without it his pressure had been very, very low. Very low. He might have had a seizure but they weren't sure. They weren't sure what was going to happen with him. We couldn't see him yet.

She told me that he was probably the reason I'd gone into labor. That if he had been born any later he would most likely have been stillborn. Somehow the mother's body knows what the baby needs and what that baby needed was to come out.

I'm not sure how long after that I saw them. Did my husband see them first? I can't remember. I know we had to wait until I could feel my legs and, even then, I was pushed in a wheel chair. Pushed through a set of automated double-doors and into the NICU for the first time. Our babies were on the right side of the room, towards the front. There were one or two babies we passed to get to them. Cribs and incubators lined the large rectangular room. There were sinks, monitors, nurses, rolling chairs, nursing screens, blankets, hospital gowns, shelves, lights, soap, diapers, wipes, thermometers, drawers, doctors, posters. Was it quiet or loud? I don't remember. Someone wheeled me up to the two incubators and there I met our babies. I did not recognize them at all. I did not feel a swell of love at the sight of them. I stared hard--at Lily's long, skinny body. Her teeny, tiny fingers. Her tiny chest. Her little head covered in minky hair. Her tiny diaper. At Cyrus.

I actually don't know if what I remember is seeing him for the first time or what I'm remembering is the next few days. He had a tube down his throat and a little mask holding it into place. He had his head wrapped up to cover the wires monitoring his brain activity. They had the oscillator going--can't remember what that was for. The nurses told us how swollen he was but we didn't see that--we didn't know what he was supposed to look like.

I went to him and, when I was allowed to, I cupped his feet with one hand and held my other hand above his head, not touching him where the wires were. He had an IV in his bellybutton. He was so beautiful and so still. NICU babies are so sensitive that they are not to be stroked--if you touch them it is better to not move your hands because the touch overstimulates their skin and they need all their energy to grow and heal. I didn't rub or stroke them but I would sometimes hold one hand lightly on his chest and belly. One hand practically covered him there. I felt him in there and I would sing or stand quietly, touching him and pouring hope and love into him.

One morning I walked to the NICU alone--my husband was still sleeping. It must have been the day after they were born. It was really early in the morning. I was up, pumping the tiny bit of colostrum my breasts were producing and using a syringe to pull out every precious drop from the pump parts. At some point we counted the steps from my room to the NICU but I can't remember the number. One hundred and fifty maybe? You walked through the quiet halls, quiet except for the healthy cries of the full-term babies sleeping in their bassinets in their mothers' rooms. You got to the double doors and picked up a phone hanging on the wall. That buzzed the clerk inside who then let you into the hallway. From there you passed through another door into the NICU itself. That morning I got buzzed in and they saw it was me right about the time I saw that Cyrus' bed was surrounded by doctors and nurses. "You can't come in right now!" someone told me. I stood there, looking in the window at all those professionals hustling over my boy and I started to weep. Someone eventually came and stood next to me, not saying anything. No one looked at me or talked to me. It was so scary and so lonely. And I knew I was not going anywhere because if my son was going to die I was going to stand there and be there when it happened.

He didn't die.

He was so very sick. I found that I could hardly look at Lily. Luckily my husband would go straight to her and talk to her, change her, hold her feet in his hands. I was afraid that Cyrus would die and that I would not know how to mother her in the wake of losing her brother.

Once upon a time. . .

My two older children were born in San Francisco. As a third generation City girl this appealed to me but the real reason behind it was that I was seen by a high-risk obstetrician who worked at California Pacific Medical Center. I have a complicated medical history and that, plus a twin, IVF pregnancy put me square in the category of high-risk for premature labor. Even though we were living in Martinez at the time it didn't seem too crazy to drive into San Francisco for all of my appointments. . .and there were a lot of them. My liver doctor is there. My gastroenterologist is there. Now my OB was there so I was getting all my ultrasounds there. When I was diagnosed with low iron I got two iron infusions there, alongside roomfuls of cancer patients getting chemo. Talk about a strange dynamic. My perinatologist was there--the woman who greeted me at our first appointment with "Oh, I've been waiting to meet you! Laurie called me at the grocery store to tell me about you and once I looked at your chart I couldn't wait to meet you."

Um. Thanks? For doctors who like a challenge I was looking like one sexy patient.

