November 5th

Today has been a pretty good day for Missy and Noah.

Missy has continued to progress well. She has been taking less pain medicine and I think it caught up with her a little bit today. She's had a bit more pain with getting out of her bed and walking around, though she walked up to the NICU to see Noah without a lot of difficulty.

She has been taking care of getting Noah's milk supply up to speed. He only requires about 9 mL (1/3 of an ounce) per feed right now, so that isn't a whole lot.

Missy has been having difficulty with her uvula since her intubations. She has had swelling and it has been giving her some trouble. Her voice is audible now and the personnel at the hospital realized that she was from somewhere other than the Philadelphia area. She enjoyed talking to the lady who delivers her meals. Apparently that lady is originally from South Carolina. You never know where you might find a good Southerner...

Missy is excited to be able to come home tomorrow. Unless something unforeseen occurs overnight, that is what is planned. It is going to be quite difficult for her to come home without the little guy though. She has already been upset thinking about that. It's one thing to cognitively know that he is better served at the hospital. It is something completely different to emotionally know that.

Noah is doing pretty well. He continues to tolerate his feeds. As I mentioned, he's up to 9 mL per feed. His bilirubin level is down significantly, but they are keeping the "blue light special" going for now. I am not certain as to why, but I don't think it's anything significant. He seems to be the incredible shrinking boy. He was down to 2 lbs 15 oz (1336 gms) last night. I don't know what he is tonight. He should start rebounding with the weight tomorrow.

Today, the decision was made to get a cardiology consult (I gave them one on Sunday, but they can't bill for that!) because Noah has a murmur. A cardiologist from A.I. DuPont Children's Hospital in Wilmington, DE came up and evaluated Noah. He performed an echo and verified that Noah has a PDA (see my post from yesterday). The PDA is of moderate size and there is a little effect on the heart; the left atrium is slightly enlarged. The plan is to give Noah IV ibuprofen over the next three days and hopefully the PDA will close. If the PDA doesn't close with ibuprofen, Noah will likely undergo surgical ligation. This will be performed by a team from DuPont. I suspect that if that is the case, they will perform it right at the bedside in the NICU.

For those who are wondering why the cardiologist and surgical team are from DuPont and not the Children's Hospital of Philadelphia where I work, the neonatologists at Lankenau are actually a part of the DuPont system. So, it's about keeping it in the system I guess. I don't know what they would say if I told them I would need to have one of our surgeons do it. That might be fun just to see the look on their faces...

Noah had a head ultrasound tonight to make sure that he had no evidence of bleeding in his head. Bleeding in the head is fairly common in premature infants. It is more likely in the significantly premature infants (24 or 25 weekers). Noah had no evidence of prior bleeding, which is great. Once he gets the ibuprofen, they will likely repeat both his echo to evaluate if the PDA has closed and his head ultrasound to make sure that no bleeding occurred as a result of the ibuprofen. The side effects of the ibuprofen include bleeding, kidney issues, and problems with the intestines. Thankfully, ibuprofen has been shown to have a lower risk of these sorts of problems than the traditional medicine for PDA closure, which is indomethacin.

Missy called me tonight to report that Noah "christened" her when she was holding him. Apparently, the little guy overcame a diaper and a blanket to get to her. Good job, son!

That concludes the "update" portion of today's blog posting. Now is my chance to write a bit about some of the things that I have been considering over the course of the day. I have been considering the wonderful blessing that is Christ's Church and the Body. We have been so encouraged in so many ways by our family and friends in Christ. It's been overwhelming.

Friday, as the hardest day was playing out, God was faithful to provide the support we needed. He has been faithful to encourage us through not only His direct working in the medical situation, but also through others. I have received so many phone calls and emails of encouragement. Today, I was bombarded (in a great way) with people's favorite verses. The power in the word of God is awesome. Hebrews 4:12 says, "For the word of God is living and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart." I added the italics for emphasis.

As I was running this afternoon, I was considering a recurring prayer that friends from our church have been praying for Noah. The portion that is recurring is that Noah would "come to know Christ at a young age." That's an interesting prayer given the circumstances. It foregos the obvious prayer, that being "please heal Noah." It implies that God will do that. It implies that those petitioning the Lord for Noah's saving knowledge of Christ know that God is going to take care of these present circumstances. I was struck by that. I was struck by the faith that it demonstrates. It is almost like those praying it (like Hobie, John, and others) are saying, "Of course God is going to take care of Noah in this. He is going to be fine, grow up, and come to know Christ as his Savior. We have to start praying for that now." I can just hear them saying, "Why wouldn't we pray in that manner?" What wonderful examples are our friends!? We are so blessed.

For those who have paid attention to the prayer concerns that I have been listing at the end of each posting, you might have noted the distinct absence of requests for "healing." This is my attempt at continuing to "simply trust," something that I mentioned when writing about the events of Friday. Obviously, I want my family to be completely healed and healthy. Who wouldn't? Ultimately, God has a plan for my family that is far better than my desires. When Abraham took Isaac to Mount Moriah (Genesis 22), he had no desire to sacrifice his son. He simply trusted that God had something greater planned. I pray that I might one day have such a faith.

Thanks for checking on Noah and Missy today.

Please pray for the following:
Noah's neonatologists
Missy's OB/GYNs, Drs. Laveren and Heinzel
Strength for our family during the days and weeks ahead
Opportunities to be salt and light to others
Noah, and his big sister Anna, that they would come to know the Lord at a young age
Each other

Thanks to all who have sent emails of encouragement. As I mentioned above, I have received a large number containing some wonderful verses of scripture. In considering which encouraging verse/passage to post tonight, I selected a set of verses from a less frequently quoted book: Lamentations. These verses were sent to me by Jerry Johnson, M.D. who is the grandfather of one of the patients at CHOP whom I have had the opportunity to care for. Dr. Johnson is an amazing, Godly man whom I came to respect as soon as I met him. His son David has become a good friend and I appreciate their family greatly. Now that family which I ministered to is taking the opportunity to minister to me. Praise God for the Body of Christ! How cool is that?

Dr. Johnson is a retired OB/GYN and has seen first-hand the sort of situation that Missy was in. I greatly appreciate his words of encouragement through God's word.

"Yet this I call to mind and therefore I have hope: Because of the LORD's great love we are not consumed, for His compassions never fail. They are new every morning; great is your faithfulness. I say to myself, 'The LORD is my portion; therefore I will wait for Him.' The LORD is good to those whose hope is in Him, to the one who seeks Him." Lamentations 3:21-25