The 4am Teeter-Totter

At 4am, I woke up as if someone had kicked me. Nobody had done such a thing.

In the dark, I stared at my phone which was charging on my nightstand. I stared at it and expected it to ring.

It didn't.

So I decided to call the NICU to check up on my boys and found out that Cameron wasn't having a good night. He's okay, which is why they didn't call me. But he's struggling. 

I had noticed he was having more A's and B's than usual the day before and was a little bit concerned. A's and B's are when they stop breathing and their heart rate gets low. A=Apnea. B=Bradycardia. This causes their oxygen levels to fall. But the CPAP mask doesn't work as well as the prongs and can explain is increased number of A's and B's.

In the past, when he starts having more than usual, it means something is going on. Last night, the nurse was having to intervene by patting him on the back, moving him around, etc. Anything to wake him up enough to get him to remember to breathe. She's one of his primary nurses which are nurses we've asked to be assigned to each boy when they work so they get to know them well and know when something is "off" but isn't showing in labs or vitals just yet. It's an extra level of protection for my boys. 

She knows Cameron well and knows this was unusual for him. Being a small premie, the part of the brain that reminds them to breathe isn't completely developed yet. Some A's and B's are expected. 

The nurse said his caffeine dose was changed from twice a day to once a day. The caffeine helps remind them to breathe. It sounds like they'll probably go back to twice a day.

More evidence that something is going on is his HeRO score. The HeRO score is constantly calculated by his monitor and is an early indication of infection. It's based on his vital signs and goes up to 7. The lower the number, the better. Cameron has been floating around at a 3, but as of late is a 7. 

The other problem is he started to get bruising around his nose where his mask sits, a sign that his skin isn't taking the pressure of the mask. They switched him back to the prongs which scares the crap out of me because that's what damaged his nose in the first place. They positioned them carefully and the plan is to rotate him between the mask and prongs if his A's and B's settle down. If not, he may get intubated. The number of A's and B's he's been having concerns them because he's having too many. 

They took a chest x-ray and his lung expansion wasn't the greatest which is something else that may push them towards intubating him. And as a reminder, being on the ventilator damages their fragile lungs. It's always weighing the cost/benefit of each procedure or medication. There's always a downside. 

Wyatt is having a good night though. His PICC line went in nicely. He's tolerating his food. He's been stable.

They seem to teeter-totter. When one is up, the other is down. Wyatt was the one who's been down and Cameron was up. Sounds like they've decided to switch. 

I hope they figure out what's wrong with Cameron quickly. Last night was his last dose of antibiotics for an infection he's been fighting.

You can see the sore starting on his nose from the mask despite all of the foam and protective barriers they've used. Poor guy. 

I want them to be better. Just fat, happy, healthy babies in their cribs with no IVs, no tubes, no tape.

Current news

Today the Tiny But Mighty would be 28 weeks gestation and are almost three weeks old. A lot has happened in those three weeks, many ups and downs, but they're fighting like warriors and Nick and I are so proud of them.

Wyatt is currently on a ventilator. Just a few days ago, he was taken off of a machine called The Jet. As best as I understand it, it oscillates puffs of air to keep his lungs open. He's been taken off of it before then needed it again, so when they took him off this time, I noticed The Jet was still on his rack of life support. Today when I came in, it had been removed which says something about their confidence in him.
He is fighting pneumonia however. He had just gotten over some pulmonary hypertension issues only to get pneumonia which brought back a little bit of his pulmonary hypertension. His oxygen needs are low. The nitric oxide they use to treat the pulmonary hypertension is low as well, so he's doing good all things considered. He's on a 10 day course of antibiotics, possibly 14 days. He's had two 7 day courses of antibiotics and always two days after, he tanks. So this has been a stubborn thing that they're hoping just needs a longer course of medication. The poor guy had all of his IVs removed and was taking all his medications by mouth (which actually means through his feeding tube), but for the antibiotics, he needs a PICC line. This will be his second and I hate that he has to get poked so much, but it's what he needs to get better. His electrolytes looked great as well as his blood gas so they were going to wean him off of oxygen a little bit.
We can determine how good he feels by how much he looks around. When he's feeling good, he's very responsive to my voice and tries to find me. It makes my heart go pitter-pat when he does that and today he was looking for me so I know he's feeling better.
A few days ago was a different story and it was breaking my heart. I'm so happy he's back to using his sweet little peepers again.