I never really worried about having the babies early, despite all the anxieties of the doctors. My OB always erred on the side of caution and she had me do every test, every extra ultra-sound. She always whirled into my room like a hurricane, thoughts flying, words speeding out of her mouth. We didn't talk much about my labor because she always seemed to be shushing me like, yeah yeah we'll get to that. She was a woman who got what she wanted and more than once I was shoe-horned into last minute, i.e. non-existent, holes in peoples' schedules where I was greeted with poorly hidden rolling of the eyes as if to say "Here we go again". I was always fine. This doctor was like a highly strung master musician. She checked my cervix at every appointment and would stare off into the distance and they tell me something felt off. Off to ultrasound I would go where the tech and then the doctor would assure me that everything was fine.

At the end of May I saw her and she examined me, attuned to her fingers like an artist. "Something is not right," she said. "These babies are coming soon." The next doctor agreed that my cervix was shortening, a sign of labor coming soon. Not right away, though. Come back next week. I went back next week, June 6th, and had three doctors appointments before lunch time. An appointment where they strapped me up to a monitor to check for contractions (they call it a non-stress test). No contractions. An appointment for an ultrasound to check the length of my cervix. That doctor told me things still seemed slightly strange but that I could come back the following week to check in. He debated giving me a shot of steroids to strengthen the babies' lungs but worried that the timing wasn't right and he didn't want to give it too soon. And finally a visit to my hepatologist, my liver doctor. Can't even remember why I went to see her. A regular check-up perhaps. All fine, see you later.

My cousin and I had lunch together and then she went to the opera with a friend while I drove myself home. I sat down to watch TV and my water broke shortly after.

I texted my husband that I thought my water had broken. What?!? he said. I think I'm ok I said. Maybe I should go get checked out but I think it's fine. We discussed driving down the hill to the local county hospital but I called my OB's office where the nurse told me to come to our hospital in the city. My husband was home by that point, around six in the evening I think. He packed up in a hurry, trying to decide whether or not to put the car seats in the car, trying to decide what baby stuff we needed. We brought the car seats, just in case. Just in case what? I was two days shy of 32 weeks pregnant. Full term is 38-40 weeks. If we had these babies we would not be taking them home any time soon.

My contractions started on the drive to San Francisco. My cell phone rang--it was the Berkeley Rep Theater calling to ask if I wanted to renew my season ticket subscription. I tried to get off the phone quickly but the guy wasn't paying attention. I finally said something like "I'm in labor" but I think he must have ignored me, thinking that wasn't possibly what I could have meant. The sky was so beautiful over the Bay. So, so glowingly gorgeous. Tranquil.

By the time we were pulling off Octavia the contractions were coming hard and fast. We timed them and there were about two minutes apart. I was having a hard time concentrating on giving directions--we'd never even been to the hospital together so he didn't know where it was. Even as we glanced at one another, thinking the contractions were pretty close together and thinking that might mean. . . no, I still didn't think those babies were coming that day. No way.

We pulled up in front of the hospital, on California Street. I waddled quickly up the brick stairs only to discover the front door was locked because it was after hours. I huffed in frustration and came back down, following signs taking me around the corner to the ER entrance on Cherry Street. I almost barreled into a couple rounding the corner but they quickly drew apart to let me pass. It was like being in a movie. I think my husband was parking? I can't remember. He must have been. He came to meet me in the chairs outside triage. As we waited I urgently needed to find a bathroom. I ran down the hallway and locked myself in, convulsively throwing up and well let's say emptying everything in every way. Eww, gross. As I sat on the bathroom floor, head on the toilet, heaving, I let the knowledge that these babies were most likely coming that night sink in.

Our triage nurse was awful. I don't think she really had a clue of what was happening. She couldn't get an IV in. She kept us there forever--at least an hour, maybe more. She kept asking us the same questions over and over again and both of us wanted to smack her. We finally got sent upstairs, me in a wheelchair. I kept throwing up, over and over. The contractions were strong. I felt panicky, like if I could just get a second to catch my breath I could actually do this but the puking kept happening and the contractions kept happening. Fast, hard. I hate throwing up.

More of the same questions, more people in and out of the room. I was crying at that point, though still seriously considering how to answer the question "On a scale of 1-10 how much pain are you in?" We hadn't called my parents or my sister yet--didn't want to worry anyone too early. The doctor came in, not my doctor. The on-call doctor--a tall, gentle-faced, gentle-voiced Asian man in his 50's or 60's.

