Thursday, April 24, 2014

Who They Are -- M

M is a baby.

She was born at 31 weeks gestation and tested positive for exposure to multiple drugs. She spent a month in the NICU at the hospital in which she was born. When she was discharged, she went directly into foster care.

Her mother also tested positive at the birth for drug use. She admitted to one of the drugs, claimed the others "must be what the nurses gave me for pain." (That's, um, not possible.) M is her 3rd child. Her first two were already removed and her rights to them were terminated last year. I'm told that she made virtually no attempt to work her case plans for those two children, insisting that she did not have a drug problem and did not need rehab, regardless of what the case plan required. The oldest is currently in the works to be adopted by her foster family; the younger (now middle) child is already adopted by a paternal family member. All three children have different fathers.

When we were called about baby M, we were told there was a "high likelihood" of her becoming available for adoption. It was important that her foster home be willing to adopt her, if it came to that, to minimize the number of moves in her life. We agreed.

There are no resources available in biomom's family. The caseworker was unsure about biodad's family, but doubted anything would come of that. In our state, having prior TPR's does not mean you automatically lose rights to future children, but it is grounds for DFCS to request permission from the judge to skip the will-the-parents-work-the-case-plan step.

It's still too early in the case to know if she really will become a permanent member of our household, but it is much more likely than any of the other cases have ever been. (The closest previously was S, whose mother stepped up, worked hard and got her daughter back.) I'm hearing mixed messages. I heard the judge tell BioMom that DFCS would work with her and "hand her baby back" if she did what she needed to do this time; the caseworker told me she is having a "staffing" in May in which she will request permission to file for TPR. Caseplans were written and given to both parents last week. They have weekly, two hour visits, none of which have actually been two hours (they have either been significantly late or left early at every visit.). My current mantra is: it's too early to tell what will happen. I think the month of May will be revealing -- will TPR get filed? will there have been any progress on the case plans?

Right now, she just eats and sleeps and fills her diapers, blissfully unaware of the uncertainty swirling around her future.

Monday, April 21, 2014

Newborn Fog

The state keeps sending me younger and younger kids.

I think this was deliberatly planned to ease me back into night-time feedings. Because, good heavens, if we'd been doing this 3 years ago, when Edmund needed me to help him get his breakfast in the mornings and Susan needed me to remind her of each step in her morning schedule to get out the door and even Peter would sometimes get distracted and lose track of what time he needed to leave the house for the bus....I never would have survived it. Now, though, they can all get their own breakfast, they generally get themselves ready and out the door on time; all I'm really doing is packing their lunches. So, for now, I'm doing that the night before, just in case M has a rough night.

Generally, though, baby M is doing fabulously. At just over 2 months of age, she's finally passed her due date, making her adjusted age positive.

(Early Intervention came out to do her initial assessment before her due date. The worker told me, laughing, that there really wasn't much point to it yet...she just wanted to get her into their system for later and she'll come back in a few months. Development for preemies is assessed based on their "gestational age" -- the age they would be if they'd been born on time. When EI was here, her adjusted age was "negative 1 week." Developmental goals? Eat. Sleep. Grow. Keep breathing.)

Speaking of breathing, there have been no more scary incidents leading to hospital stays.

But she is eating every 3-4 hours around the clock. And each feeding takes about 30 minutes, plus a few more minutes to mix up a bottle of formula (or warm one from the refrigerator) and then clean up afterwards. So that means our sleep mostly consists of a series of 2-3 hour naps. Mr D takes a turn when he can, but since I can nap during the day and he has to go to work, that mostly consists of taking the last feeding before bed, so I can go to bed early. Even with that help, I'm spending most of my days in the hazy land of not-quite-enough sleep that I like to call "newborn fog."

She's growing like crazy -- already outgrown some of her preemie clothes. The 0-3 month clothes are still a little big, so she's hanging out in "newborn" size for now. As she gets bigger, she will begin to be able to go longer without eating -- already, last night, she slept for a 5 hour break between feedings -- and before I know it, she will sleep through the night. At which time, I will wake up and run to her room, terrified that she's stopped breathing again and then not be able to go back to sleep because of the adrenalin surge caused by that panic. But eventually, she'll do it regularly enough that I will expect it and then, oh, then, I will truly get a good night's sleep.

Saturday, April 5, 2014

...and a Crazy Day!

I answered the phone and Mr D told me that he was still at the hospital, M was fine, but he was exhausted and I should check my texts and call him back. He had sent me text updates as things happened, knowing they wouldn't wake me, and that way the timeline was clear and coherent as it would not have been if he'd tried to tell me about it by the time we were talking. (He's a smart man.)

The children's hospital had not agreed with the emergency room's plan to send M home. Instead, they wanted her transported to their emergency room, via a special pediatric transport ambulance. Mr D waited 3 hours for the ambulance, because there's only one and she was now pretty low on the triage list for it. (After all, she was stable and in a hospital.)