Cameron has been doing well. His tummy has been having a hard time waking up so they've had to give him my milk over the course of an hour for him to tolerate it. But tonight, they're going up on his feeds because he's doing so well with it. They're also fortifying it (2 additional calories!) to give him a boost as he's a little behind on his weight gain. Depending on procedures and how they're doing, sometimes both have had to have feeds withheld. Since Cameron was slow to come around with feedings, he's behind.
He's also been off the ventilator for a while and is on CPAP. But we've had a setback. For reasons not clear to us yet, the CPAP prongs rubbed his nose which created a wound which then turned black. Long story short, the piece of his nose that separates it into two nostrils died and his now gone. He looks like he has one large nostril.
We are devastated. Our handsome little boy. I came home and was just about inconsolable for about 24 hours. We had prepared ourselves for health problems, but not disfigurement.
Plastic surgery has been consulted on this. Though I haven't talked to them (they're supposed to call me soon), it sounds as though he still has two nostrils and some structure is still there. The wound is healing well and not progressing. The NICU changed his CPAP to the CPAP mask so his nose can heal.
The issue with the mask is that it has to put pressure on his face which can cause his fragile skin to break down. They've got some foam and so far his skin is handling it. If his skin starts to break down, they have to intubate him. The problem with this is that the ventilator damages their lungs, can give them chronic pulmonary disease and Wyatt already shows signs of that.
The nose thing is cosmetic and would be something to fix when he's older.

I think it can be fixed.
I hope it can be.
I have a lot of questions for plastic surgery, needless to say.

Healthwise however, he's doing really well. We get to hold him, though keeping his mask sealed while doing so is proving to be a challenge. But, he can get his skin-to-skin snuggles once a day most days.
We can't wait for Wyatt to improve to the point of us being able to hold him.

And that's the difference for these very early babies. People often think they're just like full term babies, only miniaturized. But they're not.
You can't lift their bum too high while changing diapers because they can't deal with the blood pressure change.
You can't touch and talk to them as much as you want as the stimulation is too much.
You can't stroke their face to console them. If you can do skin-to-skin holding, you can't rock them, you can't pat or stroke their back. It's too much.
You can occasionally talk quietly to them. You can occasionally place your hands over their legs or body, but stay real still to simulate the womb or you'll upset them. You can change their diaper and take their temperature at 8am, 2pm, 2am, or 8pm. But that's really all the interaction we can get with them.
I want to rock them, cuddle them, kiss their sweet face, and tell them over and over how much I love them. But right now, it's not good for them.

When we visit, we spend hours just sitting and staring at them in their isolettes. We watch them sleep, watch them twitch, trying to will their health to improve. We judge their coloring, the shape of their belly. Is it bad? Is it good?
Is he comfortable? Is he okay? Will he be okay? When will they be stable enough to move out of the most critical care room?
For hours we watch their heart rate and their oxygen saturation go up and go down. We spend hours listening to alarms go off because their saturation and/or heart rate dropped too low and we watch the nurses revive them. Those alarms make our own hearts stop. We hold our breath each time. But this is all normal premie stuff.
You're constantly attached to your phone. Every noise it makes, every hour of every day...is it the NICU with bad news?
The stress is an unrelenting pressure in our chests. It tests our stamina, our sanity. But we must stay strong for our boys.

They rarely have a good day at the same time. We're almost always worried to the point of nausea about one of them. But they're fighting and doing everything we ask of them. Such tiny but mighty little boys. We're so proud of them.

Wyatt

I got to hold Wyatt for a few moments as they changed out his isolette.


Cameron

The Support

Now that the labor and delivery story is up, this blog will be more about updates on how the Tiny But Mighty boys are doing.

But before that, I wanted to take a moment to thank everyone for the amount of support they've shown. 

To my friends and family,

Whether it's a kind word, cheers for my boys, asking how we're doing, advice from those who have been there, or donations to their medical funds. Thank you. 

To Nick's co-workers,

I know time he had to take off work put more on your shoulders. But you generously took that on, brought us food, brought them prayers, well wishes, and even a very special blessing. Thank you. 

