Week 35: Right now, right now? Maybe later, later?

Well, my 35 week check up was yesterday morning and I can’t even begin to understand where my head is today as things are just all jumbled.  Going into the appointment, I was anticipating all sorts of doom and gloom due to my weight gain this past week, a four-day headache that acetaminophen just wouldn’t shake and the knowledge that we’d be repeating fetal measurements (in other words, just how huge are we talking? And is vaginal delivery even still an option?);  but having hopped in the car almost two hours early to learn that the inner-loop of the Capital Beltway was closed due to a turned over vehicle blocking both the two Hot Lanes as well as all four of the regular lanes, I began to think my pessimistic expectations of the morning’s happenings were a bit too cheery for what was actually in store…  

Taking just shy of those two hours to get to the hospital due to knock-on accidents and residual area-wise back ups, I arrived just on time to go straight from the ATC reception into the ultrasound room for my exam.   Running a biophysical profile, checking my amniotic fluid index levels and measuring Baby’s overall growth, Tamara - the wonderful sonographer I’ve worked with through both of my pregnancies with this doctor’s office - was comforting, yet frank about where things currently stand: 

Biophysical Profile: 8/8

Amniotic Fluid Index: 29.6 

Estimated baby weight:  7 lbs 3 oz (85% percentile)

Abdominal Circumference:  34.2 cm (+18 days)

Head Circumference: 34.1 cm (+19 days)

Showing me the 3D pictures of his (practically identical to GW and GV) face, Tamara and I couldn’t help but notice the chubby cherub cheeks that Baby’s acquired in the last few weeks.  Suggesting that I cut even more carbs than I already have (okay, I’ve been cheating on my protein only diet some, but not terribly excessively… I’m dreading the idea of three more weeks of omelets…) to ensure that Baby doesn’t continue to put on excessive weight and break through that magical 9 lb 4 oz threshold that would ensure a doctor mandated delivery by cesarian, she encouragingly said that things were by and large looking good before sending me down to another nurse, Kaye, for my weekly NST. 

Delivering me to my reclining blue chair with waiting goo, padded belly straps and monitor, Tamara provided a report summary of the ultrasound which I promptly scrutinized for the twenty minutes Baby's heart accelerations and movement were monitored.  Passing this go around with no-prompting (thank you!) I was relieved to hear that, in spite of his large size, the NST and ultrasound were exactly what the doctor would be glad to see.  Setting my pessimism aside, but not out of reach, my meeting with the perinatologist was all that remained of the morning's flaming hoop session. 

Surprised not to be seeing Doctor Bronsky as he's typically the go-to in office practitioner at the ATC on Tusesdays (apparently Doctor Nies, along with everyone else in NOVA, is down with the flu so he was off covering for her on the L&D floor), Doctor Khoury called me back to his office in a flourish of compliments: "look at that belly!" -- "you look wonderful!" -- "it's so great to see you, dear!" Having dreaded my next appointment with him since my early November given the zero tolerance, minimal wiggle room estimation he made of me, my weight and my macrocosmic baby I acknowledged his praise with a half-hearted "thank you" and began throwing up as many emotional barriers as possible to handle whatever read he'd make of my test results.  

Stating that he didn't feel like a c-section is required at this point, he began by stating that the issue with diabetics with large babies - regardless of previously successful delivery histories - is that even if the baby doesn't measure above the weight threshold requiring surgical assistance for delivery, there is a significant risk for shoulder dysplasia that we'll need to  address mindfully.  Moving on to look at my AFI numbers and wishing to alieviate his concern with the possibility of preterm labor, he called down to the nurse practitioner, Laura, to have her check for effacement and dilation before sending me on my way for the week.   Running the Group B Strep test while at it, Laura made the ambiguous comment "oh yeah, you're super soft" before returning to her other patients.  Knowing that this generally meant things were heading in the correct direction for delivery, I gathered my things and began to walk out to reception with the intent of asking "anything else?" when Doctor Khoury practically tackled me in the hallway preventing my hasty exit. 

