Congrats, Grad!

Big Boy with his best friend at their preschool graduation.
(This may not be as big a deal as they made it out to be -- he
isn't starting kindergarten in the fall. I'm not sure we're
going to do preschool next year either. I keep thinking "three
years in a row of half-day school? ugh." Plus, he got into
an afternoon program, and afternoons are the only time I get
to spend with just Big Boy . Not sure I'm ready to give that up yet.)

After the ceremony, we had a picnic in the "big gym" as the kids
called it. Then 7 classes sang and recited memory verses for their
End-of-the-Year Chapel. Big Boy really got into the singing and sign
language! It was really impressive to hear all the verses and
songs they'd learned through the year.

Cramming

Certain milestones in a child's life stand out as particularly challenging for a parent. The delivery, breastfeeding (should you choose this), sleeping through the night, learning to walk, learning to obey, and potty training all come to mind.

Somehow I seem to be cramming nearly all of these into a few short months.

I'm facing the delivery of baby #4 in less than 2 months. I've had one baby with and two without an epidural (and no, I didn't get the epidural for the first one!), and definitely prefer the calm that an epidural brings to the situation. I've considered trying to do it without again, but only because it might get me discharged faster if I don't have to wait for the epidural to wear off. Since we believe the baby will get transfered to Children's within a few hours to examine his heart and stay on top of his condition, I want to do whatever I can to get discharged quickly myself. (Before anyone freaks out, I'm not going to put my own health or safety at risk. And I know how unpredictable deliveries are. Each of my three was totally different, and my recovery time for each was differnt. Calm down!)

I forgot to ask at my last OB appointment, but I'm guessing, all else being equal, that an epidural would only add an hour or two to my stay. If that is the case, I believe it to be well worth it and I'm totally going for it. I could use one now, actually. I never dreamed that a woman's pelvis could ache and burn so badly. Seven weeks to go...

Of my three other children, two still have trouble sleeping at night. The oldest has been waking up at the ungodly hour of 5am lately. We can't figure out why. She's gotten much better at laying quietly in bed until we get her up, but then she naps during school, which isn't good either. I hope it's just a short-lived phase in her recovery.

The youngest has nightmares and loses all of her highly-advanced-for-a-two-year-old communication skills when upset. So trying to calm her down and get her back to sleep can be difficult. Scott has taken this job over as we think some of it is a ploy to get mom's attention in the middle of the night. And we both agree that she needs to get used to seeing him at night instead of me.

Because I do plan to try breastfeeding the baby. And even if I don't, I will probably do a significant number of the night-time feedings since Scott does have to go sit at a computer all day. I've decided that the 6 months of pumping I did for our oldest would be suicide for a mother of four to attempt. If this baby is unable to breastfeed within a week or two of his birth, I'll just pump for comfort til my milk is gone and switch to formula. Even if I do breastfeed, I'm not sure how long I'll last with three other kids who will very quickly learn that breastfeeding means mommy can't intervene as easily.

Which leads me to another disturbing trend. Lately I've been wondering if I'm speaking English in our house. The younger two, in particular, have developed the despicable habit of completely ignoring me. I'm not sure if this developed during Elli's recent hospitalization when they had multiple caregivers, if I've gotten lax in my enforcement of the "obey the first time or you suffer consequences" policy because of all the care Elli has required and because of my utter exhaustion of late, or if this is a phase they just so happen to both be going through simultaneously. Regardless of the origin, it has made life very difficult at our house lately. The remedy is grueling work to really only say something once and then follow through with action.

Adding to the complexity of all of the above, I've taken on toilet training Little Girl. The clock is ticking and I really really don't want to have three in diapers and one with dubious bowel control at one time.

(Before training a boy, I never would have understood why someone would invent disposable hand covers...)

Even though I know that the less-than-eight-weeks I have before the baby arrives is very short and she'll probably relapse when the baby finally arrives home, I want to get some good hard work in now so we can settle back into it when the dust settles.

