Great Expectations

The End Of The World

2007-09-19T10:26:00.000-07:00

Ainsleigh Brynn Hopkins

5 March 2007 --- 16 September 2007.
Daddy's tiny angel, returned to Heaven all too soon.

Ping

2007-06-24T16:53:00.001-07:00

At long last, I've processed a bunch of pictures and uploaded them to the Flickr page. There are a lot more pictures, and in higher resolution, available via my WinkFlash account. Why two accounts? Simple: WinkFlash doesn't enforce a disk or upload quota, which I like. But Flickr doesn't require visitors to join to see pictures, which I also like. So for now I'm maintaining both pages. If you're interested in the extra high-res pictures, let me know and I'll help you get set up over there.

Ping

2007-04-05T20:21:00.000-07:00

My computer problems solved, I've got a lot more pictures up over at the Flickr page.

A Couple Of Very Quick Points

2007-04-04T13:39:00.001-07:00

1. I think my WinXP install, now in continuous use for ~20 months, is dead. I'm not sure of this; there are a few more tricks I can use to try to bring it back to life. But the prognosis is, shall we say, Not Good.

2. In response I've learned how to do the resizing from the Linux command line. Tonight I'm planning on copying all the pictures from my laptop to my work computer and resizing them remotely.

3. Because anything that can be done from the command line can be automated with a shell script, I expect to have all of the pictures resized within about fifteen minutes of getting home tonight.

Missing Pictures

2007-04-03T11:41:00.000-07:00

I'm working on the pictures, I really am. Before I post pictures, though, I need to process them in several ways. First, I need to look at all the pictures and choose the ones worth keeping. I then sort the pictures into folders with descriptive names. Within each folder, I look at each picture and give it a descriptive name in place of its camera-assigned serial number. Today, I remember the context for each picture; for instance, I can differentiate the pictures taken at St. Mark's and at Primary Children's. In ten years, I may not be able to do this. Thus, if I'm going to relay all the information in these photos to my adult daughter thirty years in the future, I've got to make the relevant annotations now. Anyhow, once the photos are sorted and named I have to make a "network size" copy of each one that I can upload to Flickr without killing my disk allotment or your bandwidth. Then lastly I've got to upload and caption them all, and post a ping here at GE/BQ letting y'all know that they're up.

Unfortunately we've been, ahem, a little busy lately. What's more, my computer isn't really cooperating. When I open a folder of pictures, Windows Explorer wants to render a thumbnail of every file inside it. Because I've got a whole lot of pictures in each folder, this is a little more than my computer can handle. Consequently, WE crashes every few minutes as I try to sort and rename the pictures. To circumvent this problem I've developed a hybrid approach by which I look at the pictures with Firefox (which sensibly just displays the filenames as html links) and rename and sort them from the command line. This is cumbersome and extremely annoying, not least because I know virtually nothing about the allegedly obsolete DOS command line language, and thus have to have a third window open to a DOS cheat sheet. Anyway, be assured that I am working (slowly) on this and I do hope to have a bunch of pictures up soon.

Homecoming

2007-03-23T11:05:00.001-07:00

The echo from yesterday afternoon shows Ainsleigh's ductus all but
closed; there's just the barest squirt of blood flow through it, and
they think it's on a trajectory that will have it completely closed
over the next few days. As it has closed, not only has the aortic
coarctation not gotten any worse, but it has actually vanished
completely. Blood flow through her aorta is now entirely normal.

This wasn't really supposed to happen; I'm inclined to use the word
"miracle" myself, but won't hold you to this description. What we do
know is that the inside of her aorta, just below the junction with her
left subclavian artery, had a clearly visible obstruction on Friday,
Sunday, and Tuesday that was clearly not present on Thursday. Call
that whatever you want.

Anyway, soon after the echo our cardiologist pronounced Ainsleigh
healthy and ready to come home. After some paperwork and infant CPR
training, we left the hospital at about 6:15 yesterday afternoon. By
7:00 we had our daughter at home --- still two days before she was
technically "due" to be born. We have some follow up to do with
cardiology (she's still got those septal defects, for instance), but
she appears to be healthy and happy to be at home.

The Hardest Part

2007-03-22T11:59:00.001-07:00

A technician is going to echo Ainsleigh's heart again today. When she's done, she'll write a report. Then a pediatric cardiologist is going to read the report and examine the images from the echo and decide whether he thinks the ductus is still open and whether he believes that the coarctation is a problem. If the latter remains unclear, he may consult a few other cardiologists. When he's got a Final Answer, he'll report the answer to a neonatologist, who will report it to a nurse practitioner, who will report it to Ainsleigh's bedside nurse, who will report it to Sarah, who in turn will call and report it to me. Whatever the results are, I think I can handle it. But the waiting for information to trickle all the way down to me is simply excruciating.

Voice Mail Etiquette

2007-03-21T12:48:00.001-07:00

Its very important, when one's loved ones are hospitalized, that phone messages from doctors and other hospital staff are carefully worded. Most of the actual medical personnel with whom we've dealt have been really good about this. On Friday, for instance, our neonatologist at St. Mark's called to warn us about the impending transfer to Primary. (It turns out that I didn't get the message until after I turned up at the hospital, but that's neither here nor there.) As always, her words were "Hi, it's Dr. Liu; Ainsleigh is fine, but I need you to call me." That middle clause is critical, because the doctor knows that without it, the message "Hi, it's Dr. Liu; I need you to call me" is nothing short of terrifying. Unfortunately, other hospital staff have been...less consistent. Last night I arrived home and got this message: "This is Kristi at PCMC. We need to talk about your health insurance. I'm in the office from 7am to noon tomorrow."

