Tuesday, March 31, 2009

Slow Learners

Today, on the way home from the cardiologist's office, Peeper started squawking about fifteen minutes from home.

(Or five minutes? Or thirty? Who knows? It seemed like hours.)

As Shrike performed the Glowworm / rattle / please-Baby-please-shut-up-be-happy song and dance in the backseat, and I barreled drove as quickly as I safely could down the Interstate, we discussed possible causes for her distress.

(Also known as, the "What the fuck is her problem?!" conversation. Not the first time we've had it. I'm sure it won't be the last.)

Shrike brought up the fact that she'd pitched a similar fit in the car last night, while we were out picking up Taco Bell (Yes. Picking up Taco Bell. With the baby. At damn near midnight. You got a problem with that, June Cleaver?) and I said, "Yeah, she got a little happier when we took her out of the carseat while we were eating (in the parking lot - the plan was for her to nurse, since she was being so pissy, but she wasn't interested) but started up again when we put her back in, so I think she was just mad about the carseat."

When we got home, I changed her diaper, as is our routine and - Hello! Poopy pants!

Cue flashback music and effects . . .

Cut our car, in the Taco Bell parking lot last night . . .

Whozat: Do you think we ought to check her diaper?
Shrike: Nah, she's fine.

Cue ominous music . . .

Cut to the changing table at home, after the trip to Taco Bell . . .
Whozat: Let the record show, that I was the one who said to check her pants!
End flashback, return to changing table this afternoon . . . .
Whozat: Doh!
So, we've now decided that anytime she suddenly starts squawking in the car for no apparent reason, we will find the nearest safe and convenient place to pull off the road and investigate the diaper situation.

Live and learn, Mommy and Mama.

Live. And. Learn.

Cardio Report

Peeper saw her cardiologist again today, and he's still very happy with how she's doing.

Her echo showed that her heart function is still great, and there is no accumulation of fluid around her heart.

He also said that "she looks like a different kid," and that she's "breathing normally," which is a big change from before surgery.

When I asked for some numbers, to put it in perspective, he said that he did not actually count her respirations today, but "eyeballing it" he'd say she was breathing 25 - 35 times per minute, and that before surgery, her respiration rate was in the 60s.

In other words, she was breathing twice as fast as she should.

And now she's not.

Amazing.

He said her incision is still looking good, and snipped the little stitch on the incision where her drain tube was. The suture didn't actually all come out, but it should be able to fall out on its own now.

He also reminded us (I'd forgotten they told us this at the hospital) that her main incision has a lot of internal stitches under the dermabond, and some of them way work their way out through in the incision.

He said that it's okay to just gently pull them, and snip them off short.

He also told us that we "might get an inch or two."

I thanked him for warning us about that, because I would have totally thought she was coming unravelled, like a sweater!

(He said it freaked him out the first time, too!)

It seems like there might be a tiny bit of a suture peeking out at the very bottom end of her incision. It's kind of creeping me out.

He told us to drop her Captopril (blood pressure medication) back to once daily for a week, and then she can stop taking it!

(Actually, it's a week or until we run out, whichever comes sooner. We have just a tiny amount left, and he said not to bother refilling.)

We'll go back in two weeks, and if he's still happy with everything, he'll take her off the Lasix (which she'll continue to take once a day until then), and start spreading out the visits further and further apart.

And, I'm not putting this in the sidebar, because I really don't believe it, given the variability that we've seen from their scales, but they claim that she weighed 11 lb 7 oz!

Spittake Outtake

From this evening's photo shoot.

Daily Peep: Evil Genius

Distraction 3?

I'm sorry yesterday's Daily Peep was running late. I had it all done last night but I guess I saw something shiny and forgot to hit "publish" before going to bed!

Saturday, March 28, 2009

Daily Peep: Zip Report

Here's a recent photo of Peeper's incision. It's still got a lot of healing to do, but all the scabbiness (and glue) is gone now, and it's looking pretty good.

OMG!

How cute is our kid?!

Friday, March 27, 2009

Five Months

Dear Peeper:

You are five months old today.

(That is a lie. You were, technically, five months old yesterday, because I'm writing this at like 3 am and back-dating it. I meant to write it earlier but you and I took a reeeeaaaalllly long nap, which I am not going to complain about one bit, then I spent the rest of the evening on the phone with AuntieKay. (I've decided that trips off the fingertips better than "Aunt LadyKay."))

So, as I was saying. . . . You are five months old "today."

That's kind of freaking me out a bit, because five months is almost six months, at which point you'll be half-way through your first year, and if the the second half goes as fast as the first half, then ohmyGod, you're almost a year old, and the next thing I know, you'll be grown!

Or, maybe, you're five months old.

Of course, for the past few weeks, everything has revolved around your surgery.

Preparing for surgery. Having surgery. Recovering from surgery.

I realized to day that I tend to think, not so much that "Peeper is recovering from surgery," but rather that, "We are recovering from Peeper's surgery," because I really think it was probably a lot harder on me and Mommy than it was on you.

We had to worry for months about whether you would need surgery, then worry for a month or so about the surgery that we knew you were having, then worry while you were in surgery, then watch and worry about you while you were in the hospital, now worry about you as you recover.

You, on the other hand, were a little trooper.

Of course, on the one hand, it may have helped that you didn't understand that it was going to happen, or the magnitude of what was going on.

On the other hand, though, you also didn't understand why we gave you to those strange men (the anesthesiology team) or why you woke up "a few minutes" (several hours) later with those strange ladies pulling tubes out of your nose and throat, or why your chest hurt so damn bad (I can only assume that it must have) or why you were in such a crazy place, and in a crib (for the first time since your newborn hospital bassinet) and where the hell were your mothers - and your goody?!?

But you took it incredibly well, and I just can't get over how quickly you were back to smiling and laughing and being more or less yourself.

I am so glad that is (mostly) over with.

I think it's safe to that it was the hardest thing that Mommy and I have ever been through, and I certainly hope that you don't have any plans to top it.

I am so looking forward to a few weeks from now, when you are completely off your medications, and to a few weeks after that when you're all healed up and we don't have to worry about handling you so carefully and such, and you can just be (as Dr. C put it) "a normal baby."

The whole thing just seems surreal, because things like babies having open-heart surgery is something that happens to "other people."

Today, I was talking with someone whom I don't know very well, (coincidentally, I learned that his dad is a professor of neonatology at SurgeryHospital) and I told him about your surgery, and his response was, "Oh my God!"