"Sit, please!"   (Uh oh...)

"You're moving quite a long - 80% effaced, 1 CM dilated and baby is at -2 station - so really he could come at any time.  I want to see you sooner than seven days, come in next Monday for your next appointment and we'll check you again.  In the mean time, if things progress at all - even if you aren't sure - get to the hospital immediately... subsequent babies tend to come quickly, but with the higher risk his size presents for delivery, we really can't afford to have you have this baby in the car.  Okay, dear?" 

Knowing that the numbers he rattled off are definitely a sign delivery is coming (but not necessarily imminently - darn AFI levels making "any minute" something that could last from right now-right now through induction in February), all I could do was nod my head and attempt to process the morning's events.  So I am looking at a large baby.  I am looking at a large baby that may or may not be premature.  I am looking at a large baby that may or may not be premature and is potentially going to be ill effected by my diabetes (sugar level or lung development wise). I remember with GV we did the amniocentesis at week 37 to determine if she could be delivered that week or would require more time for lung maturity, so being mid-week 35 with a large baby that may or may not be premature and is potentially ill effected by my diabetes has me freaked by "what-ifs" of his sooner rather than later arrival.   I mean even with waiting for 38 weeks to induce her, GV still wound up in the grow-box for a few days due to her jaundice and she suffered from post-birth hypoglycemia even though my sugars were tighter than the jeans on any one of those Hollywood film stars (at least they're wearing jeans, right?).  

Feeling excited, anxious, nervous, terrified and completely unsure of what is to come, I am flat out overwhelmed by yesterday's appointment.  On one hand, GW was a 36 week 5 day baby and he was just fine with a mild case of home-treatable jaundice... but he was born well over a year before I became a diabetic.  On the other hand, GV was born over a year and a half after I went on the insulin pump and, despite all of the terrible placentra-related complications of that pregnancy, was considered a perfectly healthy, completely normal newborn within four or five days following delivery - no NICU or micro-management required by the pediatricians.  So, optimistically speaking, things could go well even if Baby decided to come early...  would things be better if he arrived following induction the week of February 9th?  Yeah!  He'd get more lung development time, he wouldn't run the risk of being delivered on the side of I-95 in a traffic jam and I'd have another few weeks to button up the house into the home it's supposed to be.   Of course, he'll likely be so huge by then that that adds more cons to the mix, but hey, there is no one perfect way to have a baby and only God knows what's actually in store. 

On that note, I'll end my weekly blathering and hope that the next update I have for you is a clear-headed one.  Fingers crossed. 

Week 33: All Alone.

It felt absolutely bizarre to walk into the Antenatal Testing Clinic by myself today.  Finding the waiting room set up completely different than it was the last time I was here in 2012 (back then all of the chairs sat in rigid rows facing away from the door toward the television; now the chairs sit in four sections with two rows facing the door, one row directly opposite those two that faces the center of the room and one row adjacent to the door that still faces the television), I was startled by the collective curiosity that hit me as I walked into the crowded room and became immediately aware of all the couples… Every single chair, but one, was composed of a matched set of mothers- and fathers-to-be and all of them looked up in some sport-like synchronized motion when the door opened and I stepped into view.  In an ideal world, I am sure that would have elicited a walking on water kind of feeling from me or anyone else who was noticed by everyone when walking into the room, but the odd man out, something’s not quite right feeling that stuck with me as I took that last chair in the corner under the surveillance of the paired off parents was enough to make me wonder if I had spinach in my teeth or forgot my appointment was supposed to be black-tie attire required rather than pregnant mommy comfy.   

