Once the initial excitement wore off, time to settle down and be a dad

So many tubes

Kat and I continued to schlep back and forth to the hospital, spending a few hours each day with Paddy whilst he slowly recovered from his surgery and pneumonia. In an attempt to get him as fit as possible before removal of the OG tube, the surgeon delayed his first feed of milk for a few days until he was able to confirm by x-ray fluoroscopy that Paddy’s oesophagus was “patent” i.e. fully repaired with no leaks. This test was carried out on Thursday afternoon which was a great relief to all of us, and meant that Paddy could try feeding later that evening. Since he still had O₂ support via nasal cannula, a central line inserted and a pulse oximeter and BP cuff, Kat wasn’t able to breastfeed him, we had to express the milk, store it in the freezer at home and bring it into the NICU. They would feed him by using a syringe or later by cupping. At first he was only allowed 5ml at a time (every 3 hours) which was obviously not enough for him, it was sadly funny to watch his delight at getting some milk and then his frustration at not being given very much. Once he was able to tolerate 5ml for 3 consecutive feedings, the neonatologist allowed the quantity to be increased, from 10ml to 15 then 30ml and after that he was allowed to feed until he was full, in her words, “like a pig!”

This is all from Kat!

Earlier in the week, I had taken the opportunity to visit the Bureau of Immigration to get my new visa. I was anticipating the familiar run around and having hired a driver to make life a bit easier, we arrived quite early. As I mentioned in an earlier post, because the annual report for alien foreigners is still ongoing, the BoI was open before 8am, I went in and started the process at window 1, and was asked to wait for 30 minutes whilst they checked my passport. I had only just started to read the newspaper when I was called back, my passport returned and I was directed to window 2. Here I was asked to leave my passport to get the visa stamp and to return and collect it from window 3 in 2 hours. I took the opportunity to pop out and get a coffee and a Danish from Starbucks and some cash from a nearby ATM. I returned to the waiting area around 8:35, and as before picked up the newspaper, only to be called to window 3 to get my passport back and then to go to window 4 to collect my ACR-I card (Alien registration card). All this was accomplished before 9am, a little over an hour after we had arrived. All I had to do now was locate the driver and head back to the hospital.

OG and Intubation tubes out

As we moved into the third week of his life we began to hope he would be allowed home soon, tubes and support were being removed, the first of these was the nasal cannula, which was replaced by the O₂ being delivered to a small funnel. This now allowed us to try breastfeeding for the first time, which was not quite a successful as we had hoped; although Kat had plenty of milk, Paddy had become accustomed to it being poured into his mouth and was therefore unfamiliar with the whole sucking concept, this was further complicated by his having a tongue tie. Still we persevered and after having his tongue tie cut, by the Thursday he was getting the hang of it and taking as much as he wanted, although it did take a while longer than with a cup. Dra. Colasito had by this time indicated that Paddy should be discharged at the weekend. In actual fact this was brought forward, despite a slight hiccup with the surgeon (who was out of the country and wanted to see Paddy on his return before discharge, but we prevailed on him to allow a follow up the next week.) to the Friday. Paddy had by now spent 19 days in hospital after his birth and we were more than happy to be taking him home.

Yahh!!

Time to breastfeed

Discharge, however, also brought about the dreaded need to pay the bill. I had been keeping an eye on the ever increasing amount this was costing and had been making payments on my debit card to try and keep up with the amount, since my card is only permitted to pay out P70,000 at any one time, I had to make several such deposits over the two weeks, but I was now in the happy place of believing that I was ahead of the game and any additional over the past 24 hours was going to be well under the magic 70k; how wrong I was. I had forgotten that so far the bill was comprised of only the consumables and equipment usage, no doctors’ professional fees (PF) had so far been included, however, how bad could it be, after all Asian Hospital has a policy that PF is heavilly discounted for fellow doctors and their family, yeah, that’s fine in as far as it goes, but if the PF is normally a lot, even the discounted amount can be a shock. Not to put too fine a point on it, the total bill and even with the PhilHealth Insurance contribution (of P37,000 of it hah hah!) was into 7 figures. Having said that, like I mentioned previously, Asian Hospital and Medical Centre is probably one of the top two or three places in the country and definitely Luzon island that you could get the level of care Paddy needed. The fact that the 4 hour surgery had been carried out on a two day old baby and without the need for a blood transfusion was on its own worth a small fortune and the costs for similar care anywhere else in the world would have been considerably higher. It is, however times like this when you miss things like the NHS back in the UK, although had he been born there, would the doctors at the local maternity unit have diagnosed the EA and TEF so quickly and would he have needed to be transferred to Great Ormond Street Hospital for treatment and go on a waiting list, all of these questions bounced around my mind as I hoped my UK credit card would cover the remainder of the bill and they would allow us to go home. Fortunately, HSBC didn’t quibble, even when it took me 3 attempts to get the correct PIN, Doh!!

