Getting acclimated and making introductions . . .

Its been a great first couple of weeks at home . . . loads of great family and friends have stopped by the house to meet Ethan and Noel and check-up on how Adam and I are coping with new parenthood. Here are some highlights from the first few weeks . . .

-Avo (Rita) was our first in-home visitor and was quickly joined by a ton of Adam's clan . . . Great Aunt Suzee helped with a first feeding,
-Uncle David had a great couple of days with the Brigade before heading back to Hong Kong . . . fantastic to have shared this experience with him before he headed overseas and the boys LOVED him.
-Patricia & Dan all made their way to the house for one of our first meals home . . . and Ethan thanked Dan by "leaking" all down the front of his dress shirt!

-The boys' sweet Gramma holding Ethan

-Sharon and Claire were so great to bring us lunch during our first week home . . . Claire was so sweet to the boys

-Godparents Travis and Denise made their way to town with "Godsisters" Teal and Collette on our second weekend home . . . great time together and an amazing meal (filets and king crab) made by T&D.

-Grandpa Buck made his way to town on the third weekend to meet the latest additions to the Knippa family tree

-Uncle Ron seems to adore the boys as much as we do . . . he's been by more than anyone and has even played "weekend night nurse" for us on a couple of nights, which has been much appreciated.

-Self-proclaimed "Duchess Shawna" made her way to town over the first weekend and got to see us in our acclimating mode . . . trust us, Shawna, we're much more competent now! :)

Thanks to everyone for the meals, stories and great visits in our first few weeks.

Brudam

Our complicated and emotional journey HOME . . .

Well, we finally made it back to Dallas on Wednesday night, more than 2.5 weeks after arriving in California. What was supposed to be a simple turn around trip became a more complicated affair than we ever could have bargained for. That being said, there is always a silver lining and ours was the AMAZING intensive training we received from the LLU staff.

Well, over the 14 days in Loma Linda, Bruce and I were an ever present fixture in the NICU. Whenever visiting hours were open, we were there. And whenever the doctors made rounds, we were there. During these rounds, imagine me to be much like a screeching parrot repeating the one phrase my owner had taught me, "We're flying home as soon as we're discharged, so please take that into consideration when releasing us." I mean, it got to the point where Bruce, the KING of communication, was telling me to lay off the "Polly Want A Cracker" act. So imagine our surprise when, after getting the green light for discharge, we show up at 2.00p to take them home and Bruce is greeted by our new attending physician with the following conversation:

• Doctor Feelgoodstein: I hear you're thinking of flying home tomorrow
• Bruce (Blissfully naive): Absolutely - we are so excited to get these boys home!
• Dr. F: Well, unfortunately, I just don't think it's a good idea to fly them home. I don't think their lungs can handle the air pressure and shouldn't travel by plane for a while.
• B: Really? That seems a bit unfortunate...it's going to be quite a long drive home.
• Dr. F: Well, driving really isn't an option either. You see, this is what we call "mountains" and the boys shouldn't get above 3,000 feet for at least 4-6 months. You can consider driving up to Canada and then back down to Dallas.
• B (internal alarms on High Alert): With all due respect, doctor, this is a bit shocking as my broken record of a husband has told everyone who would listen about our travel plans.
• Dr. F: Well, I'd be comfortable releasing them only if they flew home with oxygen support, a pulse oxymeter and a Respiratory Therapist.

That's all my man needed - A TASK LIST!!! Within minutes, Bruce is feverishly making phone calls and arranging transport of oxygen tanks, calling American Airlines for a ticket for the Respiratory Therapist while I, judging by the photo below, was updating my Facebook status or stumped on the word scramble of the day, "loev."

And it wouldn't be a Brudam experience without a wrinkle within a wrinkle. Midway through Bruce announcing he'd checked all of his task boxes, some random person decides to interject her opinion on the situation using words like "liability," "litigation" and "license" (She apparently loves alliteration). All of a sudden, our case worker says she wants to try to arrange a private medical transport back to Dallas. REALLY? I mean, we're already jokingly referred to as "chichi" by our friends and all we needed was to bring our babies home on a private plane. Our reputation would be galvanized and our friends would make fun of us until their throats were hoarse.