Yeah, exactly.

I guess we kind of tried to be a bit nonchalant about it (Yep, this is me, nonchalant. Lord help you when I start making a bit deal about something.) but this really is a huge damn deal, and it's really kind of hard to wrap my head around the fact that we have done this big damn deal thing, and that we've all come through it with flying colors.

I try to picture how we'll look back on it, years from now.

How you'll tell people (probably in response to questions about your "zipper.") "Oh, that? I had open-heart surgery when I was a baby," or we'll casually mention it in passing, "Yeah, when Peeper was at SurgeryHospital. . . . " or tell some other terrified parent, "Oh, my daughter had that surgery years ago. . . ."

But it's hard to imagine it just being "something that happened once" and not something all-consuming.

But, of course, I know it will, eventually, be just something in our past, which makes it all the more surreal.

Right now, we just need to get through the next few weeks of recover, so we can move on from this whole chapter of our lives.

Another thing I'd like to move one from is this whole question of what's going on with your belly and your booty and your poopy and whatever else that's about.

I'm getting very frustrated, because I hate the idea that you are hurting and we don't know what to do about it.

I'm not getting a lot of answers from your doctors, or from Dr. Google, for that matter.

Mostly, it just feels like a lot of speculation about what exactly it is that I am doing wrong, that's hurting you.

If someone could just tell me what it is that I'm eating that's not agreeing with you, I would be happy to stop eating it, but it's more like, "Well, try cutting out this for a few weeks, and we'll see how it goes," but then it's a few more weeks of not having an answer, and your symptoms come and go so much, we can't tell if we've solved anything.

So, far, I'm avoiding all dairy-containing foods, but I don't know if I've seen a difference. I just keep wondering if it's something else entirely.

And it's just killing me to see you hurting (which doesn't happen all the time, but when it does, it's awful - but is it even poop-related, or are we just blaming everything on that?) and it scares the hell out of me when I see the blood in your poop (even though it's only happened a few times, it's still terrifying every time, because it's just so wrong).

I just want an answer and a solution, so we can move on from that one, too.

Mostly, though, despite all that, you are great.

That's still my answer when people ask how you're doing.

"She's great!"

Still half sliced-open from surgery? "She's great!"

Spitting up all the time? "She's great!"

Bloody poop? "She's great!"

Crying her damn fool head off for an hour this morning? "She's great!"

Medications (only!) twice a day, and doctors at least once a week? "She's great!"

Because you are.

You are just great.

Reaching and grasping and shaking your rattle? You're great.

Laughing til you get the hiccups, just like Mommy? You're great.

Snugging beside me in bed at night? You're great.

Sucking both your thumbs at once? You're great.

Cracking yourself up in the mirror? You're great.

Giggling at BigGaloot's tail swishing around? You're great.

Enthralled with your Glow Worm (this has been a lifesaver lately)? You're great.

Nursing all night long? You're great.

Greeting Mommy with a big gummy grin? You're great.

Taking a "shower" in my lap, or Mommy's? You're great.

And for so many other things that I'm too tired to even think of, you are just the greatest.

And I am the luckiest.

Still, even after five months, every couple of days or so I still look at you and just think "Oh my God. We have a baby. How the hell did that happen?"

It just still seems so surreal and so unbelievable that we could possibly be so lucky.

Of course, I am also, over and over, overwhelmed by the huge responsibility that is you.

The idea that we have been entrusted with such a huge and important job as nurturing and molding and forming a human being is just absolutely overwhelming, and humbling, and just the greatest honor ever.

I only hope that I can live up to you.

Happy birthday, my little sweetness


love,
Mama

Daily Peep: Just A'Swingin'

Peeper's really starting to enjoy her swing, especially now that she can reach, grasp and chew on the toys attached to it.

We've got it in the kitchen, and she's usually happy in it long enough for me to fix something to eat, or to deal with the dishwasher.

Maybe someday I can actually cook again!

Thursday, March 26, 2009

Good New on the Auto Front

Shrike's car had a tire with a not-so-slow leak, and needed to be inspected; my car had an even less slow oil leak and really needed to be inspected.

(Mine was due in October. I readily admit that I have no excuse for not having done it sometime in the first twenty-six days of the month, but since then, I've been rather busy.)

We dropped her car off on Tuesday, and the mechanic called yesterday to say that the tire had been repaired (or replaced?) and that it had passed inspection with no problems.

Yay!

Today, she switch cars out her car for mine, and he called back this afternoon to say that it's all ready to go, and that the oil was leaking because the filter was really loose.

Yay again.

Also WHEW!

Daily Peep: Attentive

No, she's not looking at me, she's staring over my shoulder.


Wednesday, March 25, 2009

Structurally Sound

Peeper got her Synagis shot today, and we got word that her abdominal x-ray was normal, showing no blockages or structural wierdnesses, so that's good to know.

I wasn't particularly worried about it, but it is good to rule out that kind of thing.

I asked the nurse about the possibility of thrush, since Peeper had quite a bit of antibiotics post-op, and she checked out her mouth and declared it all clear.

I'm still not completely convinced that's not the case, though, since I'm definitely feeling some ouchies on my end of the equation.

Other possible explanations for that could be that she's nursing more frequently since surgery, including basically all night long, now that we've freed her from the nest and convinced her that the side-lying position is cool, and maybe her latch isn't so great in that position, but I read something just today saying that "often the only sign of thrush is that nursing is painful, when it was previously painless." Hmmm. . . .

She is still spitting up a bit - not like those three crazy "Hey, here's all the milk in my tummy!" times, but certainly more than is normal for her. (Any is more than normal for her.)

This nurse said the spitting up could be related to having been intubated, but it didn't start in earnest until about three days later, so that seems odd to me.

She did suggest that I keep a log of what I eat (ruh roh, I need to start that!) so that we can see if there's anything specific that seems to be related to her bloody stool, and said that if she has any more, to call in and see about having her checked out again by one of the doctors.

Barring that, she'll go back around April 22 for her last Synagis shot (since the insurance was willing to pay for one more, they want to go ahead and do it, since she's had the surgery and all that, even though it will be the tail end of the season) and again on April 29 for her six-month well-baby check-up!

Yes, it does seem we could do those at the same time, but there are some vaccines that can't be given until after their actual six-month birthday, so we can't do that appointment any sooner than April 27 (also Shrike's 40th, by the way), but that's past the Synagis window, so we have to have two separate appointments.