So, for those of you who actually see me in person over the next several months, if I seem extraordinarily cranky, please don't take it personally. I've probably just cleaned up the 18th accident of the day and run out of both underwear for the kids and carpet cleaner for my new partner-in-crime, the Bissell Little Green Machine.

Hide and Seek

Elli is a tricky patient. For the last 2 weeks she has played a masterful game of hide-and-seek with us and her doctors as we tried to figure out what was going on with her.

The game officially started two Thursday mornings ago, while I was at work. (I personally believe that she's been playing for months -- spiking phantom fevers and coughing up stuff just often enough to keep us all guessing.)

Anyway, the nurse called to report that Elli had a fever and must go home. Scott picked her up, but she acted completely normal all afternoon, including consuming an entire McDonald's yogurt parfait. He theorized that she was pulling a Ferris Bueller -- faking a fever to get out of school and spend time with dad (he was home when she got on the bus, so she knew he was working from home that day). We suspected maybe she'd gotten overheated during recess (she's very sensitive to extreme temperatures), which made her look feverish.

The next morning, I noticed that she was warm when I got her out of bed, but that's fairly normal too. Her body temperature is like a pregnant woman's -- she's always hotter than anyone else in the house and frequently gets so hot she sweats in bed. I gave her some Tylenol just in case -- she seemed a bit out of sorts, but has loose teeth and all sorts of little things -- and sent her off to school.

They called as soon as she arrived, saying she was still feverish, and really shouldn't have come back since kids are supposed to be fever-free for 24 hours. (I sensed a quiet "tsk, tsk" in that comment, but we honestly didn't believe she had been feverish the day before!) They also told me that 5 other kids in her class were out with high fevers.

I was supposed to attend a "Mommy Party" held by Big Boy's preschool class that morning at 10:30am, so I began a mad scramble to find a sitter to watch the girls. I hated to miss the party -- Big Boy had been talking about it, practicing songs, and making surprises for weeks. At the very last second, I got ahold of a friend from church, who miraculously had the morning free and could drop everything to come over.

When Big Boy and I got back, Elli's fever measured 102. Now I knew we had a serious virus on our hands. I learned a trick at the hospital when she was a baby -- you can safely stagger Tylenol (acetaminophen) and Motrin (ibuprofen) 3 hours apart, so when one dose wears off, the other one is working at full strength. I've grown more hesitant to use this trick, so I usually alternate every 4 hours, but either way, it was safe to give her more medicine. So around lunch, I gave her Motrin and let her rest on the couch.

That afternoon I watched her progressively grow more and more lethargic. She never just lays anywhere -- she's always moving and rolling and can't be safely left anywhere she might fall. She also never naps. But that afternoon, she lay motionless, drifting in and out of sleep.

As the hours passed, her fever had actually worsened -- by 2pm it was up to 104. That's when I decided to call the doctor for advice. I said I didn't want to come in if I didn't have to -- just wanted him to know and to make sure I was doing everything I could for her at home. He told me I could go to every 3 hours, give her higher doses of the fever reducers, and bring her in if she had trouble breathing. About an hour later, she started grunting with each breath, so I called back and managed to snag the last appointment of the day.

Elli decided to play with the doctor. You know how a car can cause you all sorts of fits... until you bring it to the mechanic? Elli perked up, stopped grunting, and the fever disappeared (all probably due to the adjustment in meds) just in time for her appointment, so she appeared to be on the mend by the time we walked in.

However, that night "it" returned with new vigor. She awoke around 4am burning up with fever and grunting with each breath. All day Saturday she alternated between grunting and dozing.

Then she kicked the game up a level. That afternoon she threw up. That evening she had an hour-long episode of a new and unique-for-her crying that clearly indicated an internal pain unstopped by the alternating doses of tylenol and motrin. Which, incidentally, didn't relieve the fever either -- she remain over 100 degrees all day. She couldn't take a deep breath or lay on her back. We finally got her to calm down when we propped her over on her left side.

