Quick Photos

Double Trouble.
Feeding both babies.
Passed out...but not for long.


Si and Gabe passed again out after another feeding.



Christmas with the Birnie Family.




Suzanne's mom, Shirley, and stepfather, Barry, have arrived in Seattle from San Diego. They have rented a house by Alki for a two month stay.



Sister, Stephanie, here for a week to help out. She has been a lifesaver!



Christmas Eve

Homecoming

Aside from conception and birth, Thursday was the biggest day in the boys' short lifetime. After 59 days in the hospital, they were released and finally got to come home!

The change came very quickly; when the feeding tubes were removed on Saturday the 27th, both the boys demonstrated a significantly increased vigor in their feeding. They also continued their stability in breathing and heartbeat. Before we knew it, we were getting orders to transfer the boys out of the Infant Special Care Unit and into Pediatrics. Suzanne spent all day Wednesday at the hospital, there for the transfer Wednesday morning and making the transition with them. Derek joined the family at 5:00 and we all spent our first 24 hours straight together.

The stay at Pediatrics was meant as a transition time; the medical staff felt that they boys were ready to go without medical care, but wanted to keep them there for at least 24 hours to make sure. It also served as a time when we could take over their care, but have staff nearby. What a transition it was! The boys were so fussy, none of us got any sleep until 5 am. Still, when noon rolled around, their health still looked great and we got our release orders, just as the snow started falling. It took several more hours to check out with all the appropriate folks and get the paperwork, and at 4:00 we were rushing down the hallway hoping nobody would come after us saying it was a mistake. We had envisioned taking the boys on a final tour of all the different wards and thanking the staff for their support, but Si had a bit of a melt-down (we think he was afraid of his car seat), so we made our escape quickly. Suzanne describes the trip down the hallway and to the parking garage as a really "out of body" experience - it was almost impossible to believe that after almost 70 consecutive days (including Suzanne's inpatient care) we wouldn't be coming back anytime soon.

As intensive as our whole experience from September through last week has been, we know after four days at home with the boys that we're in for the ride of our lives. It's been as dramatic as if they were just born. It does feel like we've kept it together (we've been quoting Dave Best - "K.I.T. - Keep It Together") pretty well; we've both showered most days and we've been able to get most of our own meals down. However, it feels like it's only havoc nearly averted, with disaster lurking just around the corner. Both the boys have had some really rough nights. Why is it that they're up for hours at a time demanding food, attention, changing, or some other unnamed mysterious pacification from us only during the night and then they sleep all day eating only the minimum amounts? So, we're a little rough around the edges as we all find our routines.



We really shouldn't complain about the energy the boys have! Only a couple weeks ago, the Nurse Practitioner was expressing concern about their lack of vigor, and now they are both strongly and loudly demanding their feeds. Gabe smacked Suzanne in the face yesterday because she wasn't warming his bottle quickly enough.

We had our first outing yesterday; we took the boys to meet their pediatrician and get their first checkover by him. The Swedish Physicians Children's Clinic is just a block and a half from our house, so we bundled them up and strolled over. They both got clean bills of health, with just a few things to keep an eye on! It was so good to get out of the house and it was such a beautiful crisp day, that we walked another couple of blocks to the coffee shop and then to the food co-op even though we didn't really need anything.

All you very generous folks who have been offering to help out - now's the time! Here are the things you can do:

• Meals: A prepared meal is always welcome! Several folks have brought us frozen casseroles and they've been a blessing. Fresh, light meals are also welcome to sleep deprived, addled parents. Plus, it would be nice to introduce the kids! Our very good friend Kelly Bryant is coordinating meals, so drop her a line: 206-784-9599 or kbryant96@yahoo.com.
• Dog Care: Benji's doing great as big brother! He's super gentle and hasn't shown any signs of jealousy. Still, if you have time to take a walk with him he'd be your best friend for life.
• Break time: Family members are welcome to come by to take over care and let us sleep for a couple of hours. Give us a call.
• Chores: The house is mostly set up for our current situation, but there are a few pieces of work we meant to do and now will have difficulty finding the time: cleaning, firewood stacking, one last mow of the lawn...
• Supplies: We have the basics we need for the kids for right now. Still, there are a couple of items that might come in handy. We're trying to keep a registry updated at findgift.com.

A couple housekeeping items:

• We've secured the domain name www.birnietwins.com! Right now it will just bring you to this page, but it should be easier to remember and tell to others who are interested in the twins' progress or our chaotic story.
• We've moved our online photos to snapfish.com (free log-in required) instead of yahoo.com, uploading is quicker, there are no limits on the folder sizes, and you can order full-rez downloads in addition to prints (although you should e-mail us for those).

Bye bye feeding tube

Note: we started drafting this post on Saturday the 27th. Things got busy, as the next post will indicate, and we never got a chance to finish and post it. Posting it now for the historical record:

It's been a roller-coaster of a week.

We've been asking the various nurses and doctors for their personal estimations on when the boys will be ready to go home. On Thanksgiving, one nurse guessed it would be a couple more weeks, "but definitely before Christmas". Another guessed a week or two. A key issue was that each of the boys appeared to most of the nurses to have some issues with stamina: they weren't finishing all their feeds, so the nurses were using the feeding tube about once each shift.

