the day Lomi was born

Lomi turned 11 years old yesterday, October 29th.
Good God, has it been that long?

I was a medical intern, tired after a 24 hour call. It was October 28th. Instead of getting some zzzz's, I freshened up and went to a despedida for my brother in law at Dad's Mega Mall. After the extremely satisfying buffet, I had felt some tightening of my huge belly. Upon reaching home, I felt this heaviness and went straight to the bathroom. Gush! Uh-oh, my water broke...my heart skipped a beat as I had a fleeting panic that my baby had come out with it. He didn't. Whew! I stepped out and Jun was waiting. He had already been uneasy and even more so upon seeing that I was quite drenched. His eyes met mine and I saw his panic. "It's okay. We just have to go to the hospital. Let me change first."

We drove to Taft Avenue en route to Manila Doctors Hospital.
"Crap. My admitting orders...it's in my Harrison's at the call room."

My blockmates Kendrick, Jun S and Noela went on a frantic search for it. I think they almost turned the shelves over and still couldn't find it. Whatever. They blew kisses as Jun drove me away from PGH.

We arrived at the hospital after midnight. It was October 29th. After enduring labor for 19 hours, Lomi was ready to come. So I was told.

Push. Push. Push.

Lomi had other plans. I guess he was all excited and had a run of fetal tachycardia.

I had my c-section at 1930H. Lomi was born at 1948H.

Feeling woozy out of tiredness and the morphine, I heard him cry. I have never felt happier. When he was brought to me for bonding, I found myself tearing up over this little miracle.

Eleven years have passed. Mama na siya. Is this the same baby that Jun was eagerly cradling in his arms and dancing to sleep? He wouldn't be able to do that now. He certainly has grown. But he certainly is still my baby.

sleep

I am having the pleasure of a lull. It is 0437H and have just attended the delivery of a 36 week IUGR infant. I am winding down the hours to the end of my 24 hour shift at 9am. No sleep yet for me. Sleep was once an elusive commodity when I came here. Partly because of the busy nights on call but also because it took some getting used to being alone in bed. With November just around the corner and winter at its heels, I can definitely use the feeling of a warm body to snuggle with…my kids, my hubby. But I make do with down filled pillows and a personal heater at my feet.

I have a double bed but I only sleep on the left side. A friend of mine had told me to relish having the whole space to myself and lie right smack in the middle. Thoughts of the Vitruvian Man go into my head. I tried to do that the other night but found myself going back to my preferred fetal position, again on the left side of the bed. I wondered why that is.

And so I came across an article about sleep positions. It really is very interesting. Apparently, I am in the majority. 41% of 1000 people prefer the fetal position in sleep. People who are tough on the outside and yet soft on the inside (sounds like a commercial). I have no clue what the science is behind these interpretations, but if you are curious, check this site out http://www.flatseats.com/General/positions.htm

Didn’t I say I had a lull…it’s over now. A kid just self-extubated.

I look forward to sleeping later.

lush

I have just seen the movie The Legend of Bagger Vance. One scene keeps replaying in my mind. Junuh, portrayed by Matt Damon, was engaged in a drinking spree. He told a 10 year old Hardy the merits of being a drunk. In essence, Junuh admits that with each gulp, thousands of brain cells die among the billions. But.... The first cells that die are the sad cells so that in drink, one finds happiness. The next to go are the quiet cells, so naturally, one can only get loud and louder. Then goes the stupid cells, so that even in loud drunkeness, there are remarkable utterances of lucid wisdom. It is not because of these perks that men become drunks. Among the last brain cells to die are the memory cells. Now Junuh says, these ones are tough and just can't seem to let go, continuing to torment and drive one to drown in intoxication.

Hmmmm....

one

I had a free weekend. I must say that on Friday, I was feeling pretty upbeat. I was rejoicing with the thought that I would be away from the stress and unending demands of my work.

I had a free weekend. I am glad that it is about to be over. Much as I love having days off, I must admit that I dread the monotony of my life outside the hospital. After going through the mundane tasks such as clean up, laundry, grocery shopping, I find myself feeling empty left with having all this glorious free time by my lonesome. My mind wanders to half-way round the world, thinking of my time lost for Jun and the kids.

I roam the streets of downtown Toronto, begging for exhaustion so that I can sleep easily and soundly tonight.

Tomorrow, I shall go back to work. Inevitably, there will be someone who says,"I can't believe how you are managing being far away from your family." or "But you always seem to be happy, with a big smile on your face."

