The Worst Day of Our Lives
The medicine that Nathan's doctor's have been using to address the clot are not working - the clot seems to have stopped growing since Friday, but at its size continues to consume all of the blood products that Nathan needs for his body to break it up. It is also infected, so they are unable to clear the staff infection from his blood. To continue with this approach means we would simple watch Nathan deteriorate over the next two weeks as the infection begins to impact each of his organs and body systems.
Surgery is not an option yet because the risks are too high. In Nathan's condition - so premature, all organs and body systems underdeveloped and having this infection - the mortality rate is 70%.
The "middle ground" also comes with high risk. It took discussion all day yesterday and a call to the top cardiologist for dealing with clots in the world to determine the best course of action and all the doctors involved admit we are in uncharted territory. They plan to give Nathan very low doses of TPA - a "clot busting" medication that will hopefully begin the work the body has been unable to do. This medication can cause a major bleed anywhere in the body. We already know that Nathan has a very small, perfectly normal for preemies, bleed in his brain. The biggest fear is that this bleed would be effected and by the TPA. A massive bleed in the brain is a possibility. Nathan's team will monitor his body with head scans and heart ultrasounds every few hours as they give the TPA. The hope is that as soon as the medication begins to decrease the size of the clot the antibiotics will begin to work and the infection will clear up in a few days. With the infection cleared all prospects look better and the body can hopefully take over the work of the TPA.
So today they do one last round of scans and then begin the new medication. For us it will be a lot of sitting with Nathan and praying.
More Waiting
After careful consideration Nathan’s care team determined that before they could begin the TPA (clot busting drug) they needed to give him a central line. Nathan will need so much support in the form of blood products, antibiotics and other fluids while on TPA that he would need 6+ IVs to get everything into his body. There is no way his veins could support that many IVs, so counter to all medical practice, they put a direct line into an infected body. This line is sure to become infected itself, but it will get us through the TPA treatment.
When we learned about the line we understood, but were devastated. It’s another delay in starting treatment for the clot and it was another very risky procedure. They called on Interventional Radiology to put in the line since the procedure would be a little less risky than surgery. Being so young and so sick the anesthesia was particularly dangerous for Nathan and there was always the chance that they wouldn’t be able to get the line in. We sat with our parents and clergy friends from Trinity while the line was put in. By God’s grace Nathan came through with flying colors.
Now we have to wait until tomorrow morning for the TPA treatment to begin. The risk of the new line bleeding out is too high in the first 12 hours that Nathan has it and no one wants to start such a risky medication in the middle of the night. So we’ll stay at the hospital tonight and be with Nathan in the morning when he begins TPA treatment. Being with him as the drug enters his body won’t do anything medically, but it will make us feel better.
Nathan Update
Nathan did very well on his first day of the scary, clot busting, medication (TPA). The brain scan showed no change (good news) and his stats remained stable throughout the day. Unfortunately, the heart echo showed that the clot has not changed at all. They're going to continue this very small safer dose of the medication and check again this morning to see if things improve. Please pray that this starts working today. If it doesn't they'll have to increase the dose which will only put the little guy at higher risk.
Daily Nathan Update
For those of you who are just joining us, here are some of the details of Nathan's problem. The doctors believe that the clot in Nathan's right atrium is infected with a moderately easy-to-treat strain of Staph. Since the antibiotics can't treat the clot for the infection, Nathan will continue to have the infection until the clot begins to break down. So far the clot itself hasn't been causing Nathan any problems, other than keeping him sick. But if we can't clear the infection soon, the bacteria will start to do some real damage. Everything is more complicated because Nathan is so young.
Today was kind of an up and down day. This morning's heart echo again showed no change in the clot's size, so they increased the dosage on the TPA from 0.05 cc to 0.1 cc. Kind of a downer, but they had intentionally left some wiggle room on the dosage in case of this sort of thing. They've been watching Nathan like hawks since he started this new treatment and Katie and I are very grateful for that.
The first pick-me-up came when we learned that Nathan's blood cultures had not grown any of the staph bacteria yet. All of his earlier blood cultures had come back really quickly. A fact that is related to the intensity of the bacteria in his blood. But I'm pleased to report that this blood culture remains clean as of the 36 hour mark. We need no growth for 48 hours on two separate blood cultures to call it truly clean, and it will be pretty unexpected if this first one does not come back "positive". But, this seems to be a sign that the infection is weakening. This is something that was not expected to happen until the clot began breaking down, so something's going on in there!