Bruce then channeled his best Julia Sugarbaker announcing to all (with a slight Southern accent) that we were leaving today, we were leaving with our babies and they'd have to pry those babies from his cold, dead hands. I swear I saw 12 nurses jump to their feet for sixteen and one-half minutes of uninterrupted thunderous ovation as flames illuminated his tear-stained face! And that, my friends - just so you will know - and your children will someday know - is the night the lights went out in Georgia...er I mean, Loma Linda!

Lo and behold, we were discharged from the nursery about an hour later and at the hotel soon after. Avo finally got to hold the babies and she hugged them with all of her might. And Bruce looks infinitely more relaxed holding the babies in the comfort of our hotel room.

I was SUPER stressed about the flight home, though big kudos go out to Victor, our Respiratory Therapist (seen below) ...

And our pilot, both of whom made us feel so comfortable about flight home.

After a rather uneventful flight home, we arrived in Dallas to another set of eager grandparents (Gramma and Papa) anxious to hold Ethan and Noel.

Ethan and Noel's first sibling dispute!

I'm sure we'll catch a lot of "firsts" on camera . . . but we definitely didn't expect to capture Ethan and Noel's first dispute. This exchange occurred when we co-housed the boys for the third time . . . Noel was having NONE of it and decided to let Ethan know just how much he wanted his own space.

Good series of pics with Noel on the left in the green, pushing and even throwing a right hook directly to Ethan's face . . . we jumped in not soon thereafter, but it was definitely a funny moment . . .

Our PHENOMINAL Loma Linda NICU nurses!

The "early days" portion of our blog would really be incomplete without a posting dedicated to the phenomenal nurses of the Loma Linda NICU, who took incredibly care of Ethan and Noel (and their parents) over the course of two weeks. When it became clear that Victor Valley Community Hospital was completely ill-equipped to handle our situation (despite repeatedly touting their "four bed NICU"), our primary goal was getting the boys to a place where we felt they would be safe and in competent hands . . . as you will all quickly see from our descriptions below, getting Ethan and Noel to the Loma Linda NICU was an incredible stroke of good fortune . . . we consistently encountered the right people/personalities at the right time in our collective journey and we owe the health of our sons to these folks . . .

Kris and Stephanie were the Care Flight nurses that handed the respective helicopter transports for Ethan (Kris) and Noel (Stephanie). After getting very little information from the Victor Valley Hospital staff, Kris and Stephanie showed up and educated us on what Ethan and Noel were experiencing and how they would be cared for over the coming weeks . . . they provided an immediate calm from the storm with their knowledge and confidence that the boys would be fine.

Yon (holding Ethan in the picture) was the very first nurse we met at Loma Linda - she was Noel's original night nurse post-transport and had an incredibly calm and caring demeanor that really helped us know that the boys were going to get through their struggles. We bonded immediately with Yon and observed her care for our boys as if they were her own . . . the connection was so great that we asked Yon to be our "primary" caregiver for the boys, which meant that she was assigned to one or both of them whenever she was on duty. Once he boys were out of danger, we loved trying to make Yon giggle and chat - we learned that she has three daughters and has become very conscious of cleanliness since working in the NICU - we would arrive each morning after a night with Yon to find a huuuuge bag of dirty laundry, much more than we'd find when we had other nurses taking the night shift with the boys. Yon was simply outstanding in every way - compassionate, competent and efficient . . . she seemed to adore the boys and provided them with tremendous care.

Sharon (holding Noel in this picture) was our first day nurse for Noel and was just as incredible . . . she was outgoing, funny and incredibly positive with a charming smile (which we had to coax out of her for this picture). She framed situations perfectly for us and made the afternoons fly by with fun conversation. We clicked immediately with Sharon and she is the one that actually introduced the term "primary" to us in asking if we'd be open to her being our day primary for the boys (of course we were ok!). Sharon was an incredible help in the final few days and came up to the hospital on our discharge day (her day off) to see the boys head home . . . it was a very good thing, as we needed real help surviving the final day debacle (to be detailed in a later post) and Sharon was phenomenal for us in that crisis. Sharon was a genuinely lovely part of our time in Loma Linda.

Alison was our second day "primary" and was incredibly fun . . . she has a bubbly, happy personality that brightened up what could be long days in the NICU. We didn't match-up with Alison as often as we would have enjoyed (she was off for most of the boys stay), but when she was assigned to them, the afternoons sailed by . . . she was also great in helping us line up competent, fun nurses for some of the nights and the days when neither Sharon or Alison were working. She's holding Noel in this picture (great smile matches the great personality). Adam and I both felt we could be friends with Alison in our daily life . . . hoping all goes well with her plans to start a family in the near future!