Well, Silas got tired of this on Thursday and pulled his feeding tube out on his own. The nurse on duty wasn't in a hurry to replace it, and tried giving him all his feedings from the bottle. It worked. When it came time to change Gabriel's tube (done weekly) later in that shift, she just pulled his out and didn't replace it. Viola! Gabriel started taking his feeds on his own as well.

This all deeply impressed the Nurse Practitioner (who gives most of the medical orders), and on Friday she changed their feeding schedule to "on demand" rather than every three hours. Both the boys started eating more at a feed, allowing them to sleep longer. Now we're talking days, not weeks.

But, it's up and down: Early Saturday morning the nurse called us to say Si had blood in his stool. After consultation with the Neonatologist, they were suspending his feeds...

And another pound

Recent vital statistics:

Silas: 5 pounds 8.1 ounces, 18.3 inches long.
Gabriel: 6 pounds 0.4 ounces, 18 inches long.

Other observations in brief:

Eyes: Their eyes are currently a kind of steely blue that's common to all babies. The opthalmologist asserts with confidence that they will not be brown since no brown pigment flecks are visible. He says they will most likely be blue, but could change after six months or so to a hazel or green.

Timeline: Our best educated guess on their release date is one to two weeks. They need to be eating entirely on their own and gaining weight, as well as going for five consecutive days without any significant interruptions in heartbeat, respiration, and oxygen saturation in the blood.

Labor Dispute: The hospital and its organized nurses and staff are at an impasse in negotiations over their contract, with the issues focused on health insurance and retirement benefits. According to the hospital, there is a possibility that they may reduce services and tranfer patients. Our experience with both nurses and administration has been positive and we hope the parties can find their way back to the bargaining table.

We'll be celebrating Thanksgiving with the boys in the hospital tomorrow. Check back for pictures.



Links of interest:
Photos of the boys in the hospital (full and unedited)

Perspectives on the Labor Dispute:

• Seattle Post Intelligencer: Swedish says contract talks with nurses at 'impasse'
• Nurses and Hospital Workers' Union press release
• Swedish Medical Center's press release
• The Campaign for Safe Hospital Staffing at Swedish

If you want to write a letter to Swedish and encourage them to negotiate, write:

Richard Peterson, CEO
Swedish Medical Center / First Hill
747 Broadway
Seattle, WA 98122-4307

Five Pounds!

Silas rests easy after a tough week

Silas just crossed the five pound mark yesterday! Gabriel got there several days ago. You may recall that the boys were born at about three pounds each, and their weight dropped to two and a half pounds at the lowest point (it is common for almost all infants to lose weight in the period just after birth). They have now doubled their weight since that point!

It's been very steady progress in the twelve days since our last post. Silas was released from the NICU just at the time that there was an empty bed in Gabe's room (four cribs to a room). Later, another crib opened up and we were able to get the boys next to each other again.

Silas' first bath

Our first bath with Gabriel
(a zealous nurse got to him first without us last week)

Since we've spent so much time at the hospital, a lot of our parental worry has been focused on the arrangements there. For example, one doctor had considered releasing Silas straight to the Pediatrics department, bypassing Gabriel completely; Suzanne had a heart-to-heart with the nurse in charge the next shift and arranged the move into Gabe's room. Likewise, we relied on the diligence of another nurse to get the boys moved into adjacent cribs a couple days later. It's hard to image a more satisfactory experience than we've had at Swedish Hospital, but like any large institution, there's definitely room for self-advocacy to impact the decision-making.

Gabriel patiently waits his turn (well, maybe not that patiently)

Medically, the boys are getting really strong. Neither of them has had an "incident" (a recordable interruption in their heartbeat or respiration) for a little over three days, which is a big improvement from the early days when there were eight to ten in a day. Their feeding has also become much more vigorous. They are drinking about 3/4 of their diet on their own from a bottle (with the other 1/4 by gavage through a feeding tube). These two factors are the key things to keep an eye on; they will be released when they've demonstrated they're strong enough to eat all their own food and when they go five days without events.

Mom spends time with the boys (Gabe on the left, Si on the right)

In as early as two days or as late as a week or a week and a half, we'll get them transferred to Pediatrics, where we'll stay in the hospital for a couple days with them and then bring them home. Thanksgiving still looks like a good shot!

We're deeply thankful for all the prayers, support, and offers of help.

Benji's waiting to play with the boys.

Silas is on the Mend

Quick update: In our last posting, Silas had just been moved back to Intensive Care with a fever and a number of other complications. We still don't have a clear diagnosis, but he appears to be on the mend. His fever's been gone for a few days. Other indicators, like his skin color, energy level, and intestinal activity are looking much better, and this is backed up by many of the lab results. The doctor's thesis is that it was a sepsis (bacterial infection) that the lab cultures didn't catch.

Under doctor's orders, we'll begin resuming his feeding today. If he tolerates his feeds well, and the final lab cultures come back negative, he's got a good chance of getting out of intensive care within a few days.

Gabe continues to do well. He's now over 4 1/2 pounds (4 lb 9 oz) and finishing his entire feeds from the bottle with increasing consistency. He looks forward to seeing his brother again.