Providence St. Vincent Medical Center Ceremony

Providence St. Vincent Medical Center had a really nice ceremony for all the babies that did not survive during the last few months tonight.

Erin and I were invited of course because of "Herricle" James.

It was a very nice ceremony.

It's unbelievable how much James has changed our lives. I think that Erin and I are both (sometimes reluctantly) seeing the miracle that James is ("Even if it isn't the one we want.").

I still can't articulate it, but it is there. Some day I'll write it down.

Cowgirls

We are concluding a much needed great vacation in one of our favorite places: Sun Valley, ID.

This is a note to self, not to mess with the women in my life under any circumstances. One is a converted cowgirl and the other is a native.

I'm including pictures to help me remember.

Mending

I haven't said much here in a while.

My dear mother is still here. She was just talking about this blog and how much she liked it so I figured I better update it.

Erin is out on a girls night out. She is healing wonderfully. My mom has been doing healing touch on her since she got here. It seems to have helped. Erin's doctors are amazed at how fast she has healed.

I'm not quite sure yet what the miracle is with James. But I'm positive there is one. At some point I'll write about it, but not yet. I have lots of ideas what it is. Its probably a couple things. One thing is for sure, our family will never be the same. We've grown.

Erin is Home

I brought Erin home today.

All her blood tests looked good. She has about 6 weeks of recovery in front of her, but is already making great progress.

We saw Dr. Buckmaster today and he was optimistic about her recovery. Erin will see him next week to have a checkup and get the staples out of her incision.

Lauren was so happy to see her mommy walk through the door.

We got to say one last good bye to little James' body today. He was so small, but so sweet. He had obvious Barnicle and Herrick features. Its very sad thinking of what could have been.

Whenever we got really sad in Erin's room today the sun would come out. When we walked out of the hospital the sun broke and shined right on us. We couldn't help think that it was our little guardian angel James telling us that he was going to be there helping us through this.

Happy Birthday Erin

Today is Erin's birthday. Unfortunately, she will be spending it in the hospital.

Looks like we'll get her home tomorrow (Sunday) at the earliest.

Anyone who has read this blog the past few months understands what a lovely person Erin is.

She put her heart and soul into giving James a chance at life.

She sacrificed a lot and did it with a smile.

Words can not express how proud I am of my wife.

Happy Birthday Erin!

Better Day

The weather in Portland has been beautiful the last two days.

I can't help but think that James had a little bit to do with that.

The day he was born and died was very cold and grey.

The sunshine has really helped lift my spirits.

Lauren has been a joy to be around in the hospital. Children are wonderful. She was very sad to hear about her brother James. She didn't know what death was until yesterday. She asked to pray to him before we went to bed last night. Today at the hospital, she wanted to go to the hospital chapel to say hi to him. Although this is sad, its also comforting.

Erin continues to get better. She is walking around a bit and the color has returned to her face. Her blood tests are looking good. She is smiling.

We no doubt have a long road in healing the hurt of losing James, but after today, I know that with time and love we will get there.

Steady Progress

Erin is making good progress in her recovery.

She got the catheter out last night and is starting to walk around a bit.

She was transfused some more blood yesterday to bring her levels back up.

We are looking forward to getting her home when she is ready. Seems like it will be Saturday at the earliest.

Thanks everyone for all the emails / comments. They really help.

The Best Medicine

Click picture to enlarge



Lauren is of course going to be our family's best medicine to get through all of this. Such a sweet child.

I picked her up from pre-school, got some pizza with her and Nana & then brought her to the hospital.

She was very happy to see her mommy.

James Michael Herrick

We decided on a name for our son: James Michael Herrick.

Its a family name that means a lot to both of us.

James was baptized yesterday. The priest said a very special prayer. I don't remember the exact words, but he asked God to take James into heaven and make him our guardian angel.

My mother said that she thinks that James started protecting us when we rushed Erin to the hospital. She thinks he realized that he couldn't survive without resulting in the loss of his mother so he sacrificed himself for us while he still could.

Safe Night

Erin had a safe night.

She is recovering at a good rate. They had her sit up and stand up last night.

The nurses are very impressed with her progress. They are taking great care of her.

