Peaks and valleys

Life is full of peaks and valleys.

I let the kids sleep in this morning while I got the van loaded. I showered and put on a nice shirt and jeans and had a mocha. We ate pancakes and then rolled out of town at a leisurely pace.

I kept my phone turned on and clipped to the visor just above my head, but the gorge is full of dead zones. Some are long and expected, like the winding drive along the Columbia between Touchet and Umatilla. Some are shorter and you might never know, unless you missed a call at 11:34 that buzzed in as a voice mail several minutes later. I pulled over at Boardman and bought the kids milkshakes while I checked my phone.

1 missed call. 1 voice mail. JoAnn.

I don't remember all the words, they spilled out like marbles from a bag, but I remember the tone. JoAnn rarely chokes up. She's the most rock solid person I know. She's grounded, spiritual, trusting and confident. So when her voice cracked as she said "They're taking Nanette in for surgery..." my heart hit the front of my chest.

A tiny bit of Nanette's colon got stuck to her diaphragm. Maybe it caught in a stitch, or maybe it got pinched in between the two edges. Thoroscopic surgery is far less invasive than the traditional lateral cut along the lower edge of the diaphram, but it does leave the underside of the repair hidden from the surgeon's view. Over the past week, as Nanette grew stronger, weaning herself off her respirator and even pulling out her pic line, the tiny piece of colon pinched in the suture withered and died. A tiny hole appeared, not just in the colon, but in the diaphragm as well. Tiny, but enough.

As Nanette ate, her intestines filled with food and the friendly flora that helps us digest. This is part of the natural process of becoming a human being. But those bacteria that nestle quietly in the bowels are unwelcome in the rest of the body. As the hole opened between her bowels and her chest, fecal matter spilled into the space just below her left lung.

Thursday night, Nanette tossed and turned. JoAnn sat up with her, watching her through several small fevers. The morning shift came in and nurse Mary noticed a bit of greenish ooze from one of the surgical penetration points. She turned Nanette and found a pool of yellow fluid on the sheets and a lump on Nanette's back. Dr. Valerie Newman, the neonatologist on duty, prodded the lump with her finger and fecal matter and infection gushed out. Everything happened fast after that, and I got the frantic voice mail from JoAnn.

By the time I pulled onto Graham drive, surgery was done but Nanette was not yet back in the NICU. I parked at the Ronald McDonald House and towed the kids up the walk. In just a week, the azaleas had burst into fiery plumes of fuscia, and the trees glimmered light green against the taupe brick walls of Emanuel. Carter tugged at my arm, eager to see his mom, Katie's flip-flops slapped on the pavement. My shirt stuck to my back.

We met Josie and Gordon and JoAnn in the waiting room, and Gramma and Grampa Cooke joined us a few minutes later. The kids hugged momma and we took them potty and Carter jumped around till Gramma Cooke took him upstairs to the playroom on 3. Chaos mixed with waiting.

Dr. Sanjay Krishnaswami found us at about 3:30. He very patiently explained (at least twice) what had happened and how he had fixed it. They'd gone back in through the original thoroscopic entry points and had cleaned out the infection by scraping and flushing with saline. In order to keep the area drained, they'd installed two chest tubes. Nanette just got rid of her painful chest tube a few days ago, now she has two more. That first one was to evacuate excess air from her chest cavity. These two suck out any fluids and infection.

Dr. Jay made a small incision in Nanette's belly and separated the colon from the diaphragm. He pulled the injured loop of colon out of her body so he could work on it. The edges of the hole in the colon were ragged and dead, so that piece had to be cut away. He sewed the two fresh ends back together. I can't imagine how painstaking it must be to sew on something that can't be any larger than a piece of macaroni.

He also had to go back in and repair the hole in the diaphragm, and he mentioned that while he was working on the underside, he made a few additional stitches to shore up the original repair.

This all puts us clear back to last Friday, with Nanette back on a respirator (tube down her throat,) a catheter and foley bag to monitor urine output, tons of morphine to control pain and thrashing around, an IV in her neck, an NG tube to keep her stomach pumped, and chest tubes. Plus, now she has this infection and three different kinds of antibiotics, plus a bag of lactated ringers (it's not ringers lactate, like you hear in the movies, and by the way, no one ever says "stat.)

Also, Nanette is now getting an infusion of 68ccs of A negative (about the size of a kid's juice bag, but full of red blood.) It's almost funny to see all the stuff they're pouring into her. Almost.

There's no way that JoAnn and Nanette will be home for Mother's Day. We'll miss the balloon stampede and the flapjack breakfast. Carter likes the way the flames shoot out of the propane burners. Katie likes the colors and the way the balloons float up like giant bubbles.

Katie nestled into my lap after dinner. She's sharp enough to understand that Nanette is getting all the attention. It's bad enough to have a new baby - you know the kids are going to feel slighted. But now everything is about Nanette. And it's not just us. It's Gramma Josie and papa and Gramma and Grampa Cooke. Everything revolves around Nanette. I can tell Katie that she's important, but like I say, she's sharp. Actions speak louder than words. I don't know how to help her understand why mom doesn't come home. I don't know how to help her understand why I'm going to spend the night watching Nanette. There's no easy way to be a mom or a dad. But I know this; I have more love in my heart for these four people than ever, and it's doesn't divide evenly or parcel out or allocate - it's more like the parachutes that blow off a dandelion stem. It billows out, it makes more, it fills the spaces and nooks and crannies and increases and increases. Nanette makes me love Katie and Carter more. Parents know this. Love is not a word that goes with "or." Love is a word that goes with "and."

I forgot to tell JoAnn that Kelly Walsh died last night. I don't know why it struck me so hard, except that the day before, he swung his big Sweet Onion Sausage truck around in front of me and I waved at him and he smiled at me. The next day, he smiled at me from the front page of the UB, dead from a heart attack.

Peaks and valleys.

p.s. Our little friend Silus has a blood infection and an infection in his lungs. Joshua isn't eating enough, so he's going to have to go home with a tube into his stomach and an IV in his neck. Baby Audrey just arrived last Saturday from Labor & Delivery with a serious heart condition and her lungs are failing, so she'll be going in for major surgery tomorrow morning at 7AM. If you pray, and if you get a moment, please send a little whisper for these children too.

May God be with you in all things,

j