To my off-road friends,

For such a tough group of people, you've made the soft spot you have for others, especially kids who are struggling no secret. From prayers, well wishes, the laughs, to donations to their medical fund, thank you. 

To my neighbors,

We moved here only a few months ago but y'all have been so generous with support. Since I've been home from the hospital, we haven't had to cook a single dinner. Y'all have provided us with nutritious, tasty meals and even some treats. That and your prayers are something we've really appreciated. Thank you.

To the NICU,
Thank you for saving my babies and for helping them fight. The care they're getting is second to none. 

We're extremely lucky to be surrounded by great people. 

Labor and Delivery, pt 3 - They arrive!

About 7pm, as if a switch was flipped, my entire stomach contracted.
We'd had a long day of testing and procedures. At 8am I was at the connected children's hospital for a fetal heart echo. They wanted a cardiologist to look at the boys' hearts because Twin to Twin Transfer Syndrome can cause heart failure, backwards blood flow, and other problems.
It was a two hour long ultrasound on a rather uncomfortable table. I was squirming by the end of it and all the pressing on my belly was causing cramps.
After that test, I went to see the Maternal Fetal Medicine (MFM) specialist. There, the boys got an anatomy scan and we weighed the pros and cons of an amnio reduction. Baby B, Cameron, had too much fluid and his heart had abnormalities which told them he was feeling the stress of dealing with all of the extra fluid. Since the laser surgery was off the table now, an amnio reduction was the only thing we could do for them.
The benefits I was most interested in was that some of the pressure would be relieved and blood flow in the placenta would be improved. Also, relieving some of the pressure might keep me from going into labor so easily.  As it were, I would have contractions just from brushing my teeth. This wasn't a fix, just a bandaid that would hopefully keep them in there longer.
The con, it could bring on labor. And the doctor explained that if they were born now, the odds weren't with them. Labor would be a 1-2% change.
Of course we could simply monitor them and if they stayed in, they could wait until they were so sick that they were better off out than in. That day, they were better off in.

Nick and I discussed things and chose to do the amnio reduction. We knew the risks of doing nothing and the babies did not fair well. We both were of the mind that if we lost them, we couldn't live with ourselves if we'd done nothing.
The doctor removed over a gallon of fluid from Cameron's sac and he still had plenty to spare. I had minimal cramping, less than what the ultrasounds caused. I felt better and the doctor sent me back to my room.

Then they called us back to do a biophysical profile of the boys. It was basically another ultrasound. By the time this was done, it was about 5pm. I had endured about 6 hours of ultrasounds that day, each of them causing me to cramp.

Just before 7pm, things changed. It felt as though a fist was squeezing my insides with purpose. It wasn't painful, but it wasn't like the cramps I'd been having. Three minutes later, I felt another.  Three minutes after that, another.

I called the nurse.

She gave me a sheet of paper and a pencil. I was to draw hash marks for every contraction I felt and they would determine how many per hour I was having. Thirty minutes later, I had drawn nine hash marks and the contractions were getting stronger. I had suddenly, without warning, without any slow gradual increase, leapt into having 15-20 contractions per hour.
The nurse put me on the monitor which meant she and one other nurse had to sit and hold the monitor over my babies.
Their pushing on my belly with the monitors only made the contractions worse which had now added cramping to my misery. They handed me a button to push with each contraction.
"This is worse than when I originally got here," I said to the nurse. They paged the doctor.

I kept pushing the button with each squeeze I felt. I couldn't see how I could be having these types of contractions and not be dilating.
Word came back that the doctors were in the OR or tending to other emergencies, but they'd be down as soon as they could. It wasn't the answer I wanted. Just hang the magnesium. Give me the pills that stopped this before. I couldn't have my babies now. It was too soon! Too soon!

I labored for two hours before a doctor was finally free. I had lost complete control of my body. I laid on the bed, shaking uncontrollably from pain and the anxiety of being in labor at only 25 weeks gestation. I had gone from 2.5cm to 5cm dilation. No, no, no! My nightmare was continuing. Labor was progressing. My little boys! I couldn't lose them. I'd lost two babies before these two boys. I couldn't go through this again. How would I find the strength?