"Ok, let's see how we can keep these babies in," he said calmly as he gloved up to examine me. He put his fingers inside me and took them out almost right away. "No, we can't keep them in. You're 5cm dilated. We need to take them out."

No one asked if we wanted a C-section. No one said they were worried about the babies so I'm not sure why we immediately went to the OR for a C-section. It didn't occur to me to ask or to lobby for a vaginal delivery. We did what they said. I was still throwing up every few minutes. I wanted to rip the monitors off of my belly because they felt suffocating. "Call my mom," I said to my husband. He did and went to put scrubs on to join me in the OR.

I wanted to marry the anesthesiologist. He sat me up and tried to get me to hold still and stop puking for a second so he could stick a needled into my spine for the spinal block. It worked quickly and the relief was so intense that I seriously wanted to hug him. Except I couldn't move very much. As they lowered me onto the table and set me up I mentally observed how the feeling in my legs drained away. My friend Nikole had recently described her C-section to me so I felt prepared and was interested to compare how I was feeling to what she said. I don't think I felt scared--not that I remember. I'm at home in the operating room--I've been in there many times, as a patient and for work. It's cold but it's familiar. They drew the blue sterile paper drape up so I couldn't look down and see him cut into my belly. And then, one after another, our babies arrived.

Lily, Baby A or as we called her "Steak Baby" because she always kicked after I ate steak, came first. We didn't know she was a girl until the anesthesiologist told us. It took her a few seconds to cry but then I heard her. They came and showed her to me--tiny, bright red, unrecognizable--and then took her away to clean her up and check her out.

A few minutes later Cyrus arrived. Before they got him out I felt lots of pressure, lots of pushing on my belly to get him out. The anesthesiologist exclaimed "You've got one of each! It's a boy." We smiled. But he didn't cry. I'm not sure how long it took me to get concerned--not long. I noted the different tone in the room. The quiet, anxious scrambling. And no crying. They didn't bring him up to see me but took him to the incubator to my left, a team of people huddling over him. I turned my head to the side and could see him. Limp. Tiny. Pale. Still no crying. A doctor finally came up to me, not the OB. He quickly and calmly introduced himself as one of the perinatologists. Your son is very sick. We need to take him out of her so we can take care of him. Ok, I said. And they took him away.

I got sewed up. They wheeled me out into the hallway and there were my parents, looking so relieved to see me. I kept going, into Recovery. The babies were gone. My all-over body itching was back, even though I couldn't feel my legs at all. Was I scared? I don't remember. I can't call up anything about how I was feeling right then, except for itchy and kind of stoned. Stunned. I know we named the babies in the OR but as I write this I can't remember or imagine when that would have been. After Cyrus came out, our Ice Cream baby who spent much of the pregnancy shoved up under my ribs by his sister. But he wasn't in there very long and they were working fast so who asked us for names and when? I don't know. My husband and I looked at each other, suddenly parents, and raised our eyebrows at one another like, are we really sure? Are we really ready to name these people who we weren't ready to have met yet? The enormity of speaking two names out loud for the first time, of naming people, sunk in but yes, we were ready.

Lily Helena and Cyrus Wilder. They had arrived. Eight weeks early. Our first NICU experience had begun.

Frog Park

My brain actually goes blank when the relief of all babies being quiet in their beds sinks in. It's just. . .I have yet to find the words to describe the quality of such a silence. It vibrates. It's as though the rest that each of them is unfolding into somehow latches onto my skin and spreads to cover me, muffle me in cotton. No one is touching me. They are all getting what they need. I am alone which I really need to be.

I don't know how long I have because the Bigs aren't really taking a morning nap these days. They're in an in-between state where they can hardly make it to their afternoon nap without losing their shit but if they sleep in the morning they don't want to sleep in the afternoon. So I put them in their cribs with books and tell them I'll be in to get them in a while. Meanwhile the Littles are napping for real. Daphne and Lily are the sleepers. Daphne will be happily playing or eating and will go from zero to a hundred, screeching like she is on fire. That means "Put me down right now I am tired and I am over all of this nonsense!" She almost always falls asleep within five minutes of that moment. Lily will start laying her head down on things or will walk over to her crib and ask to be lifted in. Cyrus and Cleo would stay up all day and all night for the most part. I see aspects of myself and of their dad in them--two people couldn't be more different when it comes to sleep than my husband and I are. Let's just say Lily and Daphne are my people.

