Sunday 27 August 2017

Day 293

We thought we would start off this blog with sharing a few photos that the very talented Kelly Linde Photography took for us while Malachi was still in the NICU (about a week before his move to the PICU). We are so grateful to her for generously offering to take these photos for us. We will treasure the beautiful video and the photos, as we can look back and remember the everyday experiences of the NICU life. 






Since our last blog update, we have been very busy with preparing for going home. Between completing our training, ordering equipment, preparing our house, buying the necessary non-medical items we need for Malachi, booking lots of tests and follow up appointments, speaking to lots of different health care professionals, contacting and setting up new outpatient services, and practicing our skills on Malachi (extra trach tube changes, using the rescusitator bag daily, practicing getting him ready for a walk, hooking him up to our own home equipment, etc.)... each day ends up being quite packed with activities. We now have a tentative home date of Thursday September 28th! This date is a moving target, especially since we need to have trained home nurses lined up before we are allowed to go home. We are discovering that this could be difficult to line up in time but we are staying hopeful! We qualify for the maximum amount of covered nursing, which is 5 shifts of 8 hours a week. We are hoping and praying to have these 5 shifts at night, so that we will "only" have to stay up 2 nights a week. 
A trained person has to be awake and watching Malachi 24/7. This is largely why the hospital will not allow us to go home without nursing lined up. We would burnout in a matter of days, since Nathan works full time. This is also why we are currently in the process of hiring a nanny. We need to have 2 adults in the house at all times because one person needs to be watching Malachi and the other two triplets still require a lot of the normal baby attention and care. 
It's overwhelming to think about juggling it all. Sure, there will be times when all 3 babies are sleeping and calm. But there will also be those times where one baby is hungry, the other has a poop explosion and needs a bath, while the other is pulling on his tubing and needs to be distracted with a different toy. (We can't even imagine what it will be like when they start crawling! We will need to be following Malachi constantly with all his machines to make sure he stays connected! Not to mention how Liam and Taylor already try grab at Malachi's tubes and cords and put them in their mouths...) 
It gives us such deep and overflowing joy to think of all 5 of us under the same roof. We can't WAIT to be together and not need to be constantly missing either Malachi or Liam and Taylor or each other. We can't WAIT to relax together instead of always bouncing back and forth between the hospital. We can't WAIT to be alone in our own home and around our own table and in our own bed... (goosebumps just writing about it!) The joy and anticipation is extreme. But just as extreme is the fear and nervousness over taking Malachi home. We are quite confident in his everyday care and even trach changes are getting less scary. But ultimately it's the intense fear of an emergency situation. We are "trained" many different types of emergency scenarios but we have never had to take control in a real emergency. Will we panic and forget everything? Will we be able to remember what to do and when? Will we react quickly enough? Will the ambulance arrive on time? As going home becomes less of a concept and more of a reality, the weight of responsibility feels heavier and heavier. We know Malachi's life is in God's hands ultimately, but we know that his life is medically fragile and dependent on medical equipment and machines. It's our responsibility to ALWAYS be on guard and paying attention. It will be mentally exhausting and draining. 
But he is 1000% worth it all (and that extra zero is not a mistake). 

So on to the updates on each triplet...

Liam: 
Our little man continues to show quite the personality more each day. When he's happy, he lets everyone know it by shrieking loudly and laughing out loud. When he's upset, he lets everyone know it too by complaining and sometimes having very loud meltdowns. He concentrates quite intensely on toys and smiles very easily. He is so fun to play with! This past week he started solids and caught on pretty quickly to it. He's also close to sitting by himself. We haven't had appointments lately with Liam and Taylor because we are trying to book them in with Malachi's appointments shortly after discharge. 



Taylor:
Our sweet princess is still our smiley and happy girl. She smiles with her whole body like she just can't contain her joy! She still loves to whisper but is starting to coo out loud a bit more. She's very quiet and rarely cries. Like Liam she is close to sitting and has also started solids. She's not a fan at all of rice cereal, and we have some great footage of that! 