I realize that this might seem overly self-conscious of me to write about or perhaps entirely too trivial to even mention, but the strange thing about that moment wasn’t so much the receipt of these people’s innocuous attention as it was the fact that I’d never before noticed that pregnant mom’s rarely arrive at the ATC alone and when they - I guess I should say “we” - do it’s enough to distractedly drop People magazine to wonder what’s her story.  I mean, as a high risk clinic it makes sense to have someone there with you to endure whatever bad news awaits or to confirm that whatever medical phrase the doctor just said is actually a positive thing, heck that’s how I’ve been operating up until today, but to realize in such black-and-white, seriously look at your surroundings that, yep, it’s completely strange to be here without HB today was a whole new level of surreal.  Maybe I’m applying too much weight to the shift, but I’ve heard tell that going from two to three kids is the hardest transition for parents to learn and this might just be the first taste of that difference I’ve noticed. 

Anyway, so there I am (no shit) all by my lonesome at my first unaccompanied perinatal appointment dreading whatever gloom and doom report of fetal complications, maternal weight gain or what-have-you when I’m called back for the NST which, much to my shock, Baby passed within the first five minutes of being monitored.  Required to remain on the machine for a minimum of twenty minutes, the nurses let me be and read the final chapters of Lisa See’s Red Princess Mystery series (thanks for sending that AS! Loved it.) in relative peace and quiet with only the constant background noise of little one’s wub-wub-wub heart rate to distract me.  Feeling skeptically hopeful that the appointment might not be such a disaster, I went back to the waiting room (alone) and began my next book (okay, Mom, I’ll read the Eragon series… you happy?).  

Shortly there after, Lin, the Chinese sonographer who works part time at the ATC and part time at the main doctor’s office called my name.  Seeming a bit shocked to see me (alone) at the hospital rather than in the normal office environment (with husband and kids in tow), she was quite a bit more eager to chit-chat while checking on Baby.  Covering the weather, the older kids and what we can only assume is the adorable face of this Baby (he’s shy and keeps his hands in front of his face for the 3D sonograms), she could feel me tense when she began measuring the four amniotic fluid pockets around his body.  

“What were you last week?”  she asked. 

“30.0,” I responded. 

“Oh… well you’re down to 26.8!” she announced with a note of triumph.  

Taking that emotional leap of faith from tentative hope to actual happiness as a result of the appointment’s exams, I couldn’t help but smile with relief at the positive turn of numbers this measurement indicates.  See, the thing about AFI levels is that they are supposed to peak between week 32 and 36 before gradually beginning to decrease as full term approaches - so the concern for the past several weeks has been whether or not this decrease would occur or if, Heaven forbid, the AFI levels would continue to rise making for higher risk complications at the onset of birth (namely premature rupture of membranes or placental cord prolapse).  Given that this 3.2 cm reduction would indicate that Baby and I are actually headed in the right direction… holy smokes! What a weight off the world!

Practically floating into my appointment with the doctor, it was such a pleasant surprise to find the soft spoken, kiddie-gloved Dr. Nies waiting behind the desk with her welcoming smile and perpetual encouragement.  Looking over the NST and AFI results, she announced that they wouldn’t need to see me twice a week at this stage of the game as they had initially anticipated and that, if I had no questions, I was free to schedule a once weekly NST for the upcoming three weeks.  Explaining that we’d be repeating fetal measurements week 36 when we’d also be looking to go-ahead and schedule induction (did you see that?!  She said “INDUCTION!” NOT C-SECTION!) for the second week of February…  what A-W-E-S-O-M-E news. 

You can imagine the unrestrained pregnancy glow that emanated from my being as I reentered that couples-only waiting room a full five inches taller than I had when first arriving earlier in the morning.   Soaking-up the five seconds of “single-mom” fame that repeated itself in the group stare as I began to check out, there was no second-round of doubt going through my head about my vegetable-free teeth or my chic mommy-comfy outfit because, yeah, I am the third-time mom that came alone to the hospital’s high risk clinic and you know what I just did? I had a kick-butt appointment.  All by myself!