Around 3am, she was in the children's hospital ER and nurses were attempting to take blood. That was when it happened again. Monitors went crazy and she began turning blue again. One nurse ran out of the room, carrying M and giving rescue breaths as she went. Another paused long enough to tell Mr D that they were heading to a trauma room immediately because M's heart and respiratory rates had dropped dangerously low. Once they had her stable again, she was admitted.

When Mr D and I spoke on the phone, they were in a PICU (Pediatric Intensive Care) room. He had an idea for a plan for the day, so we discussed it. I would get the respite boys up and take them with me to take Peter to his event, drop Peter off, come home to meet person picking up the respite boys, then go back to the event. Seemed like the best idea and it worked fairly well. (The sporting event was the opposite direction from the person who was coming to get the boys, so it wasn't realistic to change that plan, even if I had wanted to call that person -- who I didn't know -- that early on a Saturday morning!) In the end, I missed all of Peter's actual competition, but he was graciously understanding, which was a relief.

M was transferred from the PICU to the NICU on Saturday afternoon, at which point Mr D finally came home. She had spent a total of about 24 hours in our home before returning to the hospital.

...Followed by a Scary Night...

I survived the afternoon with the 3 year old and the baby. (How did I do this every day when Susan was born and Peter was not-yet-2?) Peter was invited out to dinner by a friend to celebrate his birthday, so he left the house before Mr D came home from work and took the next baby feeding at about 6pm. While the baby was eating, I fed the other kids dinner, with Mr D and I planning to eat together after all the kids were down for the night.

That didn't happen.

M had mostly finished her bottle and Mr D was trying to convince her to take a little more, when he suddenly went very still and stared at her. He called me over and asked if her color was OK, hoping what he was seeing was a trick of the fading light.

It wasn't.

She had stopped breathing and was turning blue. We immediately began tickling her feet, moving her arms and mentally rehearsing infant CPR steps....when she suddenly inhaled again. Her breathing was uneven and choppy for a few minutes and her color slowly changed from blue to white to her natural skin color again. She was OK, but now what?

It didn't seem right to call 911 now. The emergency was over, wasn't it?

It wasn't possible to just assume everything was OK and go back to normal. We were both terrified to take our eyes off of her now, knowing that the only reason we had known she'd stopped breathing at all was that Mr D happened to be holding her and looking at her at the time. How could we possibly sleep tonight?

So, we called the pediatrician's office to ask what to do. They told us to take her to the emergency room, but to be sure that a second adult was in the car to sit in the back with her just in case it happened again while on the way. (If it did, we were to pull over immediately and call 911.) Well, that could be tricky.

At that time, we actually had 2 adults in the house. But we also had a 3 year old foster child, who we certainly weren't going to take to the emergency room. The 1 year old was still off with Marcie. We also had Susan and Edmund, who we would have left at home alone in an emergency, but couldn't leave in charge of a foster child. After staring at each other blankly for a few seconds, Mr D and I agreed we should call the caseworker. Maybe she knew of someone nearby who could come sit at the house for a while....

Mr D explained what was going on. Unfortunately, the caseworker didn't have an immediate idea for someone to call. She asked if we would be comfortable with any of our biological kids in charge, prepared to break the rule about caregivers for foster kids because of the emergency. But, the only child we would leave in charge of a 3 year old was out at a birthday dinner. While we were all desperately trying to brainstorm a solution, it rang the doorbell. Marcie was back.

After some discussion, the plan was formed. Marcie rode in the car with M while Mr D drove, leaving Marcie's car in our driveway. I stayed at the house with the other kids and got them to bed. The caseworker met Mr D at the emergency room, intending to drive Marcie back to our house to get her car, but Marcie called a good friend to pick her up instead, so the caseworker ended up staying at the emergency room with Mr D.

The nearest emergency room is not a children's hospital, but it does have a separate children's emergency department, so that's where they went. M spent almost no time in the waiting room (preemies are very high on the triage priority list!), and the doctors and nurses were pretty sure it was sleep apnea, something very common in preemies. At about 10pm, Mr D told me that they were probably going to discharge her soon, but had put a call in to the nearby children's hospital (where N had his surgeries) to get their opinion first. I went to bed, expecting that he would be home sometime in the wee hours of the morning and wanting to be sure that at least one of us was rested for the next day. Because the next day was already going to be busy. Respite boys were to be picked up at 9am, Peter had a sporting event in the morning where he (and an adult to drive him) needed to leave the house around 7am and would be back around 1pm, immediately followed by a birthday party that afternoon.

I woke to the phone ringing just before 6am, with no Mr D in the bed beside me.

Friday, April 4, 2014

Crazy Week....

So, Baby M was supposed to come to us on a Monday, direct from the NICU.