I tried to palpate her belly to see if any specific area hurt, but she was so tight and tense I really couldn't be sure. I thought her back might be more tender and began thinking either appendix or bladder/kidney infection. We discussed calling urgent care more than once. Ultimately, we decided to wait it out another day since our home oxygen monitor showed her levels to be normal.

Sunday the virus hid. We thought she'd finally turned the corner. She ate a decent lunch and was more alert that afternoon. Scott and I breathed a mutual sigh of relief as I was able to keep my plans to send her to school and go into work Monday afternoon.

Again at 4am (what's the deal with 4am???), she woke up with a 103.4 fever, along with grunting and shallow breathing and everything else we'd seen Saturday. Scott and I both agreed that five days of fever was enough. As soon as the doctor's office phones turned on, I hit the lines, looking for the earliest appointment I could get. It worked out well that Scott had already planned to stay home -- he kept Little Girl and took care of Big Boy's school routine while I took Elli in.

The doctors agreed that five days was too long. We began in earnest what would end up being days and days of seeking.

First step was a rapid-strep-test. Result? Negative.

Next step was Children's outpatient center for a chest x-ray, urinalysis and culture, CBC (complete blood count -- high white cell count shows the body is fighting an infection), and pulse oximeter reading (to get a good oxygen level).

Result? Pneumonia in the lower left lobe and an elevated white cell count. I got the news while on the way down to work. They decided to admit her (directly -- we got to bypass the ED) for a couple days of IV antibiotics.

We began a 2nd mad scramble. Scott worked to find someone to watch the younger kids until my mom could get there, packed overnight gear for me, and drove Elli down to the hospital. I called my mom, took care of my work responsibilities, signed all the papers in admitting since I have all the copies of insurance forms, and met them once we had a room all set. Scott said Elli looked awful the whole way down (times like these we hate that 45 minute drive to Children's).

We headed up for a long night on a general/community pediatrics floor. (More on this in another post.) She was still clearly in pain, vomited during the admission process, and refused to eat. The nurses started an i.v. and we tried to keep her hydrated and comfortable by giving her fluids and fever meds through the night. They started two oral antibiotics, saying the only good candidate for i.v. was one she'd had a significant reaction to as an infant.

In the morning, the attending physician explained the physical pain for me -- she not only has fluid in her lungs, but in the space between them and the ribs. He recommended a change of antibiotics to better address this part of her "complex pneumonia." It came in oral form so we could go home on it, and they talked about sending her home. I knew in my gut that she wasn't ready, but at the same time, I thought we had our questions answered. So I agreed to a discharge and we took her home that afternoon.

But the virus wasn't done yet. She had two more horrible, agonizing bouts of screaming, both shortly after we gave her the new stronger antibiotic. I called the pediatrician in the morning and begged him for a PICC line (peripherally-inserted central catheter) so we could give her i.v. antibiotics and bypass her stomach altogether. He managed to get her an appointment that afternoon, and we drove back down to Children's. He did warn us that we might have to stay overnight if they couldn't pull together the home care nursing required for all patients going home with a PICC line.

We've had trouble getting the PICC put in before, but that day she flew through the process. We did spend the night, but again made plans to head home the next day. Finally, about 5:30pm, we were packed and ready to go. Then a medical student came in and told us that her clotting time, a test we'd requested that morning, came back extremely high. They believed it was a false reading because it was drawn from her PICC, which contains heparin and would therefore lead to an abnormally-high reading. They asked if we wanted to wait for them to retest that day, or just come back for a lab the next day.

We decided to have it redrawn while we were there. I had a suspicion that it was high, based on our 7 years of experience with her. And I wanted to save us a trip the next day.

The second test came back almost as high as the first -- her blood was so thin that we could not safely take her home without risking internal bleeding and death. Before I left, she had another spell of screaming, and this time her oxygen level dropped significantly and her skin looked gray and mottled. We got the doctors in, and they ordered a chest x-ray.