Bill paid, receipts in hand we were helped to get Paddy to the car by one of his nurses, I am not sure they are ever totally happy to see one of their patients go home, as they must, despite all their efforts, form an attachment, especially with those that are in their care for a while, we will certainly miss their care and attention.

First meeting with the family

Now came the really hard part, we had been parents for the past 19 days, but hadn’t been very hands on, in fact, we had been by necessity fairly hands off. This time we were on our own with a very delicate and small little boy in our care with peculiar demands and only one method of communication that was sure to gain our attention, crying and yes, he can cry quite loudly. We hadn’t even told Kat’s parents at this stage that he was coming home, as we wanted to actually get him there before we made the announcement, which we did shortly before posting a picture of him on FaceBook in the car seat on the couch in our living room just after we arrived. This photo has already got 300 likes and many comments from around the world. The next few hours were spent, like I am sure many more days and months shall, listening to every noise he made, and those he didn’t worrying whether he was OK or not, we jumped up to check on him several times to find him happily sleeping without a care in the world, or on occasion grizzling about a dirty diaper or needing feeding (which he seemed to want hourly or so), I guess this is the way it’s going to be for a long time…….

An unexpected turn of events

We spent the second week of February doing some things we shan't be able to do so easily once Paddy is born, we spent a week getting in a visit to a newly opened resort complex in Manila (City of Dreams) where we stayed in the Hyatt Hotel. Kat was also able to attend a pharma company sponsored event taking in lunch followed by a tour of Intramuros with Carlos Celdran (an infamous yet popular comedian/social commentator and tour guide). We followed this by attending the Philippine Infectious Diseases convention in Ortigas, which included a drive across Manila on a Tuesday morning and making me watch "50 Shades of Grey" since we had a spare afternoon before the convention.

After Kat has attended the convention we headed home via Asian Hospital where we had a scheduled Bio-Physical Scan for Paddy, this took a bit longer than anticipated as Paddy wasn't too keen on moving about as much as he should, but after a little while he moved enough to keep Dra Niza happy. She did however ask us to return for a follow up scan and consult on the Monday, as we started the 37th week.

This is pretty much when it all went wrong, or at least all of our expectations were upended and we had to respond accordingly. On the Sunday morning, Kat told me that Paddy didn't seem to be moving quite as much as previously, but we chose to wait until after lunch before we got worried since this would allow her to have something to eat and raise her blood sugar. As the afternoon wore on it was clear that Kat wasn't happy with his lack of movement, I suggested that we might want to go to Asian Hospital ER to have him checked out, she agreed.

Upon arrival at the ER, Kat was triaged and we were moved up to the Genesis Centre, which is the birthing / neonatal facility for observation. She was hooked up to a Non-Stress Test machine and the on duty OB took a look at the trace, seeing quite quickly that there was a lack of movement in the baby and his heart rate was OK but also not changing when he did move (getting faster or slower). She called Dra Niza who requested admission for further observation and to be kept informed about the ongoing monitoring. Even before we had a room organised, the trace indicated that Paddy may be in difficulty and Dra Niza decided that we need to prepare for an emergency cesarean section later that evening. This all passed Kat and I in something of a daze since it moved so quickly, I had to double check that they were planning the CS that night.

Waiting for the CS, I hadn't
shaved for a few days

It took a while, seemed forever, but was only around 3 hours before Dra Niza arrived and Kat was wheeled into the delivery room; I was given some scrubs, booties and a hair net (yeah yeah, laugh all you want) and asked to wait until they were ready for me. I was called in, no video but I could take photos and don't touch the blue draped areas. Kat was awake, having had a spinal anaesthetic, her head poking out of a sheet separating us from the surgical field. Dra Niza commented on the fact that Kat's polyhydraminous state meant that they needed to be careful with all the amniotic fluid as she cut through the last membrane, a lot of water came out, sluicing down to the floor where it wasn't caught by the drapes. Paddy, it turned out was now in a breech position, not only that, but he had also managed to wrap the umbilical cord around his neck (cord wrap); this was the reason his movement had been restricted and why it was important to get him out now. At 10:43 pm he was eased out feet first after having the cord cut to remove it from his neck.

Here he comes, ass first!!

At this point Dra Niza handed him over to the neonatologist, Dra Colasito to check him over and clean him up a bit. This is where the world, which was already a little wobbly on its axis turned totally upside down, although Kat wasn't really aware of what was going on. After suctioning the fluid from his mouth and nose, a soft tube was pushed down his mouth, it didn't seem to go as far as expected, so the procedure was repeated through each nostril and then again the mouth, with twisting but with the same result, it didn't go in very far. Paddy had announced his presence by making a loud cry, which was a great relief, I still didn't know what was going on with him.