We are learning more about how serious the situation was yesterday. Luckily, Dr. Guinn acted quickly and set a plan into motion to get her to interventional radiology and into surgery with the surgical specialists Erin needed including Dr. Guinn, Dr. Buckmaster, an oncologist, and a urologist.

We didn't know it at the time, but the doctors hoped that when they took her to interventional radiology that they could control her bleeding and somehow buy her enough time to carry our son a few more weeks where he could have a chance at life.

Unfortunately, the interventional radiology stuff wasn't enough to stop the bleeding so they had to proceed with the surgery to save Erin.

They also hoped that they would be able to save Erin's uterus, but her placenta bleed so badly during surgery that they couldn't.

There was a 10 minute period of time that things were very scary. The nurses brought me our son and told me that the doctors were working very hard on Erin. It was terrifying. Thankfully, the time passed quickly and they checked the operating room again and the surgeons had things under control.

Erin's OB stopped by Erin's room last night and did say that what occurred is typical for how emergency c-section & hysterectomy typically go. There is so much blood flow to the uterus that the surgeons only have minutes to do their work.

As the fog clears from the events of yesterday, we are very thankful that the outcome was quick and clear. We are glad that Erin's body and our baby gave us such a clear warning sign and that we got her to the hospital so quickly and the doctors did their jobs so well. This of course isn't the outcome we wanted, but things could have been so much worse.

Maternity Ward

Erin got transferred to the maternity ward a few hours ago. I'm writing this from her room.

My mom is here.

Lauren is at her friend Hannah's for a sleep over.

Erin will recover here for the next few days. Sounds like the earliest she will get out of the hospital this Friday.

We have gotten to spend a lot of time saying good bye to our son. Its incredibly heart breaking, but definitely something we wanted to do.

Thank you all for all your well wishes - they really really help. It is good to know that your friends share your pain and truly care.

The nurses gave us some good booklets to read. Its sad, but true. I think that the booklets will help us find the miracle in this some day. A sample excerpt:

Our joys will be greater; Our love will be deeper; Our lives will be fuller; Because we shared your moment

Its hard to see getting over this. I don't think we really ever will. And I think thats is eventually going to be ok. But right now its awful. Especially for Erin.

We really are glad that we tried our best to make this work. Erin was the best patient imaginable. We took risks, but were not reckless. We'll never wonder what could have been. For us, that is going to help a lot.

Update

I met with some of Erin's surgeons and they were happy with how the surgery went.

I'm relieved we acted when we did. They said that if we hadn't acted, we would have had to rush her into surgery later.

They had to give her a hysterectomy and take 1 of her ovaries. This will be ok with Erin.

She did need 2 units of blood and they recycled 2 units of her own blood.

She is in surgery recovery now (not ICU). Hopefully I will get to see her soon.

Sadly, I met our baby after he had died. He truly is beautiful. He weighs just 1 pound and is 11 inches long, but already had the beginnings of black hair. I got to hold him and talk to him. I'm glad for that. Erin will get to hold him when she recovers a bit.

The nurses and doctors really know what they are doing here - I'm glad somebody does.

I'll update this later on tonight or tomorrow with an update on how Erin is doing.

Thanks for all the prayers and well wishes.

Sad Conclusion

Sadly, I'm writing this from the waiting room at the hospital.

Erin had another bleed tonight - much more than the previous ones.

Her doctors said that Erin's health is now the priority.

Her main doctor - Dr. Buckmaster came into the hospital to make sure that he concurred with the recommendation to deliver tonight - he did.

Sadly, the baby is just 23 weeks old today. He isn't old enough to live.

Erin is with the interventional radiology team now.

After that, they will take her into surgery where they will do a c-section and likely a hysterectomy.

I will get to hold our baby before he dies and they will make a memory book for Erin that she can have when she wakes up from the surgery.

This isn't what we wanted to happen - its very sad. I'm very sad that I'll have to say good bye to our son, but am glad that I will get to meet him.

I just want to get Erin through this. They are hopeful that she will be fine, but with the previa and accreta there could be complications.

Please keep her in your thoughts and prayers.