A brain scan following the increase in the TPA showed that everythings fine up there, and there is no evidence of any other harmful bleeding in Nathan's body. The preliminary report on tonight's heart echo is that the clot is definitely more mobile, but not necessarily any smaller. This is both comforting and scary. Any sort of change means that the clot is being affected, but we don't want it to break free of the wall of Nathan's heart and travel to his lungs. That would be catastrophic.
Katie and I have said prayers, and have faith, that nothing like that will happen at all, and that the final readings of the heart echo will show that the clot is indeed smaller. We hope you will join us in those prayers and that faith.
-Tim
Good News
The clot is 60% smaller!!! Now you can go get some sleep. At least, that’s what we did. We got the news on Friday night and for the first time since Monday went to sleep in our own bed. We’re still catching up on the sleep we lost this week, so stay tuned for the whole story or track us down and ask us in person. The short version of the story is that the doctors couldn’t have been more surprised and your prayers worked. So keep praying – we’re not out the woods yet, but we’re starting to have good days again.
God Has Given
Nathan means “gift of God” or “God has given”. And God truly has. He gave us our incredible little boy, he gave us a miracle in the reduction of Nathan’s clot and, as Tim pointed out, he’s given the doctors at Children’s Hospital experience they need in treating a combination of health issues that very rarely come together and that none of them have treated before. I’ve been thinking about what Nathan’s doctors are learning as they treat him and while I know the next child to come in with an infected clot will benefit, I’m still having a hard time with the fact that they are learning through my son’s illness. I want to give Nathan’s Creator a good punch in the nose just about as much as I want to say Thank You.
Final Score - Nathan:1 The Clot:0
We knew from day 1 that our little guy was a fighter, and he’s proven us right throughout this entire ordeal. Here’s a little more detail on these recent, amazing events (with a little bit of a recap).
As of Wednesday 3/2/2011, Nathan already had the first treatment of TPA (clot-buster), and the doctors took a look at his heart again. Despite the scary, risky drug, the clot remained unchanged. This was not entirely unexpected, because the doctors had decided that a very low dose of the TPA would be safer for Nathan, and it just might give a boost to his natural clot busting enzymes. But this clearly didn’t work, so they bumped his dosage from 0.05 cc to 0.1 cc and let it run its course through the end of Thursday. The heart echo on Thursday night showed a clot that was still the same size, but more mobile. The doctors said that the clot looked like a tether-ball, with the “tether” being attached to the wall of his right atrium. So a “more mobile clot”, simply meant that the “ball” was swinging around more with every beat of Nathan’s heart. This scared the doctors (and us), because they didn’t want the “tether” to break and the “ball” to flow over to the lungs and cause a fatal problem. So they resolved to stop the TPA and try to keep Nathan stable until he reached the ripe old age of 34 weeks. This would give him a much better chance of surviving a thrombectomy (clot removing surgery.) They thought this was a pretty good plan. He’d been stable through everything they’d had to do to him, the TPA hadn’t done any damage (but not too much good either), and his Staph infection (oh yeah, did we mention the Staph infection?) was weakening, so now all we had to do was hope and pray that the “tether” wouldn’t break for two more weeks. I use a hint of sarcasm here, because I think that if Katie and I had had the energy, we would have been a lot less pleased with this outcome than we actually were. As it was, we were just happy to have only one thing left that threatened the life of our child.
So it was on Friday that she and I decided we should stop staying in the sleep suite at Children’s Hospital, and get some rest in our own bed. Feeling uneasy and relieved at the same time, we made our way home and did some much needed chores and napping. At 6:30 we got a call from the hospital. I’ll never forget it. I was sitting up in bed watching Katie’s expression and reading the tone of her voice for any hint of the goodness or the badness of the news.
“Really!?” she said. “That’s great!”
After that I kind of tuned out. There weren’t any tears of joy, so I figured it was moderately good news. Maybe his platelets were up, or they’d finally gotten the heparin to a therapeutic level. Katie finished taking notes and let me know what was up. The clot was 60% smaller, Nathan was perfectly fine and stable, and the doctors had no idea how it happened. Then there were tears of joy.
