A perfect storm

Last Wednesday, I ran into a mom of one of C. Samuel’s classmates for the first time since we lost Jane. Reflexively, she asked, “So, what happened exactly?” then immediately seemed to regret it, saying “You probably don’t want to talk about it.” I suspect this is the thought process most people go through when they hear our daughter was stillborn.

For the record, I don’t at all mind talking about it.

At the time of Jane’s birth, we knew extremely little. Dr. R suspected a placental abruption: I had no risk factors for stillbirth aside from maternal age; even with the close monitoring that came with going past term, I showed no indicators of an underlying cause; and my labor progressed extremely quickly (a classic sign of abruption). Moreover, Jane came out looking perfect, with no signs of cord injury (the other likely cause for demise of an otherwise healthy pregnancy).

Six weeks after my due date, we went to our follow-up appointment with Dr. R. By then, the results had come back from the dozens of tests performed on me…

The verdict?

Dr. R said that to the best of her knowledge, Jane’s death was the result of “a perfect storm.” I Googled the expression, and found it defined as “A situation where a calamity is caused by the convergence and amplifying interaction of a number of factors”. Sounds about right.

What were the factors converging to result in Jane’s demise?

Dr. R said there were three contributors that we know of, namely:

  • We know that Jane had a small, insufficient placenta, although we don’t know why. Risk factors for this include drug use, high blood pressure, pre-eclampsia, gestational diabetes, advanced maternal age, and infertility. Dr. R said she had looked into the infertility link further, and found that it has only been demonstrated for pregnancies achieved through IVF…so not Jane. The only known risk factor I had was advanced maternal age.
  • Jane had a shorter-than-normal umbilical cord. I’ve learned that the normal range is 35-80 cm, and that Jane’s was 30 cm after being cut. Dr. R freely acknowledged that some may have been lost in the cutting. So definitely on the short side, but not far outside the normal range. She said that a short cord increases the risk of a cord injury.
  • The main vessel of Jane’s placenta contained some “old, organized clots”. Dr. R suggested this may be due to an event that pinched the cord. (More on this in my placental pathology report, reproduced in part here.)

Dr. R suspects one additional contributor to Jane’s death:

  • Dr. R still believes I had a placental abruption. She said she can’t prove it (for example, my test for maternal fetal hemorrhage was negative), but supporting evidence includes my crazy, tumultuous labor (from 1 – 10 cm in less than 2 hours), old brown blood in my amniotic fluid (which was visible upon dilation), and “port wine-colored” blood delivered with Jane in my amniotic fluid.

Would Jane have been okay otherwise?

There’s no way to know if Jane would have suffered from my crappy placenta and blood clots if she had been delivered earlier. She looked perfect at delivery, so…perhaps not.

Was Jane “growth restricted”?

Dr. R said we can’t tell if Jane fit the definition for intrauterine growth restriction (IUGR) or if she was just small for gestational age (SGA).

Was there an underlying cause?

Kaiser did tons of tests on me. All came back essentially normal. I do not have a clotting disorder. I did not appear to have any relevant infection during my pregnancy with Jane. Dr. R promised to send me my test results by mail. (She did, and I summarized them here.)

How could we prevent this from happening in a future pregnancy (assuming we can get pregnant again)?

For any future pregnancy, Dr. R would recommend that I take low-dose aspirin through 36 weeks to prevent clots. (I actually took the low-dose aspirin through the first trimester with both Jane and C. Samuel, on the advice of Dr. Y. Given my test results, she does not currently recommend heparin.) We would do monthly growth ultrasounds, along with additional Doppler scans to check the baby’s blood flow (specifically the cord flow and “mid-cerebral artery flow”). We would do “intense testing,” including a repeat of my blood clotting tests. If anything looked bad once the baby reached viability, we “will act” (that is, deliver him or her early). Dr. R also recommends a scheduled C-section, rather than taking the risk of fetal distress or an accident during labor.

When should we try again?

Dr. R gave me the all-okay physically. She mentioned that some studies suggest that a shorter break between pregnancies correlates with shorter umbilical cords, but she didn’t think the quality of evidence was good. She indicated a desire to talk to Dr. Y more about this.

I’d like to write a longer post on the subject of trying again. Suffice it to say that neither C nor I want to wait long.

Are you going to retire?