Context: the other day we got a bill for Sarah's stay in St. Mark's that totalled almost $11,000. And that was for four days in a hotel-type room with a visit from a nurse every four hours. By contrast, Miss Ainsleigh's experience to date entails: eleven days in the St. Mark's NICU; five days (and counting) in the PCMC NICU; the more-or-less constant presence of a registered nurse, a nurse practitioner, and a neonatologist for that entire time; the services of at least four (and possibly as many as seven) different pediatric cardiologists; four echocardiograms (and counting); LifeFlight transfer from St. Mark's to Primary; and various attendant expenses like IV antibiotics, supplemental oxygen, diapers, formula, etc. There is no doubt in my mind that Ainsleigh's total hospital bill already far exceeds $100,000. Now, this is OK, because the U supplements my absurdly low salary with a top-shelf health insurance plan for my whole family. But under these circumstances it's not exactly good for my mental health to hear that "we need to talk" about my health insurance.

Postscript: Lest anybody get the wrong idea, all turned out well in the end. (Better, by about $1000, than I actually expected.) This post is purely about the avoidably heart-stopping nature of the phone message.

The Kid's Got A Lot Of Heart

2007-03-21T12:09:00.001-07:00

For those of you lucky enough to have escaped the "constantly pester" level of my email distro list, here follows a little status report. Un/fortunately, we didn't get to bring Miss Ainsleigh home with us as planned last weekend. Rather, I arrived at St. Mark's at 5:30 Friday afternoon to find that my daughter had been put on a ventilator and transferred into the most-critical-care section of NICU. I was, shall we say, surprised.

There began a long and scary evening in which Ainsleigh was transferred from the hospital she was born in to the Intermountain Primary Children's Medical Center. Upon arrival at primary very late Friday night, we learned that our daughter has sort of a congenital heart defect combo plate. Some of the problems are minor: she has both atrial and ventricular septal defects (basically little holes that allow blood to flow from one side of her heart to the other) that the doctors think will resolve themselves as she gets older.

One of the problems is not (or, I should say, has the potential to not be) so minor. She has a small coarctation of her aorta; this is a little bump of tissue on the inside of her aorta that impedes blood flow to her lower body. To date, she has adequate blood flow past the coarc and is OK. But she also has a "patent ductus arteriosis", meaning that the fetal blood vessel connecting her pulmonary artery and her aorta hasn't closed yet. When this vessel closes, it often causes a small narrowing of the aorta at the point where the two come together. Trouble is, the ductus joins the aorta right across from the existing aortic coarc; thus, the narrowing of the aorta associated with the closure of the ductus may exacerbate the coarctation and cause a critical problem with the blood supply to her lower body.

At the moment there's no clear consensus among the pediatric cardiology staff as to how likely this is to happen. On Sunday, two doctors wanted to release her. On Monday, however, another group of doctors came on shift and decided that she should stay in hospital until the ductus is completely closed. Their logic is that the closure of the ductus probably won't cause a critical problem, but that with the stakes involved here "probably" just isn't good enough. We were told Tuesday that if the coarc does become crtical when the ductus closes, she might go from OK to terminal in as little as fifteen minutes. If that happens while she's at home, she'll almost certainly die. So they feel like they've just got to keep her there, and keep examining her, until they see that the ductus is completely closed and blood flow past the coarc remains adequate.

Nobody's quite sure when that will be. Since her transfer to Primary Children's Hospital, she's had three echoes: overnight Friday/Satruday, Sunday morning, and Tuesday morning. All still show an open ductus, and there wasn't any significant narrowing of the ductus between Sunday and Tuesday. They're going to look again Thursday; if the ductus isn't on its way to closed by then, they'll talk about administering drugs that will force it to close under controlled circumstances. Once the ductus has closed, we'll be able to make a final decision on whether to take her home right away or go ahead with the surgery to remove the coarctation. I should emphasize here that the former (happy homecoming) is a lot more likely than the latter (surgery).

In the meantime, Ainsleigh looks good and seems happy, while her mother and I engage in that least satisfying of human pursuits: waiting.

Eight Of Nine

2007-03-14T09:15:00.001-07:00

As of this morning, Miss Ainsleigh has finished eight of her past nine feedings --- 8:00 AM yesterday through 8:00 AM today, with the sole exception of a tube feeding at 5:00 AM this morning. For a week and a half, the doctors and nurses all told us that one day she's "wake up" and be ready to face the world. It's starting to look as though Tuesdy, 13 March 07, was that day.

Of course, she's got to go entirely without the feeding tube and entirely without supplemental oxygen for 2-3 days before she can come home. So we're still talking Saturday/Sunday at the earliest. But things are really looking up.

Another Apology

2007-03-13T10:41:00.001-07:00

Sorry about the stagnation on the Flickr page. There are more pictures, including some of my parents with the baby. Unfortunately, my return to work has derailed the photo loading/editing/posting process. I hope to find time to get the new pictures up in the next few days, but it might be the weekend.

Some Other Things

2007-03-13T09:49:00.001-07:00

I'd like to note here that it's not my intention to use these postings or my various mass mailings as an excuse to not respond personally to each of you. I have a very impressive pile of emails (not to mention snail-mail cards and notes), and I'll respond to each and every one of them in time. How much time I can't say, though, so please just bear with me on this.

