The Birth of A Boy Named Boston James

This past Wednesday night, Jennifer's blood pressure continued to climb on average, even though it would occasionally drop down a bit.  We knew that was not good, but we had no idea just how fast things could turn for the worse.  That night, actually 1am Thursday morning, Jennifer woke up with significant chest and upper back pain, which prevented her from sleeping during the 4 hour segments she was allotted between BP checks.  Later that morning, Dr. Kindrick visited and explained that Jen's BP was becoming a bigger issue and that BP medicines may become necessary.  When Jennifer informed her of the chest and back pain, Dr. Kindrick surmised that it was probably caused by her laying in bed so much, which may have been causing her to experience costochondritis, the inflammation of the cartilage in the rib cage area that causes chest and upper back pain.  We thought it may have been caused by the switching of Jennifer's bed; on Wednesday evening, she was taken out of a basic bed and put into an air bed that randomly pumps up different areas of the body so as to allow for increased circulation.  Dr. Kindrick ordered up Tylenol and advised that she would check back on Friday and if the pain had not subsided she would likely have us consult with an internal medicine physician.

Friday, Jennifer's chest and upper back pain increased, as did her BP, especially during times of significant pain.  As she had informed, Dr. Kindrick set up a referral to an internal medicine physician on call that day, who would turn out to be Dr. Uddin.  Before Dr. Uddin came to visit, Dr. Payne, a perinatalogist, came by with the portable sonogram machine and once again checked the cord's blood flow and the amniotic fluid level, both of which were great.  Afterward, Jennifer reluctantly accepted more Tylenol to help ease the pain, which was supplemented with pain from the onset of a headache and some blurry vision.  The preeclampsia symptoms continued to build and the chest and upper back pain seemed to worsen.  That night, Dr. Uddin stopped in.  After asking a multitude of questions and pressing on Jennifer's chest and back to see if he could isolate where the pain was coming from, Dr. Uddin decided it was too close to the heart for comfort, consulted with a cardiologist, Dr. Lawson, and ordered cardiac enzyme bloodwork, an EKG and an echocardiogram.  The blood was taken at several periods last night and these other tests were done as well.  We entered the weekend hours with Jennifer not feeling so well, but feeling as though the precautionary steps were nothing more than good medicine.  We had no idea what was coming our way.

Yesterday morning (Saturday, October 2, 2010), around 5am, Jennifer woke up with a severe headache that was virtually debilitating and BP that was creeping toward the 170s/90s.  Jennifer has one of the highest tolerances for pain I've ever witnessed in a woman, and she was rating her headache at a 10 out of 10.  That was very alarming and it hurt me physically to watch her writhe in agony, my mind unable to ignore what I knew was happening - that the blood pressure had risen so much that it was now affecting her brain.  For the headache, the on-call OB/GYN, Dr. Lopez, who was on her way to the hospital, ordered a shot of Demerol with Finnergran for the expected nausea.  As we waited on the shot to come, I knelt at Jennifer's bedside and prayed, asking in part, that God take the pain from Jennifer and protect her and our child.  He listened.  The shot came and the pain started to slowly subside, but the BP remained high.  Soon thereafter, a nurse brought in an IV bag with an anesthesia medicine that was "just in case we need to go into surgery."  Then, when she arrived to the hospital, around 9am, Dr. Lopez stopped in and explained that the elevated BP, amount of proteins in the urine, severe headache and blurred vision from yesterday all militated in favor of inducing the pregnancy, despite that it would bring Baby Cook into this world more than 5 weeks premature.  As she explained her thoughts, Dr. Lopez indicated that she would do her best to honor Jennifer's wish to attempt a vaginal delivery, which would involve a balanced approach of mixing Petocin (the inducing agent) with Magnesium (the BP reducer that tends to stop contractions).  Only seconds later, however, the BP machine took a reading and indicated that her BP was now 206/104.  Dr. Lopez said, "that must be wrong... take it manually."  The manual reading confirmed that Jennifer's BP was, in fact, over 200/100.  Dr. Lopez said, in effect, to ignore her previous idea, that a C-Section was imminent.  Much to my surprise, Jennifer was non-emotional in accepting the necessary plan.  Realistically, it was the extreme pain she was in and the Demerol that aided this reaction.   We both knew it was in her best interest, and Baby Cook's as well, for the C-Section to commence ASAP. 