Sandal was our third day nurse and definitely entered our experience at the perfect time. Sandal has worked for the Loma Linda NICU for 30 years and that experience definitely worked to the benefit of our sons. She spearheaded the decision to move Noel off of the dreaded C-PAP, effortlessly got our surrogate approved for daily visits (something that seemed very intimidating to everyone else given the H1N1 precautions taken by the hospital), and really challenged the doctors to move forward with their handing of the boys. She was our champion feeder and probably had the largest direct impact in transitioning the boys from the NICU home. We definitely loved her spunk, candor and tremendous laugh . . . and definitely feel a debt of gratitude to her. Thanks Sandal!

Joan was our second "primary" night nurse behind Yon and was our sternest and best taskmaster/teacher. She really took it upon herself to help "teach us to fish" by showing us how to bathe, feed, burp and swaddle the boys, all of which we'd done with heavy trepidation prior to her shift. We were fortunate enough to have three nights with Joan and we grew in confidence with each "class" - by the end, we definitely felt competent and ready to care for the boys upon discharge. Joan had a great open laugh and a real softness under her tough exterior . . . she was the first person other than us to hold the boys at the same time and definitely saw them as a collective unit vs. individual patients.

It was amazing coincidence (or kismet) that the name of the sole male nurse we saw in the Loma Linda NICU was named Noel. We learned this on our first night when he was taking care of two other babies that shared a NICU room with Ethan and Noel and he'd look over every time we'd talk about Baby Noel. Nurse Noel had an incredibly serene personality and an easy smile and was an incredibly calming influence. I think Adam and I both felt an incredibly appreciation when we learned that Nurse Noel developed a special affection for Baby Noel, who was really struggling with all of his tubes and wires in the beginning. Even though Nurse Noel wasn't assigned to Baby Noel, when he would hear him crying, he would apparently come over and sing to him, thinking that he needed to hear a masculine voice for comfort (which apparently proved true) . . . it's an amazing thing to know that someone cared for your child enough to give them that kind of love and care. We eventually talked Noel into being our second backup night primary and we were fortunate enough to have had him take care of the boys for two nights, including their final night in the ward. We always had a great time learning about his family (who are all nurses, amazingly) and sharing good stories.

There are obviously other nurses that contributed to the boys incredibly journey, but the folks above are the ones we bonded with the most and the ones we'll remember the longest. Brings a smile to our face that they're now an official part of our family story.

Fudge What You Think!

Before leaving the NICU Unit, everyone is required to take a Discharge Class educating new parents on a variety of topics. We weren't terribly thrilled about taking a two hour class and decided to get it out of the way on Wednesday morning.

We arrive at the classroom about 10 minutes early and were chatting with Jeannie, a nurse that has been at Loma Linda for 30+ years. She asks us a few questions about the boys before we are joined by two other couples to making up the following micro-community:

• Brudam: A smartly dressed (MAYBE accidentally coordinated in matching Ralph Lauren sweaters) with paper and pen ready to take copious notes


• Couple #2: A young Hispanic girl and her husband with a sweet tattoo across his hairline that said “F@ck What You Think”


• Couple #3: A May-December romance of a 5o-ish year old man and a late 20s girl who could barely keep her eyes open. As the class progressed, it was clear it was a drug-related scenario going on.

Class starts off with a bang when Jeannie asks May-December couple the name of their baby and what they had. The father chimes in and says, "Lawrencia is a girl, though I was really hoping for a boy. I am still trying to get over that she’s not a boy. I really wanted a boy………………..” Sir, I think the name alone suggests your desire to have a boy. We move along nicely through uplifting topics such as "Shaken Baby Syndrome" and "How to select a good babysitter" (Did your neighbor recently kick down their front door after an argument with their significant other? They're better suited to go to the grocery store for you than to watch your baby.)

We get to the developmental milestones page that talks about what babies should be doing a 3 months, 6 months, etc. and the drug momma, who had been nodding off for 30 minutes now, somehow musters up a moment of clarity and decides to weigh in on the topic saying, “My other baby was out of diapers AND talking by 6 months…this guide is BULLSH!T!” Jeannie politely responded with, "Wow, your baby is quite advanced!" and most everyone in the room didn't even pick up on a hint of sarcasm!