Dr. R answered confidently, “Oh I’m going to see this through!” She also shared (perhaps unprofessionally, although I hardly fault her for it!) that she had a dream that we had another, healthy child. I hope her dream proves to be prophetic!

On our way out the door, I handed Dr. R a Thank You card, in which I shared our feelings of gratitude to her, along with a photo of us with Jane:

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When I got home, there was an email from Dr. R in my Kaiser inbox:

Hi, K and C! I rushed out to catch you but you were too fast and got away. The card was so touching and beautiful! Thank you so very much for the picture. It means so much to me, more than any words can express. I am here for you in any way that I can help. Please feel free to reach out at any time. In peace, Dr R

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Tests

After learning of Jane’s passing, I was subjected to a large number of blood and urine tests, and my placenta was sent to be examined by a pathologist. Most of the samples were collected in the hospital (while I was still in labor with Jane, or shortly after). A few more blood tests were added roughly a month later, after I shared some information about my family history (re: blood clots) with Dr. R.

I’m not a physician and haven’t spent a lot of time looking into these tests and what they mean. But on this 2 month anniversary of Jane’s birth and death, I’m parking them here for posterity, and also as an easy way to share them with my physician friends (or anyone else who cares to take a look). I’ll wait to summarize the key takeaways as they pertain to Jane’s death and to any future pregnancies in a future post about our follow-up appointment with Dr. R.

Without further ado, here are all my test results. Results outside the normal range are highlighted in orange. (UPDATE: It looks like the tabulated data doesn’t display on smartphones; I recommend viewing on a computer if you want to see my numbers and/or the standard ranges for each of these tests…)

 

Complete Blood Count

This is a routine test “used to evaluate…overall health and detect a wide range of disorders, including anemia, infection and leukemia” Source

23-Jul 19-Aug Standard Range
HCT 40.6 40.9 37.0-47.0 %
HGB 14.3 13.8 12.0-16.0 g/dL
MCH 32.5 31.6 27.0-35.0 pg/cell
MCHC 35.1 33.7 32.0-37.0 g/dL
MCV 92.4 93.7 81.0-99.0 fL
Platelets, Automated Count 167 188 130-400 x1000/mcL
RBC, Auto 4.39 4.36 4.20-5.40 Mill/mcL
RDW, Blood 13.2 12.4 11.5-14.5 %
WBC’s Auto 14.8 6 4.0-11.0  x1000/mcL

 

Clotting-related tests

One of the risk factors for fetal demise is maternal blood clotting, either due to an inherited thrombophilia, or an autoimmune disease that can lead to a “hypercoagulable state” like Lupus or antiphospholipid syndrome. From what I can gather, the following tests are all related to my tendency to form blood clots.

  • Activated partial thromboplastin time “(aPTT or APTT) is a medical test [used for] detecting abnormalities in blood clotting” Source
  • Fibrinogen is a “glycoprotein in vertebrates that helps in the formation of blood clots…[It is typically] elevated in pregnancy…Low levels of fibrinogen can indicate a systemic activation of the clotting system.” Source
  • Lupus, antiphospholipid syndrome, the prothrombin G20210A gene mutation, and factor V Leiden thrombophilia are all conditions that might predispose me to clotting problems.
  • Cardiolipin antibodies and beta-2 glycoprotein antibodies are commonly tested along with the Lupus anticoagulant screen. According to my Kaiser lab results, “Clinical associations [for cardiolipin antibodies test] include SLE (25-50%), Arterial or Venous Thrombosis, Recurrent Fetal Loss, Thrombocytopenia, Valvular Heart Disease.”
  • Homocysteine is an amino acid. “Abnormally high levels of homocysteine in the serum, above 15 µmol/L, are a medical condition called hyperhomocysteinemia. This has been claimed to be a significant risk factor for the development of a wide range of diseases, including thrombosis” Source
  • Protein C “plays an important role in regulating anticoagulation, inflammation, cell death, and maintaining the permeability of blood vessel walls in humans and other animals.” Source
  • Protein S has a “role in the anti coagulation pathway, where it functions as a cofactor to Protein C in the inactivation of Factors Va and VIIIa.” Source
  • Antithrombin III is a “small protein molecule that inactivates several enzymes of the coagulation system” Source
23-July 19-Aug Standard Range Notes
activated partial thromboplastin time (APTT) 26 25-37 sec
fibrinogen 554 218-441 mg/dL
thrombophilia, 20210G-A, F2 mutation analysis negative negative
APTT 35 23-38 sec All part of the Lupus anticoagulant screen
dilute Russell viper venom induced 36 29-43 sec
Lupus anticoagulant negative negative
cardiolipin IGG, EIA 2.5 <=14.9 GPL units
cardiolipin IGM, EIA 7.4 <=12.4 MPL units
beta 2 glycoprotein 1 IGG 1 <=20 SGU
beta 2 glycoprotein 1 IGM 4 <=20 SMU
beta 2 glycoprotein 1 IGA 3 <=20 SAU
thrombophilia, 20210G-A, F2 mutation analysis negative negative
factor V Leiden thrombophilia negative negative
homocysteine, subst conc, SERP 6 5-15 mcmol/L
activated protein C resistance ratio 1.9 >= 1.9 Factor V Leiden expected to cause APC resistance ratio below 1.9
protein-C activity (actual/normal) 116 95-172 % Factor VIII levels greater than 250% may lead to under-estimation of protein C level
protein-S – functional, plasma, QN 106 50-118 % Factor VIII levels greater than 250% may lower protein S measurements.
antithrombin III activity 109 80-120 %