In truth, I smile and laugh to cope with my day-to-day personal and professional crises. Pilipino ata ako. If I cried each time, I probably would have shed enough tears to help fill the oceans that span the distance between my family and I.

undoing the fear

The news of the Glorietta bombing has shook me to the core, just as if I had been there myself and felt the reverberations of the blast. I am gripped with horror at the sight of the video footages from home. My being is enveloped with sadness for those who have lost their loved ones through this senseless act of violence.

Damn. I have let the fear in me. I can only think of my own family's safety who frequent the malls. Or will it be just the malls? These terrorists can strike anywhere. Will it stop?

Flashback to two days ago.

"Donna, is your plan really to go back? How do we make you change your mind?", queried my staff as we were walking together to the MRI.

I am flattered and say my thanks. I do want to go back home and perhaps even make a small difference.

She continued, "But never say never. Just keep your options open." I did not say it out loud, but only widespread political instability or mayhem will change my mind. Anything at all that will threaten my family's future.

And now this.

I have to stomp out the fear within me. Those terrorists will have just achieved what they wanted. I am angered by the complete disregard for human life. I am angered by their cowardice.

I am so angered...naiiyak ako.

lunch out

On the Monday after my long weekend call, though I was physically tired, my mind was still actively thinking about the 24 hours that was. I knew that I needed to sleep but could not. I took a quick shower and headed towards the Eaton Center.

I am still truly Pinoy, I am an irrepressible mall rat at heart.

It was soon 11am.

My stomach growled. I knew where I wanted to go. Jimmy the Greek. The guy at the counter was a sweet talking Eastern European who quipped, "Mahal, what would you like today?" I greedily ordered my usual. It is a delectable roast chicken dinner with a generous serving of greens, rice and potatoes. At first glance, it looks unappealingly slathered with sour cream and hot sauce. But looks can be deceiving. My taste buds attest to the truth. The meal was over in 10 minutes. Gosh, I was ravenous.


photo swiped from anime-luver 7895

who's boss

Jun recently brought Nikki to the grocery store. Just the two of them.
She would delight with sitting in the carriage part of the cart as she would point or grab at the items she wanted.
He would cautiously put back those he thought were a bit too much or not really needed.

It was a different story last Tuesday.

Nikki insisted on pushing the cart. Her arms shot straight upwards to reach the bar. Jun thought it cute and got a kiddie size for her.

"No! Ayaw ko!" Uh-oh.

"Nikki is small, so you will have to push the small cart."

"No!", even louder.

Now Jun is not one to quarrel and more so, to create a scene. Naturally, he gave in.

My poor husband, he struggled trying to help steer the cart. But Nikki would not budge an inch.

My poor daughter, we will all be ruined if you get to have your way each time.

a day in the hospital

In all the afternoon, I had gone with my staff person about the hospital.

First stop was the MRI. A patient who is a little over 36 hours old has a persistent metabolic acidosis. On the MRS, a huge lactate peak was noted. The neuroradiologist hinted at a mitochondrial metabolic disease.

Second stop was at the Department of Laboratories and Pathology. A baby had died two days back and the parents had consented to a post. It was hard to focus on the autopsy as a pathology tech was using an automated bone saw in cutting up a leg (presumably post amputation for an extensive osteosarcoma). In that moment, I wished I was vegeterian. Gulp. I don't get queasy easily but I was glad to step out and the smell of formalin wafted in the air behind me as I walked away.

Just as we were to walk out the main laboratory exits, there was a small display of equipment used there. One particular thing caught my eye.

Underneath a simple looking device was a sign which read:

This machine is used for sperm analysis. This equipment was developed based on technology from heat seeking ballistic missiles.

Hah. How appropriate. And what perfect timing.

After a long day, I needed some comic relief.

dilemma

I came home with my mind heavy with a moral dilemma. I am physically, mentally and emotionally drained.
As I enter the door, I make for my laptop and turned it on.
My sister-in-law sent me an email with a youtube link.
She had filmed Nikki as they were looking at some of my pictures with Maxine on her recent visit with me.
Once my image turned up in any of the photos, Nikki would point at the screen and exclaim,"Mama there!" She had a big smile on her face.
That was it.
It tipped me over.
I started to cry.
Ano nga ba ginagawa ko sa pag-aatupag sa mga bata dito? Ano nga ba'ng buhay ang magkakaron sila? Ito ba ang gusto kong gawin pag-uwi ko? Samantalang pano naman ang mga anak ko?..nauulila sa nanay nila...
I so want to go home. Now.
Pat says I am just crazy tired. Maybe...or not.
Please Lord, enlighten me. Amen.

playing God

Just today, I have come home after a long 24 hour call (more like 30 hours). A late preterm baby was born with a complex congenital heart defect, hypoplastic lungs, cystic kidneys and other abnormal physical features. To add further insult, it was complicated by meconium aspiration.