Lauren

We put it off as long as we could, but we just told Lauren that mommy was going to the hospital Wednesday.

Erin found a coloring book on the topic named Mommy and the Hospital. We read it to her and then told her that her mommy is going to the hospital.

It was a bit of a tear jerker to say the least.

But she seems to understand. The two thin mints (girl scout cookies) seemed to help ease the pain temporarily :)

Nana (my mother) is in an airplane right now to help. This is going to be quite the transition.

We hope we have the happy ending that the coloring book has.

Hospital Living

With the support of Erin's doctor (John Buckmaster), we decided that it was time to admit Erin to the hospital.

Starting next Tuesday (March 10), she will reside at St. Vincent until Herricle is delivered.

The doctors think its best although if we really wanted to, we could have kept Erin home longer.

This should maximize our chances at success and safety for Erin.

The doctors remain cautiously optimistic that we'll walk away from this with a healthy little boy.

There are of course lots of risks, but at least she'll be in the right place. This will introduce new stresses, but decrease some anxiety we have.

My mother will be arriving in Portland on Sunday. This should help Erin, Lauren, and me a lot.

Disability Education & Philosophy

I'm starting to look around the internet for information on what to expect as we approach viability.

Our doctors say viability is 24 weeks, but there are cases where babies survive before that.

In a quick tour of the internet yesterday I found this article that sums up the stage we are in reasonably well. It references this study: Neurologic and Developmental Disability at Six Years of Age after Extremely Preterm Birth. Both articles cover from now until 26 weeks (5 weeks from now).

Some highlights:

• 41 percent of the extremely premature group have severe or moderate mental impairment at six years of age


• 20 percent of the children had no problems, while 22 percent had severe disability, such as severe cerebral palsy (children not walking), very low cognitive scores, blindness or profound deafness


• The proportion of children with cerebral palsy with severe or moderate motor disability was 12 percent, and 24 percent had moderate disability, such as cerebral palsy (but walking), IQ/cognitive scores in the special-needs range, or lesser degrees of visual or hearing impairment


• one-third (34 percent) had problems considered mild, such as wearing glasses, a squint or low/normal cognitive scores

So when you sum it up, reads like if the baby is born before 26 weeks and survives, he has a 50/50 chance at severe disability.

Herricle is a pretty active baby; he is much more active than Lauren was. But he's a boy so maybe they just are more active in general.

We are hopeful that he's a fighter and if he is one of these extreme preemies he can survive and thrive.

My general philosophy on life is influences by a couple general thoughts:

• You make our own luck.


• Do your best with the cards you get dealt.

This philosophy has mostly been applied to my work life tho so it may need some adapting.

My mother is happy I go to church more often now. Maybe that will end up being a more prominent part of my philosophy :)

Day by Day

Unfortunately, we had another bout with bright red blood and a "pissed" uterus (what a nurse we like calls it) last night.

We were at the hospital for a while today.

This is expected with Erin's condition, but still frightening.

They monitored the baby and Erin's uterus and gave her some drugs to make her uterus stop being irritable (mild contractions).

They think the irritability comes from the issues with previa etc.

Erin is 21 weeks pregnant now.

They said that at 24 weeks the baby will be viable. She will be admitted to the hospital for the duration then at the latest (although it could very likely be sooner now).

Dr. Watson explained that after we get to 24 weeks they will take it day by day. Percentages of health literally shift by the day and the situation. Depending on how far along Erin gets, the baby will have X% chance at survival and Y% chance at major lifetime health issues. We'll have to weigh out the risks as things develop.

For now though, its still a zero sum game - until the baby gets to 24 weeks there isn't anything we have to decide.

They do think that Erin's bleeding will continue on and off for the duration. They will have to guage it and treat her with drugs and potentially blood transfusion depending on how things go.

It sounds like for the actual delivery they will also have an interventional radiologist on hand to help control blood flow.

We've heard most of what we heard today before, but its all becoming much more real the deeper we get into it. As you can imagine, Erin was pretty upset to have this happen again after having such a positive run the past few weeks.

So nothing really has changed - this was all expected, we just fell into an optimistic couple of weeks where it was easy to think that it was going to be smooth sailing for the duration. Clearly, its going to be a winding road from here to the eventual conclusion of the pregnancy.

