A Perfect Birthday

I'm not bragging on myself when I say we had the perfect birthday party. As you know, the most valuable takeaways from my adult life all involve doing less: "it's not your problem, Kinn" (?!... :)), "if it is not your (company's) core competency... outsource," and something snarky about "superfans" and inappropriate emotional investment. So we had a local artisan craft cakes, my BIL made the pinata, my SIL and MIL did so much prep work it take its own blog to document.

But I digress.

What I wanted to say was, Happy Birthday, Bo! You have become an awesome little kid. Your ridiculously long eyelashes and super velvety soft skin still make me think you are a baby, but your insatiable appetite for knowledge and your supernerdy proclivities challenge me.

What _is_ a Mandalorian Jetpack, anyway?

We had a handmade robot pinata, chocolate leaves on the cakes, games and children, family and chosen family, babies and beer. The sun dappled the lawn, and it was warm but not hot.

Baby Ahn got to celebrate her birthday a little early, and she loved running around with all the other littles.

I look at you, Bo, and I cannot imagine the black hole that would have engulfed my head had you not lived. The intense joy and privilege of parenting you is a result of that moment, when I was with you, alone in our hospital room, as you were dying. And I looked at you and thought, I don't know you yet. They say a mother will give up her life for her child. I don't know you yet. But I need to. So I am going to fight with everything I have to give you the time to become. To be. I don't think it was love, at that point that drove me. I just wanted the chance to get to know you, and for you to remember, even if it was just the slightest impression, me. You can't go, yet, I thought. We haven't even started. You won't remember me. You will only remember pain and fear. I want you to remember being loved and cherished. We need more time.

The longest-lived intestinal transplant patient died, recently. She was 22 years post transplant. I look at your face and think, 22 years is not enough. That is not good enough. That is not long enough. It's not long enough, dammit!

For now, you are running and jumping, reading and rioting, exuberant, defiant. I hope you know that we celebrate every day you are here. We are so blessed that we got to keep you here by our sides, just a little bit longer.

Summer Begins

It has gotten progressively warmer all week and was officially hot today. The nights have been cool, and perfect sleeping weather. But we're finally into summer, and I get nervous about that. We can't seem to keep Bo out of the hospital more than a year at a time, and he invariably ends up inpatient in the summers. Which is great, because there are fewer respiratory infections, but is less great, because all the residents are brand-spankin new.

Anyway, I'm hoping we can forgo the annual admission this year. But Bo got completely wilted yesterday from being out in the heat, and today, our outing was a walk around the block. When he gets too hot, he will get dehydrated enough to become nauseous and vomit. He gets frighteningly pale and lethargic. And nobody likes that. Thankfully, the fluid bolus we started giving a few months ago has kept his excruciating thirst and dehydration at bay, but it may get hotter yet, this summer.

His biannual visit to the nephrology team in Detroit was great. Two years after stopping the kidney stone medication, he remains stone-free (yay!!). And they are suggesting changes to his TPN that may alleviate some of the thirst issues (too much sodium; it had been jacked up from his last bout of dehydration and never inched down, as his blood levels remained stable, but urine levels started to rise as he recovered, but wasn't getting those scrutinized as frequently). Once the appropriate sodium levels are determined, Bo's remaining thirst (if any) can be addressed by further volume added to his midday bolus.

Since everyone woke up early this morning, we actually made it to the earlier Mass. The play room was open, but there were no scheduled activities, which meant Bo had free reign of the giant toy box. I tried to dump both kids with JVC, but Ahnnie totally melted down, so I took her into Mass with me and she was surprisingly good! Aside from saying "all done" and bolting to the doors right before Communion, she was totally sweet (and silent!).

Summers are so incredibly luscious, here, they really are like vacations. I am feeling completely rested (can I have an amen for date night? We haven't had them in a while due to nursing personnel changes, and boy did I miss them), and even with the trauma of re-carpeting the basement from sewer back-up (entirely our fault forgetting annual roto-rooter), and planning the 5 and 2 year birthdays coming up shortly, I am just so grateful for our friends in deed (Paul!!).

May you experience the Joy and Love infused in this very Life.

Regular People Angst

The today litany, gateway to tomorrow, paralyzed me. I wasn't the deer in the headlights. I was the headlights.

And when all the little people fell sweetly asleep, grimy and contented, I remembered.

Until my fist clenched at my purse, screaming something angry about scarcity, as I softly ascertained after-hours plumbers' fees. I wanted to call my mom. My heart, gripped, constrained. tight tight tight. My brain scans for an answer. I feel a dull ache. I try to think about the end of the Easter season.

I will prepare documents for hand-delivery tomorrow before jury duty. Contentment glows from upstairs. The sun kept shining.

You don't mind if we stop over, do you?

I don't think anyone ever gets used to us. Even I don't. My friend/neighbor who is like a dad to me looks at the pile of "stuff for our trip" and is incredulous.

"I can go 2 months with a small duffel," he slurs. He's like a dad to me. No. Not the one I always wanted. An old guy who comes over and says inappropriate things.