Well, lo and behold, the best was yet to come. After covering awkward topics of ways to identify drug babies and the dangers of smoking around your babies we managed to silence the room when we said we were going to circumcise the boys. The tattoo coupled gasped in horror and whispered to each other and drug momma couldn’t even give us eye contact (though, to be fair, she was having a hard time focusing on anything).

Really????? THIS IS WHAT SILENCED THE ROOM????? Whatever. We covered the page on how to handle post-circumsicion care while the other two couples silently judged us. I wanted to tell Lawrencia's Dad and say, "Cram it, sir - we've got twice as many boys as you do!!!"

We wrapped up class and Lawrencia's parents went to go smoke and the other couple went off to see the lastest addition to their 5 other children. They ended up being a rather sweet couple despite his rather jarring tattoo. As we headed off to see the boys, Bruce, always a probleem fixer, suggested the man grow out his bangs as it would frame his face nicely and make for a better first impression.

Pics from Day 9!

Cute, adorable, alert Noel . . . we can't wait to get rid of his breathing tubes so his facial swelling will decrease and we can get to know his sweet face in an unobstructed capacity







Peaceful, agelic Ethan . . . his incredibly long eyelashes are the talk of the Loma Linda NICU. His "primary" nurse, Sharon, told us that "Ethan is going to be a heartbreaker."









Given how well they were both doing, Sharon helped us finally get the boys to the same crib . . . you can learn so much about their 9-day old personalities from this pic . . . Noel is alert, interested, active . . . Ethan just peacefully sleeping.

Life in the Loma Linda NICU . . . Days 5, 6 and 7

Hello again everyone . . . sorry that its been longer than anticipated again, but we've been occupied for the past three days in very encouraging, positive ways . . . definitely happy to provide this progress report as its mostly good news as we pass into the 37th week since conception for the boys.

Noel has had an absolutely amazing three days . . . after taking two steps forward followed by two steps back during his first few days after delivery, Noel is firmly on the "forward progress" route and making great strides. His successfully managed his extobation and we think the second dose of lung development medicine definitely helped. He lived with the much more cumbersome C-PAP (heavy breathing assistance) for two full days and during those two C-PAP days, we definitely saw the return of the Noel screech, which a little unsettling but also comforting, as he'd been so silent while he was intobated. Happily, Noel's nurse on Monday felt that he was definitely ready to move off the C-PAP (she may have, in fact, assisted in the "inadvertant" dismantling of said C-PAP) and got the OK to move him to a simple, light oxygen tube, which is far more comfortable for him . . . not long thereafter, calm Noel returned to us again (tho Noel is definitely seems to be the more "expressive" of the two). The nurses have likened Noel's journey to training for a marathon and we're hoping his little lungs have completed their training and are close to ready to handling the job without assistance. In even better "Noel news," he is the best eater imagineable . . . he had always taken to the pacifier more than Ethan (translation: craved it for soothing), so we'd thought that might the case, but we were relieved to have those thoughts affirmed. He pretty much downs any amount of formula they precribe with audible enjoyment and has never needed to gavage (using a small feeding tube) a leftover amount like his brother so often does . . . after just 36 short hours of feeding, Noel hit his "max feeding" overnight and just cruised through it - we're hoping that continues (for reasons that will be come obvious as you read further in this blog posting). We're definitely excited to learn more about his unaffected personality now that he's in more comfort and we're also ready to see his cute little face without all of the swelling that comes with the C-PAP.

Ethan has remained in a very positive status quo since our last meeting . . . he has remained withiout any outside breathing support since last Thursday and maintains really solid oxygen levels and breaths per minute all on his own. Happily, the swelling in his face went down over the weekend and we really able to see his cute little face. Ethan is utterly content in his NICU home and only cries for brief moments (if at all) before settling back into a peaceful slumber . . . they moved him into a standard mini-crib a few days ago and we have stocked him with some clothes and blankets to make his crib more into a little home. The MD's stopped all antibiotics for Ethan given the results of his blood levels, so we're now solely focused on Ethan's feeding, which brings us to the "one step back" news . . . Ethan's initial interest in feeding has certainly waned and he's definitely struggling to develop interest in his "every 3 hours" feeding schedule. He's been at a max feeding level of around 50 cc's for a few days now, but he just doesn't have much interest in the bottle . . . when he does feed, he will only make it through about 20 cc's before losing interest (translation: zzzzzzzz). They then supplment the balance through his little feeding tube which seems totally acceptable to him. They're evaluating him for a possible milk alergy or possibly extreme reflux, but we're guessing its also just might still be a bit early (at 37 weeks) for Ethan and he'll take bottle feeding up when he's able to manage it . . . as we mentioned above, he also has limited interest in a pacifier, so he may just prefer sleep over food for another fews days.