The Bigs are 21 months right now, the Littles are 9 months. We have a lot of birthdays coming up in June for our tribe of Gemini. All four of them are pretty fun these days. And they are also totally exhausting.

We went to the San Francisco Zoo on Tuesday. It was a long day and the drive back home took forever. Seriously, like three hours. A lifetime in a world where you are stuck in a minivan with four small children strapped into car seats. When we rounded the exchange from one freeway to the next and I saw columns of gridlock stretching out ahead of us, I gave up. Cyrus was crying, taking his turn in the symphony of irritation that can be my day where each kids counts the next one in so they make sure there is at most a few minutes in between one meltdown and the next. We needed gas. We were all tired and aggravated. So I pulled off the next exit and followed the instructions Google had provided in response to my "playground" search. Frog Park in Rockridge. Never heard of it, never noticed it despite driving by it many times. It was a good find. I parked us right underneath the freeway we'd just exited because I couldn't figure out how to enter the parking lot. I loaded up one double stroller (not the quad because I didn't bring it with us to the zoo). Cleo stayed in her car seat, hooked onto on seat of the Bob. Daphne got seated in the other stroller seat. Lily got balanced on the front end of the stroller and I carried Cyrus. Who wore no shoes nor socks because he has a propensity for removing them in the car and I had no patience or flexibility to go searching. We entered the gate and we had arrived.

I set the Bigs loose. They were thrilled to be out of the car and immediately explored the little side playground we came to first. It had an unoccupied tire swing and a set up that included a steering wheel, my boy's fave. A dad and his two older kids kicked around a soccer ball on the grass nearby. Nannies and parents accompanied different combinations of kids and no one stared to directly at us but let's be honest, I was the only single woman decorated with four small children. I can feel the glances and I mostly just stare straight ahead, not because it bothers me so much as because I'm tired and don't want to get into a conversation so if I pretend I don't see them we stay in our urban bubbles. MUNI taught me well.

We made our way over to the water fountains where I rinsed and filled and made bottles of formula. Handed out pouches of food. Peeled a tangerine. Took in the scene. Down a small hill was the main playground--a beautiful wooden situation that definitely invited further exploration. I debated leaving without going down there, mostly because you start to know what you can handle and I was pretty sure that playground was teetering on the edge of "no way mama, you're crazy" But I knew the traffic would be mostly unchanged and none of us was ready to get back into the car so down we went.

The Bigs were excited. Cyrus found another steering wheel right away, off to the side near some tables. Lily bee-lined into the main play area and went right for a combination monkey bars/ladder deal that she doesn't quite have the skills for. Were she my only child, I might have gone in with her and either helped her or told her no. Instead I stayed where I was, with the Littles in their stroller outside the playground fence and watched her assess it, start to climb it and then decide she wasn't ready. One of the best pieces of parenting advice I've ever received was via my parents, way before I had kids of my own. They learned it at Sunset Co-Operative Nursery School, where my siblings and I went from ages 2-5.

"Don't put kids into places they can't climb themselves."

There was a sweet little tree in the backyard of that nursery school, right near a climbing structure near the back fence. Most kids wanted to climb the tree or the structure or the red tower at various points of their school career. And they mostly would, eventually, when they could navigate it themselves. If they can't climb up it's a good indication that they can't climb down. A good indication that they're not safe there. It is a great way to let kids discover their own abilities, feel safe in their bodies, and feel pride in their accomplishments when they finally do make it happen. It has been crucial to my child raising because I can't be in four places at once.

A while later Cyrus entered the playground and went straight for the same piece of equipment. He had a similar experience of checking it out, putting his hands on it and then deciding nope, not today. I never said a word to either of them and they never looked my way.

All of this is great and makes me seem like I totally have my shit together, which I kind of do in some ways. Though fifteen minutes later Lily fell backwards onto the cement from the little seat she'd climbed up on. I wasn't even looking at her. She burst into tears and I scooped her up, rubbed her back and her head, looked into her eyes and decided it was time to go. We packed up our rag-tag circus train and headed up the hill and back to the gate. A silver-haired man in his mid-60's, wearing crisp business clothes and a tie looked at us as he tried to decide whether to hold the gate open or close it. I nodded at him and he held it open.

"You've sure got your hands full!"

"Yep."

"Are those quadruplets?"

"Two sets of twins."

"Wow! God Bless you."

"Thanks"

Then to the kids, "Thanks for paying my social security!"

Hahahaha. Best comment we've received so far.