Over the next couple of days we learned that the “ball” had completely disappeared leaving a much more manageable clot in its place. Several doctors let us know how amazed they were. One even described it as a miracle. Surgery is all but off the table at this point, his infection is completely on the run, and there is no longer any risk of a sudden fatal event. The road to recovery began on Saturday 3/5/2011, for all three of us.
I can’t help but relate this amazing outcome to all of the prayer that’s been surrounding us over the past few weeks. It is kind of funny how astounded we are when God gives us the things we ask for. But I guess that’s a big part of having faith. If we actually knew beyond a shadow of a doubt, then praying would be a lot more like a fast food drive-through. There would be no learning, and no growing through an ordeal like this if we didn’t have to fight to keep sight of the belief that all things are possible with God. I know that not everyone reading this shares my beliefs, but it’s important to me that I make this perfectly clear. I believe that God healed my son and saved his life, and I will add that to the list of things for which I am eternally grateful.
A week with Nathan
Slowly but surely Nathan is making his way back to the normal challenges of being a preemie. A lot of good things happened this week to keep Nathan moving forward.
First, Nathan’s blood cultures started coming back negative. The blood culture from March 4th took over 48 hours to grow out, indicating that the bacteria load in his blood was greatly greatly reduced, and since then each day’s culture has been negative. Yay! Because of his central line and the remaining pieces of clot, the doctors have to assume that there is still bacteria in Nathan’s body, but it’s not throwing a party in his blood stream like it had been.
Nathan also started effectively losing the extra fluid that had build up in his body over the past week due to his infection and all the medications and blood products he was receiving. Each day he was beginning to look more and more like President Taft (the one who got stuck in the White House bathtub) but now with each day he looks more and more like himself. Nathan has been losing a few ounces of excess fluid every day. Right now he weighs about 5 ½ lbs – his doctors estimate that when he’s done losing fluid his “dry weight” will be around 4 ½ lbs.
On Sunday, for the first time since he got sick, Nathan’s platelets increased all on their own. We must have sounded like parents whose child has received a free ride to their top college we were so excited that “he made his own platelets! he made his own platelets!!” And being the brilliant kid that he is, Nathan’s platelet levels have continued to increase each day.
And last but not least, he has been “weaning on his vent” – doctor speak for needing less and less support from the ventilator. Before he got sick Nathan was breathing just fine without being on a ventilator so we can’t wait for him to be off it again.
This week’s big challenge has been Nathan’s PDA (Patent Ductus Arteriosus). If you remember back to high school biology all babies are born with an open duct in their heart which closing within a few days after birth. This duct often does not close in preemies. If it remains open too much blood can travel to the lungs, causing lung problems, or not enough blood can travel to the stomach, causing digestion issues. In Nathan’s case the duct remained open, but with everything else that was going on, getting it closed was not a top priority. Now that he’s on the road to recovery, being able to breathe on his own and eat are important steps, and neither of these can happen with the PDA. First step was medication, but the doctor’s didn’t have high hopes since it is often ineffective after 2 or 3 weeks old and Nathan is nearly 4 weeks old (can you believe it?!). Yesterday Nathan had a heart echo after one course of the medication and it showed that the PDA was unchanged, so they will have to close it surgically. We had hoped the surgery would be tomorrow, but it looks like the surgeons are too busy, so we’ll have to wait until Monday. It’s frustrating to see a key step in his recovery pushed back three days, but we’re trying not to be impatient. Among other things, this whole experience has taught us that life in the NICU happens in its own time - quickly for emergencies, not so quickly for other things.
And then today had a brand new challenge – namely that Nathan is getting to be himself again. And that self is a little boy who does not like to be bothered. Nathan’s been on pain medication for two weeks now, so his body is becoming accustomed to it and it is becoming less effective. Nathan is also starting to feel better and so is more active and attentive. Put those two things together and you have a little guy who has finally noticed he’s got a breathing tube in and is not at all pleased about it. It’s uncomfortable and we’re certainly Nathan thinks it’s unnecessary, so he had a pretty grumpy day and really struggled to settle down. And of course, he tried to pull the breathing tube out a few times.
So that’s been our week. Very different than last week and for that we are very thankful.
One Month Old
Nathan is one month old today, though still only 33 weeks according to the medical world. He celebrated this mile stone with visits from his grandparents and a new flat puppy from Susanne. The gift brings the flat critter count to three: flat elephant, flat bear and flat puppy. Turns out flat critter are really good for holding on to when you're tempted to pull out your breathing too.