Oh well, we're there practically every week anyway!

Daily Peep: Cruisin'

Tuesday, March 24, 2009

Daily Peep: Sweaty Heady

Peeper's still getting a bit sweaty when she nurses, but she also gets sweaty when we just snug, so I'm not too worried about it.

The upside is that when she's wet, I can fluff up her curls!


Note: Yes, she has been rockin' the Elvis lapels lately, as we've been leaving her top snap open, just because it seems like it would be too tight or rubby or something up against her incision.

And Now, For Her Next Trick . . .

Now that we've got this heart thing about licked (knock wood), we need to address Peeper's digestive concerns.

When I called the pediatrician's office today to check on her Synagis shot, I also left a message for the doctor about yesterday's bloody poop, and asked if she'd like to actually see her when we're there tomorrow for the shot.

They called back to say that the shot had been approve, for both this month and next (The insurance company had lost the pre-certification request. Shocking.) and that she had lab orders for an abdominal x-ray, just to make sure that Peeper doesn't have any kind of obstruction or anything of a structural sort going on in her gut.

Shrike was at work already, so Peep and I were on our own for this one, but it went fine. I loaded her up and we went to the pediatrician's office to pick up the orders, then downstairs to the lab for the x-ray.

That went fine, other than having to juggle Peeper and the diaper bag and my coat (Spring Temperatures, where are you?!) all by myself.

(I don't know how all those poor little kids who only have one mom ever get anywhere. It generally takes all we've both got to manage ourselves.)

She got a bit fussy in the waiting room, but a littl goody fixed that right up. Of course, then it was our turn, so she was a bit indignant about that.

Once we got in the x-ray room, she was a complete little charmer, though, smiling at the techs, and just being as cute as could be.

I wasn't too thrilled about the fact that, in order to see her abdomen, they weren't able to do any ovarian shielding, and also a bit annoyed that, after having me just open up her outfit (metal snaps) but leave her diaper on, they had to go back and do a second, naked, image because the cloth diaper was too puffy and was obstructing their view so, you know, twice as much radiation for my future grandchildren.

But, I also know that, realistically, one little x-ray is nothing in the grand scheme of things, so I'm not too concerned about it.

(I started to say, "After all, I had at least one set of abdominal x-rays as a kid and my ovaries were fi. . . ." Oh. Nevermind. But, I am quite sure that had more to do with the thirty-nine-plus years they spent not being x-rayed, rather than the few seconds that they were.)

I made sure that the techs knew that we've got an appointment tomorrow morning, and they made a note that the x-ray needs to be read and the report faxed to the doctor in time for her to look at it before then.

We certainly hope that this x-ray doesn't turn up any real problems, but we sure would like to have some sort of an answer besides, "Well, it could be dairy. Stop eating cheese and let's see how she does."

If she were having the bloody stool on a regular basis, that would be much worse, but at least we'd be able to see if we were making it better with these changes, rather than just having to wait and see if we get another random incident.

So, it continues . . . .

Weaning

Ha Ha! Had you going there, didn't I?

Peeper saw her cardiologist today and he was very happy with everything, and is starting to wean her off of her medications!

Effective immediately, we're cutting them in half - going from four 1 mg doses of Captopril a day to two, and from two 5 mg doses of Lasix to one.

We'll see him again next week, and if he still likes everything he sees, we'll drop the Captopril completely, and if everything is still going this well when we go back two weeks from that, he'll take her off the Lasix as well!

She's been on Lasix since she was about two weeks old, and Captopril since about three weeks, so it will be a big damn deal to be off of them.

He said again that he ". . . knew she'd do well - she was well-nourished and had good protein stores. . . " and that the surgeon had already reported to him that everything went great, with no problems.

When he listened to her heart, as soon as he put the stethoscope to her chest, he said, "Wow - I can't hear a thing!"

Referring, of course, to the complete absence of the murmur that was so prominent just a few days ago!

He also said that her incision looks good, and if the one little stitch in the drain tube incision hasn't come out by next week, he'll snip it out.

("They are supposed to just absorb, but I probably remove more of them than not.")

He did an EKG, which was "beautiful" and he also "like[d] everything about the echo."

(Peeper, for her part, liked nothing about the echo.)

The echo showed no evidence of any residual defects (meaning the holes are completely closed); her heart function looks good (including the right ventricle, which was still not quite up to snuff on Thursday); and the overall size of her heart is smaller, which is good.

As I said above, we'll go back in a week, and then two weeks after that, and if all is continuing to go well, she'll be off her meds by mid-April!

Monday, March 23, 2009

Riddle Me This

Remember a while back, when you laughed at me for wanting to say "vet" instead of "pediatrician?"

Well, now I'm not sure which one we should call, because the kid and the dog are exhibiting identical symptoms.

Seriously.

Peeper and PerfectPup had synchronized bloody poops this afternoon.

What. The. Fuck?

PerfectPup has had hurty-poopy issues off and on since she was about six months old, but only in the past few months have we seen blood, which was diagnosed as colitis.

(Which, I think, is just a fancy way of saying "hurty poopy.")

She was doing some yelping yesterday, and then actually had one hurty poopy in the house, which is definitely out of the ordinary for her. Then, she was clingy again today, so we knew it wasn't over yet.

(When she's not feeling well, she follows us around very closely, then poops and cries.)

Peeper was in my lap, and PerfectPup was right beside the chair, whining. I told her, "Well go outside if you need to poop. Go find Mommy to let you out," and she trotted off.

(Seriously, she did. Actually I think Mommy was outside - ironically, picking up poop.)

A few minutes later, I heard her yelping and said to Peeper, "Poor Puppy!" - Just then, I felt Peeper pooping. At the very same time.

Later, I was walking down the hall to take Peeper for a diaper change, when I passed PerfectPup and saw that her fluffy white booty fur had some blood on it.

I hollered to Shrike, "Hey, have you seen PP's butt?" She had, and was on the case.

Just then, I opened Peeper's diaper and shouted again to Shrike, "You're not going to believe this one!"

Upon further inspection of Peeper, we also noticed that, instead of just the same perianal (thank you for the big word, Anonymama) redness that she usually has, she's red all over her booty-cheeks.

(Sorry. Buttocks. Or, as LittleNiece says "Butt tocks." You know, your butt has several parts: cheeks, crack, hole, tocks. . . .)

Butt, I digress. . . .

So, now what?