Week 32

Squeezing just one more appointment into 2014, today marks the beginning of my incessant trips up and down I-95 for perinatal appointments.  Starting weekly appointments, soon to be bi-weekly appointments, I went into today with my fingers crossed that we'd be able to receive more complete information about Baby #3 than we did just two weeks ago from Doctor Bronsky.  It's not that I've been worried - okay, maybe it's more accurate to say that I am no more worried than normal - since we received jack-squat in hard-fact updates, but with how hard I've been working to keep my glucose on target and my weight (and the eggs...) down all while enduring near constant Braxton Hicks contractions leaves me feeling like knowing something - knowing ANYTHING - more than last time would at least give me a context within which to frame my insomnia and compulsive (aka distracting) fiction reading.  

Having received a reminder call yesterday about my "appointment with Dr. Bronsky tomorrow at 10:00 AM," I became more anxious for answers as we walked into the, once again, full waiting room.    Realizing something must have changed with their scheduling procedures, I said a quick thank you to God that we brought GV along for the day given her compact-sized entertainment value package. While waiting... and waiting... and waiting... and waiting to be called back for my lab work, sonogram or first non-stress test (NST) of this pregnancy, GV took it upon herself to wish everyone in the room an individual "Happy New Year!" in her best Shirley Temple attempting to be Santa Claus voice.  Noting the several holiday decorations around the room, she also began a ruckus round of who's on first with me, much to the delight of the other couples and staff witnessing the conversation: 

GV: "Look Mama! My found a Christmas tree!"

Me:  "No, GV, say 'I found a Christmas tree."

GV: "You found a Christmas tree, Mama?"

Me:  "No, I didn't find a Christmas tree.  GV found the Christmas tree. Can you say, 'I found a Christmas tree'?"

GV:  "My found a Christmas tree!"

Me: "No, say 'I found a Christmas tree.'"

GV: "You found a Christmas Tree?" 

Me:  "AGH!"

You get the gist...

Anyway, eventually I am called back by the quiet Chinese sonographer and we traipse our way back to the exam room (where GV promptly insists we should look at baby via her belly button).  Knowing it's now or maybe never that we get our answers about Baby #3 for the day, we promptly start to hound her with questions about my AFI levels, his weight and size.  Happy to please, she not only provided us with another set of 3D pictures of the little one, but the cold hard facts I was craving: 

Amniotic fluid index: 30.0  (99%)

Fetal weight: 5 lbs 2 oz (74%) 

Head circumference:  32.2 CM (84% or 36 wks 3 days)

Abdominal circumference: 30.0 CM (88% or 34 wks) 

Femur length: 6.3 CM (38% or 33 wks 4 days) (huh...)

Thanking her profusely for her assistance, I head back out to the waiting room where GV and I inevitably continue our two-year old pronoun reindeer games until I'm called back for my basic biophysical profile check.  Finding my weight to be up one pound since my appointment two weeks ago and my blood pressure to be perfectly within my normal range (114/63), the nurse sticks a gigantic pink sticky note to the front of my chart reading "KETONES (++)" before sending me back to wait for Dr. Bronsky's patient que to call my number.  Another fifteen or so minutes later, we're finally shown in to his office where we sit down and I automatically tense from nerves and HB puts on his "drill the doctor" face.

"So between his weight and the AFI levels, are we looking at scheduling the induction shortly?" HB asks in a leading manner.  

"The hospital won't allow for us to schedule an induction farther than 3 weeks out," Dr. Bronsky responds barely looking away from my electronic chart. 

"Even with him measuring several weeks ahead and her amniotic fluid levels so high?"

"Well, his weight and the AFI levels are all high because you're diabetic," he explained. "We won't let you go past 38 weeks anyway." 

Feeling stung by this last comment given my stellar HgA1C, I chose this moment to chime in that my glucose is under tight control. 

"So why are you spilling ketones?" he asks over his glasses.  

