From Dawn Till Dusk

(Also posted in the Pinoy Moms Network, comments may be read here)

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When Nico was still in my womb, I was the happiest person ever to listen to his heart beats during those regular check ups with the doctor. Those heart beats, hearing from a Doppler that’s rubbed in the tummy and sounding like a staccato of horses up for a race, were music to my ears then, as those sounds only reassures that my Precious Little One is just as safe and sound inside. And what a thrill it was when I had my very first sight of my Son through a sonogram. It was only a two-dimensional ultrasound that I was able to avail of at that time when 3Ds and 4Ds are the latest medical technological trends, but nevertheless, I felt so much joy and happiness seeing this Little Tiny Creature as it moved in circles and kicked inside my tummy. Not only that the sonogram preliminary sees the physical formations in my baby, it also determines if there are abnormalities in his fetal development. And I was, as always, was at peace every time my OB-Gyne reassures me that everything is just but all right with my pregnancy. “No need to worry for anything. The baby’s fetal developments are within normal values, and his heart is at the speed of average beatings,” I remember my OB-Gyne saying. With a reassurance from my health care provider, who then has been a constant source of strength in spite of my high-risk pregnancy, I trusted and had faith in God that everything will turn out just fine.

Not until that one faithful day came, my unexpected, untimely delivery—all due to an early breaking of my bag of water. My positive outlook in life, my trust and my faith in Him—all of these were abruptly turned into being shaky and cold as I saw my son fighting for his life in the Neonatal ICU, bare with his very thin body and skin, resuscitating for grasps of breathable air through a ventilator, laid to be comforted, miserably not in my relieving arms, but in a man-made machine called the incubator. And he was in it not for a couple of days, but for 10 long days. Never in my dreams that my baby would be in such comprised situation.

And just when the thought of seeing my baby suffering in the consequences of prematurity haven’t synched in my mind just yet, the attending Neonatologist disappointingly informed us of a murmur that he disturbingly hears in Nico’s heart. The doctor lamented on the possibility that my baby has a hole in the heart. I was on a total denial hearing that shocking news. “No, my baby is not ill nor he has that heart anomaly,” I continue on convincing myself then crying into tears. But the more denying I get to myself, the more reality strikes straight through me as soon as the 2D Echo performed by one of the best Pediatric Cardiologist in the Philippines there was, confirmed the presence of the hole in Nico’s heart.

The Patent Ductus Arteriosis
The heart anomaly is called Patent Ductus Arterioris or PDA. Usually common in prematurely-born babies with respiratory distress syndrome (which Nico experienced at birth), PDA occurs when the artery, scientifically called the ductus arterioris, fails to close at birth. The ductus arteriosis remains open while the baby is inside the womb of the mother as it functions as the sole supplier of oxygen to the baby, bypassing the lungs which are not yet functional until the baby’s birth. Normally, the ductus arteriosis automatically closes at birth (at the first breath of air of the newly-born baby) as the lungs already functions as oxygen supplier. But in the case of Nico, having been born with respiratory distress syndrome, the ductus arteriosis remained patent or open, thus the occurrence of a PDA. The Neonatologist attempted closing the open artery by orally administering Nico with doses of Ibuprofen. It is the premise of the doctor that Ibuprofen would cause some swelling of the arteries, thus may result closure. After several attempts however, the artery remained open.

An illustration of a heart with a PDA (image from the University of Michigan Health Systems)

There are about five types of PDA and Nico has the most common: Type A which is a funnel-shaped ductus with a localized narrowing at the pulmonary artery junction. The hole, according to the 2D Echo is about 2.7mm, quite huge for his very young age and doctors said it needs immediate closure via a surgical operation. If the artery is not closed, the doctors said it will be hard for my baby to gain weight as the pumping of the heart works double time than the usual due to the hole. Nico would also be susceptible to respiratory infections and diseases as the hole, that brings oxygen from and to the lungs and heart will be the source of infections and flooding of excess water to the lungs. During the 2D Echo, it was also found out that Nico’s left ventricle was enlarged and it will the more be enlarged if a the hole is not ligated. Everybody else were advising me and my husband to proceed with the operation and some even offered lending us a huge amount of money just as to go across the operation of our baby.

Some Temporary Remedies
But we were stubborn enough not to give in with their advices and instead search for other safer alternatives. The Pedia Cardio, who was very much disappointed at our decision had no other choice but to prescribed medicines that would temporarily aid Nico’s heart to function quite well. With the doctors prescription, I persevered administering his medicines. One was Lanoxin, to calm palpitations of the heart and Furosemide, to induce urination so as the lungs will not be flooded with water. It was quite disappointing seeing Nico not thriving so well but I guess that was the consequences that we had to accept since we opted not to have Nico undergo an operation. It was a strive having Nico breastfed on me as he (though eager to feed) find it tiring sucking milk so we resorted to feeding him on a bottle instead.