Some thoughts:

Thrush? We're not seeing anything in her mouth, but she did get a lot of antibiotics post-op. I may be feeling some nipple tenderness myself, but on the other hand, she's been nursing 24/7 since we got home, so maybe they're just tired.

Maybe it's the "gets worse before it gets better" thing again with the dairy. Would that happen again, from cutting out the rest of it from my diet?

Maybe the bloody poop (and probably hurty poop, although the bloody one didn't seem to hurt) and the redness are unrelated? The poop could still be messed up from the morphine, and maybe the redness is because there was a diaper-laundering miscommunication, and they've not been getting their extra rinse, to remove any detergent residue.

(Ack, I need to go put all the clean diapers in for an extra rinse right now!)

This all happened, of course, at around 5:30 pm, so we didn't call the doctor's office about it, because we figured we'd get the same answer as before, that it's not an emergency unless it's a whole lot of blood, or her stool is black with older blood, or something else bad.

I will be talking to them tomorrow, anyway, to see how they're coming along with the insurance company, regarding her last Synagis shot, which she's supposed to get this week.

It seems the insurance company is denying it, saying that she doesn't need it because "RSV season is over."

Tell that to all the RSV babies who were in the hospital with her, or the baby that our doctors diagnosed on Friday, or LeaderH (DoulaK's La Leche League co-leader) whose baby (about six weeks older than Peeper) was diagnosed with it today.

(Rememember when DoulaK stopped by yesterday? She had dropped off some things to LeaderH right before that, but just left them on the porch, because everyone there is sick, and she's got like three births coming up, and has four kids of her own, and can't afford to be sick or germy. Thank God!)

But, again, I digress. . . .

So, Peeper is spitting up a whole lot less now, but still more than normal for her. She's had another bloody stool (one diaper, plus a teensy maybe bit on the next diaper) and she's screaming her ever-loving head off, pumping her little leg and not settling to nurse, fairly often, probably when she needs to poop, and her whole butt is red.

Coincidence? I think not.

And, PerfectPup is having hurty, bloody diarrhea, too.

Coincidence? Surely, it must be.

Right?

Then and Now: The Carseat

November 1, 2008 - 5 days old (Car seat test)



March 23, 2009 - 21 weeks old (Night-night ride)



Daily Peep: Thumbelina

More Surgery Photos

These are from the real camera, and better quality than the ones I sent from my phone while we were at the hospital.

Right after surgery


Under oxygen tent


Feeling a little better


Out of bed

"Fall Risk" - Ya think?


Home


Lesson Learned

Cloth diapering baby is great.

Cosleeping, with baby big enough to "fly free" in the bed without a "nest" is great.

Having baby sleep essentially ten hours, interupted only by some whimpers that are quieted by rolling over and sticking a boob in her mouth (and that one time that I woke her up for medicine around 1 am) is really great.

However . . .

It would probably also be great to actually change baby's cloth diaper at some point during the ten-hour period.


PS: Did I mention that baby takes Lasix?

Sunday, March 22, 2009

Examine Her Zipper

This is a pretty good shot of Peeper's incision, six days post-op.


The smaller incision, below and to the right, is where her drain tube was. There's one stitch in that, which will just fall out.

It seems to be healing nicely, and when we were bathing her this evening, we noticed that the scab is already starting to come off in a couple of small places.

There are, of course, plenty of internal stitches (plus some wires, holding her sternum together), but the outer layer of skin is sealed with dermabond, which is basically a medical-grade superglue.

I'm sure that they put it between the two cut edges when they brought them together, and there's also about and inch-wide strip of it "painted" over the whole incision, which you can see in the photo.

That will also just wear away over time, and one edge is already starting to peel up a bit. I can't tell you how much restraint we are both having to exercise to stop ourselves from playing with it.

If it were on my own body, I'd have it about half off by now, I'm sure, but instead, I'm making do with trying to get the remains of other various adhesives - EEG leads, EKG leads, IV-sealing bandages, etc - off her skin.

(You can see some of that in the photo, on her neck (IV), and around her nipple (EKG); I think most of the EEG goo is out of her hair now.)

We have been told, by the way, that the scar will stay roughly the same absolute size as she grows, so it will not extend the full length of her chest as an adult. (Or, more importantly, as a teenager.)

I wasn't able to get a good description of exactly where it will end up (how high on her chest), but hopefully, it will just be more or less hidden in her cleavage, eventually.

We're also told that it should heal to be pretty thin and light, especially if we're careful to avoid too much sun-exposure in the first few years.

Of course, we'll use sunscreen on her anyway, and even before we had a scar to be concerned about, we liked the idea of "rashguard" style swimshirts better than traditional bathing suits for her anyway, mostly for sun protection, but also because so many little girl's bathing suits are so grown-up looking, and we really don't like that.

(Ah, but that's a whole 'nother post. . . .)

It occurs to me that, as she gets older, may be a fine line to walk, though, between covering the scar to protect it from the sun, and coming across (to her) as trying to hide it.

Although I can certainly understand that she may become self-conscious about it at some point (or maybe not, since it's something that will always be there, as far as she knows), I certainly don't want anything we do to give her the idea that it's something to hide or to be ashamed of.

I know that we'll get lots of questions about it, and she'll get even more later, so I guess we will just have to model for her how to answer nonchalantly, and to explain how she got it.

Which is certainly nothing to be ashamed of. In fact, I think it's something she should be pretty proud of, because she's been a real trooper through it all.

Daily Peep: Good Day, Sunshine


Saturday, March 21, 2009

Readjusting

We've now been home about two days, and we're all still kind of getting readjusted.

Peeper saw one of her pediatricians yesterday, and she was quite impressed with the difference in her heart-sounds from the last time she listened. (There is no murmur at all now!)

She didn't really have a whole lot of insight for us on the bloody poop issue, though (and we've not seen any more since) but recommended agreed with my recommendation that I cut out the rest of the dairy from my diet - start actually reading labels, rather that just skipping the milk, cheese, ice cream and such.

She acknowledged that, "I know it's a lot of work. . . " but as I told her, "Well, it was a lot of work carrying her [Okay, not really.] and having her [Yes.] but it was worth it, and this is, too."

(But does she have to be sensitive to like my favorite foods in the whole world? Couldn't she be allergic to broccoli?)

Although the bloody poop is gone, Peeper's still spitting up, and had a couple more rather impressive spits while lying in her "nest" in the wee hours this morning.