The doctor decided to transfer me back to labor and delivery where I would be started on magnesium and other drugs to stop labor. But their rooms were full so I had to wait.
Meanwhile, my contractions kept getting stronger, more frequent, until they finally seemed to run together.
"This contraction won't stop," I complained, gripping the bed rails with white knuckles. They reassured that they were working on a room for me.
"I'm not going anywhere, I'm right here," my nurse said to me.
I was already experiencing pain I'd never felt before, then suddenly it ratcheted to an entirely new level. The pressure was intense. I hadn't taken any birthing classes yet. I had no idea how to deal with the pain and pressure, but I knew exactly what it meant. I clamped my knees together knowing what was coming.
"I feel like I need to push," I said through unshed tears.
"Like you need to have a bowel movement," the nurse asked.
"Yes!" I punched the plastic bed rails over and over to distract myself from the pain, from the overwhelming pressure. Please, stop. Not yet babies, it's too soon!
"Don't push," a chorus of nurses said to me.
"I know," I ground through my teeth.
The nurse caught the eye of another nurse. "Lets just take her over," she said in a decision that likely saved my babies.

The contractions were relentless. I held my knees together, fighting with every fiber to not push. I punched the bed rails, I cried out, anything to keep those babies in.  The pressure though. Oh God the pressure.

The doctor checked me again. Holding babies in while the doctor checked my cervix was a feat equal to lifting cars off of children. Everyone in the room quietly waited for the doctor's next orders. "Okay," she said to me. "You're going to have this baby vaginally."

I looked at Nick as I hugged the bed rail. A tear slipped out, "It's too soon." Too soon.

The doctor barked orders. "Call anesthesia! Get her to the OR!" It was a whirl wind of controlled chaos, but all I could focus on was not letting Wyatt come out yet. It could kill him.
With her hand still inside of me, pushing Wyatt back, she apologized for how crazy things seemed. With one hand she put on a mask. She straddled my legs as she rode on the bed with me to the OR.

Masks flying, equipment and carts wheeled about. NICU's readiness was confirmed. Somehow I managed to crawl onto the operating table without birthing Wyatt during the transfer. As I laid down on the table, I felt my water break.

Before I could contemplate that, an anesthesiologist was over me. I was breathing like I was sprinting towards a finish line. He clapped a mask over my face which seemed to pinch my nose closed, suffocating me. I wrenched it off immediately. "It's oxygen! It's good for the babies," he said and slapped it back on. For the babies, was all I needed to hear and I held it in place for him.

Lots of things happened in what seemed like an instant. And ultrasound, an IV placed, none of which I was aware of. I was simply straining to keep my body from pushing Wyatt out. I was losing the battle, but I'd fight to the bitter end. Not yet Wyatt. Not until they are ready to help you, sweet boy.

"She's obviously uncomfortable. I'm going to have her push," the doctor announced over a conversation about the IV.
A nurse appeared over me. "Push...like you're having a bowel movement. Curl your body around that baby and push."
That I did.
"Whoa! Not so fast!"
Two pushes and I hear, "We have a baby and he's trying to breathe. Lara, he's trying to cry!"
I couldn't hear his little voice, but that he was alive was enough to celebrate. He wasn't even far enough along that he should be trying to breathe. By some miracle though, he was.
I didn't even see Wyatt. NICU quickly whisked him away. Saving his life was more important than me taking a precious moment from him to see him. Besides, Cameron was next in line.

"Baby B is transverse. Prep for c-section!" Cameron was laying sideways across my cervix and couldn't come out that way.
"Take some deep breaths," the anesthesiologist said to me. At that point, I completely gave in. Things were out of my control. One baby was here, the other soon after. At that point, I really wanted to just run away from everything, something the anesthesia would give me.

It seemed to take forever for the gas to work. And it would be gas, not an epidural. They didn't have time for anything else.
He showed an assistant or nurse, maybe a resident or student, I'm not sure which, where to press on my throat to prevent me from aspirating when they put me under. I slapped his hand away and rather than argue with me, he waited until the gas did its job.

Ten minutes after Wyatt was born, Cameron came into the world. At 9:17 pm, Wyatt was born. By 9:27pm, they had me knocked out, cut open and delivered Cameron.