Last Night And This Morning

2007-03-13T09:44:00.001-07:00

This is all three-steps-forward-and-two-steps-back stuff. As I mentioned yesterday, Ainsleigh was doing really, really well at 8:00 Monday morning. The nurse said that she'd had a little fever overnight Sunday, but she nonetheless looked good, was breathing easily, and took all of her breakfast in record time. Then, through the day, she worsened somewhat. By 5:00 yesterday afternoon, she was visibly struggling to breathe; in fact her breaths seemed more like panting than anything else. She also refused to take any food, and squirmed uncomfortably the whole time I held her.

I was pretty unhappy when I left her yesterday afternoon, but things have been looking up again since then. At 8:00 last night she was back on supplemental oxygen and sound asleep, but her breathing was slow and regular and she seemed to be resting comfortably. Then this morning she looked great again; she was more awake than ever, breathing easily without extra oxygen, and took every drop of her breakfast. Though she sneezed a few times, she seems comfortable and happy today. Once again, I'm hopeful that this will be a Good Day, and that tomorrow...will sort itself out when it gets here.

One day at a time.

One Day At A Time

2007-03-12T15:29:00.001-07:00

Of course, the most frustrating thing is that there's really nothing to be done. Perhaps her current symptoms will finally lead the doctors to an underlying cause for her condition. In the meantime, though, there's naught for us to do but bear up under the strain of this thing. It is, in word, trying. It's the most trying thing, in fact, that I've ever been through. Under these conditions I comfort myself with a single, relentless mental refrain: one day at a time.

So. I'd be lying if I said that this isn't an ordeal, and that the unchanging and seemingly inexplicable condition of Miss Ainsleigh wasn't discouraging. But my faith fills me with a perfectly irrational confidence that this, too, shall pass. Ainsleigh's largely healthy, and she is (ahem) beautiful. And every day we minute we get to spend with her between now and the 24th is a bonus minute.

A Very Small Bit Of Actual New Information

2007-03-12T15:19:00.001-07:00

As I mentioned below, on Thursday afternoon we were hopeful that an extra couple of days in the hospital boarding room would enable Sarah and Ainsleigh to come home together on Sunday. That, I am sorry to say, turned out not to be the case. It is now Monday afternoon, about a week and two hours (give or take a weird government-mandated time change) since Miss Ainsleigh's birth, and she remains in NICU. The criteria for releasing her from NICU remain the same: she must be completely off of supplemental oxygen, and she must be able to take all of her nutrition from a bottle (ie, she must have no more need for IVs or feeding tubes). Since Thursday, there have been flashes of both good and bad news on both of these fronts.

As to the oxygen, the news is unequivocally good. The trend lines for her oxygen consumption are great. She spent all day Thursday on the oxygen. Friday, she was only able to keep her blood oxygen saturation up in the absence of the oxygen cannula for about half an hour. By Saturday night, this had climbed up to an hour or two. And sometime late Saturday night or early Sunday morning, she started tearing the cannula out on her own and living without it for hours at a time. (The nurses generally let the baby sleep for ~2.5 hours at a stretch, and during that time notice that the cannula has come out if and only if the monitor shows her blood oxygen content falling.) As of today, she's spending much more time without the oxygen than she is with it; even when she was feeding this morning she had no need of the cannula. This, as I say, is pure unadulterated good news.

The feeding picture is a little murkier. As I noted Thursday, the doctor wants her to take ~45mL of formula every three hours. Through most of last week, she was just way too sleepy to come close to this goal. At feeding time, she'd be awak for about the first ten minutes and in that time would take about 15mL of formula. You could then antagonize her just enough to keep her partially awake for a further 20 minutes and get her to take another 15 mL of formula. After that she was out, and the remaining 15mL of formula needed to be pumped into her via the feeding tube. This kind of behavior was the rule all day Wednesday and Thursday. On Friday afternoon, however, she suddenly perked up and took a full 45mL of fluid at three feedings in a row. I was really pleased by this. The NICU staff (both doctors and nurses) have been telling us constantly that there will be a day when her little lightbulb goes on and everything turns around abruptly. With three consecutive successful feedings on Friday, I thought we had reached that day and that the end of the NICU ordeal was in sight.

I was incorrect. Friday's burst of energy became Saturday's lethargic hangover, and we could hardly get her to eat anything. By Saturday evening the staff decided not to even try bottle feeding her at most meals; rather, at two of three meals Saturday and Sunday they let her sleep and administered the entire 45mL of formula through the tube. What's more, those feedings where we did attempt to bottle feed her were unsuccessful; we'd stepped all the way back in time to the feeding performance of last Wednesday.

Then this morning things seemed to be looking up again. As I mentioned, I'm back at work today. I stopped on the way in, though, to do the 8:00 feeding. The nurse let me bottle feed Ainsleigh, and she did extremely well --- much better, even, than she'd done on Friday afternoon. She took the first two thirds of the bottle in about seven minutes and the whole thing in about twenty. What's more, she seemed more alert and stronger than I've seen her before. Though the nurse told me that Ainsleigh'd "had a rough night" and that she had a bit of fever, I didn't get the impression that anyone was hugely worried about this. As I left the hospital, I was feeling better than I did all weekend.

I'm frankly not sure how my elevated mood has held up through the day. So that I might get some work done (and, despite my general exhaustion and my heart being elsewhere, I have gotten some work done), Sarah went to the 11:00 and 2:00 feedings while I stayed in the office. By phone, she informs me that the NICU staff seems much more worried about this fever business than I thought they were. They've already done another chest X-ray to look for fluid on her lungs. They've also drawn blood for another round of lab tests and started a new course of IV antibiotics. What's more, so long as she's sickly they're back to feeding her through the tube. We are, in other words, back to her condition as of Wednesday.