Jen minutes before she was to deliver our baby...very drugged up at this point

Just the two of us for the last time

Jen's best friend, Lauren, who was one of many who rushed to be by Jen's side

When Dr. Lopez left the room, the team of medical professionals sprang into action much like the finest of military units.  Meanwhile, I comforted Jennifer and told her all would be well, and the two of us happily acknowledged that in less than a couple hours we would be parents and would finally know our son or daughter.  Also, because it was not lost on me, I pointed out that until that moment, Jennifer and I had always formulated specific plans - be it for college, our Wedding, or buying a home, etc. - and had always executed our plans according to the plans, yet someone had just taken complete control over the most recent big plan - that is, to have a fully natural, vaginally delivered baby - and ripped it up, tossed it out and set forth his/her own plan that we would simply have to live with.  We really had no idea just how different our plan was from his/hers.  At that point in time, we both had to just ignore the fact that we, the consummate planners, had no written birth plan, no nursery furniture, no to-go-home-in outfit for the baby, no car seat and not even that ever so important hospital bag that all expecting parents pack with all of the essentials for their usually short-lived time in the hospital.  We had nothing of these sorts - just the two of us, our laundry for a couple days, some rotting fruit and a camera with partial battery power and no charger.  But, we also had the tabletop Cross that we had bought for Boston's room.  These things would do just fine.

A loopy but smiley Jen about to have her baby

After a few phone calls and text messages, all done while the team of nurses prepared Jennifer for the surgical event, I donned my surgical suit, mask and booties.  In what felt like seconds, we were headed down the hallway toward the operating room.  Jennifer was taken directly to the operating room itself, and I was asked to sit for a few moments in a sterile area while they prepared Jennifer.  A few moments later, I was called into the room.  A team of four people (Dr. Lopez, an assisting physician, an anesthesiologist and a nurse) were situated around Jennifer and three others (NICU personnel) were holding their places around what was obviously the bed into which the baby would be placed immediately after it was delivered.  I was taken behind a curtain that was set up so that Jennifer's head was isolated from the rest of her body.  I combed her hair with my hand, asked her if she was feeling anything (as I had already watched some of the incisions being made) and we exchanged some thoughts.  Within what felt like mere seconds, Dr. Lopez looked up at me (I could stand and see over the curtain) and got everyone's attention in the room and said the baby is coming out and "Daddy" gets to tell us what it is.  I was a little nervous I'd make the wrong call given that my brain was being over-stimulated.  The anesthesiologist joked and said not to make the call too early, just in case it was questionable.  We all laughed.  A few seconds later, I saw Baby Cook's head peek from Jennifer's belly.  Baby Cook had lots of hair, as expected.  I lowered myself down to Jennifer's head and told her I could see the baby's head. As I lifted back up and looked over the curtain, I saw Dr. Lopez lifting Baby Cook high in the air, facing my direction. One glance downward was all I needed. Baby Cook was a boy and so I made the announcement, thankfully getting it right. The room cheered. I knelt down to Jennifer's face and kissed her forehead as her eyes filled with joyful tears. We had our boy, and his name was Boston James, which we had long ago decided.

Jennifer's First Sight of Boston James

By the time I raised up from Jennifer, Boston was already being handed over to the NICU team.  It didn't register to me at that time that I had not been the one to cut the umbilical cord.  I was told to go with Boston and the NICU team.  I gave Jennifer a parting kiss and went to meet my son.  While I stood there in utter amazement at the thought that this most beautiful infant boy I'd ever seen was my own son, the NICU team took various measurements of him (he was 19" long) and watched to see if he would start to breathe on his own.  Fortunately, he did so, and he was then wisked over to a set of baby scales (he weighed a whopping 5lbs, 12ozs.).  Though he was small in comparison to full-term babies, he was much bigger to me than what I had expected, given that he only made it to 34 weeks, 3.5 days of gestation, i.e., he had come 5 1/2 weeks early.  He was long and thin-looking, given that he never had a chance to gain his baby fat.  His face was round and it was readily apparent, make that blatantly obvious, that he looked much more like me than Jennifer... long and lanky torso and limbs, big hands and feet, small mouth and all.  His eyes, however, were those of Jennifer.

Boston was almost immediately taken to the NICU nursery and placed into a heated baby bed, but not before he was taken over to Jennifer's face for a quick introduction.  Before she saw him, I had made my way back around the curtain to her.  I'll never forget the look in her eyes when Boston's innocent face was placed within inches of hers.  She smiled that smile that only a mother can do at the first sight of her child.  The love affair with Boston had just begun and it was extraordinary to see from my vantage point.