While I was in a tornado of activity, Nick had been dressed in scrubs and put in the recovery room. Initially, they were going to have him there. But things were moving too fast and too much was going on. It was okay because saving the babies lives was the most important. We can look at them later, if they survive.
A nurse would come in to update him and even took pictures of the boys. But during all of this, Nick mostly stared at a wall. All he could do was hope, pray, everyone would be okay.

Slowly the anesthesia haze lifted and I came to. Unfortunately, the anesthesia wears off faster than the pain meds kick in and I found myself in as much pain as when I was in labor.
Nick says I was nice about it though. I would wave my hand over my stomach as if I were casting a magic spell and give a pitiful sounding, "Hurts." I would learn later that having a c-section after a vaginal delivery is about as painful as it gets.

They connected the dilaudid pump plus a few other pain meds. I struggled to keep my eyes forward as we got updates from the NICU, from doctors, from social workers. The boys were still hanging in there.

My night was not done though. As soon as I was concious, they began "uterine massage". Every hour, someone would come in to press on my stomach to help get the uterus to shrink back down and clamp off any bleeding. Ugh!

After I had recovered, they wheeled me back towards the OB floor. But we made one important stop at the NICU and I met my two precious boys.

Labor and Delivery, pt 2

Either by design or by mistake, the large rectangular window near me on the helicopter was just out of my view. All I could use was the lower corner closest to me but my view was mostly of the night sky. The sun had long gone leaving no color to the sky. Pitch black cloaked the mountains and I could see a few twinkling city lights if the helicopter tipped enough. I stared at what were light grey walls in the dark, watching medical equipment swing with the movement of the helicopter and feeling a constant vibration I assume comes with every helicopter. It's not a floaty feeling like an airplane. It's kind of a grit your teeth and hope the thing holds together feeling. Someone had a flashlight they'd turn on I assume to look at me, IV medications, or other necessary things. Occasionally, objects swirled together as tears filled my eyes. I managed to blink them back, but the weight of the situation still pressed on my chest, on my heart. My babies.  Please protect my babies.

The pilot expertly navigated the brick-turned-bird to the hospital and we swooped down, circled, and then landed with a gentle thud. Except for the flight nurse asking if I was okay, everyone was quiet while the helicopter powered down. 

Cool air skipped across my face as the door opened. As gently as they could, they unloaded me and wheeled me into Labor and Delivery. I was helped into a hospital bed in my own room with a closed window to my left that I'd learn later was not to the outside, but was to the NICU. My room became busy with activity similar to the last hospital. They confirmed information from me, they got my side of the story. They took vitals, checked medications, asked how I was feeling. 

"I'm okay," I said to them. Things had calmed down at least. I wasn't in any pain, just somewhat scared.

The doctor soon came in, introducing himself as a resident and telling me who his attending physician was. He asked my side of the story, checked if I had dilated anymore, which I hadn't. Then the nurses came at me with that blasted monitor.

We hadn't given the babies names yet and so they were referred to as "Baby A" and "Baby B". Baby A earned his letter by being the one closest to my cervix. He was also what is called the "donor" with their Twin to Twin Transfer Syndrome. His fluid levels were much lower than Baby B who essentially had an Olympic sized swimming pool to float around in. This would cause me and the nurses much grief.

The nurse applied gel to my stomach and, with a disc attached to a cord, slid it around my stomach, hunting for Baby B. With each press of the disc, I could feel the cramping start. I knew they needed to check a heart beat on them, but I was slowly trying to scoot out from under them with my behind. 

As soon as they'd get a heart beat on Baby B, he'd swim away to another part of my abdomen. And while he darted every direction, poor Baby A was pinned to the wall of my uterus by Baby B's insane amount of fluid. They could usually find Baby A fairly easily. And if they got two heartbeats, there was always a discussion of whether or not they have two babies on the monitor or if they were capturing the same baby.

After an hour of torture and cramping due to my belly being pushed on, they called in the doctor who did an ultrasound to find Baby B. And even with the ultrasound, they couldn't catch him. The doctor could see him, the nurse would put the disc on my stomach, and then Baby B would swish away, applying a well aimed kick to the disc to confirm just who was in charge.

I was trying to find a happy place as I had about had enough when the doctor said, "Well, we have them on sono and they're happy with a good heart beat. So lets just monitor them by ultrasound."