I was meeting the foster mom of the respite boys for the handoff on the Wednesday, mid-day.

We spent Monday morning scurrying about, doing everything we could think of that might need to be done in the next week. Caught up on laundry and ironing, grocery shopping done, bedrooms prepped for kids to arrive, pack-and-play set up in our room for the baby. Early Monday afternoon, we got a phone call that the baby wasn't coming today after all. She'd had "a rough weekend," the hospital said, and they would keep her until Thursday, probably not arriving here until early evening that day. (The "rough weekend" was later defined as a drop on one of her monitors, the hospital insisting that it was so short that it wouldn't have even been noticed if she hadn't been on the monitor already.)

Well, that was OK, we thought. It meant the first day and half with the respite boys would be just them. It meant we'd really only have Friday when we would have 6 kids in our home as the respite boys were set to be picked up Saturday at 9am.

The respite boys were a lot of fun. The 3 year old was lots of energy, lots of questions, lots of playing with trucks and trains and blocks and crayons. The 1 year old was cuddly and easy; he ate, he slept, he crawled slowly across the floor to pick up things and then hand them to me. We did some fun stuff on the Thursday -- go to the park, make some muffins, play with Play-dough -- knowing that Friday would be very much a survival day. Unfortunately, the 1 year old had a touch of the sniffles. Not a good thing with a preemie coming into the house....

The respite boys were fed, but not yet down for the night when Baby M came. She is tiny and came with instructions to keep her homebound as much as possible for about 2 months. The agency caseworker who brought her to me informed me that the hospital had made her an appointment with the pediatrician for Friday morning. Could I make that appointment? A moment of panic ensued as I envisioned trying to manage a doctor's appointment with all 3 of these kids. Mr D decided that he could take the morning off of work, so we could divide and conquer. The caseworker insisted that I call her if we needed anything, mentioning a specific person she had in mind who could probably come to the house to help me out if needed.

I posted about how bad I am at asking for help......so, of course, I said I'd be fine.

By morning, I knew I wouldn't be fine.  M was eating every 3 hours (whether she thought she was hungry or not), but taking nearly an hour at each feeding. We were both exhausted and the 1 year old's sniffles had added a cough.

We texted the caseworker at 7am, telling her that it would actually be great if that person ("Marcie") could come help out. The caseworker called me about 30 minutes later to talk through what exactly we needed. I told her about the 1 year old's cough and said I was concerned about keeping the germs causing that away from the baby. Mr D would be home until about noon, but then he did need to go to work; I didn't want to be alone with the 3 little ones, so maybe Marcie could lend me a hand that afternoon? Caseworker would call Marcie, figure out a plan, then call me back. Mr D and I discussed the fact that the ideal would really be for Marcie to just come take the two respite boys out for the afternoon.

Caseworker called me back and said that Marcie didn't think she should be around the baby (she was on antibiotics for a sinus infection herself) and she had some errands to run, but she could come take the 1 year old with her and bring him back after her work was done. She probably couldn't have him back here until about 7 or 8 o'clock, was that OK?

Um, yes! I could cope with the 3 year old and the baby. The 3 year old was old enough to wait a minute or two if necessary, old enough to be set up with an activity that would keep him occupied through a feeding, old enough to keep toys out of his mouth! The baby just ate and slept.

So, that was the Friday. It got even more exciting that evening, but this post is already too long....

Wednesday, April 2, 2014

I am insane

Well, I'm either insane or unable to form the word "No."

We were going to wait until the first of April to even consider taking any new placements. The last weekend in March was going to be busy with family activities, so we'd get through that and then be "open."

(Have we ever actually waited as long as we said we would to be open?)

Then I got an email. "I know you aren't open yet, but would you be willing to do a few respite days next week? This family is trying to go out of town for a wedding and need someone to take the foster boys, ages 1 and 3...." And, of course, my favorite part of the email: "If you can't do it, feel free to say no. But you're kind of our last option. It's hard to find someone to take them during the week."

I've been on the other side of the respite request too many times to say no to that. I kind of tried, because the last day of respite was going to be that busy Saturday at the end of March, so I said I could take them, but would need them to be able to leave first thing Saturday morning.

So, that was planned.

Then (here comes the insane part), I got a phone call. "I know you aren't open yet, but...." We had told the agency we wanted to be considered for potential adoptive placements, specifically of a little girl. They'd just gotten a call -- 1 month old girl, born prematurely, being discharged from the hospital NICU into foster care, mother has been TPR'ed on two other children already. How could I say No to that either?

She was due to come to us two days before the respite boys. The agency offered me the chance to back out of the respite, but how could we do that? Make someone else's respite care fall through 5 days before they were supposed to leave town for a wedding?

The result was craziness in our house for several days. It got even crazier than we could have imagined.....but the baby is waking up, so I'll have to post more later.