 

Liver-related tests

I’m guessing liver function is of interest for detecting intrahepatic cholestasis of pregnancy, preeclampsia, HELLP syndrome, or acute fatty liver of pregnancy? Or maybe hepatitis?

  • Alanine transaminase (ALT) and aspartate transaminase (AST) are liver enzymes. “Serum AST level, serum ALT (alanine transaminase) level, and their ratio (AST/ALT ratio) are commonly measured clinically as biomarkers for liver health.” Source
  • Bile acids (including cholic acid, deoxycholic acid, and chenodeoxycholic acid) are “steroid acids found predominantly in the bile of mammals and other vertebrates…synthesized in the liver…[and] aid in the diagnosis of a number of conditions, including … intrahepatic cholestasis of pregnancy.” Source
  23-July Standard Range
ALT 8 <=54 U/L
AST 29 <=30 U/L
cholic acid: 3.7 <= 1.8 umol/L
deoxycholic acid: 1.5 <= 2.4 umol/L
chenodeoxycholic acid: <0.5 <= 3.1 umol/L
total bile acids: 5.2 <= 6.8 umol/L

 

Kidney-related tests

Poorly controlled diabetes is another maternal cause of fetal demise. The following tests evaluated my kidney function and blood glucose levels.

  • Creatinine is “an easily measured byproduct of muscle metabolism that is excreted unchanged by the kidneys”, so creatinine levels in blood rise if kidneys aren’t doing a good job of removing it. Glomerular Filtration Rate (GFR) is the “volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time.” Both are measures of renal function.
  • Blood glucose is the level of sugar in my blood. An abnormally high value might be indicative of diabetes.
  • Hemoglobin A1C (HGBA1C) screening measures hemoglobin (the oxygen-carrying protein in blood) that has been modified with a glucose molecule. In the presence of continually high blood glucose levels, HGBA1C builds up slowly over time, so its value gives you an idea of how well blood glucose has been controlled over the past three-months.
  23-July Standard Range Notes
Creatinine 0.46 <=1.10 mg/dL
Glomerular Filtration Rate >89 >89 mL/min/BSA
Glucose, Random 91 70-140 mg/dL
HGBA1C% 4.9 4.8-5.6% >6.5% is diagnostic of diabetes. 5.7-6.4% indicates increased risk for future diabetes

 

Tests for infections

  • Syphilis is a sexually-transmitted bacterial infection. Untreated in the mother, it can pass to a fetus and cause a variety of horrible outcomes including stillbirth. Source
  • Parvovirus B19 (aka fifth disease) is a mild viral disease that may, in rare cases, cause anemia and/or miscarriage. (Interestingly, I found the same said of Coxsackie virus, for example here, which I did get while pregnant with Jane… I’ll have to ask Dr. R about it…)
  • Cytomegalovirus is a virus in the herpes family that typically causes no or mild symptoms. It’s not clear to me whether a causal relationship has been established, but at least a few articles seem to point to a correlation with stillbirth (for example, see this source).
  • Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii, commonly transmitted by eating undercooked foods (like rare steak), or coming in contact with cat poop (for example, when changing the litter box, or gardening). Toxoplasmosis usually causes mild or no symptoms in non-immunocompromised adults, but when it passes from a pregnant mom to a fetus, it can cause a variety of terrible outcomes, including stillbirth. Source

The latter three tests include tests for two different types of antibodies: IgG and IgM. The IgG antibodies are the long-term antibodies that are present if I have ever been infected with the pathogen; these antibodies confer immunity to future infections by the same pathogen. The IgM antibodies are part of the short-term response to an active or recent infection. Their presence in my blood at the time of Jane’s death would indicate an infection that happened during my pregnancy (i.e. one that could have impacted Jane). For more, see this.