Advances in prenatal diagnosis made it possible to detect these problems beforehand. Consultation after consultation done with physicians seemed to have indicated that there is a medical and or surgical answer to this baby's anticipated problems. After all, the chromosomal study done antenatally was 46 XY. I think that is about the only normal thing going for this baby.

So what happened? We intubate, put the baby on high frequency jet ventilation, give surfactant, start nitric oxide. Maximal support.

Why? Because we can.

The result of our efforts? A baby with a strong beating heart.

She is alive. But will she have a life?

I have been here in Canada over a year now. It never ceases to amaze me that we will just about resuscitate any baby with whatever affliction. Medicine has evolved in such a way that there is always some form of treatment available for conditions which may have been deemed incompatible with life a couple of years ago. Being humans, we have long sought to be masters of our own mortality, or perhaps, immortality. But to what extent should we intervene in the natural selective processes of life?

Honestly, while I was standing by the warmer working on the baby, I found myself suddenly stop and think, "Is this what I want to do? How far do I want to participate in this exercise?" On the other hand, should I pass judgement on this being? Who am I to say that she wouldn't be productive and happy in the future should she survive? Should the word miracle be a part of medical syntax?

The resus nurse assisting me gave me a nudge. "Are you okay there?"

I think not.

la leche

It is not a known fact around the unit that I work in that I have kids, let alone that I have three.

This afternoon, I was encouraging a mother, who had just delivered 3 days back, about her breastmilk. She was getting frustrated with all the pumping she does and the little volume she produces for her preterm baby. I had just remarked that I knew how difficult it is in the first couple of days because I had breastfed my kids too.

She stared at me in disbelief.

"You have kids?! You are such a little thing." And she was looking me over intently.

"Yes, I do. I have three in fact. And I breastfed each one of them."

She looked floored. "But you're still so young. You can't be a day over 25."

"Oh, you just made my day." I was beaming. "I am over 25. No doubt about that. You know what the secret is? I started out when I was 12."

And we both started laughing. The mother at the next bedside was looking at the two of us.

Mom number 1 says: "Can you believe it? She has three kids. If you can have three kids, then I sure can have breastmilk for my baby here."

I rest my case.

-----------

Just so that we are still in the topic of breastmilk, I remember when I first started my fellowship in Canada in 2006.

It was July 4 when it was my first time ever to participate in rounds in North America. Each nurse at bedside gave us the scoop on how the baby did from the night before and currently. In doing so, there were many unfamiliar abbreviations and acronyms spilling from her mouth. Add to that the spiel from the respiratory therapist, the pharmacist and the dietician. I was quite disoriented...maybe it was also the jetlag.

Anyhow, I caught on eventually. Frequently, there would be report on rounds that EBM is not available. EBM is expressed breastmilk.

When I left the Philippines, I was still breastfeeding Nikki who was barely 14 months old at the time. I did not have the heart to completely disengage her especially at night. However, I was still getting heavy with breastmilk in my first few weeks in Toronto. Even heavier was the thought that Nikki was herself crying to sleep those nights. Sigh..

Many times I was tempted to say, "EBM? I have lots of EBM."

Now if only the concept of a milk bank wasn't so foreign here in the first world where they are abreast (no pun intended) of how precious breastmilk is, I wouldn't have wasted so much.

Maxine sends an e-mail

dear mama,

Kamusta ka? I had a good time in my exams. I had no low scores. All in all my score when i add it together is 387. i only have 7 mistakes in one subject and the lowest is 18 mistakes. my classmate alexis salazar made 1 pair of earrings for me.

si Kuya umiiyak kanina kasi gusto niyang kumain. si nikki mas lalong kumukulit. si papa nagpapatawa parati. Totoo ba na sinabi ni daddy na bibilhan mo kami ng bagong dvd? tapos shoes and things? nagpunta ako sa bulacan tapos pumunta kami sa Walter Mart kasama si elio at marco. Nagpunta kami sa church at nagkita ni patrick tapos si papa pumunta kanina sa SM at maraming binili. Bumili siya ng isang set ng table na may 3 chairs na maliliit. Si papa binili niya si nikki ng 3 bagong shoes at binilhan niya ako ng bagong wallet at lalagyan ng tubig. May binigay din sya kay kuya pero di ko alam.