(Could have been worse - most of the night, she was on the boppy in my lap.)

I called the doctor's office about it, because although this amount of spit-up might be a "good day" for some babies, it is very out of character for her.

The doctor said that the spitting, and what seems to be some painful poopies (but not hard or bloody) is likely caused by her little digestive system just having a hard time getting revved back up after being slowed down by the morphine that she was getting off and on for most of the week.

On Friday, she pooped around 2:30 pm, on the way home from the doctor's office, and then I don't think she did again until about 11 am today. That is not normal for her.

So, I suppose it's no surprise that she's spitting up. She's been nursing almost constantly, and nothing's leaving through the other end, so where else is that milk going to go, but back out the way it came in?

DoulaK stopped by to visit for a while this afternoon, and Peeper spit up a bit while she was here. She said that it was obvious how rare an occurance that is, because we were completely unprepared for it.

There was no spit-rag handy, there was none in the diaper bag, and we were absolutely at a loss as to what to do about it.

I had to go all the way to her bedroom, and into the dresser, and grab a cloth-diaper-that's-not-being-used-as-a-diaper to clean her up!

So, we're hoping she'll have the kinks worked out in the next day or two, and the spitting will stop, as well as the dramatics involved with pooping.

At least, we're assuming that's what she's crying about; she's got her leg a'kickin' and is not wanting to settle in to nurse, which generally goes along with poopy issues.

Also, we've had some crying just it's almost time for another dose of Tylenol, which we're assuming has to do with hurting from the surgery itself.

All in all, though, she's really hanging in there and doing very well. I've never had thoracic surgery, but I know that she's "getting around" much better than I was five days after abdominal surgery.

On the other hand, she is still very much a poor baby.

We have to remind ourselves that, on the inside, she had a pretty significant problem which has now been resolved - because, on the outside, it sure looks like we took a perfectly good baby and broke her.

Spring?

Flowers! In our yard! On our kid!

Daily Peep: My Girls


Friday, March 20, 2009

Are You Sick Of Hearing Me Talk About Poop Yet?

So, we took Peeper in to see the pediatrician this afternoon, for a post-op look-see and to talk about the bloody (again!) poop.

This was the same doctor (there are several in the practice) who saw her recently for her four-month appointment, and for her cold.

She said that she's looking great, for just having had open-heart surgery, that her incision is coming along nicely and that she couldn't hear any heart murmur at all!

As to the poop thing, basically Shrike and I both felt like the gist of what she said was, "Hell if I know."

I could be related to the narcotics that she had for pain relief slowing down her digestive system, and it's irritated as it's getting going again, or it could be more of the same, which could be a sensitivity to something in my diet, which could be dairy.

None of that is definitive at all.

We did agree that removing the "obvious" dairy from my diet has not done the trick, so she said to start reading labels and try to avoid all dairy products - which pretty much rules out just about anything that comes in a box.

That also rules out chocolate, which is going to be a tough one for me, but which I've kind of had a nagging feeling about - probably more like a fear that it was going to be the culprit, or at least an accomplice.

I asked whether I ought to do an actual elimination diet, but she said to try getting rid of the rest of the dairy and we'll see where things stand next week, when we go back for Peeper's last Synagis shot.

Oh, and she weighed 10 lb 7 oz - which, as I'm sure Anonymama will tell you, if I don't beat her to it - was my birth weight.

Daily Peep: That's More Like It


Confidential

Since it's worked so well for us so far, the next time you're talking with insert-supernatural-intervener-of-your-choice, please request some healthy-heart-mojo for the husband of a new friend, and some sticky-baby/ies-mojo for someone very special to us.

Thanks.

Thank You Thank You Thank You

Again, I want to thank all of you, and so many other people, for all of your kind words, your concern and your insert-supernatural-intervention-of-your-choice for Peeper and the two of us over the past few days - hell, over the past year since she was conceived - and even before.

It's been incredibly helpful, especially during the hospital stay, to check my email, or here or Facebook, or the Carepage and read messages of support from so many people, from family members to old friends to new virtual friends to perfect strangers.

There are a few people whom I should thank by "name" as well: Shrike's family and DoulaK for sitting with us at the hospital while Peeper was in surgery, and her mom for making a grocery trip this afternoon; A for house/dog/cat sitting; W&C for walking our dogs - and then blogging about it, complete with photos, so we could see for ourselves how well it went; E/K/S for offering to deliver dinner last night, although we ended up passing on it because we were just so exhausted and not up to it; MOMS Club, who will be providing us meals for six different nights over the next two weeks.

Also, we can't say enough good things about the people who took care of us at the hospital - our surgeon, the nurse practitioners who actually managed Peeper's post-op care (especially K, who took great care of her, spent alot of time talk with us about her condition and the plan - and is "family."), the nurses who cared for her around the clock, and the volunteers staffing the Ronald McDonald Family Room.

I also can't say enough good things about the support that we felt from the parents and families of other patients. The family room set-up on the pediatrics floor allowed families a chance to mingle, and talk and support each other.

I know we had some very relevant things to say to the family of the heart-baby (Tetrology of Fallot) who was a day behind Peeper, and in the next bed, (especially assuring them that what they were seeing with Peeper was where their son would be in 24 hours), but also the families of the preemie with RSV, whose twin brother was out in the waiting area with his parents; the three-year-old who'd had some sort of breathing issue (I never really got a good idea what was up with that) or the seventeen-year-old girl with the head trauma from an auto accident.

All radically different medical situations, but worrying about your baby is worrying about your baby - whether she's a few days old, or almost ready to move out.

After all, in what other situation would I be sitting there at 5 am, talking to an Amish (or possibly Mennonite, but I'm pretty sure Amish) woman about the wonders and benefits of breastfeeding and natural birth?

It was great to know that everytime I stepped out of the PICU for a break, someone would ask me how Peeper was doing, and would share their child's progress.

It was so exciting yesterday, when most of the kids that we'd been following so closely got "promoted" to intermediate care, and then home today.

It was like we suddenly had a whole bunch of new best friends - like camp, but with a lot more stress.

I made a point of saying all that to the family services representative who came to check on us today.

A few minutes later, she was back, asking me to help out with a video they were filming, to help raise money, through Children's Miracle Network, for a new children's hospital, with more family facilities, more private rooms, etc.

After taking a moment to put on some make-up and real clothes, I was happy to do it. I said some of those things on camera, and showed off Peeper's Carepage.