Having gone hyperglycemic over night (peaked at 178 mg/dL) due to changing basal requirements and still coming down post morning coffee (sample taken while at 148 mg/dL), I showed him my glucose monitor and the absolutely minimal out of range fluctuations I've had for the past 24 hours.   Knowing his threat with GV that "if you don't get your postprandials under control, you're going off the pump and onto injections," I shouldn't have been surprised by his expression of curiosity and confusion upon seeing my CGM monitor but his limited understanding of it spewed forth in his following comments: 

"Your glucose still swings dramatically, so these complications are directly relevant to your glucose control."

OUCH.  

Even with a HgA1C in the solidly normal, non-diabetic range of 4.1 to 5.9 (currently sitting at 5.5), this comment hit me like a ton of bricks: there is absolutely nothing more I can actively do to protect this baby from my diabetes.  Regardless of my locked down diet, my minimalist insulin usage and my target glucose range of 70 to 140 mg/dL, my limited tolerance of glucose is impacting Baby's glucose  ranges (aka his macrosomia), urine output (aka my AFI levels) and delivery options (induction or c-section, here I come).   It's honestly no wonder that my irritable uterus went into an encore round of Braxton Hicks just in time for my non-stress test to start - gee, thanks doc, for the pep talk.  Fortunately, Baby showed the proper accelerations and decelerations of his heart rate so at least I have that one shred of silver lining for the day that his heart, at least, isn't screwed up because of me! 

Information wise, the appointment was a major success. Emotionally speaking, however, I'd be lying if I said that I didn't feel like I've been run over by a bus.  I so try to put everything into taking care of this little one (and the older two, of course), but today left me with this feeling of unavoidable inadequacy and, it's knock-on effect, a dreaded sense of hopelessness that I am finding difficult to curtail when faced with yet another omelet dinner...  I realize it's only another handful of weeks (GW arrived at 36 wks and GV at 38, so that puts us anywhere from four to six weeks away from show time) until we're at the finish line and fumbling now isn't worth the cost of admission, so I won't, but dang it I'm exhausted and hurt and ... 

Until next week, I guess. 

Week 30

All I can say about my week 30 appointment is that I am beyond grateful that I am already a parent, because if it weren't for GW and GV I'd be a furious, incoherent mess as I sit here typing at the computer.  Having spent the last two weeks fretting about my weight, my amniotic fluid index (AFI) levels, and Baby's rapid weight gain I hardly slept a wink last night as I tossed and turned in anticipation of my perinatal appointment this afternoon.   Waking up twenty minutes after the alarm clock went off and finding an abnormally high weight on my home scale (up two pounds from yesterday... guess I shouldn't have had that banana) didn't start the day off well.  Attempting to look at least partially decent for the first time in a week, I threw on some clothes, quickly did my hair and make-up and went into the kid's room to find both GW and GV awake but still lounging in their beds.  Happy to not continue the morning battle with our usual "but, Mooooom, I'm still tired..." argument, the kids easily slipped into their laid out outfits and went downstairs to the kitchen to begin our breakfast routine - which, again, went surprisingly well. 

So off to school we go and as I'm dropping GW off in his class room, I pull his teacher aside to let her know that I'd need to pick my son up early today to accommodate our perinatal appointment that is scheduled for just after lunch in NOVA.  Informing me that, "well, we're not going to be here today and we won't be back by that time," I was a) shocked to learn of the field trip that the parents weren't informed about (seriously?!), and b) dreading the dream crushing "you can't go" conversation that I was about to have with GW.  As this would have been the first time he would have been able to ride the school's bus, something he's been begging to do since September, you can imagine the near tear confusion and anger that seized his face... I explained the issue and apologized for his disappointment (to which he countered with several suggestions about his walking home from school alone, sleeping at school so we could just pick him up tomorrow and even running to the appointment on the side of the highway so he wouldn't get lost) and we finally came to a calm, albeit not happy, understanding.  We then attended morning mass and began to run some errands. 