And so was the routine for the next several days. I'd take medication, they'd check on the babies, I was ordered to stay in bed and to let them know if I needed to go to the bathroom. Once they were certain that I wasn't about to deliver at any moment, they sent me to the regular OB floor. This is where I would stay until a fetal heart echo could be done on the babies and a Maternal Fetal Medicine (MFM) specialist could see me.

And so I relaxed, took medicine, ate, and tried to get some rest. They even talked about sending me home. It was a good few days until 7pm on a Tuesday night after a long day of tests. 

I worked in an Emergency Department and often rolled my eyes at the drama television injected into their medical shows. I had never seen anything unfold the way it did that night, the night my boys were born, except on TV.

Labor and Delivery, pt 1

Though my mind was spinning with possibilities and I was pretty uncomfortable, I feel like I did a good job walking into the Labor and Delivery department looking calm and under control. 

Once all of the paperwork was filled out, I was taken back alone to be weighed. I had gained another three pounds in the span of just a few days, all fluid from the Twin to Twin Transfer Syndrome (TTTS) affecting my babies. Ugh, it was progressing, the surgery is supposed to fix it, but now we had a complication on our hands with the spotting. 

I mentally collected myself. Lots of women have spotting and it turns out to be nothing. I had read. Right?  

They whisked me away to a room. Nick followed closely. Nurses, patient care techs, they all came in strapping things on me, taking measurements, asking questions, getting me into a gown. A flurry of activity that stole my thoughts. I wasn't thinking at that point, just giving myself over to the medical professionals and simply being. 

The doctor came in and introduced himself. He was one of the doctors in my doctor's group. I had never met him, he'd never met me. But he would later work some miracles which I feel is a big part of why my two boys have a chance.

After introducing himself, he tells me he has to look and to assume the position. All of the cramping intensified during his exam, as the nurse had promised. But his findings drove fear into my heart. "You're dilated 2-1/2 centimeters and 80 percent effaced."

What?

He looked concerned.

I got really concerned.

"The baby's head is right there," he murmured to the nurse who had been running a monitor over my belly, pushing way too hard, trying to get my babies' heart beats. I would learn to hate the monitor.

He ordered a lot of medications, some of which he promised will make me feel horrible, "but it would help to stop labor."

Labor? Excuse me? I was only 24 weeks! How could I be in labor!! I was walking around just an hour ago! No, no! I was supposed to have surgery and give birth ten or twelve weeks later to two healthy baby boys. This wasn't happening! This couldn't be happening! Why was this happening?

They started an IV and bag after bag was hung and connected to my arm. I swallowed four giant pills of the same medication, some sort of super Ibuprofen. It and magnesium would try and stop labor. 

About 30 minutes later, the general discomfort began to ease. I wasn't cramping as much but I did feel the hot flash brought on by the magnesium. Things started to settle, or so I had convinced myself.

The doctor returned, asked how I was feeling. 

"Better," I said and he gave a passive nod.

"We need to transfer you because if these kids come, they'll need a NICU with higher level care. I need to make some calls. Let me check you again."

Luckily, labor hadn't progressed and the doctor left to make his phone calls.

The doctor returned again. "I can't get you transferred to the hospital I wanted because their NICU is full. But we have a second option. I'll work on that." I still couldn't process what was happening. Were the babies going to come tonight? And at a hospital that wasn't the first choice? Why was everything suddenly going so wrong?

I can't remember why, but Nick had to run home and the nurse confirmed that he had time. A few minutes after Nick left, the doctor returned. 

"I got you in to the first hospital. The helicopter will be here in about thirty to forty five minutes."

"Helicopter," I asked. My eyes about fell out of my head. I had figured I'd go by ambulance.

"Yes. The hospital is a forty five minute drive from here and if those babies come in the ambulance, they won't survive. So you're going by air," he said. 

I text Nick:



"What about Seattle," I asked.

"You're not going to Seattle," the doctor said.

I let my head fall back against the pillow. Did I say a prayer? I don't know. I was too stunned to even cry. 