Just because you’re a parent doesn’t mean you have to be lame
This is what we spend three hours a day staring at – and he isn’t even always awake...
Lookin Around from Katie Vogele-Bongiovanni on Vimeo.
Pictures, Videos, Oh My!
Photos are slowly populating the gallery and videos are appearing throughout the blog, so poke around and see our little guy.
Surgery Today
Nathan has his PDA ligation surgery today. His is the second surgery scheduled today, but the one before him is expected to take a long time, so they estimate he will go in around noon. This is a very common surgery in preemies with very low risks. Thanks to Nathan's improved health he should have no problems at all. We met his surgeon for the first time in our horrible meeting that first week at Children's Hospital and even in the midst of all the bad news he was giving us, we really liked him. We are thankful that Nathan's surgeon today knows Nathan's case so well and has been consulting on his care since we arrived at Children's - it gives us even more confidence in this surgery. Keep us in your prayers today.
Surgery Update
Today’s surgery was uneventful – just the way surgery should be. Thanks for all the prayers! We’re really excited that with his PDA closed Nathan can now get back to breathing on his own and eating. AND his platelets are at 200,000! NICU parents get excited about the strangest things… When was the last time someone congratulated you on your platelet production?
One determined little guy
5am call from the hospital: “Hi, this is Debby from the NICU at Children’s Hospital. Nathan is fine. I just wanted to let you know that he coughed up his breathing tube and seems very happy about it.” That’s our boy.
The plan when Nathan came back from surgery yesterday was to give him a day or two of recovery and observation and then determine whether the breathing tube would come out first or they would start feeding him breast milk. They didn’t want to put two body systems under new stress, so this was one of those “we’ll let him decide” things, meaning wherever he’s making good progress we’ll make the first change. Well Nathan decided all right – he decided it was time to get rid of that breathing tube. We’re still not sure how you cough one up, but we’ll find out when we get to the hospital later this morning. So right now Nathan is back on CPAP (continues positive air pressure) like he was at Beth Israel, breathing on his own. He still has a lot of fluid around his lungs and in his chest which could make it a lot of work for him to breath, so his nurse will keep a close eye on him today and probably doing a few extra blood gases (a blood test measuring the levels of oxygen and carbon dioxide in the blood to determine how well the lungs are working) to make sure he’s doing well. We’ll get the full report at the hospital.
Big day for Nate the Great
I think Nathan must be reading this blog and after my cautious predictions for the day wanted to show off.
Driving into the hospital I prepared myself for the fact that he might be back on the breathing tube if he wasn’t tolerating the CPAP. When I arrived, not only was he still on CPAP, but his nurse told me they were already beginning to reduce the air pressure because he was doing so well. We were worried that the fluid in and around his lungs and chest would make it hard for Nathan to breath on his own, but that doesn’t seem to be the case. Not only does he continues to lose fluid, but the chest x-ray they took at 5am after he coughed the tube out (to make sure everything was okay internally) showed improvement in his chest and lungs from just 18 hours earlier when they’d done his pre-surgery chest x-ray. With the CPAP we no longer get a good view of Nathan’s cute face (it’s back to the scuba gear look) but it’s worth it to be making progress.
With everything going so well in the breathing department Nathan started getting breast milk today too – not much, just 2cc every 3 hours, but eating is underway! Needless to say, he is once again impressing his doctors and nurses. I do wonder what all this independence and determination will mean when we finally get him home – we could have our hands full!
Another exciting day in the NICU
Recently our friend Dan asked if Nathan’s antics as he travels the road to recovery are normal in the NICU. We have no idea, but they seem to be normal for Nathan.
You remember that at 5am on Tuesday, just twelve hours after surgery, Nathan moved from a breathing tube to CPAP after coughing the breathing tube out and demonstrating that he really didn’t need it. In the all of two days since then Nathan’s been making it abundantly clear that on comparing the two, he does not like CPAP any better than the breathing tube, by, of course, working to pull it out! (We really need to invest in mittens to hide those grabby fingers…) Well, it turns out Nathan’s been having such success weaning on CPAP that when we arrived today his nurse told us that he’d likely be moving to a nasal cannula (another way to deliver supportive air pressure and oxygen if it’s needed, but less supportive than CPAP). We were a bit surprised that it was happening so soon, but thrilled. Even more thrilling was when they decided to make the switch while we were there. As of 2pm, no more scuba gear or white tape mustache – now we can really see our little guy! Nathan also wore his first real shirt today, a gift from the NICU. It has ambulances on it.