Then, they came to the room, and filmed Peeper herself, lying in my lap with her sleeper open to show her incision, being cute as could be.

Pretty cool way to end one hell of a week.

Homecoming

We made it home from SurgeryTown with no incidents.

While Shrike greeted the dogs and unloaded the car, I got Peeper into a clean diaper and some clothes that we recognize.

We've just switched over to her 0-3 wardrobe, and retired most of the newborn outfits, but after spending the past few days looking at her in a "new" (yardsale, I'm sure) fuzzy sleeper that she'd not worn until Monday, and seeing her looking and acting just so wrong for most of the week, it was very important to me to have her in one of "her" outfits that was familiar to me, so that she looked like herself.

We then nursed for a while and went in the bedroom to take a nap.

I laid Peeper in her nest and was getting myself comfortable when she started coughing a bit and I realized that she was spitting up. A lot.

Not vomiting, there was no retching involved (sorry), just spitting up, but like her entire stomach contents.

(This is a child who normally does not spit up. At all.)

So much for the outfit.

We stripped her down and cleaned her up, and Shrike changed out the sheet on the nest mattress.

I lay down beside her on the bed, and Shrike joined us, and the next thing you know, I've whipped out a boob and all three of us are asleep - for about 2 - 3 hours.

It was wonderful.

We've been "practicing" with nursing in the side-lying position, in preparation for moving Peeper out of her nest and letting her fly free in the bed with us.

(The big advantage of this will be the ability to nurse and sleep simultaneously while lying down, rather than sitting up, with her on the boppy.)

She's pretty much filling the nest these days, and flops her legs out the side, and often gets herself turned 90 degrees over the course of the night (Once, Shrike thought I was just so sleepy when I put her back after nursing that I'd stuck her in there the wrong way!) but we are planning to wait until she's healed up from surgery, so she's a little more protected from the possibility of us flopping a hand down in the middle of her chest or something.

But, this afternoon, we were just fine all snugged up together, and she literally stayed latched on the whole time, sleeping and sucking.

We woke up around nine, and gave her medicine (New schedule: .5 cc Lasix 2x daily / 1 cc Captopril 4x daily / Tylenol every 4 hours as needed) and nursed some more.

A little while after she and Shrike had gone to hang out on the couch, she started crying. And crying. And crying.

Shrike changed her diaper and - wouldn't you know it - blood in her poop.

Before the nap, we'd thought we might have seen a few little specks of blood in a diaper, but this was definitely there. Not a lot, but no doubt about it.

And she was crying.

So, I called and talked to the pediatrician's on-call nurse. Again, she said that unless it became a lot or her stool turned black (older, higher up blood) or we couldn't get her settled down, that it didn't warrant an emerency room trip or anything, but we've now got an appointment to see a doctor tomorrow.

Our discharge instructions said to check in with her pediatrician, and they suggested that we call tomorrow to see if we could actually see a doctor when we go for her Synagis shot next week, so we'll go ahead and do that post-op visit and discuss the poop at the same time.

She said it could be related to the morphine having slowed things down, digestively, and now getting going again (so to speak) but her stool hs not been hard at all, just a little different color that usual, and she's been saving up and doing a lot at once, so I'm not sure.

Of course, I started mentally reviewing my diet from the past few days. I'm still avoiding the obvious dairy, but maybe it's time to start reading labels and cut out all dairy?

As much as I hate to think about this, maybe I need to look at the possibilty that chocolate is a problem for her?

Maybe I need to do an elimination diet to nail down the culprit?

She finally settled down, after "dancing" with Mommy, and did nurse again. She's had a couple more small poops with no blood, and she and Mommy are asleep on the couch right now, waiting for her next dose of Captopril and Tylenol (in about fifteen minutes) and then we'll be heading to bed.

Wednesday, March 18, 2009

Intermediate Care - And Tomorrow

They just moved us out of PICU and into Intermediate Care. We have a private room (don't seem to be many of those) and they brought in a recliner, in addition to the bench/couch, so Shrike has checked out of the hotel and we're both in the room and fairly comfy.

She's on the couch and I'm in the recliner, so I can nurse Peeper sitting up, then sleep reclined. I wouldn't buy one for the house, but it's comfy enough.

We're hoping that she'll be discharged tomorrow, but you know how that works, we won't really know when until the orders are signed.

She'll have another echocardiogram in the morning, and if everything is hunky-dory, we could get out tomorrow afternoon.

If her cardiac function isn't quite what they want yet, then we might stick around a bit longer.

That's nothing to be concerned about, just that the right ventricle has to get used to suddenly having the right amount of fluid, rather than too much (it's a bit "flabby" after the hole is closed, and has to "tighten up") and the left ventricle has to get used to only needing to pump the normal force to get enough blood out the aorta, rather than pumping harder to make up for what was shunting to the right ventricle.

Basically, the heart just has to relearn how to be normal. Hopefully it has by morning, but if it's not quite there yet they'll want to keep an eye on her a bit more.

She's off the med that they had her on to help with that, so that's good, just need to see where the function is.

It's not a concern as to whether she'll get it together, just a question how long it takes.

So, if all goes as planned, we hope to be out tomorrow afternoon or evening, but no promises.

Sweet!

Out of PICU. Intermediate Care - PRIVATE room! Space for us both to sleep! Shrike's at hotel now checking out.
Echo in AM. If all good, maybe home in PM. All is going very well. Exausted but ecstatic.

Graduating

Peeper has orders to move from the Pediatric Intensive Care Unit PICU to Intermediate Care Unit.

That means an actual room, with just one roomy (Although our current wardmates and their parents are quite lovely. More on that later.) and with a bed for an adult, right there in the room.

And, a possibility of moving in an extra bed, so we can both stay there.

Now, we're just waiting for the room to be ready.

Yippee!!!

Hangin' With Mommy

Happy Girl!

After she nursed at 3 am, Peeper evidently said, "Hey, those are still here? What am I doing with these stupid bottles, then?"

After refusing a couple of bottles, we got permission for her to just nurse from here on out. Yay!

She nursed around 9 am, and then she was all happy and playing and even sort of smiling a bit. I was shaking her rattle, and she reached out, grabbed it and shook it.

Um, Peeper, you don't know how to do that!

I guess she got some new knowledge while she was unconsious? :-)



video

The nurse and I got her bathed and cleaned up a bit and just as we finished that up, and she wasn't acting hungry yet, and I needed to make a phone call, so I did that and the nurse got her settled for a nap.