20 weeks 3 days

Erin had a positive appointment today with her HR OB (John Buckmaster). She and the baby remain stable.

Her cervix thickened and lengthened significantly - best they have seen it yet.

She still has placenta previa, but Dr. Buckmaster agrees that dealing with it is within Jana Reddoch (the oncologist who will assist the C-section), wheel-house (she is apparently a bit of a legend).

The baby continues to grow normally.

Dr. Buckmaster said he was optimistic after looking at ultrasound.

Originally, they wanted Erin in the hospital at 22 weeks, but now are planning on 24 (approximately March 22) weeks given today's results. This will maximize Erin's mental health which is an important aspect of our chances at success. This could of course change quickly.

They want Erin to skip next week's appointment because during this time frame they fear car travel the most.

She will go in to the hospital at 24 weeks to maximize chances of survival for the baby & ensure that she is safe. Surprisingly - if they are right on top of things babies have a shot that young. Obviously, they want Erin to get as close to 30 weeks as possible.

So we are happy for today. Yay.

19 Weeks 2 Days

We had a doctors appointment today at Northwest Perinatal.

It went reasonably well.

Erin had a tiny bit of bright red blood over the weekend. The doctors say that she is still a bit early to be having bleeding from her placenta previa, but it does happen.

The doctor said that we have 4-5 weeks until viability of the baby. He said that right now the outcome is binary: either the baby makes it or he doesn't. He said that he is most worried about the next stage: 24-28 weeks. During this stage, if Erin delivers, the baby could make it and have any number of issues.

The concern of the doctors continues to be the previa and placenta accreta. As good as the technology is today, there is still so much they can't see. All they really know is that she has previa & most likely has accreta - but they don't know how strong the lower third of her uterus is and how it will hold up as the baby continues to grow.

The HR OBs thought it would be good to have a cystoscopy or an MRI done so that they can see if the accreta is getting close to the bladder. The gynecological oncologist does not think she needs this as she would just deal with it if she encountered it during the eventual C-section. The HR OBs defer to her on this so I think we'll skip both.

Erin will most likely be heading into the hospital in 3-4 weeks. They want to keep her home as long as possible as her mental health is a factor in our success as much as anything. The less time she spends in the hospital the better from that standpoint.

My mom is coming to Portland March 8 for a month. That will be extremely helpful. Thanks Mom!

Our friends here in Portland continue to be the best - they continue to bring us dinner which is a life saver.

Erin found a book that Lauren seems to relate to on bed rest: And Mommy's On Her Side.

Oncologist

We had the appointment with the gynecological oncologist yesterday. Man was she smart.

It was a pretty positive consult.

Our HR OBs are worried about 2 things: Erin's ability to carry the baby to 30 weeks and the surgery to get the baby and put Erin back together.

The oncologist is not terribly worried about the surgery. She also doesn't think that Erin will absolutely need to have a hysterectomy. Her key question was around what caused Erin to hemorrhage with Lauren. Once she heard how long Erin labored and pushed, she was satisfied that the cause of the hemorrhage was not some fundamental problem with Erin's uterus - just that the last time she labored too long and her uterus had no energy left to contract properly.

The oncologist will assist with the C-section. Her recommendation is to do a "conventional c-section". "Conventional" is the way they used to do it. Basically, they take the baby out from up high and leave the lower part of the uterus alone. She thinks the placenta will come out fine and if some of it is attached to the uterus and won't let go they can leave it in and it will die off naturally. If they run into trouble, she knows how to do a hysterectomy very quickly.

The oncologist's biggest concern is getting Erin to 30 weeks. Erin has to continue to be on strict bed rest and will be admitted to the hospital in 3-4 weeks for the final 8 weeks of the pregnancy. She said that because Erin is so good at following Dr's orders she has a good shot at success. She did say that lots of women go a bit crazy in the later stages of bed rest - especially when they are in the hospital. Erin is one tough cookie though, so we bet she does ok. It will be really hard on Lauren and me though not having her around. We'll visit a lot and my mother is planning on coming out to help.