With the above progress, I'm sure everyone can imagine that Adam and I have loved the experience of the past 3 days . . . we're now managing much of the boys' care . . . we do the 8pm bathtime (actually the highlight of our day, as we laugh all the way through it) and handle diapers and feedings for the 9 am, 12 pm, 3pm and 9 pm routines. We're trying to be little information sponges, taking every bit of wisdom the nurses are willing to provide and it's really raised our confidence to a point that we're defintely ready to have them home when the time comes. With all of this great progress, we'll present our first collective family portraits . . .

We continue to appreciate the postive thoughts, prayers, and stories of encouragement from everyone . . . we have felt incredibly loved and supported and we've passed that feeling onto Ethan and Noel at every opportunity. We're excited to introduce them to our entire extended family in the coming weeks and we're sure that everyone will be as enamored of them as we are. Thanks again we hope that this update finds everyone happy and well.

Love to everyone,
The Brudam Brigade

Two steps forward . . . Days 3-4 in the NICU

Hello everyone . . . given the significant events over the past fews days, coupled with the very appreciated inquiries, we wanted to provide another general update on the boys. Things are definitely looking up as we close out Saturday, January 2 . . . the boys definitely have such different stories and its hard to decide which one to tell first, so I'll just stick with the order established in the last posting . . .

Ethan has become a complete rock star in his new Loma Linda NICU home . . . we arrived at the hospital on Friday afternoon (Day 3) to see that all of Ethan's breathing assistance had been removed and he was managing it all on his own! He seems to have conquered his respiratory issues and has maintained fantastic breaths per minute and oxygen levels for going on 36 hours now. He was doing so well yesterday that we were able to initiate bottle feedings which was obviously a great milestone . . . I was able to feed him 8 cc's in his first feeding and he has definitely become a little food monster in each of his subsequent feedings which happen every three hours. Adam and I alternate feeding him and he even topped out at over 20 cc's in one of his feedings today. He has to achieve a consistent 45 cc's plus to be discharged from the NICU, so it's pretty amazing to think that he's achieved half of that a few times in just his first 24 hours of feeding! The most satisfying part of the last couple of days is just how peaceful and alert Ethan has become . . . now that he's breating comfortably and eating, he is sleeping like a champ and has even started to fill some diapers (which the nurses are all too happy to "allow" us to change). He stared at Adam for well over half of the 30 minute feeding time today and it's clear he's starting to become aware of his surroundings . . . he graducated this afternoon to holding onto his Daddies' fingers and craning his neck to see whomever is talking to him - all very, very satisfying, especially considering Ethan originally seemed to be the more distressed of the two boys. Ethan seems to have his sights set on experiencing life at the Hilton San Bernardino and we'll readily have him with us when he hits his target.































Noel has definitely had the longer, tougher journey . . . early on Friday morning, after a night of heightened breathing difficulties, the MDs made the decision to re-intubate Noel so that he could relax and expend less energy trying to breathe. After intubating him, they also issued a second dose of the Curaserf to aid his lung development. To compound matters, Noel also received a blood transfusion in the late Friday evening to aid in the circulation of oxygen and his antibiotics . . . he was just too small to produce enough new blood to replace the blood that they'd been removing to monitor his levels. Now that we're a good 36 hours past these collective decisions, we're happy to report that they seem to be paying off and Noel has had a very encouraging Saturday afternoon . . . he was extubated mid-morning today and his levels have looked encouraging since the extubation. He's still receiving breathing assistance, but his breathing is clearly much more relaxed and his oxygen levels look great. His numbers even looked good enough for him to have his first bottle feeding . . . Adam fed him 4 cc's of formula today at 3 pm and he'll now receive feeding every 3 hours as he starts the same climb towards a consistent 45 cc's plus. Noel is definitely on the road to standing on his own and he's visually a completely different baby today . . . calmer and much more comfortable given that he's not being poked and prodded every hour. Adam and I have each taken 2 hours to simply hold Noel against our chest and its been amazing to see how much his monitoring improves during that time . . . we know that its not best for him for us to hold him 24 hours a day, but all of the nurses have advised us that 2 hours/day with his ear to our heartbeat goes a very long way towards helping a premature baby fight their way through respiratory issues . . . its nice that something we've enjoyed so much has done so much good for Noel. Today was the first time we really saw Noel gain alertness and we're looking forward to watching that improve with each day.






