As you can see below, it appears I have been infected by parvovirus B19 and cytomegalovirus at some point, but not a recent infection that might explain what happened to Jane. This is somewhat good news, since it means I am now immune to getting these infections in a future pregnancy. Unfortunately, I have not been infected by Toxoplasmosis… which means I’ll be stuck eating my steaks well done in any future pregnancy…

  23-July Standard Range Notes
Treponema pallidum AB, EIA (Syphilis screen) nonreactive nonreactive
Parvovirus B19 Ab IgG: 4.9 <0.9 IgG persists for years and provides life-long immunity
Parvovirus B19 Ab IgM: 0.2 <0.9 probably no current or recent infection
Cytomegalovirus IGG, SER, QN 5.4 <= 0.8 AI IgG antibody to CMV detected which may indicate exposure to CMV infection
Cytomegalovirus IGM, EIA < 8.0 <=29.9 AU/mL A positive test may indicate a current or recent infection.
Toxoplasma gondii IGG, SER, QN < 3 <9 IU/mL
Toxoplasma gondii IGM 0.06 <= 0.549 RFV No serologic evidence of infection with Toxoplasma gondii

 

Immune-related/antibody tests

  • Rhesus disease (in which the mother’s immune system attacks her baby’s red blood cells) is also on this list of possible causes for stillbirth.
  • The Coombs test for autoimmune hemolytic anemia is looking at whether my immune system is attacking my own red blood cells (I think).
ABO and RH blood type A Pos
Crossmatch Result Compatible
Indirect Coombs test: Blood Group Antibody Screen neg

 

Other blood tests:

Fetomaternal hemorrhage screen, aka  Kleihauer–Betke test, is “a blood test used to measure the amount of foetal hemoglobin transferred from a foetus to its mother’s bloodstream.” “Causes of increased foetal-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found…Foetal-maternal haemorrhage is one cause of intrauterine death (IUD).” (emphasis mine) Source

23-July Notes
Adult RBC, Blood 2000 Conducted by counting 2000 red blood cells in my blood
Fetal RBC, Blood 0 None of those cells were determined to be from Jane
Fetal/Adult RBC Ratio, Blood 0
Fetal-Maternal Hemorrhage Volume 0 mL

 

Thyroid stimulating hormone (TSH) is a protein hormone measured to test for hypothyroidism (or hyperthyroidism, but I can’t find anything in a quick Google search about that relating to pregnancy outcomes…) From what I can tell, thyroid disorders may be correlated with fetal demise and/or low birth weight. Source

  23-July Standard Range
TSH 1.8 0.35-4.00 mcIU/mL

 

Drug tests

Smoking and illicit drug use are associated with an increased risk of stillbirth. Source

I should point out that Dr. R gave me two doses of IV morphine while I was waiting for my blood test (and approval for my epidural). So it didn’t come as a surprise to anyone when I came back positive for opiates generally, or morphine specifically. The tests included two sets of screening tests (in which they homed in on morphine), followed by a confirmatory test using gas chromatography-mass spectrometry (GCMS).

Drug screen (AMP, METH, BAR, BZD, COC, OPI, PCP, THC, TCA), Urine, Using test w visual read

23-July Standard Range
THC, Urine negative negative
Phenylcyclidine, Urine screen negative negative
Cocaine, UR, QL, Screening test negative negative
Methamphetamine, UR, QL, Screening test negative negative
Opiates, Urine, QL Preliminary positive. Pending confirmation. negative
Amphetamine, UR, QL, Screening test negative negative
Benzodiazepines, Urine Screen negative negative
Tricyclic antidepresseants, Urine screen negative negative
Barbiturates, UR, QL, Screening test negative negative

 

Opioid Screen, Pain MGMT (BUP, FEN, 6MAM, MTD, OPI, OXYCOD, HDC, TRA), Urine, Automated Analyzer w EIA

