Wednesday, June 30, 2010
Tuesday, June 29, 2010
Monday, June 28, 2010
Peyton Nicole Smith
Sunday, June 27, 2010
As we approach the third anniversary of Peyton's birth it seems like a lifetime ago. Before the memories fade, I wanted to get it written down so Peyton can read it later.
To understand how we got to where we are today, I have to start back in November of 2006. At the time I was commuting back and forth to Salt Lake for work. I would spend 2-3 weeks in Salt Lake working and then fly back to Sacramento where Travis was and work from home for several weeks. While in Salt Lake in early November, I found out I was pregnant. We had only been trying for a few weeks so I was thrilled it had been so easy. I was too excited to wait to tell Travis until I got home that weekend so I called him to share the good news. A few days later I flew back to Sacramento. We had the weekend to enjoy the news and Monday morning I called a local OBGYN office to establish care and had an appointment scheduled a few weeks out. By mid-morning, though, I had started spotting and cramping and sensed that I was having a miscarriage. I made it through a few more conference calls and then called the doctor's office back and asked if I could come in. They were just about to close for the evening but if I hurried they would see me.
The doctor performed a quick exam but she explained that just like diagnosing a pregnancy, blood tests are the best way to determine a miscarriage in this early stage so she sent me to the hospital. I waited in the ER until Travis came from work to be with me. They did a quick blood test and asked me to return in 48 hours for the second blood test. Tuesday I continued to cramp and bleed but I worked all day. The next morning, Wednesday, I went back to the hospital for my second blood test and then drove to Napa, California. You see Travis and I were getting married on Thursday in Napa. I was driving down Wednesday to spend the night before the wedding and Travis would drive down on Thursday.
Despite waiting for a call from the doctor confirming the miscarriage, Thursday I was able to focus completely on getting married and when I met Travis in front of the fountain for the ceremony I was ecstatic - not one tear! Friday we had a limo lined up for a wine tour and mid-way through our day the call finally came confirming what I already knew - the pregnany had ended in miscarriage.
Several weeks later, I was back in Salt Lake working and it was just a few days before Christmas. Travis would be flying in to spend the holidays with our family in Salt Lake. I had my six month dental appointment and was talking with my favorite hygenist about the miscarriage. She had suffered a miscarriage the same day as I had and she was really struggling with the grief she was feeling. She asked if I had yet to have another period since the miscarriage. I realized I hadn't and I told her I should probably go home and take a pregnancy test just in case. After all, I had just had dental xrays but hadn't even considered that I could be pregnant so soon. So I did just that, on the way home I got a couple pregnancy tests. I was shocked when they came back positive. What did it mean? Was I pregnant again or had I really not miscarried the last pregnancy? I called Travis to tell him the news and the next day a friend pulled some strings to get me into an OBGYN in Salt Lake. Because of my history, they immeadiately sent me over to the hospital for an ultrasound. The technician was stone faced - all she said was, "I found something and you need to go back to the doctor's office to discuss it." I waited in the lobby for almost an hour not sure what they were going to tell me - was I still pregnant, was it a new pregnancy, was it a tumor or cancer? Finally, the doctor called me in and confirmed I was indeed pregnant - again. Stupidly, I asked "but is that okay so quickly after a miscarriage?" She assured me that although they don't usually recommend getting pregnant again so quickly, if I was able to get pregnant then it meant my body was ready to be pregnant again.
So here we were again about a month later, I was calling Travis from Salt Lake to tell him I was pregnant. Despite having a miscarriage just a few weeks earlier, I had a calmness come over me that lasted throughout the pregnancy that this would not end in miscarriage. I just knew it was going to be okay.
The pregnancy progressed normally the first trimester and at my first doctor's appointment in Sacramento I had my first ultrasound and heard her heartbeat. Towards the end of my first trimester I came down with a cold. Not being able to take any mediciation I was miserable. To make it worse I was the President of a user's group for work and we had a conference out of state I was flying to. Those few days out of town I was in agony - I was running a fever, sneezing, coughing, sore throat and all stuffed up. I wasn't able to sleep for days and during the meetings I couldn't speak without coughing. When the cold finally passed I was relieved.
Around 18 weeks, I was in Salt Lake for work and with a few family members went to a local mall where you could get an ultrasound. We called Travis in and the technician was able to tell us we were having a girl. That weekend before the miscarriage we had already decided on a girl name (we never had any doubt we would have a girl). The ultrasound technician commented that Peyton was pretty tucked in so it was hard to get a good look at her.