Nathan also had his first eye exam this morning. All preemies get an eye exam around 34 weeks (his gestational age) to see how the eyes are developing outside of the womb and to make sure nothing is growing abnormally. The report is that his eyes are still immature, so the doctors will continue to observe their development and he’ll have another eye exam in two weeks.
So that’s the latest from the NICU – photos and video will be posted soon.
Today’s post brought to you by the letter G
G is for Grandmothers (and Great Grandmothers) who want to know when they can see new photos and videos. Enjoy.
No More CPAP! from Katie Vogele-Bongiovanni on Vimeo.
Swaddling is Magical from Katie Vogele-Bongiovanni on Vimeo.
Another Sesame Street Day
Yesterday we had another Sesame Street day, this time brought to us by the letter B.
First we learned that is everything goes according to plan, Nathan will be transferred to Beth Israel on Thursday morning. This means he no longer needs the intense intensive care of Children’s Hospital. We are so thankful for Nathan’s care team at Children’s but are looking forward to the quieter world of the BI NICU. On Monday while we visited with Nathan the chief of neonatology stopped by to check in with us. (She was Nathan’s attending physician and just transferred off his team last week.) She was working over at BI last week and gave Nathan’s team over there an update and they told her how much they look forward to having him back. This transfer to BI will be so different from the one to Children's four weeks ago - instead of heading into something unknown and terrifying it feels like we're heading into known territory. We can’t wait!
Then we got to try Breastfeeding for the first time! (Can we talk about breastfeeding on our blog? Oh well, we’re gonna…) Nathan was great at it – latching on right away. Mama felt like she needed four arms, but then we can’t all be as incredible as Nathan. Nathan did eventually get frustrated that breastfeeding was more work than milk just arriving in his stomach by feeding tube, but it was a wonderful first time. Babies are SO much better than pumps.
And last but not least, Nathan had a Bath. This he did not like one bit. Hopefully it was because the pink hospital basin bath tub was just too big and too girly and not because he has some philosophical objection to baths. (You never know with this kid…)
So, a very exciting day.
Also new since we last blogged, Nathan’s central line (the one that went in before TPA treatment began and was sure to become infected) was taken out on Monday. After 48 hours receiving antibiotics by IV, a new sterile line will go in today. Nathan also had a heart echo this morning to get one final picture of the remaining bits of clot before he leaves Children’s. Nathan’s team from Hematology will continue to follow him closely once he’s at BI, but the other specialties (Infectious Deceases, Orthopedics and Cardiology) have all put together a plan for him at BI and signed off on the transfer and will only be called on to consult going forward.
And that’s the news. We’ll keep you posted on the transfer.
Nathan: 2 Clot: GONE!
That’s right – the final report on Wednesday morning’s heart echo is that they saw “no evidence of thrombus.” Or, in lay terms, Nathan won and the clot is 100% completely gone. YAY! We are so thankful.
Good things too, because Wednesday started out as a very frustrating day at the hospital. I arrived at 2pm, later than I like to get there, because of a meeting at work. My hope had been that arriving later would be a good thing today because Nathan’s new central line was supposed to go in following his heart echo in morning and I would arrive when everything was finished. Instead, at 1pm, while still at the office, I got a call from Children’s – they’d forgotten to get consent from us to put in the new line. So I gave consent over the phone and let them know I would be there soon. When I arrived at 2pm they were still trying to get the line in. After considering how much longer they might have to work at placing the line, I went home, without getting to see Nathan.
At 5pm having not heard from Nathan’s nurse about the status of the line, I called to check in. They did not succeed in placing the new central line and had stopped trying at 4pm. SO frustrating – that the line wasn’t in, that the nurse didn’t call to let me know and that they poked at my son for another two hours after I left. His nurse said Nathan slept through most of the procedure (thanks to a dose of morphine from the morning’s heart echo) and tolerated the whole thing very well, but still. So so frustrating. Because they couldn’t get the line placed in the NICU, Interventional Radiology had to place the line today, so Nathan’s transfer back to Beth Israel was delayed until tomorrow.
Because I wanted to see my son and get the imaging results from Nathan’s Nurse Practitioner, Marie and I headed back to the hospital last night. I’m so glad we did! Not only because I can’t imagine going a day without visiting Nathan but because we got the incredible news about the clot.