I was exhausted, so I decided to leave Scott in charge that night and try to get some sleep at home. I had a good little cry on the way home that night. I was so disappointed that she wasn't in the van with both of us, and more than a little scared at how sick she was. I knew she was spending another night for a reason.

Before I got home, the x-ray came back. The report said, "entire left lung white, indicating either complete lung collapse or partial effusion."

An ultrasound showed the partial effusion -- she had a 2cm by 5cm pocket of fluid around her left lung, which was restricting its ability to inflate and causing Elli the pain we had been seeing. It also explained why she was more comfortable laying on her left side -- it elevated her right lung and maximized its capacity to inflate.

The doctors finally understood the necessity of constant pain management for her. They wrote for around-the-clock Tylenol (no more Motrin with her blood so thin), a dose of vitamin K to bring the clotting time back down, and 4-times-a-day i.v. antibiotics.

But Elli wasn't quite done yet. She got worse before she got better. Her oxygen levels dropped Friday evening in yet another painful episode (which really scared me) and stayed low even after she settled down, so they did more blood work. This showed a worsening anemia, or lack of red blood cells. These cells carry oxygen to all parts of the body. They ordered a red-cell transfusion Saturday afternoon, which worked an overnight transformation on her.

Sunday morning she woke up perky, smiley, and happy for the first time in more than a week. We got discharged Monday afternoon, and she's made slow-but-steady progress ever since. Today she returned to school for the first time in 2 weeks!

She has lost weight and become quite stiff over the past two weeks. She can hardly bear to sit up straight, let alone bend to her right. She still has some big coughing fits where she struggles to get a breath, and isn't quite eating enough. But she's finally really on the mend.

And we're praying that this game of hide-and-seek is done for now.

At the Hospital

I've been absent from the blog this week because Elli was admitted to the hospital on Monday for pneumonia. We went home Tuesday, but got readmitted Wednesday when she failed oral antibiotics (horrible stomach pain after each dose).

We were supposed to go home tonight, but through a series of fortunate delays and providential events, we are still there. Turns out that Elli has a pocket of some as-yet-unidentified fluid (could be pus, blood, or something else) in her left lung. It's like an abscess -- it is self-contained and therefore impervious to antibiotics.

She also has a clotting time that is sky-high -- too high to send us home, let alone doing any sort of drainage procedure tonight. They have to drain it, but we won't know when until tomorrow.

I'm SO glad they finally figured out what is wrong. She's been very clearly in a tremendous pain, but for days we haven't been able to find the source. We have an answer at last.

We think. We're learning that the story and her situation changes constantly.

Happy Mother's Day

Today Big Boy 's school hosted a Mommy Party, and despite having to pick up Elli from school with a sky-high fever just before the party started, I managed to still make it thanks to a very accommodating friend. She stayed at my house with both girls, so I could have a mother/son date with Big Boy .

He has been looking forward to this for weeks. All this week he's been reminding me that they are supposed to wear Sunday clothes. So I put on a khaki skirt and a black sleeveless shirt this morning. As we were getting Little Girl dressed, he looked at my clothes and said, "Mom. You're supposed to wear a really nice dress." When I assured him this was something I'd wear to church and that I don't have much that fits over my tummy these days, he repeated himself, "Mom, you need to wear a fancy dress."

So my son sent me back to my room to change into more suitable attire for our date.


Each of the kids made their mom one of these beautiful hats. Most of us wore them for the tea, though mine didn't sit down on my head very far. We had a very floral, English garden color scheme!

One of the other things Big Boy made as a gift was a paper called "Joy ____ -- My Great Mom." He provided all the answers to a series of questions about me.

My Mommy is 58 years old.
Her hair is brown and her eyes are green.
My mommy's favorite color is black.
My mommy's favorite thing to wear is church clothes.
My mommy loves to cook spaghetti.
My mommy hates to clean my room.
My mommy's favorite TV show is the news.
My mommy's favorite food is sandwiches.
My mommy's job is to clean my house.
My daddy calls my mommy "Joy."
My mommy always tells me "you can play outside."
Something that makes my mommy happy is when I give her a hug and a kiss.
When my mommy goes shopping, she loves to buy bread.
If my mommy could go on a trip, she would go to the beach and she would take a boat.
I really love it when mommy tucks me into bed.
She's the best! I love you mommy!