This journey has definitely not been the one we expected, but they boys are standing pretty strong as we work through their fifth day and we're remaining very patient, as we can't be sure their progress will continue at today's fantastic pace. The staff at the hospital has been amazing and we continue to feel that we are in incredibly competent, intelligent, and supportive hands. Ethan and Noel are BIG hits with the nursing staff and we've had three different nurses ask to be their "primary" nurses when they are on duty . . . that obviously sits very well with us, as we've had great consistency in the care the boys have received.

I know that everyone is as curious as we are as to how long we will be out here and when we'll be coming home . . . the honest answer is that we just don't know yet . . . it certainly seems that Ethan is on his way to being discharged within 5-7 days assuming he continues to improve his food consumption . . . our best guess is that Noel is tracking 3-5 days behind Ethan, but that is truly just a guess from the MDs based on current state . . . if that comes to be the case, we'll likely leave California within a day or two of Noel's discharge, so I think the best case scenario is in the 10 -12 day range.

Love to everyone,
Bruce and Adam


P.S. Closing this one with our first official videos of Ethan and Noel, made early on Day 3 . . . super cute!!

Gramma's and Avo's first visit!

One of the highlights of Day 2 was when we received word from the Loma Linda NICU that they were willing to lift the hard ban of non-parental visitors (due to the H1N1 outbreak) . . . they granted Gramma Barbara and Avo Rita access to Room 13 in the NICU for 10 minutes each so that they could introduce themselves to Ethan and Noel for the first time (Papa Bill had managed to sneak in his 10 minutes on the first night when he accompanied Adam and me on our initial NICU visit). It was a very special experience, as you can see from the pics below . . .







Gramma with Noel - Day 2













Avo with Ethan - Day 2















Gramma and Avo with Ethan - Day 2

Delivery and what came next . . . a scary first couple of days

At first glance, both boys seemed extremely healthy at their 36 week delivery . . . as Adam mentioned, Ethan Carsner Knippa Milam was brought into the world at 11:30 and called at 6lb 2oz and 18.5 inches. Noel Ledger Knippa Milam came shortly thereafter at 11:30 and was called at 5lb 12 oz and 18 inches. Their names have significance to both families, as Adam and I decided to include both of our mothers' maiden names (Barbara Carsner and Rita Ledger, for reference) and both of our family names. Our joy was immediate . . . they cried and wriggled like healthy babies and each had ten toes and ten fingers . . . it was an incredible moment that we shared with Kim, who was still awake while they were cleaning the boys. We were then immediately ushered out of the operating room with the boys in tow so that our MD could finish working on Kim . . . we passed the eager grandparents (Papa, Gramma, Avo in person with Buck with us in spirit) who immediately fled to the small nursery viewing window for their first glimpses of their new grandsons.










Once the boys had been through their initial weighing and swaddling, they were placed in the small Victor Valley Hospital NICU (2 beds in a room that is about the size of a standard master bedroom closet) for monitoring, during which we were informed that both boys appeared to have respiratory issues (insufficient lung development). We weren't able to hold them, but we stayed by their side to soothe them while the nurses flew in and out of the room . . . it was definitely not the experience we expected and the sight of the boys in distress was definitely unsettling.

Ethan and Noel struggled for about 5 hours during which time we quickly learned that the Victorville Hospital was a sub-standard facility that couldn't provide the requisite care (or even get their remote X-ray machine to work, for goodness sake!) . . . at 5 PM, the on-call MD informed us that he had made the decision to have the boys care flighted from the Victorville hospital to a fantastic Loma Linda Childrens Hospital in San Bernardino which has an 82 bed NICU. As we digested the shock of such a severe change in plans, everyone involved assured us

that this was for the best and completely standard as the hospital "is really only equipped to provide care for 5 - 8 hours maximum" (seriously). At 7 PM, two separate phenominal care flight teams arrived and our concerns were immediately assuaged . . . each and every person was competent and intellingent that they were immediately able to communicate how much better this was for the boys . . . but that didn't make the act of watching them transfer Ethan and Noel into transport bread boxes and load them into separate helicopters any easier.