At 20 weeks, Travis and I went to the hospital in Sacramento for the second ultrasound ordered by the physician. Again, they were sure we were having a girl but once again she was all tucked in to the fetal position so it was difficult to get many of the measurements we needed. As far as we knew, she was healthy and all was good.
I am a little bit of a control freak so I made sure to schedule a time to visit the hospital she would be born at and dragged Travis along. Two other couples came for the tour as well and they were very young - probably early 20's. I was prepared with my list of questions and drilled the tour guide (ie nurse) while the other parents remained silent. Not knowing much about the hospitals in Sacramento, we learned that the hospital did not have the highest level NICU (a question I specifically asked) and should a baby need that level of care it would need to be transferred.
Almost two months passed without incident and close to 27 weeks, I started having cramping. To be safe, the doctor sent me to the hospital where we planned on delivering to get me checked out. They hooked me up to the monitors and told me I had an "irritable uterus" - basically I was having disorganized contractions that weren't impacting the cervix so they weren't considered preterm labor. After a few hours they sent me home.
The pregnancy continued on and then right around Father's Day, just a few months before the due date. For fun, I decided to take Travis to see a 3-D ultrasound of Peyton. The technician explained before she started that if she found anything unusual she would send us back to the doctor for follow up. She explained that before doing elective ultrasounds she worked as a technician at a high risk OB group in Sacramento so we were comfortable that she knew what she was doing. Peyton was not in the mood to be photographed and it was hard to get great pictures but we got a few of her face and we were thrilled to finally see what Peyton looked like up close. The technician did say that one of Peyton's kidneys looked smaller than the other and she recommended we go back to my regular OB to get it checked out. We were both concerned, but I figured if people have two kidneys and one wasn't working so well at least there was a spare. At my next appointment, I told the OB about what the technician had said. Initally she seemed heistant to order another ultrasound but after calling and talking with the technician she quickly got it scheduled. This ultrasound experience was different then the previous three. First, there were multiple people in the room viewing the images. Secondly, they had me keep turning in various positions. At one point I was lying on my left side for what seemed like ages (a big no-no in pregnancy for a very long time) and almost passed out. After what seemed like forever, they said they had what they needed and we were allowed to leave. The technicians never said anything specifically about the findings and several days passed so I figured we were in the clear. And then I got the call.
It was a day I won't soon forget. The OB called me at home, already not a good sign. She said that the kidneys looked fine (I was thinking we had dodged a bullet) and then she broke the news - Peyton's jaw was smaller then they would expect. And there were a few other measurements that weren't where they should be and she wanted to send us on to the local high risk maternal/fetal medicine group for another ultrasound. I was stunned. I made up my mind that since the kidneys had turned out to be no big deal that a small jaw was probably no big deal either and I didn't really worry too much about it. Travis, on the other hand, was more concerned. In anticipation of the next ultrasound, though, I did some research on the internet about micrognathia and Pierre Robin Syndrome. At least I would go armed with some of the terminology when the doctors started discussing their findings.
A few days after the call, Travis and I went for the ultrasound. It was hard to believe in the space of a few weeks we went from thinking we had a healthy baby to sitting in the waiting room of a high risk clinic uncertain of what they would tell us. The technician went about her business quickly and called the doctor in. He explained what he had found - a small jaw, shortened forearms and eye sockets that were not where they should be. In addition, Peyton was measuring small overall for her gestational age which could mean the prengnacy was dated incorrectly or that she would be low birth weight. He sent us on to the geneticist who went through our family history and explained that with the information they had from the ultrasound they did not have a firm diagnosis. Due to the late stage of pregnancy, there wasn't any further testing they wanted to do. At this point, we were just going to have to wait until she was born. The geneticist explained that they would send the findings on to my regular OBGYN who would work with me on a revised plan of care.
At my next regular OB appointment, I had lots of questions. I didn't know much about what we could expect, but it certainly seemed logical to me that if Peyton's airway was compromised by a small jaw that at least two things should happen - they should schedule a c-section to make sure everyone was available and that we should change the hospital to one that had a higher level NICU. The OB would have none of either suggestion. She did order me, though, to come in for weekly appointments and twice weekly stress tests to monitor Peyton. The week prior to Peyton's birth there was some concern at the results of one of her stress tests so they sent me to the hospital to be checked out. After getting some apple juice in me, Peyton started to perk up and they let me go home. I was originally due 8/23 but when the due date came and went the doctor let me know that she would let the pregnancy continue on at least another week and a half before considering inducing labor. I shared with the doctor that my mother's first labor intensified so quickly that she barely made it to the hospital before the baby was born but she waved off the concern since there wasn't any strong indication of a genetic component to fast labors.