"I can too, without these hooligans and all their stuff. What do you suggest? Wiping their butts with paper napkins from McDs? Improvised TPN with Mountain Dew? They do look the same."

He back pedals just enough to not look idiot. We finish packing and go. Then we get to our destination, and the hurriedly masked look of horror on our hostesses face leads me to the conclusion that my fearless co-pilot did not warn them that: we're moving in.

I know it's just 4 nights. But the mini-van is packed tight, front to back, top to bottom. It's almost as dense as the end of the school year and moving back home with all your shite.

And these are the Mother's Day gifts that I will cherish I'm guessing into my amnesia filled alzeimery old age: the nephrology fellow's follow-up phone call to tell me that we aren't just "good keeping up with Bo," but "damn good;" being invited back by the friends whose house we invaded and fully took over; seeing the heartwrenching creatives from CCS and their new digs (I did cry at the fine arts exhibit: they may not always have the most sophisticated ideas, they _are_ mostly around 21/22, give em a break), but they have been trained to the most rigorous level of complete execution (polished, dazzling and layered); and the glee my maniacs expressed on our return to our gingerbread house on top of the rainbow, next to the herd of unicorns.

Love to all the mommas out there. May your maniacs sleep in. May your spouses allow your craigslisting to go uncommented upon. May your new HE washer/dryer set's happy chime send a thrill down your spine (no, I still don't cook, but I DO love my new set). May you all wake up to fight another day.

I love you all.

Haircuts!

Everyone (except me) got their haircut yesterday at Suzanne's new fabulous space downtown. Bo sat so still and quietly, even though I could tell he was nervous. He flinched each time she sprayed water on his hair. Still, what an improvement on the screaming he used to do. I think it helps that Ahn went first and she did not cry at all. She did get bored, though. Somehow, I ended up with more hair stuck to my clothes than anyone?

Executive Summary

This blog is primarily to provide hope and understanding to families (including mine!) affected by life-threatening diseases resulting in the need for Total Parenteral Nutrition and Omegaven, especially those affected by Microvillous Inclusion Disease.

  Orbiting the realities of TPN/Omegaven and the physical needs of the child, equal consideration to the health and well-being of the caregivers is essential (especially when said caregiver has a propensity for space exploration). The way I see it, if my spouse or I fall apart, no one else will be able to advocate for Bo as forcefully. Likewise, the care and feeding of our support networks are the third leg in the tripod, the minimal number of legs required to support another object (said object being our family unit). These updates keep friends, family and our MID families in the loop with the medical, psychosocial, emotional and financial (insurance) peculiarities of having a kid with a life-threatening condition, who also happens to be gifted (the term is "twice exceptional," groan). Topics feathering out to my job search (yay, got the new job!), my angst (PTSD is nobody's baby), and the relentlessly NON-Keyensian way the world refuses to give us more hours in the day when there is CLEARLY a HUGE demand (I spent more hours a week working out than some people do at their jobs, now I don't have time to brush my teeth some mornings- don't worry, I have the spare toothbrush at my desk)... these are all topics that were introduced by way of new parenthood and MID. They are by no means exhaustive of the inner workings of my chattery brain, nor a comprehensive update of all the goings on of the household. It just seems that way, because MID touches so many aspects of our lives. 

Today's report is: great (nursing, labs and school) for now! Bo was serially: eligible to apply for medicaid, approved for medicaid and approved for private duty nursing. AND, his labs were virtually unchanged from last month and the several months preceding (= he's very stable, yay!). Yesterday I meet with the school district to set up the plans and strategies needed to keep him safe at school (IEP, IHP, 504)- more meetings for this summer.

Medicaid Primer: While each state has different criteria for medicaid eligibility, all are under a federal law (IDEA) to provide an education to each child in the least restrictive environment. Michigan's medicaid is income based, and before switching jobs, we didn't have a need for medicaid. The new job does not provide the necessary nursing, so to continue his care, we needed medicaid. I had expected denials all along the way, but was fantastically surprised. And now, we have it (till it gets reviewed again by the Michigan medicaid medical director in 2 months). The school district may be confused by Bo, but I am hopeful.

School Plans:
IEP- tied to federal funding and tons of paperwork for the schools, for adaptive curriculum and academic modifications
IHP- tied to health, less legally binding, no $$
504- what to do, medically, if... legally binding, no $$, a must for fragile kids

 As for me, I am struggling with some avoidance, time management and anxiety. I used to be very athletic and fit, then I had kids, Ahn finally stopped nursing a few months ago, and now I'm feeling pressure to lose weight and get healthier. I'm too stubborn to care about twisted normative values being shoved down our popular-culture throat. I'm more worried that I'll spend time at the gym and Bo will horribly die in childhood and I'll be standing at his graveside thinking what a waste of time that was. The very next thought is equally horrifying: I keel over or compromise myself and have a heart attack or stroke, and the whole family will have to pay for my less than stellar cholesterol and waist circumference. Both scenarios kinda suck and I'm paralyzed. My only solution is to wake up early and go to the gym when everyone else is sleeping, but that means going to bed as soon as the kids do, and I won't have time to mellow out after all my commitments have been met for the day. See. I need a few hours there.