Thank you Mama.

Ingat ka diyan.
I Love You Too.
I miss you too.


Love,

Maxine

it isn't just about the turkey

It is Thankgiving weekend here in Canada and I was invited over to Kuya Masselle's and Ate Lita's. It is a time to reflect on the years past, to be grateful for the blessings received and to look onward towards the future. More importantly though, it is also to relish the present, to re-connect with family and friends, and make new ties. No wonder Pinoys living abroad have taken to this tradition. It certainly goes well with two of our great past times, kwentuhan and kainan. I swear I must have eaten food enough to last me a week and then, may pabaon pa!! Thank you po!


tsibugan na!

Kuya Masselle's annual "craved for" turkey


crispy, yummy turon


pose muna tayo

the turkey after -- did I not say it is craved for?!

through the screen

Just now, I have logged off from YM. Being on-line with my family is a daily ritual. However bizarre it seems, my kids have adjusted and wholly accepted seeing me through the computer screen. Maxine would chat with me about school, her friends, I would hear her rave about Pokemon games on DS and her fave mag, Total Girl. Lomi is tinkering with his new toy car, taking it apart and then putting it together. Nikki, who at most times used to ignore me, to my delight now talks her jibberish at me looking straight at the camera. I watch as they all sit together, heads bowed down, as they draw (well, Maxine does, Nikki scribbles and Lomi writes his favorite words). I see Nikki finishes ahead and looks disinterestedly at her sibs' creations. She makes for the bed and says, "Mama! Look!" and she jumps up and down, landing on her bum and laughing out loud. She then pulls, as she screams, on her big sister and brother and orders them to jump as they all held hands. Such a little tyrant! They land a big merry mess on the bed. Up and down, over and over. The laughter drowns Nanay Linda's worries about the bed holding up to such a "beating". But who cares. A bed is just a bed. Easy enough to buy one. These memories are priceless.

losing the future

Dying. It is a subject not many will be comfortable talking about. This afternoon, I had attended a discussion centered on withdrawal of care. Back home, I think this would be similar with the concept of HPR or "home per request".

My first experience dealt with a 24+ week gestation infant who required a full blown resuscitation which I had supervised upon her birth. A day three head ultrasound had revealed bilateral intraventricular hemorrhages with parenchymal extension. We had a family meeting which I thought was just to disclose these findings to the parents and the implications for the future should she survive this acute phase in her care.

It was more than that. "It is our professional recommendation to withdraw life sustaining technology."

The silence that followed was deafening. The mother began to uncontrollably sob. Her husband's tears welled up in his eyes. Sound medical evidence corroborates this advice. But still, I had this unbearable weight on my chest that just threatened to suffocate me. Their pain was so palpable that I hope never to fathom what they went through.

They say when a parent dies, we lose our past. When we lose a partner, we lose our present. But when we lose our child, we lose our future.

Since then, I have been numbed. I have been involved not infrequently in such discussions. To cope, I intellectualize things. It really is for the best. I have learned to detach my emotions....at that moment. Once I get out, I feel so spent. I so want to hug my own kids and count myself blessed that I have them.

The death of a child will always be an unwelcome reality, more so a newborn infant. I marvel at the indomitable love parents have, how else can any feeling human being come to terms with saying "hello" and "goodbye" in the same breath?

let there be light

This morning, I was blow drying my hair in my room and Pat was doing some ironing in hers when something very unexpected happened. I couldn't believe it when it did.

My hair was still wet and the dryer just stopped. I thought I had pulled the plug accidentally but it was still snug into the wall outlet. I heard Pat exclaim, "Brownout?" Huh?

It turned out, a fuse blew and our bedrooms and more importantly, bathroom, had lost power. I sent an email to our super to attend to it and promptly got a reply that the building maintenance people would see to it within the day.

I came home rather late from work. As they say, when it rains, it pours. I had to attend to a 25 week triplet birth and a near term hydrops baby. It was pushing 7 pm when I saw the outside world again after being cooped up in the unit. It was already getting dark. My thoughts were only on a long, soothing hot shower to ease my aches and pains. I dropped my stuff onto the sofa. Going in to the bathroom, I flipped the switch and still no lights! Crap!

Imagine my dismay.

However, this did not dim my plan of a leisurely evening. I will not be deterred. I let the water run in the bath. I lit my tea lights. Lovely. It was better than what I had imagined. Now this is the life.

If only candle power could make my hair dryer come to life too.