Our First Family Photo

As the surgical team tended to Jennifer, I followed the NICU team as they took Boston to the NICU nursery.  Dozens of other measurements and assessments were made of him, and I just watched and kept out of the way.  As Boston's little body was poked and prodded, twisted and turned, suctioned and wiped down with various medicines, I conversed with the nurses who repeatedly stated that he had no anomalies and was essentially in perfect health.  There, all around us, were babies who were days or perhaps weeks older, most of whom had very serious illnesses, which necessitated all sorts of tubes and IVs.  Selfishly, I was proud that Boston was not going to endure that.  I never would have thought that I would feel bad for having a healthy baby, but that's what happened.  I couldn't dwell over this thought, though, because I knew that a) Jennifer was still being put back together and I felt an urge to get back to her, and b) friends and family were now waiting for some word about Baby Cook so I needed to get from Jennifer to them with all due speed.  After Boston was wrapped up, placed under the heat lamp and given a small amount of formula to drink and I had been given the run down of the NICU rules (only 2 visitors at a time and only parents or grandparents could come into the NICU to see him), I headed to our room where I knew Jennifer had been taken.

Minutes old

Boston James Cook - less than 15 minutes old
Holding Daddy's Hand - less than 5 minutes old

As I walked into the room, several nurses were still tending to Jennifer, setting up her various IVs and making sure her position on the bed was appropriate.  I was able to get near her, hug and kiss her and we both just grinned and marveled at the reality that we had gotten the boy we wanted and that he was healthy and in good hands.  This was short-lived, given the friends and family in the waiting room.  Jennifer was unable to visit them or to have them visit her, so I would make the announcement about Boston.  After corralling the visitors and making the announcement, I then took each of Boston's grandparents and my lovely Granny Slates to see Boston one at a time.  Under NICU rules, only I could touch Boston before Jennifer, so no one touched him before Jennifer, except Dr. Lopez, the NICU team and me.  After these visits, I apologized to everyone that Jennifer was not visitable and to those who were not allowed to see Boston, and then I headed back to Jennifer.

When I reached Jennifer, I greeted her once again with a hug and kiss and told her she was an amazing woman and had created a beautiful baby boy that everyone who had visited him already thought was just awesome and sweet.  It appeared as though the day's big events were over and we would soon be able to roll Jennifer's bed into the NICU so she, too, could see Boston and finally hold him.  It didn't happen that way, not even close, not by a mile.  Around this same time, the cardiologist who had been asked to review Jennifer's cardiac work-up from the evening before, Dr. Lawson, came in and, with some of the best bedside manners I've seen, explained to Jennifer that the echocardiogram had revealed that Jennifer's aorta valve was leaking.  Dr. Lawson said this can be a mere result of the high BP pushing the valve open when it was supposed to be closed OR it could be an actual tear or dissection in the valve itself, in which case Jennifer would require immediate, emergency surgery, given that such dissection is a life-threatening condition.  Amazingly, the woman I married, who easily sheds tears at hearing difficult news, fully accepted Dr. Lawson's recommendation that she be taken immediately to a CT scan to aid Dr. Lawson in determining if a dissection had occurred.  Jennifer's nurse then unhooked many of the wires that were attached to Jennifer, set up the IV tower for transportation and we proceeded to roll Jennifer across the hospital to the CT imaging room.  When we arrived, Jennifer again heard some bad news.  First, she would have to move from her recovery bed onto the narrow bed of the CT machine, which was no small feat given that she had only hours before had an 8" incision cut into her lower abdomen.  Second, the contrasting fluid used in the CT method contained iodine, which is toxic to babies and meant that she would not be able to breastfeed Boston for a couple days at least or even provide her breastmilk to him in a bottle.  Despite this news, Jennifer agreed that it was better to determine whether she had a problem with her heart.  Her so-called "recovery room" bed was postioned next to the CT machine and, in less than hours from undergoing a C-Section, Jennifer moved herself onto the bed of machine.  During the test, she remained still and (we think) followed the instructions of when to breathe or hold her breath.  The test was over in just a few minutes and, once again, Jennifer moved herself, this time back onto her own bed, and we headed back upstairs to the L&D Dept. for what we thought was finally going to be a relaxing afternoon.