 I did, in fact, wake up crazy early today. But that's so I can do 2 years' of taxes (last year I was in outer space, remember? No I didn't get an extension, so we'll see what happens) and finish that TPS report (snort). Wish me luck, or send me any spare minutes you might have found under the couch cushions.

Breakin the Law, Breakin the Law

I'm generally not so much a rule breaker in that rebellious eff-you everyone sucks kind of way, I'm a rule breaker in a "I'm here to meet Hans Clevers, he's giving a talk at noon, "meet the pioneer;" I'm meeting the pioneer" kind of way. So I crashed the largest scientific conference in the world, to meet the biggest name in Cancer, the guy who is going to cure MID. With a baby on my back, a four year old holding my hand, my bewildered spouse, and no official identification or admission, we walked through the gate, past the Pfizer booth, down the cavernous carpeted concrete exhibit hall, and up to the lecture hall with 4 security coats trailing us, worrying about insurance liability, children under the age of 12, admission, identification verification, etc. I am pretty sure a host of angels (or jedis?) stood their ground with us, "these are not the unregistered and underaged children you are looking for." We met Prof Dr Clevers for the 15 minutes between his arrival at the hall and the MC's shepherding him to his seat on the dias. I think this really was the only time I've been star-struck, and the only time I've legitimately stalked someone. HC: How did you find out about my work? Me: I've been following your work since you discovered the intestinal stem cell Lgr5 (3 years ago). I read your Tokyo group's paper on colonic stem cell transplantation. It's amazing that all you have to do is shoot the stem cells up in an enema... HC: and they stay there. It's been eight months already, and they are still there. Me: But how can you get cells into the small intestine, past the ICV? HC: easy; an NG tube that goes all the way through the small intestine with perforations along the way. Me: stunned. It was 15 minutes, and enough hope to last a lifetime. I finally get what groupies are all about. It is connecting to your dream incarnate, to hope and love and a dream come true. We may never meet again. We don't know when they will start clinical trials in children. Those first trials will probably use immunosuppressant protocols like those for surgical whole-organ transplantation. The second generation (if they get there, with funding and longevity) will be the one with self-cells genetically transformed. And who knows when of if THAT will ever happen. But whatever is driving this venture capitalist, MD/PhD, the new Chair of the Dutch Royal Academy of Science, I believe he will press on until this thing is cured. All I can offer is Hope. All I can be is Hope. All I can trust in is Hope. There is no world without end, without Hope. There is no world worth living in. There is no future. There is only Hope. You think that something that is broken cannot be re-broken, especially if it has never been fixed. You can't imagine that something like a broken heart can get more broken, because the pain is unfathomable. And you really can't foresee something as small as a newborn and as full of hope as a baby would be the instigator of that excruciating pain of a re-broken heart; the one that was never fixed. I think the worst year of my life was the first year of my second child's life, because all the wonderful moments were sharply barbed reminders of the exquisite pain and deprivation I didn't know I was missing with my first, affected child. My mind was blown that year. My daughter was beautiful, exuberant, voracious. She rarely cried, she ate with gusto, she smile so hard her dimples popped and her eyes disappeared. I loved her deliriously, I was so full sorrow. Somehow, the resumption of delirium, disorientation, fatigue and pain simply jettisoned my being into outer space. I was catatonic with grief. And then, I began my descent back to earth, the thaw, the flash, the burning ozone refined the sting and suddenly, I was back on our home planet. With a new human, a new job, a new life. I did not expect that. I had heard secondhand that a second child was healing, after having a child with special needs. And it sounded so vague, and veiled. I couldn't have guessed why. I couldn't have guessed that the healing required a break so sharp and searing that my whole being would be blown miles into the sky, into outer space, to freeze and thaw, to orbit and crash, to burn-up in a flame so hot it turned white. But I did, and it did, and I am. Back on earth, grateful for the ride, stunned by the views, happy to be home again. And as always, I write to you because I love you. Because you might be looking for me to tell you that there is Hope. Because this isn't my blog, about my feelings for my feelings, but because it is for you to find, because you are looking to see what will happen when you find out your child or nephew or grandson has MID. We are always here, steadfast. We will always Hope. We don't know what is coming next, we never expected the world to blow up and then get made whole again. There are diseases so rare that prevalence and incidence cannot be estimated (MID), there are unnamed syndromes, there are things that cannot be fixed, but might have work arounds, there are things that aren't fatal but profoundly affect quality of life. There are the affected and those who love them. There are caretakers and those who love THEM. This blog is Bo's blog. It is a light in the darkness for anyone looking. It is hope, it is information, it is armor, it is love. My story is incidental, I am only a supporting player, a narrator. I'm just telling the story of my son, because he can't (well, at least not at the technical level). If you have questions, need help, want recommendations, want to shout out, send us love or give a high-five (or fist-bump if you're from Chicago), never hesitate to do so.