Despite all this, I'm hopeful that the current downturn is both slight and brief, and that come tomorrow or the next day she'll be back on track. We'll see about that, of course, and I'll keep y'all updated on her progress.

The News As Of Thursday

2007-03-12T14:20:00.001-07:00

For those of you in my email address book, the following post will be mostly recap. It has been edited very slightly from the original message I sent out last Thursday, but there is no new information in it. What I'm doing here is preserving this text as a sort of baseline from which to go forward with updates on Miss Ainsleigh's medical condition. There will be another post with new informaiton in it in just a few minutes.

Ainsleigh is almost three weeks early; she was due on the 24th and born on the 5th. That's technically "full term" and wouldn't normally trigger an automatic, lengthy stay in the newborn intensive care unit (NICU). However, little Ainsleigh just didn't want to wake up and make a fuss in the operating room. After a few minutes of shallow breathing and no crying in the OR, the nurses decided to take her into NICU.

The doctors there told us Monday night that the central problem was her breathing, which was too fast and too shallow. Monday afternoon and evening, this fast, shallow breathing wasn't even enough to properly oxygenate her blood. In the Monday pictures, you'll see a sort of plastic dome over her head. This is an oxygen tent; in order to make her breathing more productive, the doctors used this tent to create a little microenvironment with 50% oxygen content.

Almost as soon as they put her in the tent, the doctors started slowly reducing the oxygen content. At about 2AM Tuesday, they brought the oxygen content in the tent down to 21%, the same as atmospheric O2 content, and removed the tent. Some time later they also decided that she was holding her body temperature well enough and moved her from the baby warmer to an ordinary crib. Note that the Tuesday morning pictures have her out of the tent and wrapped in a blanket.

Tuesday morning, however, the doctors were still concerned that she'd be unable to coordinate breathing and eating, so they were still feeding her through the IV tube. Tuesday afternoon at 2PM they decided to try feeding her for the first time. She's got to take 45mL of formula every three hours to be released from NICU. She's very sleepy, though, and it's hard to keep her awake and focused on eating for long enough to get that much formula in her. This, and a continuing problem with her blood oxygen saturation falling while she eats, is the reason she's still confined to NICU.

The picture as of Thursday was mixed. To get the necessary amount of formula in her, the doctors have put in a feeding tube so the food can be pumped directly into her stomach. This has allowed them to take out the IV and should help her gain strength and weight. After a brief time off of oxygen altogether, her mealtime breathing problems caused them to put her back on oxygen (this time through a cannula, one of those little things that goes in her nose) late Wednesday. She gets the minimum amount of oxygen possible, but just can't quite seem to get off of it altogether.

Anyway, that's where were at on Thursday afternoon. To get out of NICU and go home, she's got to get entirely off of the oxygen and begin drinking ~45mL of formula on her own, without the tube, every three hours. We're not there yet, and we're not sure when we will be. In the meantime, we're allowed to peek in on her whenever we want, and to hold her for half an hour at feeding times (ie, every three hours). Sarah was discharged from the hospital Friday, but stayed on in a kind of hotel room across the hall from NICU for an extra couple of days. We were hopeful that Ainsleigh and Sarah would come home, together, on Sunday or Monday. That didn't happen, of course, as I'll discuss in just a moment.

Hello, World!

2007-03-06T18:50:00.000-07:00

I'm Ainsleigh Brynn. I was born, somewhat unexpectedly, at 1:34 PM MDT on Monday, 5 March 2007. I weigh 5 lb 14 oz and am about 18 inches tall. I currently live in the NICU, but my parents are hopeful that they'll get to take me home soon.

Catching Up

2007-02-16T17:35:00.000-07:00

I've finally gotten around to scanning a bunch of the pictures that have been piling up, including the photomicrograph of Ainsleigh and her ill-fated sibling at the blastocyst stage in addition to a couple of sonogram pictures from the very early stages of Sarah's pregnancy. We also had an ultrasound today, though, and I really want to get up a particular picture right away.

The ultrasound machine is usually focused in on what you might call a single "depth" in Sarah's belly. This leads to the familiar, grainy-looking, hard-to-decipher two-dimensional sonogram images like this:

This image, which is kind of creepy owing to the orientation of the little one's head, was taken with the ordinary ultrasound probe on 2 February. As you can see, the quality isn't very good. This is what basically all of the sonogram pictures from both 26 December and 2 February looked like, which is why I haven't bothered to put them up; once she grew to the point that you couldn't see all of her at once, the pictures got really hard to understand.

But the ultrasound machine is also capable of focusing in on the baby's head, for instance, and then scanning through various focus depths to take a whole set of these two dimensional images. This set of 2D images can then be sort of stacked up to make a 3D image. The result is really amazing.

This is Miss Ainsleigh, rendered by the computer in what I would call space-filling 3D. As you can see, the detail is really amazing; you can even start to play the "who does she look?" like game if you're so inclined. You can perhaps also make some preliminary judgements about her personality. That bright, blurry mass at left is her hand; she's got her thumb pressed against the tip of her nose and is wiggling her fingers in the classic nyah-nyah gesture.

We're very excited about this picture; it's really bringing it home for us that she's real, and she's almost here.

Pick Me!

