The Whole Wide World

Logged back in for the first time in a long time and found an unfinished draft from the first 6 weeks postpartum...and here we are 6 months postpartum. Perfectly representative of how life has been as new parents. I used to be on top of my texts and social media, but now I find myself responding to messages a day or two later...if I respond at all. Still waiting for life to find its rhythm, but so far, every day has been different. The twins sleep when they want to and don't when they don't. Sometimes they nap at the same time, sometimes they choose to take turns. It's like treading to keep your head above water and never knowing when you'll be able to take the next gulp of fresh air. 

What's happened since the last time I sat down to jot down my thoughts? 

Well the nipples are doing great now. It seems I was very concerned about these last time. I hope they can retire soon as the kiddos have started testing their new baby teeth out on solids. Something about watching them gum tortillas and fruit brings me great joy. Luna is obsessed with my coffee cup and even after I offered her a drop to taste thinking the bitter taste would turn her off, she demanded more. I may have inadvertently created a monster. When I see them tracking our food with their eyes and reaching out with their grabby hands, I feel a twinge of pride. These are definitely our little foodie babies. 

Uram's mom has been here for almost 2 months. I can no longer remember what life was like without her. She wakes up before me and has breakfast ready before I finish my first morning pump. She's like a laundry ninja, she has the load of laundry I started folded before I've had time to circle back and check the dryer. She cooks every meal for us and she actively denies us opportunities to eat out. (Her rule is once a week...if that. Also, no instant noodles. Uram is bereft.) She's in the garden, she's taking out the trash, she's freaking Roy Kent -- she's here, she's there, she's every fucking where. Her presence rounds out our team of Super Grandparents. Uram and I have looked at each other and expressed our misgivings about how our life will probably fall into shambles once she leaves in September because we've become so accustomed to her support. 

The girls have outgrown their reflux (finally). Now our next hill to conquer is the sleep schedule. It's been an uphill battle. Their naps can be anywhere from 30 minutes to 2.5 hours. We still wake them up once at night when I do my middle of the night pump. The logic is that it's better for me to wake up once then have them wake up between my pump and my alarm. Hoping we can phase this out in the next month or so...and maybe end middle of the night pumping too. 

We had our supply scares. One particularly bad clog left my boob feeling like there was an octopus latched to it. It took over a week for it to clear and for the supply to come back to normal. But now that the girls are eating more porridge and playing around with finger foods, maybe my time as the milk machine is coming to an end. I'll miss the free pass to eat whatever I want...I'll probably blow up like a balloon once my metabolic rate returns to normal. 

It's still surreal that I am a mom. Right now it feels more like we have two new pets. It's hard to conceive that these two little crying, pooping cuties will grow into sentient beings that can talk (and talk back) one day. I've heard people say it's hard to go back to work because they miss their babies too much. But let's be real, I am more tired on days I don't have work than on days that I do. Babies are exhausting y'all. More exhausting than a demanding patient panel -- and that's saying something! But I think being away helps me appreciate them more when I return. Seeing their faces light up when they see me is restorative, even though sometimes I worry that I've done nothing to deserve being their favorite person in the whole wide world. One day they might outgrow it, but for now, I'll take it!

Motherhood, It's a Trap! (unfinished)

Growing up, my mom always told me that childbirth was painful, but the pain is all forgotten the moment they place your baby in your arms. Mind you, this is a woman that delivered me precipitously sans epidural and even had a stitch torn open when the OB reached in after the perineal repair to extract her retained placenta. After giving birth myself, I have determined this is a lie. I guess my delivery was complicated and I didn't get the beautiful golden hour of skin to skin bonding because the twins were whisked away by neonatology to ensure they were OK after the dangerous drops in their heart rate while my care team simultaneously worked on stopping my bleeding. But still -- that shit hurt (even with a glorious epidural)! 

The first few days after delivery, I was taking Tylenol and ibuprofen around the clock and still wincing every time I shifted to get out of bed to hobble to the bathroom. I peed blood for a week, although the nurse "reassured" me that this was normal for up to 6 weeks. I was peeing up to a liter at a time as my body worked to clear all the fluid I had retained during pregnancy and from the IV fluids during my labor. Even after getting home, I continued my scheduled OTC painkillers for almost 2 weeks. I hated dragging myself out for even a quick 15 minute walk due to the heavy, throbbing pelvic pain provoked by standing or walking around. For days I thought my stitches had become infected due to the level of pain I was in and also because I would wake up around midnight borderline delirious with night sweats. One particular night, I woke up drenched in sweat and found myself mid-conversation with Uram, a conversation I don't remember starting. I was also holding Lyra in my arms but I couldn't figure out whose baby she was. This all resolved within a few minutes, but I was concerned enough that I called the triage line. Turns out, this is all a normal part of the postpartum course. The night sweats are caused by the drop in your hormone levels after delivery (who knew!), the delirium was just severe sleep deprivation.  Isn't motherhood beautiful?