Another rough night

We had another rough night last night.

Erin's doctor told us to expect more bleeding as it is common with placenta praevia. He said that if it was more than what happened the first time we should call.

By 1 AM or so Erin was convinced of this and so we called. They told us to wait out the night and then to call in the morning. Erin also starting complaining of tightening in her belly.

When we called in the morning they told us to come right in. Erin's uterus had become "irritable" - she was having mild / irregular (i.e., not at a set time interval) contractions. They checked the baby and he was fine. Her cervix also was unchanged (still about 2 cm).

The doctor said that the appointment next week with the gynecologic oncologist will be helpful as she will be able to hopefully determine how fast the placenta accreta is growing and how much time we have to work with (i.e., if we can get to 30 weeks). She also may want to intervene with another surgery or some sort of a treatment as it may be heading towards placenta percreta (speaking of which my dear mother found some stories on this: here.

The doctor this morning thought that they would know more in 3-4 weeks. He thought that if they can calm down her uterus and the baby stays healthy that we will have an 80-90% chance of getting out of this with a healthy Erin and baby.

In order to calm down her uterus, they proscribed indometacin for a few days.

Needless to say, we are all a bit drained. We are holding it together though for the most part thanks to our family and friends. I'm planning on taking next week off which I hope will help our little family.

It seems like we are entering into the next really crucial phase of this. Please keep Erin and Herricle in your thoughts and prayers.

Update

So we had an expedited appointment today given our weekend ER trip.

The doctor said the blood Erin saw was consistent with placenta previa. He said we should expect to see that and as long as it doesn't come with cramping its ok.

As you can see from the new pictures, the baby looks great.

Erin is a bit shook up from this weekend even though the news today was good.

While nothing has changed, we discussed with the doctor the option of terminating the pregnancy again today. He said that if we did it now, there is a 1 in 200 chance that it would result in the loss of Erin's life. He said that if we continue and get to 30 weeks where there will be more blood flow, placenta accreta and perhaps placenta percreta, the risk will increase to 1 and 100. These are the same numbers we heard a month ago, but they are still hard to hear when the typical pregnancy is 1 in 10,000, you just spent a morning in the ER, and you've been the 1 and 100 before (the complications from Lauren's birth).

We are going to have an appointment next week with a gynecologic oncologist. She will assist in the C-section if it occurs. They want her on hand since Erin's case is so unique and based on her background is used to dealing with abnormal anatomy. Also, if there is placenta percreta, she will assist in the part of the surgery to deal with that.

All and all, the Dr. said he's reasonably optimistic if we continue to control the situation and prepare to have all the right resources on hand.

More Pictures

Latest Picture

Here is a picture of the little guy from yesterday. Hopefully, we'll get some better ones tomorrow. Click on the image if you want to see it zoom in.

He is curiously handsome just like his daddy as you can see :)

Herricle is a Boy

We had a rough night last night. Erin went to the ER after she discovered a very small amount of bright red blood. That is a color you don't want to see.

In the course of checking her out it was determined that our baby is a boy!

They are not sure what caused the bleeding at this point. It could be the cerclage or something else.

The baby is 17.5 weeks old now based on his measurements today.

Erin saw him opening and closing his hand and sucking his thumb.

They looked closely at him today. He looks great - 4 heart chambers, brain looks right, 10 fingers and 10 toes.

Lauren, our 3.5 year old daughter stated blankly, "I thought it was a sister." upon hearing the news and stared straight ahead never to speak of it again :)

We are going to see Erin's HR OB Monday to see if they can figure out what caused the bleeding. Unfortunately, the doctors today suspect placenta accreta in addition to what she still has placenta praevia. Given Erin's history, this isn't a big surprise, but it will complicate things further.

As you can imagine, we are excited at the prospect of rounding our our family with a little boy, but are also very worried about getting there from here.

We'll update the blog again after we learn more Monday.

January 25

Herricle still cooks.

We are 2 weeks into full on bed rest. Erin is doing great. It is hard, however to be so confined. Mother instincts seem to help a lot with enduring this type of thing. Our friends have been great - they organized and are all brining us dinner 2x per week. This helps a ton. We have a nanny during the week which is helping a lot.