She was asleep when I got back and they claimed she settled just fine. I hope she really did. We nursed again at noon, and Shrike got here while we were in the middle of that. Peeper started fussing around, probably needing to poop (after finishing one side and starting the other).

So, I handed her off to Shrike and we got her some Tylenol and a little glycerin suppository to help her poop and she was still fussing about the poop, but Shrike had her in their dancing position (seated) and I'm checking email and blogging, then will lay down and try to sleep.

But not pumping. I could find that I still need to a bit, but she seems to have it covered ;-)

Daily Peep: Goody Goody Goody!!!

3:30 am - almost exactly 48 hours after I had to cut her off the morning of surgery.

She did a great job. She got one side, and I had the nurse help me turn her around to do the other side (have to be very careful handling her because of the incision and the accoutrements), but she was pretty much out by then.

We put her back in bed and stood there talking for a bit until I realized that she was still awake, and "fish-facing" at me like she was still hungry, so I asked if I could give her the other side and she let me.

She didn't go nearly as long on that side, but still did a pretty good job, and she's asleep now.

I'm going to finish post this, and then maybe pump or maybe not; I'm deciding how good a job she did.

Then I plan to sleep til around 6:30, pump, and get back in there for the 7 am shift-change.

I told the nurse to go ahead and give her the 6 am feeding, since it has to be a bottle anyway.

I suspect (would like to think ;-) ) that, especially now that I've nursed her, she would not be happy about a bottle from me, even if she'll take it from someone else.

She said that I can talk to nurse practitioner when she gets here about when we can go back to nursing fulltime.

Other than that, not much news. I slept an hour or so, which helped alot. Like I said, I'll probably get another 1.5 - 2 hours sleep in a bit here.

Downright luxurious.

FAQ

Anonymama asked if it's painful when we pick Peeper up and move her.

I'm really not sure. It didn't seem to be too bad, but we didn't handle her much.

We've each held her once, and the nurse picked her up from the crib and put her in Shrike's arms, then got all her various tubes and wires and such arranged.

When we were ready to switch, she took her from Shrike and held her while she and I traded placed, then got Peeper situated in my arms.

Shrike had her long enough to give her a bottle and then some (while I went and pumped) but I didn't get to hold her as long, because she started fussing around a lot, and I wasn't able to do anything of the things I'd normally do to settle her down - nurse, put her on my shoulder, move her to a sitting or standing position, etc.

By that point, the nurse said she was probably exhausted, so she got her back into the crib, got some Tylenol in her (I think she's maybe had a bit of morphine since then), got the jammies on her and settled her in to sleep.

Tuesday, March 17, 2009

Jammy Up!

With the jammies covering her incision and the various tubes that are still going in and out of her, other than the betadine stains everywhere, she's starting to look more like a regular baby again.

Shrike is giving her a bottle of breast milk right now, and I think she'll probably head back to the hotel before long. I plan to nurse her for the 3 am feeding, and I think they'll make her get at least a couple more bottle feedings before I'm allowed to go back to just nursing.

I don't know if I've even mentioned this part, because I've been so focused on her recovery - but the doctors say that her holes seem to be completely closed.

Her heart function is not quite what they'd like to see (that's what made us think earlier that we would not be able to hold her this evening, after all) but that's kind of to be expected.

As explained by the nurse practitioner who is mostly managing her care, her right ventricle is used to being overfilled and no longer is, so it sort of thinks that it's underfilled and has to "tighten up" a bit, and her left ventricle is used to having to pump extra hard to get enough blood out to her body (because so much was being diverted to the other side) so it's kind of confused, too.

Basically, her heart has to learn to be normal, and that should take a few more hours. They are weaning her off of the medication that's helping with that, and hope to be done with it by mid-day.

As I said earlier, we are tired (much less so, since I slept for about 3 hours earlier this evening) but we are very relieved and very happy with how things are going, so far.

Daily Peep: Free at Last!

Up and About

Around 3 pm, we were told that Peeper would have to stay on one of her medications that we thought she was going to be off of this evening. That medication required an arterial line, which was what was keeping us from moving her around and holding her.

Then, the nurse practitioner who is managing her care talked the cardiologist into letting her pull the arterial line, after all, and around 6 pm, Shrike was able to hold her and give her a bottle of breastmilk, and when they were finished, I held her for a while.

They still want to keep a close eye on how much she's eating, but I've been told that I will be allowed to nurse her once this evening.

Shrike plans to stay at the hospital til around 10 pm, so she's going to give her the next bottle, at 9ish, and then I will nurse her later, when I'm the only one here.

I'm hoping I can talk them into more nursing, sooner rather than later, but they do have their rules.

A couple of thoughts on that, though - they are only measuring input, not output, because they pulled her Foley catheter at the same time as the arterial line, and also, a NICU nurse pointed out to me that they determine intake with before/after weights all the time - so I might ask if we can do that.

We're exhausted, and I'm supposed to be taking a little nap right now, but we are very, very happy with how she's doing.

Peeper's Doing Great

Peeper is awake, alert(ish), eating and content.

She's been out of the oxygen tent and on room air since early this morning.

She's had a couple of bottles (1/2 oz, 1 oz) of pedialyte, and one bottle (1oz + a teeny bit) of breast milk, and did great with those.

They are going to do another echocardiogram soon (when the echo team shows up; she's kind of near the bottom of their list) and if that's all good, they will remove her arterial line, Foley catheter and maybe something else, at which point, we'll be allowed to hold her!

For purposes of measuring input and output, they want to continue to give her breast milk by bottle for the rest of the evening and possibly into tomorrow, but I should be able to nurse her at least once this evening, and do a combination for a while until they are comfortable with her going back to nursing fulltime.

Shrike is in with her right now, and has been since she got to the hospital this morning. I'm going to go try to catch a nap in a few minutes.

All in all, everything continues to go very well, and we couldn't be happier with her progress.

Morning Report

All good.
Room air.
Pedialyte. Next bottle breastmilk?
Hope to hold her this afternoon? Nurse this evening?
Thanks for mojo.

Almost Morning

Peeper's continued to do well overnight.

I decided to stay at the hospital, since I needed to be up pumping every 3 - 4 hours anyway, and although we know the nurses and doctors are taking great care of Peeper, and we know that she's safe, I knew I'd still be worried about whether she's happy.

If we were at the hotel, they'd only call us if something were wrong, but with me here, they have instructions to come get me if she's awake and crying.