2007-02-14T08:40:00.001-07:00

Sarah has signed up for a bunch of periodic "pregnancy newsletter" things. These are updates sent every week or month or whatever that tell you how baby is developing and what you'll experience as a mom-to-be. They also offer some practical advice on how to deal with common pregnancy-related ailments. Today we get this tidbit:

"I work at a jewelry store, and we always get pregnant women's wedding rings off swollen fingers by spraying with Windex or glass cleaner. I don't know why it works, but it sure does." Anonymous

I know why it works: most commercial glass cleaners are fairly concentrated aqueous ammonia. Ammonia is a base. Human epithelial proteins are particularly base-labile; ie, they denature and dissolve into basic solution. This is why basic chemicals feel slippery: not because the basic solution is natively slippery, but because the instant you get it on your hand the surface of your skin begins to dissolve into the solution. An effective way to get a too-tight ring off, I'm sure, but probably not the most skin-friendly; I'd try dish soap first.

Baby Shower Pictures

2007-01-25T20:47:00.000-07:00

With a minimum of comments, here are some of the best pictures from the baby shower.

Here's the guest of honor. We're fixing to play a sort of "Family Feud" game at this point; Sarah's laughing at my usual disrespectful antics.

Her erstwhile husband. My brother took this picture and is especially proud of it. Supposedly there is a version that's much improved through artful use of Photoshop. One assumes this means that I've been deleted and the focus of the picture shifted to the much more attractive Sarah, who you can see here in the background.

I understand this might be soemthing of an overdose of "me" pictures, but I like this one with my younger niece, as well.

Here's a rare picture that includes my father. From left, you're seeing my Dad, my older niece, my brother's wife, my Mom, my grandmother, my brother, and my younger niece. They all have names, of course, but just because I publish all my personal business on the web doesn't mean I publish all their personal business on the web.

Ditto on names in the last two pictures. Here's my grandmother (second from right, if that's not plenty obvious) and five of her six daughters. You'll recognize the lady second from left as my mother. Granny is now 82 years old and doesn't travel well, so we don't see her that often. We're very glad that two of my aunts brought her down from Oregon for the shower; I think she was very glad, too.

This is most of us from the next generation. There are four missing. The big guy in the white shirt is of course my brother; he took all of the pictures that he doesn't appear in.

There are more, and I may put them up somewhere in the near future. But for now I hope these'll help you get the sense of the day. If there are any you want copies of in full resolution, let me know and I'll get them to you.

And A Follow-Up Appointment

2007-01-23T21:06:00.000-07:00

A week or so after the December ultrasound, we had our regular, every-four-weeks appointment with the OB's office. I say the OB's "office" because the OB herself was on vacation; we saw the office's Nurse Midwife in her place. NM has, shall, we say, a somewhat less refined sense of the value of her time than does the OB. We've seen her once before, and found both times now that she's much more interested in talking to us than OB usually seems to be.

We took advantage of her chattiness to ask her a number of questions about our visit to the perinatologist and this whole single umbilical artery (SUA) thing. She read us the perinatolgists report, which said nothing at all about Down syndrome and focused exclusively on the low birth weight issue.

At this point I told her that, as far as I could tell, the perinatologists considered it an important part of their job to find some reason we'd have to come back and see them every month. In October there was the placenta previa issue; in November that had resolved, so there was this concern about the fluid "lake" in the placenta. By December that lake had completely disappeared, so there was (is) this SUA thing. I have no doubt, I told NM, that if in February they manage to locate the right side UA they will nonetheless find some other reason that we simply must return for yet another ultrasound in March.

I've had this theory for a long time that doctors are purveyors of a commodity (medical treatment) and that they will happily sell you more of it than you need. Most medical professionals vehemently deny this, and claim they would never order any test or procedure that wasn't neccessary. So I expected NM to scold me for my cynicism, and to tell me that the perinatologists would never, ever order additional ultrasounds without good cause.

To my surprise, NM did no such thing. Rather, she more or less agreed with my thesis. Some relevant facts, passed on to me by a CNM that's been proacticing for 25 years:

1. As recently as 10 years ago, there were three perinatologists in all of Utah: one at the U, one at LDS, and one in Provo.
2. Today there are five perinatologists in the office we visit for our ultrasound work. This is not the only practice in the building, let alone in town.
3. Diagnostic technology is improving faster than the ability to understand the results of the tests.
4. The proliferation of perinatologists and the explosion of pre-birth diagnostic technology feed back on each other and lead to an awful lot of unneccesary stress for a large number of expectant parents.

The Doppler ultrasound machine, for instance, is relatively new technology. Never mind what was available when your mother was pregnant with you; we're talking here about what diagnostic test that were unavailable when your older sister was pregnant with your six-year-old neice. Put it all together and you realize that untold thousands (millions, even) of babies have been carried to term, born, and grown up with conditions like SUA that no one ever knew about.

In this context, it seems kind of silly to get your knickers in a twist over a condition that is, in the end, damn near impossible to detect. Miss Ainsleigh is right smack in the middle of the "normal" range in every ordinary measure. To find fault with her, they've got to look down inside her belly with a Doppler ultrasound machine.

Which doesn't sound like such a bad deal to me. We've all got problems; that hers are limited to an absent umbilical artery (which is in any case invisible and completely useless after birth) seems, to my malformed and mismatched ears, like good news.

A Third Ultrasound

2007-01-23T19:56:00.000-07:00

Actually a sixth, as there were three in Memphis when Miss Ainsleigh was still embryonic. But 27 December we had the third ultrasound of her "fetal" period.

There are no pictures worth posting this time. We saw a new doctor (a partner of the woman we've seen before) and with him a new ultrasound tech. Neither of them was as personable as the pair we usually see. They were clearly not focused on or especially interested in producing quality pictures for us. Oh, well.