  23-July Standard Range
Buprenorphine, UR, QL negative negative
Fentanyl, UR, QL negative negative
Hydrocodone, UR, QL neg neg
Heroin metabolite (6-MAM), UR, QL negative negative
Methadone, Urine screen negative negative
Opiates, Urine, QL POSITIVE negative
Oxycodone, UR, QL, Screening test negative negative
Tramadol, UR, QL, Screening test negative negative
pH, Urine 5.4 5.0-8.0
Specific gravity, Urine 1.01 1.002-1.030
Creatinine, Urine 35.5 >=20.0 mg/dL
Specimen validity, Urine normal

 

Opiates, Urine, Confirmatory GC/MS

Opiates, UR, Confirm morphine detected

 

Surgical pathology

I found the placental pathology report to be the most interesting item in the pages from my medical record that Dr. R shared with me…

FINAL PATHOGENIC DIAGNOSIS

Placental, vaginal delivery

  • Term placenta (40 weeks 6 days), size extremely small (~450 g expected, 225 g actual)
  • Thrombi of mainstem fetal vessels, organizing and old
  • Normal villous features (no increased immaturity, villitis or infarction)
  • Rare hemosiderin deposits within chorion, likely clinically insignificant
  • No evidence of decidual vasculopathy for chorioamnionitis
  • Short trivascular umbilical cord (>50 cm expected, 30 cm actual)

COMMENT

Although the placental weight can vary with maternal constitutional size, 225 grams is truly small and may, or may not have resulted in utero placental insufficiency. The more common causes of vascular thrombi are infection, cord compression and coagulopathy. In view of the short umbilical cord (if 30 cm is the true length), it is possible that there was compromised [sic] due the cord with the onset of labor.

[The report goes on to describe the appearance of the placenta, etc.]

When to return to work?

Returning to my list of decisions I had to make after losing Jane Margaret, one rather important decision was when/how I would return to work. (Before continuing, I should preface this with an acknowledgement of my enormous privilege. I expect this post is where I’ll lose sympathy from many fellow stillbirth moms, not undeservedly.)

Decision 8: When to return to work?

Some background:

I am a chemistry professor at a small Christian university. Privilege #1: This school happens to be in California, the best state in the US when it comes to maternity and paid family leave. Moreover, my college supplements the state-mandated leave (Privilege #2). Since we are on semesters, and my teaching load is 12 “units” per 14-week semester, my school gives us a maternity leave (including disability from the delivery plus paid family leave for the new addition) in the form of a 9-unit course release (10.5-unit for delivery by C-section). So with the birth of C. Samuel, I was fortunate enough to give birth in May, when we were on summer break. This means I got the summer off “for free”, taught only two lab sections (one day per week) in the fall (beginning when C. Samuel was 3 months old), and returned to full time in January, when C. Samuel was 7 months old. The state paid 60% or so of my salary, and my university covered the rest, up to my full salary.

In preparing for Jane’s birth, we decided I would take a small pay cut (corresponding to the 3 units that would bring me to ‘full time’), so that I could take the entire fall semester off from work. The plan was to do some traveling as a family of four; then I would return to work in January (when Jane was 5 1/2 months old). Accordingly, my department offered my usual courseload to part-time and adjunct faculty to teach in my place.

When Jane died, I was faced with an awkward decision. I still qualified for the “disability” half of my leave, but without a baby, I was no longer entitled to the “bonding” half of my paid family leave. In order to remain full-time, I would need to take back courses from the adjunct faculty currently assigned to them (who are presumably counting on that income), and cobble together 9 units of courseload from a combination of an intense half-semester course starting in late August, plus several full-semester laboratory sections. Such a schedule would preclude any travel as a family, and would require that I start back at work full-swing a mere month after Jane’s passing.

I began discussions with the HR folks at my university, exploring what options existed for me to maintain full-time status (and my accompanying generous benefits package, Privilege #3), while retaining some flexibility to grieve and spend time with my family. I learned that I had the option to take a longer leave without pay (an option that we could afford financially, Privilege #4), without forfeiting my benefits, which was good news.

Both the HR director and a representative of the disability office at Kaiser tacked on a strange qualifier in all their discussions about my leave. They said “from when your doctor releases you to return to work.” I ignored it the first couple times they mentioned it. I’d had an uncomplicated vaginal birth. My physical recovery had gone very smoothly – way better than I had expected. Obviously, Dr. R would say I should return to work 6 weeks from my delivery date – right? But the third time I heard “well, see when your obstetrician says you can return,” I decided maybe it was worth asking her.