And then, just to make the perfect end to a very long frustrating day, Nathan nursed for 10 minutes! Even though he was still sleepy from the morphine. His night nurse was super impressed and I was thrilled.
Today Nathan was flying standby for his line placement in Interventional Radiology (I think officially it’s called being “on call” – either way it means you wait around until they can fit you in) so he didn’t go down until 2:30pm. So we got to hang out together all day. The procedure went well and now, unless Beth Israel has a rush on bed space tonight, we’ll be going back across the street tomorrow morning.
Fridays with Nathan
We’re back at Beth Israel! I’ll miss the colors and welcoming feel of Children’s, the food carts dressed up as trains moving on their own through the hallways and the chance to meet clowns in the elevator, but I am so glad Nathan doesn’t need to be there anymore.
I guess we should have known the transfer planned for Thursday would be pushed to Friday – Fridays have always been big days for Nathan. My water broke on a Friday, he was transferred to Children’s on a Friday, and the clot miraculously shrunk on a Friday.
Another trend (in case you haven’t noticed) – when good exciting things happen, they’re usually pretty exhausting and don’t require immediate prayer, so you can expect at least a 24 hour delay before the news gets blogged.
On Parenthood
Can we really write about parenthood yet? We’ve only been at it for a few weeks, and really it’s mostly felt like we’re visiting a place called parenthood. We have a son but he has some very over educated (and expensive) babysitters. We got the stress and fears of being parents before we got to figure out how to be parents – more than any parent ever wants to have. But finally, this week, we’re starting to figure it out. This week I really got to be a mama.
Monday was way too long ago to remember – I think mostly we got settled into the routine of being back at Beth Israel. But Tuesday was amazing. On Tuesday Nathan hung out nursing for almost an hour. Okay, so nursing for Nathan is more a process of suck swallow suck swallow suck swallow suck swallow breathe breathe breathe breathe breathe breathe breathe breathe breathe, not a constant thing, and yes, over that hour there was a far amount of nonnutritive sucking (like being a human pacifier) but it was amazing. And Nathan got an A+ from the lactation consultant who came by and Mama didn’t feel like she needed four arms. Yay Nathan. Yay Mama. Nathan did so well that we started discussing bottle feeding.
Yes, bottle feeding. Some parents worry that if their baby starts on a bottle too soon they’ll never want to breastfeed and other parents worry that if their baby starts on a bottle too late they’ll never use one, but when it comes to preemies both breast and bottle feeding are so much work (remember, he hasn’t figured out the whole swallow and breathe at the same time thing yet) that when one is going well it makes sense to introduce the other. Also, preemies need more calories than they can get from breast milk, so Nathan gets breast milk with extra calories mixed in and that can’t come from me.
So on Wednesday Nathan got his first bottle. He was very cute about it. When I picked him up, Nathan opened his mouth and leaned towards me, ready to latch on. I felt kinda bad sitting him up and telling him we were gonna try something new and difficult. In response to this new and difficult activity Nathan kept his eyes squinched shut the whole time. But he did great. Just like his first time breastfeeding, he had no problem latching on and sucking and he got totally exhausted after five minutes. It was a great start. The plan now we’ll alternate breast and bottle feeding once a day until Nathan has enough stamina to feed by mouth twice a day, and we’ll go from there. After his bottle, Nathan hung out with his daddy while getting the rest of lunch by feeding tube. Some time after lunch, while still in Tim’s arms, Nathan started getting fussy. His pacifier didn’t solve it, tucking his arms into this blanket didn’t solve it, so Tim went to put Nathan back in his crib so we could saddle him (have I mentioned that we can just pick Nathan up now? on our own? no nurses needed? it’s amazing) and light dawned on marble head – he needed a new diaper. Yes, we got excited about the fact that our son needed a clean diaper and we could solve it for him. And it worked! No more fussing.
So we’re figuring this parenting thing out. Having a baby who no longer has a half dozen lines going into him is a huge help. The fact that he’s been around for six weeks helps. With new preemies, you want to stimulate them as little as possible, let them sleep and grow, so if they fuss, you make sure they feel secure and let them work it out on their own. Now we can pick him up, comfort him, talk to him, swaddle him up if he’s cold or fussy, unwrap him if he’s warm or fussy, change his diaper – all parent things that parents at home get to do. It’s nice being a mama.