Also, given that I've got to be up pumping, and given that I am, well, me, we figured that Shrike and I would both get more sleep with me here.

I am not fretting about what's happening, and I'm not keeping her awake!

I got some sleep, then got up to pump and visit with Peeper for a while.

I will go back to "bed" in a few minutes, until time for the nurses to change shifts. Shrike is at the hotel, and will come back to the hospital as soon as she's up.

Assuming she keeps up the good work, they will probably let Peeper start feeding later today - first some Pedialyte, then some breastmilk by bottles, to measure her intake.

As soon as they are happy with the stability of her blood pressure (it's been a bit high, which is typical) they will remove her arterial line (which is measuring it) and then we can pick her up, and I think she will be allowed to start nursing at that point.

In the meantime, they are giving her plenty of morphine and Tylenol for pain. She's awake enough to respond to her environment - holding our fingers, startling at noises, etc - but has been asleep most of the time.

And I should be, too.

More updates as I have them.

Monday, March 16, 2009

Breathing on Her Own

Peeper came off the ventilator, and had her NG tube removed around 4:20 pm. She's now under an oxygen tent and doing great.

As you can see in the photo, the tent only covers her head and chest, so we can hold her hand and touch her legs / feet.

What's most amazing is that she is already breathing better than she was this morning, before surgery. Her respiration rate is much lower and she's not sucking her chest in like she was.

Thank you all so much for everything.

Daily Peep: Post Op

Peeper is out of surgery and doing really well.

She's coming out of sedation (but will still be good and stoned on morphine) and they are talking about extubating her (taking off respirator) in the next hour or two.

The nurses tell us that she will be under an oxygen tent after that, and we won't be able to touch her, and she won't know if we're here or not, so if I'm going to leave, tonight would be the time to do it, because she should be eating tomorrow.

They've just about got me convinced to go to the hotel with Shrike tonight, but I'm not quite sure yet.

I need to get back in there, but here's a photo that I just sent from my phone.

Looks like hell, but is doing great.



In Surgery

Peeper is in surgery now.

She did pretty well this morning, and didn't start complaining too much about being hungry until the last thirty minutes or so before she went back.

By that time, the admissions nurse was in the room, and I was talking to her, which was distracting me (somewhat), and Shrike was getting the brunt of the complaints.

Probably better though, because at least Peeper didn't *expect* Shrike to feed her.

Anyway, she went back around 7:15 and she was crying when we handed her off (she wasn't the only one), but the anesthesiologist said they'd have her sedated pretty quickly. (Wouldn't you?!)

We've had breakfast, and we're in the peds family room, waiting for Shrike's family and DoulaK to arrive to sit with us, and for the lactation consultant to get me set up for pumping.

I'm doing ok on that front (so to speak) at the moment.

(Until I think for too long about Peeper, then I start letting down. Or "downloading" as I keep finding myself wanting to say.)

It was kind of rough when she was crying earlier, though.

We're not likely to have any news for a few hours, but I will update as soon as I can after we hear that she's off the heart/lung bypass, and done with surgery.

Surgery Update

Just sent her back to OR. Send mojo.

Waiting

At hospital, waiting to go.

On Our Way...

to the hospital in about 15 minutes.

The Night Before Morning Of

Not asleep.

Surgery Day

Well, by one minute....

We're at a hotel in SurgeryTown. Shrike is asleep in the bed, Peeper is asleep on the boppy in my lap and I am . . . blogging.

We were told not to give Peeper her "bedtime" (1 am-ish) meds tonight/this morning, so we figured we could go to sleep early, since we'll be up so early.

But, I was leery of putting her down for her long stretch of sleep at, say, 10 pm, because when we wake her up at 5 am to go to the hospital, I'd like very much for her to think (know) it's still the middle of the night, and not time for the breakfast that she's not allowed to have.

So, I'm on the laptop with Peeper nursing / sleeping / nursing in my lap for a bit longer, and then we'll crawl in bed and sleep until the alarm on my phone goes off around 3 am. At that point, I'll change her diaper to wake her up a bit and try to get her to nurse as much as possible, because I have to cut her off at 3:30 am.

That's the other reason for keeping her nursing for now - so that she's better prepared to get through that four hours from that last pre-op meal until they conk her out for the surgery.

I think that next to the moment when we have to actually hand her to the nurse to take back to the OR (which I cannot talk, type or even think about without crying), I think that may be the worst part of this - if she's awake and hungry while we're waiting, because she will be upset, and we will be upset, and she won't understand why I am refusing to nurse her.

(And, of course, neither will my breasts, so I'll be hurting physically as well as emotionally.)

All I can think of to try to prevent that, or at least temper it a bit is to get her good and tanked up now, to basically encourage her to "cluster feed" more or less up until the cut-off time, so she'll sleep through as much as possible.

I wish I thought I could just stay up and nurse her constantly until 3:30, but that would be pretty stupid, since I'll be up again at 5-ish and won't be getting decent sleep for the next four days.

So, I guess I'll let her finish this meal, then get myself ready for bed, maybe give her a new diapers, and we'll get in bed and maybe nurse her back to sleep if needed, then catch a couple of hours of sleep for myself.

Looking at her right now, I see that her little head is getting quite sweaty - that's a sign of fatigue which is caused by the difficulty she's having breathing, and we're seeing more and more of signs lately of the VSD actually having an impact on her - the rapid breating, sweating while nursing, her chest sucking in more, and even a couple of very brief episodes of blueness around her mouth.

That's why we're doing the surgery, and that's why it's time to do it.

But we still hate it.

Sunday, March 15, 2009

Daily Peep: Glow Worm

Peeper mostly likes this glow worm, but sometimes (like in the photo) seems a bit uncertain about it.


It's actually a "Lullaby Glow Worm" which plays (duh) lullabies when you squeeze it.

It cycles through "Brahm's Lullaby," "Frere Jacques," "Twinkle, Twinkle, Little Star," (or possibly "The Alphabet Song" or "Baa Baa Black Sheep"), "Hush, Little Baby," "Pachebel's Canon," (which we played at our wedding!) and "Rockabye Baby."

Ironically it does not play "Glow, Little Glow Worm."

Which reminds me:

Overheard one day, as Peeper was crying, and Shrike was singing to her:

Whozat: What's her problem?
Shrike: She's pissed off about all those crappy gifts you're going to get her.
Whozat: What gifts?
Shrike: You know, the mockingbird, the cart and pony . . .