Malachi:
Our youngest sweetheart has become more and more smiley in the last few weeks. He has huge smiles for us when we come in to his room and it melts our hearts the way he recognizes us. It makes it harder to leave (if that's possible!) now that he knows us. 
He has been very stable and has even come down on some ventilator settings recently again. We are SO thankful! His settings are considered safe for home, but we are still hoping to keep getting them lower before discharge. Once we go home, the "weaning" process will take a lot longer because he does not have 24/7 medical supervision. So every step forward is an extra bonus before home! 
We feel badly about all the practicing we have to do on our sweet boy between all the trach changes and using the rescusitator bag and switching him onto different equipment and circuits... but we know it's for his overall safety in coming home.
A few weeks ago Malachi failed his left ear hearing test for the second time so we will be following up with that. We are also following up on his kidney stones and gallstones before discharge. Eye follow ups will be after discharge. ENT will put a scope down his trach before discharge to check his trachea and top of his lungs. His heart has been monitored already with an echocardiogram this past week that looked improved. We are setting up an occupational therapist, speech therapist, and dietician for home. Half his equipment has been ordered for us to practice on but more will be coming in the next weeks. What else..? We are probably missing things but you get the picture. Lots to do and plan.



When the triplets were first born, the hospital life consumed us and rightly so. All of our energy and attention was dedicated to our triplets and their health. It was so overwhelming and mentally enormous that it was all we could handle (and even then, we couldn't handle it and broke down repeatedly). We could not even listen to the news or hear someone tell us about their average day. It was too much to handle. It was like our brains were "full". We let in some close family but we could not handle visitors or phone calls. Maybe it could be called "survival mode". When something so traumatic and life changing happens, it's all you can handle. 
But over time we have noticed that it has improved. Nathan was forced to overcome it quicker than Jodi because he had to go back to work. That was a hard transition that took multiple attempts before he was back to full time. For Jodi, the hospital life continued full time and still does, and so it is taking longer to be able to handle the normalcy of everyday life outside of the hospital and the triplets. Even things like small talk or hearing the news (there's a world outside the hospital!) or going to church are difficult to do mentally and emotionally, but we are slowly improving. 
It's a hard thing to explain, but talking to others we have found that others have experienced this too. When the church community and family and friends reached out to us, we felt encouraged and uplifted by all the texts and emails and cards, etc. But we also felt badly that we said "no" to so many visitors and did not answer many of the emails and texts and cards. We know that some of you have faithfully prayed for our family and still haven't met the triplets. (Part of that is for germ reasons, too, since we are very careful with having visitors over). So here's our attempt at an explanation as to why we were so closed off. And once again, a heartfelt thank you for all the prayers and the reaching out to us even when it wasn't reciprocated. It was SO appreciated and still is! 
God has truly blessed us with a loving support network that is even bigger than we could have imagined. We couldn't have done without. And it is our prayer too that this experience will be a blessing to us in the future so that we may know better how to support those who are going through a mentally overwhelming and life changing time. 

Wednesday 9 August 2017

Nanny Job Posting and 9 Month Update

In the past few weeks, Malachi’s discharge planning has begun. Community resources have been notified, medical supply companies have been contacted, and a schedule is being developed in order to get all things ready for Malachi’s transition home. The estimated timeline is 6-8 weeks from now! While this is exciting it also puts a lot of pressure on us to get the house finished, ensure all community resources are in place, mentally prepare, and find a live-in nanny. The healthcare teams (both in the PICU and the team who will be looking after us when we go home) strongly recommend that we ensure 2 people are home at all times with the triplets. This way one trained person can be solely dedicated to Malachi. We are looking for someone to help us with Liam and Taylor (the two healthy triplets). If you are reading this and know of someone who is looking for this type of position or would be a good fit – please pass it on! The job posting is as follows:

Job Posting for Live-In Nanny:
Requirements:
-          Estimated starting date: end of September 2017
-          Services required for at least 6 months (an extension is likely and can be discussed)
-          Loving, caring, dedicated, and child friendly
-          Hours: Monday to Friday from 7:00am to 6pm
-          Some after hour care may be required in extenuating circumstances
-          Assist in caring for two happy and healthy triplets (Liam & Taylor) - not Malachi
-          Assist with daily housework requirements including laundry, cleaning, shopping, etc.
-          Very germ conscious - especially in the winter season (this may unfortunately restrict some of the nanny’s social activities if sick people will be attending the same activity)
Compensation:
-          Pay to be discussed
-          Free food
-          Housing accommodations
o   Private bedroom
o   Private bathroom
o   Space to have your own time
We recognize that this will be a relationship that will need feedback both ways. We want to welcome you into our home but we also want to respect your need for space and your own time. If you are interested or have questions please email us at: nathan.vanwoudenberg@gmail.com