What they were focused on was, well finding a reason to order more ultrasounds. (This will sound less unfair in a moment.) And find one they did. The current generation of ultrasound imaging machine has a Doppler capability that alows it to see movement inside the uterus --- even inside the baby. In general, this capability is used to track blood flow in the placenta, cord, and baby. They used this in October and November to ensure that the blood flow transiting the torn placenta was adequate. They also use it to track blood flow through the heart valves.

At December's appointment they used this Doppler feature to scope out the blood flow into the baby through the umbilical arteries. There should be two of these, one runing along each side of baby's bladder. Unfortunately, Miss Ainsleigh has only one; try as he might, the good doctor could not find any evidence of blood flow through the right-side umbilical artery with his fancy Doppler ultrasound machine.

What this means isn't exactly clear. While we were there in his office, he said the principal concern was that the absence of one umbilical artery is "associated in about 1% of cases with Down's syndrome." Now, 1% doesn't seem like much of a signal to me; even assuming this effect is real, though, one assumes that the relevant 1% is massively concentrated among mothers and babies with other indications of the disease. None of these indicators are present (the doctor checked thoroughly), so this kind of seemed like a made-up concern to me.

The other big concern associated with the condition is that the total blood supply to the baby will be inadequate as she gets bigger; this may lead to low birth weight and all the attendant problems thereof. This of course is a real concern, and the doctor ordered another follow-up ultrasound at the beginning of February in order to track the baby's growth.

So we're going back in February. Having been less than completely satisfied with the more recent doctor/technician combo, we've scheduled the appointment witht he doctor we saw in October and November. At the very least, this should make for better pictures.

Don't Kick The Puppy

2007-01-22T20:20:00.000-07:00

I thought about writing a detailed account of how we came to spend Thanksgiving at the ancestral Hopkins Manor of Orangevale, California. But that story's been told. So on to more important things.

Our dog sleeps with us; always has. She used to do it on the sneak, waiting until she thought we were safely asleep before jumping into bed as stealthily as possible. Now she's brazen; our current bed is too high for her to jump onto, so she'll paw and cry at me until I lift her up into the bed.

On arrival, she comes up to the head of the bed and lies between us. We spend a few minutes lavishing completely undeserved attention on her before banishing her to the foot of the bed for the rest of the night.

During this time, she likes to lean against one of our stomachs. (Sitting up on your own is apparently a lot of work when you're a dog.) But the other day something went horibly awry. She got up in the bed, came up between us, and had just gotten comfortable against Sarah when the strangest thing happened: her mama's stomach kicked her!

I know, I know, it loses a lot in the transcription. But it was pretty funny to see the poor confused beagle look on her face. The little one packs quite a wallop, when she wants to.

A Brief History of The Time Since Thanksgiving

2007-01-22T18:50:00.000-07:00

A chronology; each of these is likely to become a whole post or series of posts in the next few days:

November
Went to my parents' house for Thanksgiving.
Began searching madly for new house.

December
Found new house.
Moved into new house.
Began commuting to work, approx. 682 miles round trip.
Got Christmas tree in blinding snow.
Put up exterior Christmas decorations in blinding snow.
Hosted all of Sarah's family for Christmas.
Had a third ultrasound.
Scheduled a fourth ultrasound.
Went to black-tie New Year's party.

January
Watched a lot of football.
Went to work. Sarah's work. This is still New Year's Day, mind you.
Met with Nurse Midwife while doctor was on vacation.
Flew to California for baby shower.
Heard Christmas tree fall over.
Developed entirely new definition of word "cold."
Scheduled Super Bowl Party.
Assembled portable crib and stroller.
Began reading to baby.
Resumed baby glog.

There's more, and pictures from the shower, too.

And...We're Back

2007-01-22T18:37:00.000-07:00

So everybody's been after me for some time to hop to on this blog. And I've meant to, I really have. It's just that...oh, whatever. Go nuts.

ANyway, I'm back at this and there's lots to report. Stay tuned...

Speaking Of Culinary Overkill

2006-11-20T15:16:00.000-07:00

Sarah and I will be having Thanksgiving together this Thursday. For the first time, we will neither be nor have guests for this holiday. (Although I have not spent Thanksgiving in my parents' home in nigh-on a decade, we have in the past either travelled to the home of Sarah's parents or hosted family and friends in our home.) Our initial impulse was to pass on making a real Thanksgiving meal. As the day got closer, though, we realized that this wasn't such a hot idea. We're traditional people, and we'd be really sorry to have skipped this wonderful American feast on account of sloth. What's more, we've got to get used to being the keepers of such things. The "going home for Thanksgiving" chapter of our life is closing, and the "having Thanksgiving at home" chapter is opening. We've all got to make the transition from "son" to "father" sometime; for me that sometime is now.

And so it was that we (OK, I) decided to go ahead and fix a traditional turkey dinner this Thanksgiving. As there are only two of us, I thought I'd buy a single turkey breast. Then we'd make some stuffing, some mashed potatoes, corn, etc. The basic idea is that one can make all the usual dishes if one simply makes very small batches of each. Unfortunately, this idea is somewhat difficult to put into practice. Case in point: in order to lure in business this week, my local supermarket offerred whole turkeys at absurdly low prices to customers who bought X number of dollars' worth of other groceries. In other words, they'd basically give you a turkey if you bought all the fixings from them. This lead to a very strange situation. I went into the store looking for a ~5 lb turkey breast (leftovers, you know). Such were on sale for the very reasonable price of $1.30/lb, or about $6.50. Not bad, right? In the same freezer, though, were whole 12-14 lb turkeys for the absurdly low price of $5. So the second breast and all of the dark meat combined cost a total of - 1.50 dollars.