We didn't have to wait long, though, early on the morning of 8/27, I woke up to some minor cramping. I watched an episode of A Baby Story and then realized that the cramping was coming in waves and it dawned on me they might actually be contractions. I went into the bedroom to wake Travis up and have him count with me and we realized the contractions were already 3 minutes apart. I called my doctor (who happened to be the one on call that morning) and explained that they were coming very quickly but they weren't very painful and asked if I should come in. She said as long as they weren't painful not to bother and stay at home. So I told Travis to go ahead and hop in the shower. In the 10-15 minutes it took him to get ready the contractions went from mildly uncomfortable to so painful I had to hold onto something to keep from falling. At that point, we made a hasty exit to get to the hospital which was about 10 minutes away.
They put me in a wheelchair to take me up to L&D and I was barely able to stay sitting as a contraction would hit the pains were so intense. Once they got me in a bed they checked me and told me I was only at a 1 and considered sending me home. That all changed less than an hour later when all the monitors went off and Peyton's had a significant deceleration. The room filled with staff very quickly and they had me turn on my side to try to get her heart rate back up. At that point I was ready for an epidural and they said they were waiting on the lab to come draw blood before they could call the anesthesiologist. They did a quick exam and determined I was between a 4-5. When Peyton's heart rate returned to normal the room emptied again but less than an hour later the alarms sounded again and the room was inundated with staff. They started to move me to a private room but quickly determined they weren't able to get Peyton's heart rate back up and made the decision to do an emergency c-section. At that point, I was in so much pain that I had a hard time focusing on the frightening nature of the situation - but Travis certainly was anxious. They wheeled me away while they led Travis to another room to gown up.
The time in the operating room is still very fuzzy to me. I remember the blissful moment when they were finally able to give me an epidural and the pain stopped. It was at that moment that I started to realize the gravity of the situation. It didn't seem like much time passed before Travis was in the room with me and they were asking if I felt it when they pinched me. Because of the draping I couldn't see much beyond Travis next to me, but Travis recalls seeing a spurt of blood as they started cutting. And then time seemed to stand still for a moment as I saw them lift Peyton from me and go behind Travis to start working on her. I recall seeing a lot of dark hair but never saw her face. I could only see his eyes, and I could tell Travis was as scared as I was when I kept saying, "Why isn't she crying, she isn't crying!" But there was no response - there was absolute silence in the operating room. Now I had seen enough episodes of A Baby Story that resulted in a c-section and not once do I remember hearing nothing spoken by anyone in the room. About that time Travis was quickly rushed out and placed in a small waiting room without any discussion as to what was going on. He told me later that he thought for sure he was going to lose either one or both of us at that point. After discussing my memories with a nurse later, she believes I was probably knocked out and that is why I don't remember anything until I woke up in the recovery room later - most likely due to the stress of the situation.
Travis spent about 30 minutes in the waiting area, alone, not knowing what was going on. During that time we now know that the hospital called UC Davis to request an immeadiate transfer. The transfer team (who we would later meet up with again at the same hospital) was en route immeadiately while the neonatal team tried twice to intubate Peyton. They were not able to establish an airway either time. Peyton was under stress during labor and aspirated meconium into her lungs. So in addition to a compromised airway due to the small lower jaw, she also was in respiratory distress from the junk in her lungs. Because they were not able to intubate Peyton, they did the next best thing and turned her onto her side to allow her tongue to fall forward and prevent further blockage of her airway while they waited for the transport team to arrive. Once she was stabilized they allowed Travis back to see her. Around the same time I was waking up in recovery and they brought me a Polaroid of Peyton in the NICU so I could see what she looked like and promised that as they got ready to take her away they would stop by my room with her so I could get a chance to say goodbye. While I waited I remember pulling out my cell phone and calling my boss to say I wouldn't be able to make a meeting that day that I had scheduled. It would be priceless to listen to that message now - I am sure I was breezy and carefree - obviously still very much in shock. As I was calling my boss, Travis was calling my sister, Kristin to let her know what was going on. All three of my siblings hopped on a plane and made it to Sacramento within hours of Peyton's birth. As promised, the transport team wheeled Peyton in to see me. Although I knew logically she was my child, I would be lying if I said I felt a deep connection to her at that point. I was certainly concerned for her well-being but there was a dream-like feeling to those first few hours - whether it was shock or the drugs or a combination of both I am not sure. Before they left, the transport team handed me a card with the phone number to call to check on Peyton in the NICU and said nurses were available 24 hours a day to talk to me.