Upon return to Jennifer's recovery room, the nurses set her back up again with the IV bags and other cables, and she laid back to gain some much needed and deserved rest.  This was short-lived.  Within 30 minutes or so, Dr. Lawson re-appeared.  More bad news.  Although the CT scan was good enough to show most of the aorta and heart, Dr. Lawson and the radiologist with whom he conferred concluded that they'd not seen enough to reach a final determination as to whether the aorta valve was dissected, or torn.  This left only one option - an endoscope, which could be done virtually immediately if only we took Jennifer up to the ICU dept on the 3d floor.  So, the nurses disconnected Jennifer and made preparations for her next trip.  By this time, around 5pm, Jennifer had still not been to the NICU to see Boston.  Her last sight of him was back in the OR just after he was delivered.  So, despite the urgency of the endoscope, the nurses convinced Dr. Lawson to let Jennifer make a trip by the NICU, even if it had to be in her bed.  Moments later, Jennifer was wheeled into the NICU, her bed placed so that her face was closest to Boston's.  Jennifer's eyes fixed upon her son and she went silent, much as we all do when we are observing something special or important, like the national anthem, a eulogy at a funeral or the inauguration of a president.  Given Jen's immaculate perception of the physical, it was clear that she was checking over her son, keying in on the most significant attributes.  She was already so in love and so proud of him and who he was, even as an hours-old infant.  In less than a minute, one of the NICU nurses moved in with a purpose, quickly grabbing up Boston and carrying him over to Jennifer with the obvious intent of laying him on her chest.  Seeing this, Jennifer let out a sigh like none other I've heard from her.  To me, this was the single, most important moment in our marriage.  By her sigh, she knew full well at that moment that she was finally going to get to touch her own child, something she'd waited many months for and something that the circumstances of the emergency C-Section had deprived her of.  Her entire reaction to this moment was so touching, it brought tears to my eyes, which had not happened until that point.  She re-affirmed what I always knew - that she was going to be the most loving and caring mother to my children.  I learned once again exactly why I married her.

Unfortunately, the moment for me was cut short.  As I stood by Jennifer's bed while she held and gazed at Boston who lay in her arms, a NICU nurse informed me that the courier for the cord blood and tissue samples was waiting in the L&D for me to hand over the samples.  In these modern times, cord blood and, to a lesser extent, cord tissue have been used successfully to treat a donor or his or her immediate relatives, most often for leukemia.  Despite the significant costs, Jennifer and I knew we would incur them so as to give Boston all of the advantages we could, even if the contingency never arose for him, God willing.  So, I kissed Jennifer goodbye and headed in a hurry back to the L&D.  On the way, the lactation consultant gave me a crash course in how to clean the breastpump accessories.  Oh, how fulfilling that was!  After handing over the samples and receiving a receipt in return, I then took off for the ICU.

When I arrived at the ICU, Jennifer had already been taken back to a room where the procedure would take place.  I was permitted to visit her shortly and then instructed to wait in the waiting room.  I was joined by her parents, Robert and Gloria.  Dr. Lawson visited us before the procedure and told me that it would be over in less than 15 minutes and that he would immediately report his findings.  While we waited, we recounted how the day had gone and kept repeating our wish that Dr. Lawson would find nothing wrong with Jennifer's heart.  The wish was granted.  Thank God Almighty.  Dr. Lawson came back to the waiting room within 20 minutes and told us he was able to see every portion of the aorta he needed to see and that it was perfectly normal.  That was the best of news.  We were then taken back to see Jennifer, who was already alert and all smiles.  What a huge relief to see her that way.  The nurses taking care of her told us she would have to stay in the ICU for another 30 minutes or so just so they could observe her to ensure the anesthetics wore off properly.  While she waited there in the ICU, I took Robert and Gloria back through the NICU to see Boston before they left that evening.  Within an hour, Jennifer and I were finally in our room and she was finally able to relax. 

Before Jennifer dozed off for a long, much-deserved nap, we made plans with her night nurse that she would be awakened around 11pm so she could be taken to see Boston for his 1130pm feeding.  11pm came and Jennifer woke up, refreshed, and ready to see her baby boy.  Because Jennifer was still unable to get out of bed, two nurses graciously readied her bed so that it could be wheeled once again down to the NICU so she could see Boston.  Around 1145pm, we were in the NICU and Jennifer was holding and feeding Boston and admiring his every feature.  It was confirmation, yet again, that a love affair had begun and she was going to be the greatest mother for our son, which brought a sense of peace and comfort to me.  Being married to a wonderful woman is one thing, but seeing her so easily and naturally transition into the mother of your child is beyond the greatest of moments.  Here again, I find myself so blessed to get to experience this life of mine. 

11:45pm - after a long day, mommy's late night visit

Thanking God for Wife and Child,

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