Well, it turns out that I'm just way too Scottish to pay more for less --- ever. I won't even take less for the same price; when milk is buy one gallon/get one free, I take the free gallon home even though I know damn well that I'll never even finish the first one. Is that irresponsible? Sure. But I'm psychologically incapable of leaving the free milk in the store. Similarly, I found that I was just not able to pay $1.50 more to get less turkey. So I bought a 13 pound turkey. To feed two people. And so what I've said with respect to birthday cake goes double for Thanskgiving turkey: if you need some, by all means come by and take some.

More Pictures

2006-11-17T20:52:00.000-07:00

As promised, here are the pictures from yesterday's sonogram. First, we have her little heartbeat:

Yes, I said her. Confirmation thereof:

Her face looks a little creepy from the front. We are told this is because her bones have hardened but her face hasn't really fleshed out yet. Consequently we're basically getting a picture of her skull. To wit:

Lastly, remember last month's picture of little Ainsleigh fexing her arm? We get a similar picture again this month; this one was taken just before she shot her left elbow into Sarah in response to the pressure from the ultrasound machine:

It really cracks me up; it loks almost like the pose a bodybuilder or a pro wrestler might strike. Say it with me now....

OHHHHH, YEAAHHH!

Yesterday

2006-11-17T14:25:00.000-07:00

Sorry to've left this so long; I just now realized that I haven't posted anything about yesterday's sonogram. Good news all around:

1. The baby is definitely a girl; there is no need to change the baby's name or the color scheme here at GE.
2. The placental bleed observed during the earlier ultrasound has sealed itself off and is no longer an issue.
3. The placenta has moved up the side of the uterus and is no longer in position to interfere with the birth.

In other words, every slight complication we thought we had has now resolved itself. Can't beat that.

Appointments

2006-11-12T19:27:00.000-07:00

We visited our OB this past Wednesday. No real news on that front; the baby's heartbeat is still strong and Sarah's been feeling well. The OB is a little more concerned about some things that appeared in the ultrasound than the perinatologist who actually conducted the test was. More on this later, when we know more; we've got another ultrasound scheduled for this coming Thursday. This should clear up some of the things the doctors are concerned about; also, this ultrasound should settle the remaining uncertainty about the baby's sex. Pictures, and video, to come Thursday evening...

My Back Hurts

2006-11-12T19:16:00.000-07:00

Our front bedroom, home to various boxes of junk since the day we moved in, now looks like an actual bedroom. Also, we (actually I, since Sarah is no longer really capable of climbing the stairs) cleaned out the basement so that our landlord can finish it and install a bathroom. We also washed and folded essentially every stitch of clothing in the house. How busy have we been? I have seen not one play of football all weekend.

Landmark

2006-11-10T15:54:00.001-07:00

I felt the baby move for the first time last night. Mind you, Sarah feels her move more or less constantly now. Last night we were watching TV when Miss Ainsleigh got especially active. Sarah put my hand on the relevant part of her belly, and sure enough I could feel the baby rolling around in there. It was faint, strange, and pretty much the coolest thing ever.

Standing Athwart History

2006-11-01T15:33:00.001-07:00

I've been married for nigh-on six years. Each morning, Sarah and I get out of bed fairly early. We weave around each other, more-or-less seamlessly sharing our one bathroom as we clean and groom ourselves for the coming day. I walk the dog, then fix our lunches and kiss her goodbye. We come home from work in the late afternoon or early evening. When we get home, we fix dinner; usually we do this together, but sometimes one of us does it alone and simply serves it to the other. We eat together at the table. After dinner we clean the table and the kitchen. Then we retire, together, to the living room, where we sit by the fire and work/read/watch TV/surf/whatever. I drink a glass of port or a dram of Scotch. (Strictly for medicinal purposes, of course.) We pet and play with our dog. Then we go to bed fairly early, because we've got to get up early the next day and start it all over again.

The point of this story is that we are, at this point in our lives, exceedingly ordinary people. (I don't mean that in a bad way; I believe that even the most "ordinary" people are actually extraordinary in all kinds of ways. But, that, as they say, is another story.) We've turned out to be exactly the sort of people we always knew we would be. More importantly, we've become the people we always knew we ought to be: responsible, productive adults, wildly in love with each other and working very hard to create the kind of home we know our daughter is going to need.

And yet I was struck, the other day, by a very unsettling thought. I was, at the time, sitting by the fire and sipping a really excellent port. I was also reading a novel, Snow Crash , in which a set of characters was described as being "in search of the America they always thought they'd grow up in." That phrase hit me like a falling safe. Suddenly, I was struck by how very close to anachronistic my position was. Who drinks port after dinner anymore? Who heats their home with a wood fire? Who reads novels from hardcopy? And, most importantly, who has a wife and a child and dog and vows to hold onto them all until Death himself rips them away?

Well, there may be lots of people who still do those things. But the numbers are falling quickly. I read the other day that the majority of households in the United States are not centered on married couples. The number of people living without a partner or with a partner (or partners) to whom they are not married now exceeds the number of people living with an actual husband or wife. This is a truly shocking development. It reflects, to my mind, a large-scale rejection of the idea that there is such a thing as "the people we ought to be". In place of this idea is a revolting narcissism that holds every choice to be as good as any other and insists that whoever we happen to be at any given moment is good enough. Cohabitation is the equal of marriage, artificial insemination is the equal of fatherhood, drug addiction is the equal of self-discipline.