He actually got quite a few right... though a number are hilariously inaccurate. This house is "his" house? And my job is to clean his house? I think his future wife might have something to say about that (or maybe she'll think that's a fine arrangement... who knows?).

Anyway, Happy Mother's Day to all you mothers out there.

Especially to mine. I'm thankful that you endured all the trials, filth, disrespect, and failure to appreciate you. Every day I'm a mom I grasp a little more what you did for us. I love you and I'm so glad we live closer now!

Three Cheers for Summer Knitting

I've been itching to start something new, something for the baby, something that would be a tangible demonstration of optimism about his condition. I got a gift certificate to my favorite yarn store for my birthday this year.

I took a quilting class with part of it (and finished Sam's birthday quilt - his birthday was in September and mine in February). I used more of it to buy some really summery, boyish mercerized cotton yarn that I just love. It has been calling to me from my knitting bag for weeks now.

I have forced myself to ignore those calls. Instead, I made myself finish the Christmas stocking I have been making for my niece Millie.

(Yes, this 5-6 months late thing is becoming a pattern. Let's not even mention the baby gift I still haven't finished because I totally screwed up the armpits for a sweet little girl who is 7 months old this month.)

I finally finished the knitting last week. It was May.

I still need to do some light blocking to keep the edge from rolling up. I also need to add the essential bell to the toe -- all Christmas stockings in my family have to have at least one jingle bell.

(Any bets as to how long it will take me to actually get this to a mailable state?)

The second, and I do mean the second, that I finished weaving in my yarn ends on the stocking, I began my swatch. (Brooke, aren't you impressed? That's an actual swatch! I'm determined to make this fit.)

Friday, I cast on for my baby all-in-one for Luke, the little boy we're expecting mid-July this year. I've been knitting every chance I get, so my progress is stunning... for me.

(This is just a few days of dedicated knitting. I can't hardly believe it. But stockinette does move quickly, even when striping.)

I actually considered saving this to work on in the hospital (we're expecting at least a 1-week stay in the cardiac care unit after he's born -- longer if he needs surgery right away), but the folly of that thinking quickly smacked me across the mouth. He might outgrow it before I completed it if I waited that long! Wisdom dictated that I cast on months in advance so that he will have a chance of still fitting it when I actually finish.

I love the way the colors are working together. I love the blues and greens after working with Christmas red. I love the feel of mercerized cotton and the smooth textured fabric this is creating. Variety is a beautiful thing!

As I Was Saying...

LittleGirl sent us racing for the Poison Control number this morning.

I got up early this morning, very sleepy after a long grueling week. We had dinner with my in-laws last night, so we had been out late the night before and my bag was full of evening-out-with-the-kids type stuff. Being home with a sick child most of the week while Scott was putting in 14-hour days has rendered us both exhausted. In my half-asleep stupor, I emptied the bag on a table in the dining room and started loading it with the files I needed for a morning at the office.

Scott pulled in from his Friday men's breakfast, I headed out, and all seemed well. I'd gotten Elli dressed and packed for school, Sam was getting dressed, and all instructions were clear.

Then, about 9:05am, Scott called. I knew that wasn't a good sign -- he was supposed to be loading kids in the van to drop Sam off at preschool at that moment.

He said, "I just found Little Girl chowing down on melatonin tablets. She got them off the dining room table. She's got quite a few dissolved and stuck to her face. Any idea how bad that is for her?"