The level of discomfort I had with just a second degree tear (skin, muscles), I can't imagine how people manage with third or fourth degrees (skin, muscles, anal sphincter). I would just die. Luckily, I didn't suffer from any constipation, although the first time wiping after delivery, I was like, "Who's butthole is this?" because the hemorrhoids and swelling had rendered it unrecognizable to the hand that has dutifully wiped it for 32 years. Pregnancy is wild. 

Now my body is fully recovered. My anemia is steadily resolving thanks to the confinement meals and nourishing snacks my family has been bringing me. (My hemoglobin jumped from 8 to 10 in 2 weeks without iron supplementation. Forget IV iron, eat pate!) I no longer require painkillers for the hoo-ha -- I can walk without pain although my stamina is so reduced I feel muscle fatigue in my legs after just one lap around the park. But postpartum life is like trading old problems for new ones. The body is healed, just in time for me to endure the trials of prolonged sleep deprivation and learning how to breastfeed. The babies sleep for 2.5-4 hour stretches at a time. If we are lucky, we catch a cumulative 7 hours of sleep a night, although most nights we are averaging about 5 hours of fragmented sleep. 

Breastfeeding is its own beast. I can quite honestly say I would rather give birth again (with an epidural!) than continue breastfeeding. The first time Lyra latched onto my nipple, I may have let out an involuntary yelp. What did I do in my past life to deserve birthing children that are part piranha, part shark? The twins will fuss around trying to find the nipple before CLAMPING down with an audible "NOMF". Lyra will also shake her head furiously to the left and right after latching -- yeowch. The pain and swelling from their attempts to nurse would slow down my supply for a day, then I would try to get back into it again in a vicious cycle of fruitless suffering. It was to the point that I would dread feedings and pumping. No one tells you this, but sometimes when you are breastfeeding, you can experience a wave of negative emotions. This phenomena is called dysphoric milk ejection reflex. I would feel like I wanted to cry and I would have no idea why. For these reasons, I ended up deciding to exclusively pump. I did it for the nips. I reasoned that the twins would still get the benefit of breastmilk and it would be more sustainable for my poor bitten off nubbins in the long run. 

Even pumping comes with its own set of challenges. I couldn't figure out the right flange fit for the hospital grade pump I was given. The standard set was too small and would cause a pinching, stabbing pain that would linger for hours even after pumping. I tried sizing up, but this caused my areola to swell up, which led to clogged ducts. Clogged ducts are the devil. I tried everything. The old school of thought was that this was caused by fatty milk and to apply heat and massage to try to "clear" the obstruction. This has been replaced with the idea that the obstruction is caused by swelling and should instead be treated with anti-inflammatories and ice. I tried both with limited success.  I even started taking sunflower lecithin to emulsify the fat (Side note, I make gloriously fatty breastmilk because I am apparently a happy cow from California. I fondly refer to it as Booba milk tea). In the end, the only thing that helped was to discontinue the hospital grade pump and use the portable pump instead, which reduced the trauma to my nipples. Hours of midnight Redditing to figure all this out, guys. There is a special feeling of commiseration with your fellow internet goblins when someone asks the same highly specific question that you have 2-3 years ago and you can see all the people in the comments who are also up at 2-3AM trying to get the answers. 

Postpartum Processing

Well, here I am -- Mother of Dragons. The twins arrived in a dramatic fashion on January 9th after a lengthy induction process, a process that at first seemed to drag on before the proverbial shit hit the fan. 

Our induction was scheduled for January 7th. Naively, we thought we would pop the babies out overnight, then head home 24 hours after that. Oh ho ho, nope.

Even though  Luna's head was pretty low from the start, my cervix was only 1cm dilated so we were advised to start with a balloon placed in the uterus to stretch the cervix mechanically along with some medication to help get the body's labor process started. I've done cervical checks and placed balloons back in my days as a resident, and first and foremost, allow me to apologize to all the patients who have ever had to experience these. I would get an epidural for these alone. After the traumatic cervical check upon admit, I took their offer for a dose of fentanyl before insertion of the balloon. "It'll be like having a bit too much to drink," they said. OK, yes it was, but more like when you are clutching to your bed for dear life after a particularly ill-advised night out, praying to Jesus for the ceiling to stop spinning. Was it worth dulling the sensation of being abruptly fisted by the OB and having a balloon the size of a cutie orange inflated inside me? Maybe? Fine yes, but just barely. 