These cultural trends have been evident for a long time. But they seem to be accelerating rapidly. For instance, there has been a quantum shift in college culture since I arrived in Oxford in 1998. My fellow students and I partied and drank and dated profligately. But we did not, as a general rule, confuse having a good time with the meaning of life. While we enjoyed chapter life, we understood that the real purpose of the fraternity was to develop lifelong bonds of brotherhood between us; while we enjoyed dating, we understood that the real purpose of all that dating was to find a partner that we could marry and build a life with. By contrast, YSIL and her friends have lost sight of all of these underlying purposes. They party together but never build real friendships. They date but do not love. They go to class but do not participate actively in their own education. In short, the sense that they are supposed to be becoming something better than they are is almost completely lost.

I'm not sure what has precipitated such rapid and fundamental change in American culture. I'm also not sure to what extent these changes have propagated or will propagate across social groups. There are already pockets of the United States in which the idea of "who we ought to be" has all but ceased to exist, and other pockets in which its definition is being expanded beyond meaning. In the short term, it is possible to insulate one's self from these destructive cultural forces by carefully choosing one's community. In the long term, perhaps the effects of these changes will be obvious enough and deleterious enough to drive people back into traditional notions of family, responsibility, and morality. In the medium term, however, it appears that the alteration (I would say decline) in American culture will be profound. This causes me to worry greatly for young Miss Ainsleigh, who promises to come of age in precisely this unhappy medium timescale.

I don't want you to read this as a gloomy post. I am, at core, an optimist. I believe that --- Hell, I know that --- my daughter will live to see wonders that I could never dream of. It is probable that what is gained will be greater than what is lost. But the slow fade-out of my world nevertheless pains me. I suppose I always thought that my children would grow up in the America that I grew up in, and that they would consequently grow up with the same sense of who they ought to be that I did. For better or worse, the former now appears impossible. It thus falls to me to instill the latter in my children. That I may be unequal to this task is the single great fear with which I approach my new role as "father".

A Pretty Good Little Saturday

2006-10-30T14:14:00.001-07:00

Before being laid low Sunday by a mild illness and a stronger medicine, we got a lot done on Saturday. Having spoken to Sarah's family, it looks like everybody's Christmas travel plans are all set, so we decided we'd better start getting the place ready. There's now a mattress in the crib and a big stack of firewood in the garage. We've also acquired an adult-size bed for our guest room. (There's no bedding yet, though. We might've gone to Bed, Bath & Beyond, but we didn't have enough time.) Now, so long as there's not a blizzard the weekend before Christmas, everything'll be great...

Posting Tonight

2006-10-25T19:19:00.000-07:00

Confession: the biggest obstacle to posting here is not really time. Truth is, over the past few weeks I've spent plenty of time watching TV and reading a novel (Snow Crash by Neal Stephenson, to be exact); that time could, in principle, have been used to put up some text both here and at BQ. The truth is that I ordinarily work at a computer all day, every day, and that the thought of sitting at my computer when I get home makes me want to puke. Tonight that problem doesn't really apply, because I've been working on a theoretical issue with pen and paper for the last couple of days. If this holds up, who knows how much blogging I might get done.

All My Girls

2006-10-25T19:03:00.000-07:00

Sarah is, at the moment, all curled up on the couch with Daisy the beagle. Together they make my three favorite people.

In Other News...

2006-10-25T18:38:00.000-07:00

Winter is coming on rapidly here in Salt Lake. It was snowing today when I left work, and it snowed earlier in the day down near Sarah's work. Of course, it was 65 degrees yesterday, so the ground is pretty warm and the snow didn't stick. It's also pretty toasty here in my living room, where my wife has had a roaring fire going since before I got home from work.

Uncertainty

2006-10-25T17:55:00.000-07:00

Sorry to've been so slow getting back to this. I've been trying to write a "the story so far" kind of post, but I don't have a lot of spare time these days and I'm afraid the story so far is very close to escape velocity. So I'm going to post what I can when I can and hope that we eventually catch up.

Since I posted the sonogram pictures last week, there haven't been a lot of new developments. I should note, perhaps, that despite the color and tagline of this blog, we're somewhat less than 100% sure of the baby's sex. The pictures are less than conclusive, not least because the baby was pretty darn uncooperative. It was uncanny, really; whenever the sonogram tech tried to get a picture of the relevant area, she threw her hands between her body and the camera. Also, she spent much of the ultrasound period with one leg folded up under her; "sitting on her foot", as the doctor said when she came in to take over for the tech. The doctor had better luck than the tech, but was never able to get a perfect picture. Thus, we think "girl" with something like a 95% confidence limit, but opinions vary.

Of course, Sarah was eager to pin this all on me. Just like Daddy, she said; stubborn and uncooperative as all get-out. To my mind, though, the fault here was clear. After all, someone in my house likes to sit with one foot folded up under them; that someone is not me.

First Pictures

2006-10-16T21:06:00.000-07:00

This is Miss Ainsleigh in profile. The sonographer has attempted to label the relevant anatomical features. The labels are pretty far from their targets but, I think, mostly unnecessary anyway.

Such nice bicep definition. Be nice to this little one, or she'll kick your ass.

This is her face from the front. Again, the labels are kind of misplaced but give you the general feel of the orientation of the picture.

Lastly, I give you the evidence of Miss Ainsleigh's gender. I'm not sure she'll thanks me for posting such a picture on the Web, but there you have it.

More on the ultrasound appointment tomorrow, but for tonight I've got to get to bed.

Hi There

2006-10-16T21:02:00.000-07:00

This blog is created to chronicle the birth of our first child, the soon-to-be Miss Ainsleigh Brynn Hopkins of Salt Lake City, Utah. More on the history and philosophy of this blog and whatnot to come. For now, it's late and I've got to get the sonograms up...