I emailed Dr. R, filled her in on the background regarding my teaching schedule and the HR director’s statements, asking,

“…I just wanted to check with you to see what you think, so that we can figure out what to do about my leave (whether to take teaching load back from an adjunct, or accept a pay cut commensurate with the additional leave, either of which would be fine).”

Within a few minutes, Dr. R called my cell and told me she would write whatever I wanted, on whatever form I needed her to. I sent her the form and she replied,

“Hi, K! I have completed the form. I have put that your return to work date is 1/1/2017. Please respond if this is appropriate for you. If you decide to return to work prior to that time, we can always amend things. I have found that it is easier to ask for more time off up front than have to keep going back and requesting more time if needed. Please let me know where I can fax the form. 🙂 Dr R”

Later, at my follow-up appointment, Dr. R gave me the heads-up that she listed “postpartum anxiety” in my chart to justify the additional leave.

So I’m also privileged to have the nicest OB in the world (#5, in case you’re still counting).

I’ll return to full-time work in January. In the mean time, I’ve been taking care of myself (getting regular massages and mani-pedis); visiting Jane’s grave; writing (this blog, and a long-overdue manuscript); gearing up to give a couple of talks (a guest lecture at my previous institution, a video clip with my collaborators, and a talk to a local American Chemical Society section); and spending time with my family (potty-training, swim lessons, visits to Legoland and Sea World, etc.) In a few weeks, the three of us will travel to Rome on the trip we had hoped to do with Jane.

 

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Jane’s grave on Friday. Grass is starting to fill in nicely.

Caterpillars

I used to think caterpillars were cute little things that transformed into butterflies. Their eating habits only impacted me as the subject of Eric Carle’s charming book (one of C. Samuel’s favorites).

Image result for the very hungry caterpillar

That was before caterpillars started attacking Jane’s wildflowers.

Our friends S&Q made this beautiful planter for my husband C’s birthday, as a memorial to Jane. They planted wildflowers (seeds of which we had as a takeaway at Jane’s funeral):

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Our lovely memorial planter, pre-caterpillar

This is what it looks like now:

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I declared war on the caterpillars:

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Concentrating hard as I pick out caterpillars with chopsticks

Prisoners of War:

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Eew!

I may or may not have kept the POWs in a small tupperware container until after C. Samuel’s bedtime, and then released them into a mean neighbor’s yard under cover of night…

How to help someone grieving a stillbirth, and Potty Training

To break up the stream of sad posts, I thought I’d make a list of nice things that people have done for us in the hours, days and weeks since Jane’s death. By putting it here, I plan to refer back to this if, heaven forbid, someone I care about has a similar (or even not-so-similar) loss and I am looking for ways to contribute.

Here’s a non-comprehensive list of amazing things people did for us:

Acquaintances, work colleagues, extended family, and friends:

  • Sent an email, Facebook message or text (or several, to check in from time to time)
  • Prayed for our family
  • Sent a card or flowers (to our house or to the funeral/interment)
  • Referred to Jane by name  ❤
  • Contributed to Jane’s memorial fund
  • Attended the funeral, viewing, and/or interment
  • Asked to see photos of Jane… and told us how beautiful she was
  • Took us out for a drink or meal
  • Sent a meal or treats (in a disposable container)

Close friends and relatives:

  • Came to the hospital and held Jane
  • Took (so many!) photos of Jane, and of us holding her
  • Visited us at home
  • Helped care for C. Samuel, and our dogs
  • Served as a point of contact (to notify others of what happened, funeral information, etc.)
  • Set up a meal train (on takethemameal.com)
  • Set up a fundraising page for a memorial (on caring.com) Actually, C did this, but I would definitely offer to help someone with it in the future. Gofundme.com also works well. We chose caring.com because they charge lower fees, so more of the money goes to the intended purpose.
  • Maintained a list of flowers, meals, gifts, and memorial donations as they came in; bought thank you cards and stamps; wrote and mailed thank you cards for early flowers and gifts; and addressed and stamped the rest, so all I had to do was write the message and sign
  • Went to Target and Buy Buy Baby (fighting with staff as needed) to return unused baby items
  • Offered to go with us to the funeral home and/or cemetery to make arrangements
  • Hosted out-of-town funeral guests in their guest room or whole house (friends who were out of town)
  • Helped with the funeral and reception (letting people know about it, getting a guest book, designing/printing the program, making seed packets for the guests, coordinating caterers, getting booze, set up/clean up)