As parents we are filled with so many different emotions surrounding the discharge planning. We are overjoyed, terrified, impatient, excited, nervous, and filled with a great weight of responsibility. Will we be able to take care of Malachi at home? Will we burnout? Will we be able to react appropriately in an emergency? Will we have a sense of normalcy finally?
In the coming weeks we need to pass a simulation test. After this test we will be allowed to take Malachi for walks around the hospital without needing a nurse or respiratory therapist with us! We can’t wait but it is also daunting. Then Malachi will need to pass the carseat test so that we can start going for car rides with respiratory therapists and healthcare team members to “practice” different emergencies that can happen while driving. We will then need to sleep overnight in the hospital for a few nights without having any help from nurses or healthcare members. In addition to these steps, we need to have all the community resources, insurance, medical equipment, nanny, medical supplies, and nursing lined up before we are allowed to go home. So there is a lot to do and figure out.
Malachi is doing very well. He has been on the same settings for a few weeks and the plan is to not “rock the boat” or challenge him onto lower settings too much before going home. He is getting stronger every day. He loves to be held in a sitting position and he loves to go in his stroller. When the PICU isn’t too busy the nurses and respiratory therapists put him in his stroller and let him hang out with them in the nurse’s station (while his parents can’t be in the PICU). He has lots of smiles for everyone and lots of energy.

First time holding Malachi this way!


We also recently learned how to hold Malachi upright against our chests. Not a big deal to hold a baby against your body? Actually, it takes a lot of practice and some work to ensure that the trach, tubing, and cords are all comfortable and safe! It was an amazing feeling to finally scoop Malachi up and hold him upright on our chests! He loved this position before his trach surgery while he was still on the CPAP mask. These little moments highlight to us over and over that we cannot take each little moment with our babies for granted. The “normal” baby developments and interactions are not always “normal” and they are each precious gifts from God.
Being in the PICU each day also reminds us that good health cannot be taken for granted. Every day we are reminded of sickness and pain and suffering. We constantly hear children crying, see critically ill children with IV lines, casts, breathing support, sedation, etc., hear codes being called on to the hospital intercom, see healthcare teams rush to an emergency or critical situation… We walk into and out of the PICU and see the wheelchairs and hospital beds wheeling down the hallways. We walk into and out of the hospital and see the ambulances and hear their sirens every night. It breaks our hearts again and again. It makes us hug our babies a little longer and a little harder. And it makes us long for the day when God will wipe away every tear and alleviate all suffering.

Tummy time is also quite the process

Loving tummy time and looking at himself in the mirror


Liam and Taylor were baptized on Sunday August 6 with the service led by their Grandpa VanWoudenberg. The Bible text for the sermon was Psalm 139. It was a beautiful (and tiring) afternoon. What a rich blessing to hear God’s promises to our three babies that they are his children!

We will end this blog post with the words from this hymn:

If you but let the Father guide you, relying on His faithfulness,
He will be evermore beside you in all your sorrow and distress.
He who on God Most High depends builds not his house on shifting sands.

Will anxious care or bitter sighing at any time give true relief?
And what avails us our decrying each morning’s evil, trouble, grief?
We only add to grief and stress by discontent and bitterness.

Be still! What God in His good pleasure to you in wisdom may impart
Is given you in perfect measure; thus be content within your heart.
To Him who chose us for His own our needs and wants are surely known.


That last verse speaks about God’s perfect wisdom. It was His plan to bless us with triplets at 25 weeks gestation. All their health complications were in His plan. That Malachi needs to come home on life support is part of His perfect plan too. Sometimes (often, if we are honest) we feel like we can’t handle it. We feel like it is too much for us and we are going to just break under it all. But what a comfort that it is all in God’s plan for us. He is with us, loving us, and caring for us… shaping us, teaching us, growing us.