First chance exam in delivery room

The Neo-natologist and the on duty Paediatrician then whisked Paddy away, a quick fly past Kat to show her the baby, but it was momentary. I was asked to follow down to the NeoNatal ICU (NICU) once I had removed my scrubs, which I did. Once in there, Paddy was hooked up to oxygen support and an x-ray was ordered, repeating the tube insertion so they could see the depth it reached in his oesophagus, it was clear from the films that he had an oesophageal atresia where the tube at the back of the throat doesn't extend down to the stomach, this is often accompanied by a tracheal oesophageal fistula, where the bottom of the oesophagus joins to the wind pipe halfway up and it seemed he had both. There was one other associated anomaly, which fortunately he didn't have and that is a lack of an anal opening.

Dra Colasito examines
him some more

Once all this had been explained to me, and the need to surgically correct this quite quickly, it was clear that Paddy was going to be staying there in the NICU for several days. I was keen to get back to see Kat, upon leaving the NICU I was surprised to bump into Kat's mom and her best friend Dulcie, it was by now almost midnight. I spent the next hour or two bouncing from the delivery suite to the NICU to check up on the most important people in my life, alternately talking to Mommy and Dulcie and Dra.s Niza and Colasito as well as the nursing staff. Kat was recovering slowly and was due to be taken to her room in an hour or so, I went back to the NICU where the doctors were talking to Mommy Luz to explain to her what was going on. Shortly thereafter we got to Kat's room to try and sleep, it was hard as we both knew that our little boy was a little bit broken, although we hoped they could fix him quickly.

His nameplate

The next day dawned and Kat and I were both emotionally drained, the roller coaster of the past 14 hours had taken its toll on us. That said we had a challenge to face and a baby son to welcome to the world. I was able to go down to the NICU to see whether he had a comfortable night and what the plans were, I was told that he also had a Pattent Ductus Arterios (PDA) where a small blood vessel bypassing the lungs to allow the circulation from the heart to go to the placenta for oxygenation. This is relatively more common and often corrects itself after a few days, a second 2D echo would be needed later to confirm it had closed.

Kat's first visit with Paddy

I was also able to take some more photos of him. Kat was confined to bed until she was able to demonstrate her recovery from the CS (anyone who has been there knows what this is, I won't embarrass her by going into detail). Once she had, the OB allowed her to be taken down to the NICU in a wheelchair, this was to be the first time she had seen him properly and as you can imagine it was an intense moment and later quite hard to leave him behind to return to our room. The surgeon was due to see him again the next day with the surgery proposed for the afternoon. Some friends had also visited us that day, it was great to see them all and to feel the love for us from them.

The day of the surgery was all a bit of a blur, we had several forms to sign and a chat from the surgeon to explain what he planned to do after the diagnostic tests had provided him with the information he needed, although as he said, it all depended on what they found when they got in there, he also took us through the alternative plan if needed.....

A few hours later we were called down to the OR Suite to see him again, the surgery had been a success and plan B had not been used, everything was as hoped. Paddy should have a full recovery and lead a normal life, we saw him back to the NICU before getting back to the room for a much needed night's sleep.

On the Wednesday we went to visit Paddy for a while, he was much more relaxed than before as he was now able to breath more easily (although intubated and with a chest drain in place) and could swallow for the first time. This was also the day Kat was to be discharged, several doctors popped in throughout the day giving us updates on Paddy and also prepping Kat for going home, Dra Niza checked her dressing and when I looked at the wound site, I was amazed at the tidy sutures and almost invisible incision, this didn’t mean that Kat could be overly active, we were warned that she would take several weeks to fully recover and shouldn’t drive her car for at least 3 weeks.

The next few days were spent visiting with Paddy, his progress was agonisingly slow, or at least that is how it seemed to me, but he was visibly getting better, his breathing was much less laboured and he seemed brighter when he opened his eyes. There was only one slight problem, he is not allowed to be fed, instead he was getting his nutrition through IV, this meant that he felt hungry pretty much all of the time, and that made him very grumpy. Some tubes were removed (he was extubated on Monday), we had to consent to a central line being inserted by a cut down procedure, this would reduce the needles stuck in him to get IV access as this line is more permanent and doesn’t need to be transferred from site to site and to avoid infection.

At the time of writing this on Monday March 2nd, we received the news that Paddy's paediatrician is hoping to allow him to feed through his oral - gastric (OG) tube once the surgeon agrees and they are hoping to remove the chest drain around the same time.

I also learned that my application for permanent residency has been approved and all I need to do now is to visit the Bureau of Immigration to have my passport stamped and to get my new ACR-I card, which I am planning on doing later in the week.