Once the balloon goes in, it is checked on in 12 hours if it doesn't fall out on its own. 12 hours is a long time to be stuck in a hospital bed chained to a monitor. Uram and I watched a few episodes of Hospital Playlist to pass the time. After seeing the frankly insulting quality of the hospital food, Uram offered to go out to pick up real food. We found out that one of our favorite taco trucks that we used to frequent in our early dating days when he lived in Sunnyvale had a location across the street. We joked about how our relationship had gone full circle now while eating my "last meal" of suadero quesadillas and cabeza tacos. I am so grateful to have a such a supportive partner in Uram. I've had to pee every 10 minutes in the final stages of pregnancy and during the induction I would have to detach myself from 3 monitors, unplug my IV, and wheel everything to the bathroom quick pace to try to avoid an accident. I never had to ask Uram to help me.  He took pride in "cable management" and I would watch him observing the monitors in typical Asian father fashion after each assessment. Even in the middle of the night, if I made the slightest movement, I would see his head pop up like a prairie dog from the pull out sofa to see if I needed help.

Once the balloon came out at 1am, the cervix was dilated to 3 cm. We continued pitocin overnight, but only advanced to 5cm by the morning. They offered more fentanyl for pain management and I was like "Hell no, but can I have some Tylenol to take the edge off?" The nurse asked me "For...a headache?" "And I'm like "No, for the labor and this giant orange lodged in my pelvis ." In the end, I requested the epidural less for pain management but just to get a Foley (urinary) catheter placed so I could stop getting out of bed to pee.  At that point, two days into induction,  it felt like we had been in that hospital room forever, but the babies' arrival was nowhere in sight. 

Then that afternoon, one blood pressure reading changed everything. I'd been having mildly elevated blood pressures in an otherwise uneventful pregnancy, nothing symptomatic or that didn't improve upon repeat. My BP was now elevated to above 160. Unlike in my field of medicine, in the OB world, this blood pressure is not something that you can just "watch and wait" if there are no symptoms. When the pressure was still above this range 15 minutes later, I was diagnosed with severe preeclampsia and started on a magnesium drip. Minutes after the first bolus of this medication was started, I projectile vomited. Bring the fentanyl back, that was a happy memory compared to this. The magnesium also burned its way along my IV line and veins. The nurse was like "Yeah, that happens unfortunately... here's an ice pack." A few hours later, my epidural stopped working. I started feeling tremendous pressure and pelvic pain to the point where I requested a cervical exam. The cervix was still unmoving at 5cm, but baby's head kept descending lower and lower. I also asked the nurse to check on my Foley output to make sure it was draining -- it turns out that baby's head had dropped so low that it had compressed and obstructed my bladder catheter. After moving the catheter around, almost a liter of urine drained immediately. I don't know if it was the draining of the bladder or the redosing of my epidural that helped, but I finally got comfortable again. 

At the next check, there were still no changes. I knew that something was looking gnarly down there because every provider that pulled back the sheets winced and went "oooh." I finally asked Uram to take a look and he shrugged and said "It's really swollen." "How swollen?" "It looks like testicles." THANKS URAM. 

The resident brought the attending to have a discussion with us. This is when I knew that things were really not going to plan. Given that the cervix wasn't changing, my water was broken, and the risks associated with pre-eclampsia, they offered me a C-section that night. The options were to wait 4-6 hours for the next check and if there were still no changes, we could pull the trigger on the C section then or, just roll back to the OR now. While having the babies out sooner rather than later was looking more and more appealing, I also thought about the recovery process after a C-section, especially with having twins. Would I be able to lift the babies in and out of the crib? I remember the painful and slow recovery course after my fibroid removal and that was only a C-section lite.  After discussing with Uram, we decided it would be reasonable to compromise and wait 2 hours and if no progress then, we would call it. We settled in to have a quick power nap. 

I woke up 2 hours later to the unpleasant sensation of my epidural no longer working on my right side. I also felt waves of pressure pain that told me that there were definitely changes. First things first, call the anesthesiologist back, because if the babies are coming out my hoo-ha, I ain't doing this with no half-ass epidural. Epidural now refreshed, the exam confirmed that the cervix was now completely dilated. We made preparations to roll back to the OR (twins are always delivered in the OR in case the second twin needs to have an emergency c-section); it is now day three of induction. 