In the afternoon hours, I spent time making a few phone calls to family and friends and matter of factly started the process of pumping milk for Peyton to have in the NICU. Later that night when Travis came back to the hospital after visiting Peyton in the NICU at UC Davis, he broke down and cried for the first time in front of me. As he expressed his concern for his daughter, I remember comforting him and telling him everything would be fine but I had very little emotion. That night Kristin stayed with me in the hospital so Travis could get some rest for the long journey ahead. Kristin told me later that she called her husband back home in Utah to share her concern with him that I wasn't emotional at all and she was worried about my mental health. The hospital must have also been worried because they made sure to put me down a hallway without other mom's with their babies to try to protect me from the sound of crying babies.
The next morning, I pulled out the card to the NICU at UC Davis. When I got through to someone, I asked if I could get an update on Peyton's condition. The person on the other end of the line asked, "Who are you?" and as I responded, "Her mother" the reality finally hit me and the tears started flowing.
For those of you who have read the blog over the years you have a good idea what happened from there. I have struggled in the years since to come to terms with the events of her birth. It isn't that I mourn the loss of the picture perfect birth - the carefully constructed birth plan was thrown out the window the minute I entered the hospital and I have no regrets. But I have lingering anger at the risks my OBGYN took with Peyton's life. I was no medical expert but knowing what I know now - I am certain most other doctors would have pursued by request to have a scheduled c-section at a hospital with a higher level NICU. I am still angry to think we were miles apart from each other at such a frightening time. Travis and our families had no choice but to split their time between two hospitals. A sad reminder of that fact was presented the second night I spent in the hospital. To help celebrate the birth of the baby, the hospital wheels in a table with a tablecloth and flowers and a full course steak dinner on china for two. While Travis visited with Peyton, I sat at that table and cried. But what prevents me from moving past the anger is knowing that Peyton could very well have died in that operating room. But something good came out of the experience of having a medical professional downplay my very valid concerns - once Peyton was born I wasn't going to let anyone ignore my input ever again. I may not have stood up to my doctor when I should have, but I would damn well stand up for Peyton. And I have. I don't need to be their friend, I don't need them to like me but they are going to listen to me and if they won't then I will find someone who will because that is what Peyton deserves. So maybe that anger is not such a bad thing - I think I will hang on to it a little longer.
Saturday, June 26, 2010
Peyton Nicole Smith
Now before you think Mommy is really mean for trying to hide - consider this. If I was to play at their house, Mommy would have to go with me for safety reasons because of the trach. Our back yard is a weed pile so playing outside where it is fenced it is not possible. Mommy doesn't trust me to play out in the front yard so that leaves one other option - the girls coming over to play at our house. After a long day at work, Mommy is rushing around to get laundry done and dinner on the table so she is not really prepared to entertain a bunch of kids. But like I said, she gave in and answered the door since she knew I was happy to have them over. Mommy learned some interesting tidbits from the girls which could explain the stalking - they aren't allowed to watch TV and their dad actually is encouraging to come over to see if I can play. Super!
So Mommy helped facilitate the play date with the three of us (with my limited ability to be understood, Mommy needs to translate) for about an hour and then sent the girls on home. Despite not getting the laundry done, she couldn't help but smile at the sight of me taking the hands of the girls to walk up and down the stairs. In a world where many people can't overlook my differences, these girls accept me just how I am.
Peyton Nicole Smith
Peyton Nicole Smith
Tuesday, June 22, 2010
Peyton Nicole Smith
Peyton Nicole Smith
Peyton Nicole Smith
Friday, June 18, 2010
Wednesday, June 16, 2010
Tonight while my parents were eating dinner, we all watched Seconds From Disaster together. Now Mommy hates watching war movies because she thinks there is enough terrible stuff going on in the world that when she does watch movies and tv she wants to see something more cheerful. For those who haven't seen it, the title is pretty clear - Seconds From Disaster is not a happy show but Mommy is fascinated. The show walks through the moments leading up to disasters and what caused them - as it is normally a series of different events that leads to the disaster. The show my parents watched tonight was on the Oklahoma City bombing. I sat in my little car in the family room and for the most part wasn't paying much attention to the TV. Then it showed a simulation of the actual bombing and I said very clearly, "Oh no - uh oh!" It stopped my parents in their tracks and Mommy asked the question, "How much do you think Peyton understands of what she just saw?" My parents consider me one smart cookie and it definately got them wondering - how much of what I see every day am I taking in? Clearly as demonstrated by my signing ability I take in a lot - often picking things up the first time. My parents are certainly going to be a little more aware of what they are watching when I am around!
Peyton Nicole Smith