And then my phone rings... "Mrs. Cammack?  It's Perinatal Associates.  We have you down for a 1:30 appointment this afternoon, but we're going to need you to come in at 12:45 instead." 

No problem... if you live in NOVA.   Big problem if your husband works 45 minutes away, isn't answering his work phone, cell phone, texts, email, instant messages or my ESP and, in best case scenario traffic, the doctors office is one hour away.  While I had an hour and forty-five minutes before we no-sh*t needed to be on the road, I spent the next 55 minutes trying to reach HB before he finally answered and had exactly 50 minutes remaining to pack up and get home before we were officially late.  Shockingly enough, his little commuter car got him home exactly on time and we hit the road. Thanks to construction and accidents, we wound up only being slightly late to my (considerably earlier than we were prepared for) appointment. 

Then guess what happened... 

For the first time in our experience at this doctor's office, HB, the kids and I were left to wait.  Usually prompt and punctual, we waited for an hour and twenty minutes before my appointment officially began.  So, for those of you who are parents and know the agony of cooping kids for an excessive amount of time in a non-child friendly environment like a business or office, you recognize that had we kept our originally scheduled appointment for 1:30 we would have only fought 45 minutes of "place of business" behavior without lunch, toys or books rather than the doubled length of frustration.  

Enter miracle number one:  those kids were complete angels.  Granted GV didn't want me to read my book and she insisted on climbing to the adjsent chairs exclusively from my significantly smaller lap (at least something is smaller about me!) than from the floor, but they whispered "psst I love you" to one another and to each of us, they snuggled us individually and in turn, and they even managed to let the other two couples in the waiting room wait in what could almost have passed as a child-free sense of peace. 

During that wait time I was called back briefly to the nurse's station for my typical vitals check. My BP was great at 114 over 69 and, thank goodness she measured that first, because the minute I saw the number on their ruddy scale I flushed with anger.  Eight bloody pounds up from yesterday on the home scale and right back to the number I was advised would cause a c-section four weeks ago.   Yeah, yeah, yeah, I know you can't compare results between two different scales and in one instance I weighed myself sans clothes before breakfast and in the other I was fully dressed (a seasonally appropriate sleeveless shirt and flip-flops for today's gorgeously frozen tundra weather, mind you) and it was post 1 cup of greek yogurt, but STILL! Are you freaking kidding me?!

Enter miracle number two:  upon slumping back into my waiting room chair, GV climbs up into my lap and, taking my cheeks between the palms of her hands, she looks deeply into my eyes and says with the most sincere concern "you okay, Mama?" Forcing the deep breath I wouldn't have found anywhere else, I was able to tell her "yes, I'm okay, GV" before giving her a hug and feeling at least some of the world's weight fall from my shoulders.  Too bad I couldn't have been weighed again...

Finally, finally, finally the nurse comes out, calls my name and leads our troop to the sonogram room. Having discussed with GW that he'd be able to help with the sonogram if he asked the sonographer  very nicely, my heart sank when Dr. Bronsky walked in to the room in place of our normal nurse.  Knowing full well the answer to GW's question would be either silence or "no," when he approached the table to inquire "may I try?" I spoke as kindly as I could to him "no, not now GW." Automatically lead to the "but you said I could!" face of anger and tears that I'd already seen that morning regarding the bus, I briefly explained that we'd talk about it after the appointment before shifting my attention back to the sonogram.  I found the doctor ever so casually checking Baby's position (head down, good), heart rate (132 bpm, good) and ... yeah, that's it. 

"What are the AFI levels?" inquired HB, trying to prod for additional data. 

"They looked fine," was the brief response. 

"Oh, well those numbers and his weight have been of concern at the last few appointments..." HB said suggestively. 

Taking the wand back up, Dr. Bronsky then began to actively measure the amniotic fluid pockets around Baby.  Correcting himself, he then stated, "yeah, your fluid level is definitely high.  It's up to 27 cm.  But that's almost the same as it was last time."