The flight crew arrived to the room just before Nick did. They asked questions, took information from the hospital staff. I was instructed to lay on my side. They wrapped a sheet around me to protect my dignity and strapped me down onto their gurney. Buckles and straps went all over me, clinking and clacking together, buckling with a snick. The crew was extremely polite and kept conversation light.

The hospital doors slid open and the cool air hit me. Lights slid across the shiny paint of the red and white helicopter as they pushed me towards it. As an EMT, I had sent a patient by helicopter, totally unaware of the impact it would have had on my patient. 

I was the patient now and as they slid me into the back, it finally began to dawn on me just how serious this was. My babies' lives were in jeopardy. I wanted Nick there with me.

As the helicopter whirred to life, my eyes filled with tears and my chest heaved. Please, baby boys. Stay put. 

But I would quickly learn that I had absolutely no control over the situation.

Wyatt and Cameron knock, knock, knocking on cervix' door

I've been told that I'm one tough cookie. As much as I'd like to believe that I'm in possession of an extreme amount of fortitude, it's more likely that I'm simply one dense cookie. Dense cookie like the first ones you ever made for a boyfriend or girlfriend. Dangerous, inedible, weapons of drywall destruction should you fling one at a wall. No bounce at all, just a heavy thud if you drop one on the floor. I wouldn't use the 5 second rule in this case. Just consider it a loss and keep the dog from eating it to avoid the 3am diarrhea they're sure to get from said dense cookie.

For a week, I'd been uncomfortable. I'd toss and turn in bed, unable to find a good way to sleep. My stretched belly felt like it should split right down the middle if I so much as twisted or bent wrong. It was like a balloon inside of me kept expanding. My ribs constantly ached and riding in a car made it seem as though my rib cage was about to pry open. My right side ribs were the greater offender and I'd press on them for a little bit of relief. I squirmed around constantly. I was 24 weeks and looked full term. But twin pregnancies are known to be uncomfortable. So I put up with it not knowing it was actually prelabor. These are the things dense cookies do. They ignore signs.

I was 24 weeks and 4 days when I saw my maternal fetal medicine (MFM) specialist. He measured my cervix. It was 4.5cm or there about. Fluid levels on Cameron were above normal. Wyatt had low levels, but still normal. It was Cameron's heart that caused my MFM concern. His heart showed signs of stress in trying to deal with Twin to Twin Transfer Syndrome (TTTS). There was a little bit of thickening on one side of his heart and so my doctor diagnosed them with stage III TTTS and recommended Fetoscopic Laser Photocoagulation. The procedure would split the placenta in two and stop the TTTS. If everything went as planned, I'd carry to 36-37 weeks. The procedure comes with risks, including a 40% chance of one of them dying. However, if I did nothing, there was an 80-100% chance of both of them dying.

I would have to fly to Seattle to have the procedure done. My appointment was set up for that Monday at 8:45am. I was instructed to fast just in case they take me into surgery right away, since TTTS can worsen rapidly. If I didn't have the procedure Monday, they'd wait until Tuesday.

Things were happening so fast. I was scared to death that I could lose one. I was also a bit relieved. There was a procedure that could help. We also had a diagnosis and a plan. Even before TTTS showed up, I was worried about it to the point of researching it nearly every hour I was awake. I'd learned that increased protein could help prevent TTTS or at least help it from progressing. And so I managed to ingest 200 grams of protein daily. I felt like I had a brick in my stomach 24/7.  There are many cases where TTTS remains at stage I and all they do is closely monitor. I was not one of those cases. Left alone, mine would progress with dire consequences.

At 24 weeks, 5 days, we had our hotel and flight arrangements made to the tune of $1800. Everything was listed as medical. The airline gave us a $200 discount due to it being an emergency surgery. The surgery center we'd go to had a deal with some hotels near the hospital. We found a place to board the dogs that I was happy with. "Cage free boarding" the place was so they wouldn't be locked in a kennel for the next 5 days. Everything had worked out so smoothly.

After dropping off the dogs, we stopped by my husband, Nick's, office because I had to use the restroom for the twentieth time that day. That's when I noticed the spotting and my heart screeched to a stop.

I called my doctor who recommended I go to labor and delivery. I told Nick we had a change of plans. The amount of worry consuming me for the 45 minute drive from our location to the hospital was but a ripple in the ocean compared to what we were about to face.