My heart sunk. This was my fault. Melatonin was one of the items I removed from my bag and plopped on the middle of that table in the dining room this morning. It's a hormone that occurs naturally in our bodies and is connected at least partly with our sleep cycle. Elli takes a synthetic supplement to help her sleep while she weans off a seizure medication that has wreaked havoc on her sleep cycle for the past 3 years. It's working well for her, much to our relief (a child with a disrupted sleep cycle = a parent with a disrupted sleep cycle... if not an entire family!).

My coworkers pulled up the Poison Control number (I should have it memorized by now since this is the fifth time we've had to call -- it's 1-800-222-1222) and I gave it to Scott so he could call. Again. They're getting quite a file on us!

He told me later that Big Boy insisted Little Girl had only eaten one tablet. They guessed that at the most she had ingested 5 tablets (or 5 milligrams), which wasn't enough to cause anything more than sleepiness. They told us to call a doctor if she got too sleepy to rouse easily.

She was extra cranky all morning, and took an early nap. This could also be from the late night and exciting evening at an indoor playground last night.

So she is right as rain... til the next time. This girl cuts us NO slack.

Death Wish?

Anna has to be one of the most into-everything kids I know. She's super-cute and super-smart, which I am beginning to believe is a deadly combination. You just don't expect such an innocent face to be capable of the things she does!

I think she took her life into her hands three separate times yesterday -- that I know of. She tried to stick her fingers into a power outlet once, tried to insert a plug adapter (one of those polarized-to-unpolarized thingies) into another, and managed to remove the "child-proof" cap from a bottle of children's Motrin.

We discussed all the options for child-proofing the power outlets today and concluded that she'll probably figure them all out in about 2 days. Not that we aren't going to go more heavy-duty on this... it just somehow seems futile in light of her track record.

I haven't even counted the incidents of near-bodily injury, including the frequent spills and subsequent wipe-outs on the kitchen floor (because the water dispenser on the refrigerator is a toy, not a source of drink), jabs from pointy knitting needles or super-sharp scissors or fabric pins (why can't she leave stuff that isn't hers alone? she has a bazillion toys, yet she continues to get into MY toys!), and falls off the deck because she's climbing up onto the railing.

Yet the girl is afraid to slide down the slide. I'll grant that it moves you along pretty fast. But come on!

I don't know if we're going to make it through this phase. I am certain of one thing: if we do, it won't be without at least one more traumatic injury (remember the stitches last summer (scroll down for that story)?) and multiple trips to urgent care.

I think I can smell the fiberglass cast now.

Curve Ball

Today was supposed to be a crazy day -- swimming lessons for the two youngest, followed by two appointments for Elli in the afternoon, followed by company over dinner. And Scott at work functions til at least 9pm.

Yesterday, my mother's instinct started sending out low-level alerts. Something was wrong with Elli. She refused food and drink, coughed a lot, and lacked her usual spark. She had also spent most of the day Sunday emptying her bowels.

In fact, quite a few things seemed to be off with her, and had been for a few weeks now. I finally decided to take her to the doctor.

He diagnosed a sinus infection, and suggested that her new, super-high-calorie formula might be to blame for the two bouts of diarrhea in the last week. I went ahead and dropped her off at school, after picking up an antibiotic.

Last night, she ate enough bites to get her medicine down. I gave her a 50/50 mix of water and formula and we put her to bed.

This morning, I walk into her to room to find both diarrhea and vomit. After giving her a thorough bathing, stripping the bed, cleaning up the pajamas, and tossing everything in the washer, I proceeded to cancel everything for today.

The one thing I hated to skip was swimming lessons. The kids both knew we were supposed to go, and today was the last day of the session. But as the morning progressed, I could tell that Elli was truly miserable and that a swimming pool was the last place she'd want to hang out, even for a short, 30-minute lesson. So we stayed home.

So instead of running hither and yon, wearing all of us out, we spent a quiet day at home and I've gotten a lot of bill-paying, paper-shredding, and paper-sorting done, in between caring for Elli, moderating Sam and Anna's constant bickering, and catching Anna getting into trouble or making major messes.

And of course, the constant prayer that no-one else starts vomiting until Scott gets home tonight. Especially me.