In the OR, I remember thinking, well this is anticlimactic. With the epidural now working, I felt waves of pressure but no intolerable pain. On my left, I could hear Uram (now in an adorable sterile bunny suit) encouraging me through the pushes. I preened as the OB told me how good my pushes were -- hips flexed, pelvis opened, abdominal muscles engaged -- I am textbook, I am magnificent. (To be fair, Luna did all the work because her head was already 3+ well before the cervix was open.) Just as it sounds like we are nearing the final push, I hear the haunting sound of the baby heart monitor slowing down. The atmosphere of the room changes. They quickly consent me for a vacuum assisted extraction. From my perspective lying down, Luna's arrival is announced by a spray of blood across the OB's face shield. I don't hear her cry for what felt like far too long. But my focus is split as the OB is now telling me that the second baby is not yet engaged in the pelvis and the cervix relaxed back to 6cm. We can't push again until the cervix opens up again, but she will try breaking the second bag of water to try to bring Lyra down and facilitate this. The bag of water is broken and we wait for Lyra to "labor down" but again, we hear the heart rate monitor drifting downwards. I take as many deep breaths as I can, a human oxygen conduit to my baby. I consent for an emergency C-section, but if baby's heart rate tolerates, we can try a light push to see if that will stretch the cervix again to completion so we can complete the vaginal delivery. One push gets us to 9cm, the second push allows us to push the final remnants of the cervix behind baby's head. I am now pushing for my (and Lyra's) life. The vacuum makes another appearance. Pushes are usually done in intervals of three, but when they ask me to just keep going, I know that every push matters and we are seconds from a stat section. I should have done more arms and abs in this lifetime because it was a STRUGGLE to keep my legs up through those last pushes, but praise the Lord, because Lyra was launched into this world and the beautiful sound of her shrieking immediately filled the OR. As I threw myself down back onto the table in relief, I was mesmerized by the sight of my own blood splattered on the handle of the overhead light. Someone really needs to tell the cleaning crew about that, I thought to myself, but I must have said this out loud because the nurse to my right laughed and agreed. 

It turns out that our delivery was not epic enough, because now my uterus decided it was too tired to firm up and would not stop bleeding. It's one thing to learn about the treatment of uterine atony and even perform some of the maneuvers, it is entirely another thing to experience them. I could hear the names of different medications to stop bleeding being called out -- vague recollections of them telling me I would get a shot in my arm (eventually a second) and feel some pressure below (pills inserted in the rectum). Luckily, I was distracted from all this by another round of nausea and vomiting, an uncontrollable cough, and the worst dry mouth I have ever experienced in my life. I remember begging for water in my delirium and the providers telling me that they don't have any water in the OR. I would have given anything to suck on a sponge like Jesus. In the end, I lost a little more than a liter of blood. As things stabilized and the palpable relief filled the room, I couldn't help asking the most important question: "Do I still have a separate vagina and butthole?" Thank baby Jesus, only a second degree tear.  

During this ordeal, I kept telling Uram to go check on and bond with the twins while they took care of me, but he kept coming back to keep me company. It turns out that he was worried that I was going to die. I was slightly disappointed that this man did not cry when his twins entered into the world and were placed into his arms. I was infinitely more satisfied when I learned this man only cried after processing the traumatic delivery at the thought of possibly losing me. What a cutie patootie. This is the man who turned on the central heating for his pregnant wife a grand total of one time during 9 months of pregnancy. 

Joking aside, it is sometimes surreal to think about how this perfect stranger that waltzed into my life 6 years ago after we both swiped right over a shared love for food and cooking has come to mean so much to me. When I look at the life we have built together, now with the girls, and onward to our future together as a family, I truly feel blessed beyond measure. I see him changing every dirty diaper (He asked me if he really has to do EVERY diaper and I asked him how many of our babies he carried and expulsed from his body), letting me sleep through some nighttime feedings because I am so dead tired that I am not even roused by the sounds of our babies crying, and nagging me to take my medications and take care of my myself, and I can't imagine doing this with anyone else. 

It truly takes a village. Here we are three days postpartum. My parents and sister have been bringing me a different herbal soup and other delicious foods/snacks every day during my confinement. Uram's parents check in from Korea frequently to make sure we and the babies are surviving and thriving. Friends are constantly asking how they can help.  It's so comforting to know that it's never been just the two of us, even more so now that two became four. 

I've never been more tired -- not in medical school, not in residency. But for the first time in my life, I have never questioned whether the struggle or adversity are worth it or whether I could have been happier doing something else. When I look into my girls' faces, my sassiness mixed with Uram's anxious eyebrows, I know I have been gifted with a new purpose. 

It's a new year, new me, new bigger family.