We resorted for second and third opinions from the best doctors alive on earth. While other newbie parents took the pleasure of enjoying their babies visiting the mall, park or making family visits, ours were different. We rushed through early morning trips to different tertiary hospitals just to hook a 10 or 20-minute appointment with the most coveted Pedia Cardios in the Philippines whose most precious hours need not be wasted. But just as we hope we were positive we would soon find a different opinion, we failed. These doctors’ opinions where all one and the same—an immediate operation.

I almost lost hope and gave up my faith. All those times that we are on the search for a different opinion and seeing my son day by day as he strives for life, I was crying to God, questioning him for the hardship he was brought my son. “Sa dinami dami ng tao sa mundong ito na masama, bakit anak ko pa? Anong klaseng Diyos Ka para pahirapan mo ang anak ko ng ganito?” these hurting words were always what I brag of God. And I never stopped. But then I realized how close-minded I am to blame God for everything that has happened. Naisip ko, “kung hindi ang anak ko, bakit ko sinasabi na sana yung masasamang tao na lang ang binigyan ng sakit?” It was so selfish of me questioning God of that. I had doubts still but I prayed and ask God’s guidance and wisdom and strength so that I may carry on for my child. I need to move on and keep my mind in all sanity.

Two months have already passed and my privilege maternity leave has ended. My husband was asking me before hand what my plans are so he can already look for a mag-aalaga when I get back to work. But I’ve decided myself that I would personally take of my son. And I don’t care if I lost a promising career, if we don’t have enough money for a decent living, if I lost self esteem, the hell I care! I don’t even know if I still wanted to get back to work because for me, all I care about is my son.

Less murmurs and a modern device to close the hole
Three months, four months past until we got a different opinion from a veteran Pedia Cardio at Cardinal Santos Medical Center who has been an expert being in the field for almost 40 years. “The murmurs are not so disturbing, but it is enough to create a sound,” the puzzling statement of the doctor said during his check up on Nico. The doctor recommended that we continue with the medicines and observe Nico till the sixth month because according to him, there maybe a possibility for the hole to close by itself with the way he hears the murmurs.

This Pedia Cardio also introduced us to a new development in closing holes in the heart through the use of an occluder device called the Amplatzer. It calls for no surgery at all as the device will be carried to the hole in the heart through the use of a catheter that will pass through the groin of an individual. This modern way of patching the hole is thrice as expensive as the surgical operation but results are non-invasive though there are quite a few drawbacks like the possibility of a clotting of the blood and the untoward misplacement of the foreign object somewhere in the artery.

That check up lifted my spirits as I knew it was something positive and I find myself hoping again.

The miraculous closing of the hole
When Nico turned four and a half months, we went to see Nico’s Neonatologist for his regular baby check-up. His doctor, who was very accommodating and patient enough (imagine, we are on a consultation session for almost one and half hours for a pay of only P350?) to answer even our out-of-this-world questions, said that Nico’s PDA might have closed at all as he doesn’t hear murmurs anymore plus Nico’s pulse is within normal levels already. He even commended us for taking care of Nico so well that he was already thriving and gaining weight. “Ang galing nyo naman palang mag-alaga eh,” said the doctor then getting on the details how we care for our son. And he was more proud to know as I told him that Nico’s sleeping habits were already established at three months with our baby getting two long naps in both in the morning and the afternoon and an almost sleeping through the night at four months.

After that checkup, I am back at my optimisms again. I don’t know if others may call it mother’s instinct but I rescinded giving Nico’s medicines for the heart and the lungs at all. I don’t know what’s with me that I just put everything in trash thinking that my son won’t need it anymore. And I was right. After another 2D echo when he was six months old, the hole was confirmed to be closed. And how sweet it is of God to confirm this positive news on my 28th Birthday. It was truly the most wonderful gift I’d ever received in my entire life. And what’s more even positive is that I get to reconnect with God again. Indeed, He was so good. He really works in most amazing ways we seem to sometimes underestimate.

Life’s Lessons: To take care of Nico’s heart
Looking back, I feel so blessed to have been in that test of faith. If not for those trying times, perhaps my caring for Nico wouldn’t have gone this far. Many people who knew Nico’s medical history were so amazed to see how he is now. “Naku, ayan ba ang batang premature at dati eh may butas ang puso? Parang walang nangyari eh at napaka healthy,” most of our acquaintances and friends say. And to reply with those flattering words, this is my say: “Ganun yata talaga pag premature. Ang lagi ko kasing iniisip, kailangang maka catch up ng anak ko sa mga normal babies. Kaya I do extra special caring of Nico’s heart and all encompassing it para makahabol sya”. And yes, I almost forgot that much as I cared for my son, it is Him, who gave me my child, cared even more.

Nico’s heart has been as healthy as ever.