During the transport, we were incredibly thankful that we'd had some support with us . . . our folks helped pack up the rooms and transferred into a new Hilton hotel near the Loma Linda hospital so that Adam and I could focus all of our energy on the boys. We finally made our own hour drive around 8 pm after Noel's helicopter departed and the sense of relief upon finally reaching the Loma Linda NICU was immediate.

In the span of 2 hours, Ethan had fully stabilized and they'd placed on a C-PAP for moderate breathing assistance . . . he was peacefully sleeping for the first time since coming into the world and he seemed to have gained as much comfort from Loma Linda as we had. Within 24 hours he would be subsequently upgraded further to a simple nasal canula with an eye towards hopefully breating on his own soon. We were finally able to hold Ethan during the afternoon of Day 2 and he clearly loved it, tho likely not as much as we did.

Noel definitely has had the harder journey of the two, but he's fought hard to get well and is doing better every day . . . he had a more extreme respiratory distress syndrome (RDS) post-birth, but reacted well to a dose of Curaserf that helped round out his lung development. He stayed on the deep C-PAC assistance for the first 36 hours and then moved to the shallow C-PAC assistance late during Day 2. . . he's since been struggling to keep a good oxygen level, so he's continued to get a higher oxygen stimulation to help him out. The MD has estimated that Noel may be 2-3 days behind Ethan in development, but we're definitely happy with the progress he's made and everyone has assured us that this is all relatively normal for a baby with RDS. Noel also has an IV feeding tube and received his first small batch of formula late on Day 2, which we hope will digest well. He's loved his pacifier since the very beginning (he has a little Maggie Simpson syndrome) which is great - learning to continue breathing through the CPAC while sucking on the pacifier is definitely encouraging behavior and will hopefully help him take to the bottle when he's ready for it. Noel also seems to have a small bout of pneumonia, likely a holdover from the womb, and they are giving him a 7-day round of antibiotics to help him move past that - gladly, he's not exhibiting any negative symptoms from the pneumonia. We were finally able to hold Noel for the first time last night for about an hour during the evening of Day 2 and we've been promised a there's more to come tomorrow if he continues to improve. Given his slower progression and the current course of antibiotics, they've hedged a bit on his timeframe in the NICU, but I think its safe to say we're looking at 10 days give/take as a best case scenario.

Now that we're past all of the medical discussion, we'll cover the fun stuff . . . though the process started off a little frightening, Adam and I are LOVING every second of parenting . . . we visit the hospital at 8 am, 1pm, and 9 pm every day according to the visitation hours and every milestone is extra special . . . Noel is by far the more alert of the two and loves to look around . . . he is by far the more temperamental and definitely knows how to indicate he'd rather be left alone, but then again the C-PAP seems to be miserably uncomfortable, so we're guessing that's the primary contributor to his mood. We've found that we can soothe Noel by patting his tummy and have gotten a lot of practice. Ethan just started opening his eyes today, as he seems to enjoy sleep like his daddies - as a result we're a little light on eye contact at the moment, but it was great when it finally happened. Ethan loves to hold onto our fingers and loves a hand resting on his belly while he sleeps. Ethan has been much more relaxed and loves sleeping with his mouth wide open. The are both unbelievably adorable and we've had fun getting to know their features and figuring out how we'll tell them apart when we get them home, as they look very similar at this stage (Ethan is a little larger and Noel has more ridges in his ears - so far that's all we've got to use).

From the very beginning they have both recognized our voices thanks to Kim (our phenomenal surrogate) who played a digital recorder for them in utero each day . . . the NICU nurses have all noted how much calmer the boys are when we're around and speaking to them and we love being their "constants" through all the craziness. For those that have asked, Kim is doing much better after a really scare post-delivery experience . . . she has been an unbelievable God-send and we could not have been more fortunate than to go through this experience with her.

OK - that's a lot of reading I'm sure, but I don't know when I'll be able to have this much time at the keyboard again, so I wanted to get a lot out there . . . we have definitely appreciated everyone's positive wishes and kind words . . . we definitely have everything we physically need, so please just focus any efforts on sending the boys your warm wishes.

Here are some pics once we got settled into the Loma Linda NICU . . . Adam holding Ethan for the first time and Bruce holding Noel for the first time. Also including some digital images of Adam's first diaper change - ever! He handled it like a champ, especially when you look at the plethora of wires that he had to fight against . . . nice job, Pai!

During...

After :)

Looking forward to forward progress in the days to come . . .

Brudam