Percentile wise, perhaps 23 cm and 27 cm are somewhat comparable for their respective
gestational weeks, but they're both at 99th percentile and not where I ought to be

Upon collecting the two pictures he'd printed for my chart (none for us today - boo), wiping off my belly and instructing us to follow him to his office, HB and I were stunned but the limited information collected and the dismissive statement that equated 27 cm to 23 cm... neither of which is considered a good number.  

Enter miracle number three: every time we've brought the kids to these appointments and it comes time to sit down with the doctor for the last five to ten minutes before their sweet freedom is realized, they've flat out lost their minds. They roll on the floor, flop on the couch, grab things from the desks... anything distracting and disruptive they could do, they've probably done it.  But today, they sat by our feet in relative stillness as they watched a movie on mute for the duration of the appointment.  Feeling rewarded by the access to the iPad (a very rare treat at our house), they didn't interrupt, they were polite and they gave no-reason to illicit the "and you're having another one?" face and/or comment we've unfortunately received from particularly judgmental people previously.  

Sitting board straight out of anxiety, I watched the doctor as he rapidly typed the data he'd collected into my chart and answered the random questions he asked regarding symptoms I'm experiencing and my previous deliveries.  Providing very little council on my and Baby's condition or the red-flag concerns we've been fretting upon since our appointment on HB's birthday at the beginning of November, Dr Bronsky - my go-to guy and ally during GV's pregnancy - practically brushed me aside and shooed us out the door with his paltry information: he noncommittally indicated that a vaginal delivery is still possible; he distinctly commented that I can't do anything more than I already am; he passively dropped that a c-section would be required at "4200 grams or more"  for any diabetic (had to look that up, gee thanks doc, meaning 9 lbs 4 oz); and, to finish things up, he concluded that my weekly appointments and non-stress tests will begin on December 30.  

Leaving the office with my blood pressure soaring from frustration and unassuaged concern, HB and I both felt like today's visit was a waste of time and a full drain of our emotional energy.  I know I should be grateful that a professional looked things over and that he didn't feel comment was required, but less is not more with me and simply dropping off some biometric data on me and Baby surely didn't need to take the four hours - and that's before the drive home! - to accomplish.  I needed reassurance today.  I need hard facts to concentrate on for the next two weeks.  I need to know what progress, be it good or bad, we're making and how things are shaping up just in case I'm hospitalized (God forbid) anywhere except the one place my chart is electronically stored.  Walking away empty handed, empty stomached and cranky is not ideal for anyone leaving a doctors office - let alone for a woman who is 30 weeks pregnant. However...

Enter miracle number four:  those darn kids couldn't have been better behaved, more compassionate or more encouraging than they were today.  On any normal day their actions would have been ten times above and beyond the norm, but given how challenging the day was and how HB and I were seething unhappiness from our every pore, GW and GV rose a whole new level of my esteem that I didn't know I even had.  I've always loved them more than anything, but actively appreciate them? That's something I need to do more often. 

To be honest, I've found myself much more cognizant of the little things with them over the past few weeks that I simply feel I was blind to previously.  I have been so wrapped up in the drama of life and the worries of what if that I haven't given them the benefit of blossoming in my consciousness in the way that they've been doing entirely on their own.   The appointment today was, in my estimation, a complete disaster and something I would gladly take a time machine to, but in the grand scheme of things it's only one afternoon in one week of one pregnancy that will lead to a lifetime of family moments and memories with all three of my wonderful kids.   GW and GV kept my feet grounded today where my temperament alone would have taken me sky high in vexation.  While I hope to come back from my next appointment on December 30 with solid facts, answers and some semblance of comfort, I am clinging to the awareness they gifted me today that appreciating them, our time and our family in spite of the darkness that can cloud around can leave a wake of happiness where otherwise there would be none. 

Thanks, guys.

Good behavior ice cream and Santa all in one swoop?
Yeah, they're that good.