At the doctor appointment this week, the Dr. checked the heart rate - it was 145 bpm. They didn't do an ultrasound this time. Her next appointment is February 5th.

The baby is about 16 weeks old now.

At the next appointment, we'll probably find out the sex of the child. With Lauren, it was a surprise. Should be exciting.

Cerclage Success, Hello Bed Rest

Well that was quick.

Erin's cerclage only took 20 minutes. One of Erin's docs did the stich (Dr. Buckmaster) and the other manned the ultrasound (Dr. Tomlinson). Erin got to watch the baby flipping around in there the whole time.

They were not able to do a conventional cerclage, but were able to get a decent one in they said.

They said that with a conventional cerclage they do a "purse stings" stich at 12, 3, 6, 9 o'clock. She seems to be missing the 3 o'clock part of her cervix from scarring. So the at least have a stich from 12, 3, and 9. They said that she was already a little dialated so they think this will help increase our chances.

The Dr. that also was involved in the trans-abdominal cerclage attempt said that it would have been better as it would have offered more support, but this is the next best thing. He said he is "cautiously optimistic".

Bed rest starts now until delivery. She is at 15 weeks and they want her to get to at least 30 weeks. "Bed rest" means the following:

• Lay down/recline as much as possible - ideally all but 15 minutes a day


• Can get up to go to the bathroom


• Can take a shower


• Can sit upright for meals in a chair

"All In"

Erin asked one of her Drs about risk the other day.

He said, that we are "all in" at this point. He meant that there is no low risk path. Carrying the baby is "high risk", but terminating the baby would also be "high risk".

That is actually comforting (to me at least).

It would be a heart breaking decision to terminate a baby that we desperately want. We would have had to do it if the risks to Erin were clearly reckless. It is nice that we are not faced with that kind of decision.

Luckily, the Drs don't think this is reckless - they think its "high risk". There are lots of high risk pregnancies - this is just on the higher end of the spectrum.

I forgot to mention, we got some other good news Friday. The baby tested negative for the genetic tests they did. When Erin was pregnant with Lauren we didn't do any of this type of testing - it wouldn't matter to us. But back then the tests were not so easy. Given Erin's circumstances, the Drs didn't really ask us if we wanted to do the tests - it seems like its the protocol with high risk pregnancies.

The tests they do now is a combination of measuring fluid in the baby's neck (via ultrasound) and some other stuff. The tech said that the baby's neck is "perfect".

We are still so amazed that after everything Erin went through there is a baby with a perfect neck growing in her :) Must be quite a little person in there.

Jan 9

Erin had another appointment today.

The heart beat was 155.

We didn't get any pictures, but saw the baby. Erin suspects its a boy! She saw the butt and thought she saw something else. Time will tell.

Erin's cervix improved a tad the last couple weeks so they are going to make another attempt at a cerclage - this time the conventional way. Erin will have the procedure first thing Monday morning.

The baby is now 14.5 weeks old.

The placenta still shows signs of previa, but it could change.

All in all, we are still cautiously optimistic. We'll update this after the procedure Monday.

Jan 2

Jan 2, 2009 Ultra Sound Pictures


As you can see there is still an apparently healthy baby in there from the pictures above.

Today the baby measured 13 weeks 4 days.

The doctors are still concerned about Erin's cervix and uterus. They do now think that it would be possible to place some sort of a cerclage in, but are not convinced its the best path forward. Its too early to tell what her placenta is doing, but it does appear to be low right now, which means she might have placenta previa. The biggest unknown is her thin lower uterus from her b-lynch suture. There is just no way to know right now how it will develop as there is very little data on this type of case.

We continue to be impressed with the people (doctors, nurses, techs) at Northwest Perinatal Center. Erin is clearly a rare case - even there.

Erin has been on mostly self imposed modified bed rest for the last 2 weeks. Her doctor told her today that she could be a bit more active. He said that she should enjoy a bit of freedom now while she can as she'll undoubtedly be on bed rest for a long time soon.

All and all we remain cautiously optimistic. We have been really well supported by family, friends (old and new), and my employer. Thank you all for your support - it has made a big difference :)