 

We also got some lovely gifts that I would suggest to anyone looking for gift ideas:

  • Jewelry memorializing Jane

Tiffany silver initial necklace with ‘C’ and ‘J’ pendants (left), rose gold ‘J’ initial necklace with crystal pendant (top right), and handmade ruby birthstone pinky ring necklace (bottom right)

Silver locket with photo of Jane

  • A potted flowering tree (in this case, plumeria)

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  • A planter box, preplanted with flowers (in this case, perennial wildflowers that were the takeaway from Jane’s funeral; forget-me-nots are another nice option)

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  • Something for the older children (C. Samuel got some sweet toys!)
  • An engraved watch band for dad (from etsy.com)

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  • A pencil drawing (mentioned in my last post)
  • A blank journal
  • A prayer shawl (crocheted while praying for/thinking about the person and their loss, but anything comforting could be nice – like a special blanket or stuffed animal)

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Winston also loves our prayer shawl from Cre8tive Lane

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In other news, we started potty training last weekend.

C. Samuel had been fighting more and more during diaper changes and I was fed up. On Friday, he flat-out refused to let me put a clean diaper on him after removing his overnight diaper, and then announced that he had to poop. I asked if he wanted to go on the potty and he said yes, so I sat him down and proceeded to read a couple of books to him. Sure enough, when he got up, he had pooped and peed in the potty. That sealed the deal for me. Holiday weekend it is!

We are on Day 4 of potty training according to the method prescribed in Oh Crap! Potty Training, and he is doing pretty well, I think. Plenty of accidents (as C put it, “it’s literally a shit show!”), and I have to watch him like a hawk and try to walk the fine line between ‘suggesting’ that he might want to use the potty, versus ‘nagging’ him to do so (which guarantees his refusal!) But in the first three days he only had three complete misses, a number of partial misses, and lots of complete pees and poops in the potty! Just now he came to me, unprompted, and asked for help getting his pants down to poop in the potty. Yippee! Hope he keeps it up at daycare tomorrow…

In trying to potty train C. Samuel, I realize that our dog Lilly gave us a special parting gift in the last couple of months before we had to say goodbye. Namely, she got us used to dealing with pee and poop on the floor. Thanks to Lilly, we already have good reason to get our carpets cleaned (taking the pressure off C. Samuel), and we waited to replace our 10-year-old couch. (The replacement is on backorder until late October, which while originally irritating, we now see as a giant blessing.) Lilly even got us started on our list of potty training must-haves:

  1. Appropriate gear for cleaning up inevitable accidents. In our case, this includes a Hoover FloorMate for the tile floors; a Bissell SpotClean Pro for carpet and sofa; Latex gloves, Clorox Disinfecting Wipes and Lysol Disinfectant Spray (for cleaning up poop accidents).
  2. Piddle pads to protect sofa, carseats and stroller. (Right now we’re using the disposable drugstore kind we bought for Lilly; I also plan to try the fancier Summer Infant ones…)
  3. Elastic waist pants, one size too big, to make them easy to pull up and down. (Still kind of tricky for C. Samuel to get right, but the timeline from realization to urination is too short to be fooling with buttons, even if I’m helping!) We have seven of these, and managed to use every single one yesterday (our first day wearing pants).
  4. A standalone potty chair that can travel from room to room. (See #3 regarding the timeline we are dealing with here. Also, the portable potty chair makes it possible to continue watching Cars or Daniel Tiger through the whole process (see photo below). Without that option, I’d set the odds of C. Samuel independently choosing to walk away from his show to go potty about a million to one.)
  5. A support group of friends who have been through it recently or are going through it. This is the cheering squad for times like yesterday, when kiddo (a) realized he needed to go poo, (b) walked over to the potty and (c) sat down on it before pooping! Wahoo!!! (These amazing friends continued to cheer, even when I added the minor detail that he forgot to pull his pants down first…)
  6. Wine. Lots of wine.

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C. Samuel is a master multitasker. (Also notice the elastic waist pants)

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No need to stop watching Cars to do his business. (That poor sofa has seen better days… And thank God for tile floors!)