The incredible vulnerability of parenthood

Liam's big, bulbous, and, as it turns out,
perfect head.

When the twins were 6 days old, I experienced for the first time just how vulnerable my transition to parenthood had made me when I took the twins for their first check-up with the pediatrician.  Initially, the visit went very well.  Everyone made a big fuss over our tiny brood in the waiting room and the medical assistant beamed at them warmly as she took their measurements in the exam room.  The doctor complimented me on their weight gain, both almost back to their birth weights*, a great accomplishment for a breastfed baby, she said. The doctor said everything looked great and my babies appeared to be perfectly healthy.  But then Dr. R. glanced at the measurements the medical assistant had taken and examined Liam's head.  "His head seems to have grown a bit since Friday, a bit more than we would expect.  Had you noticed?"  My heart suddenly seemed to have dropped into my stomach.  I had noticed.

A couple of days before, I had looked at my son and thought how large his head looked, how sort of bulb-shaped it was, and had, for just a moment, thought to myself how he almost looked like a baby with hydrocephalus...
But then I'd told myself that I was imagining things, that my typical medical student hypochondriasis was merely being applied to my new offspring.  Of course I was being silly, I'd told myself.  He's fine.  But  here I was in the doctor's office a few days later and the doctor had objective evidence that I wasn't imagining things.  She had measurements, one taken in the hospital, and this new one taken 4 days later, and Liam's head had grown more than it should have.  She went on to say that there seemed to be widening of the sutures** that she hadn't noticed when she'd examined him in the hospital.  It might be nothing, she said, but she we needed to get it checked out right away.  She would call the hospital and arrange for us to get a cranial ultrasound right away, that day, as soon as possible.  She wrote us a prescription for it.  It said "STAT".  

For those who don't know, hydrocephalus is a condition where the flow of cerebrospinal fluid out of the brain is obstructed causing it to build up inside the brain, damaging the brain itself.  The prognosis depends on a number of factors but the list of possibilities include mental retardation, deafness, blindness and, not uncommonly, death. Treatment involves multiple brain surgeries, frequent hospitalizations, constant fear of life-threatening infection...  

I had never been so terrified in my life.  Of course we've all experienced brief moments of terror, like when we come close to having a car accident (or perhaps when we do have a car accident).  But I had never experienced this prolonged sensation of all-encompassing fear before.  There might be something wrong with my baby's brain.  I'm not sure how long it was from when we left the doctor's office to when Liam was laid on the pillow in the dim room where he got his ultrasound but it felt like an eternity.  We went home first, before going to the doctor, so that I could feed the twins.  My mother-in-law, who had accompanied me to the doctor while Lee was at work, seeing that I was upset, tried to reassure me that everything would be fine.  Fine?  There might be something wrong with my baby's brain!  She seemed to think that I needed to relax before we went to the hospital and suggested that I take a moment to sit and have a mug of tea.  Tea?  There might be something wrong with my baby's brain!  I didn't need tea.  I needed Liam to get that ultrasound so that I would know.  That ultrasound was the only thing that could save me from the terror I was feeling.  I didn't want tea.  I wanted to go to the hospital.

The ultrasound tech was very kind and gentle, both with me and with Liam, who was the perfect patient and slept right through the scan.  Almost as soon as the ultrasound probe was pressed against my son's head, I felt the knot of tension in my stomach begin to melt away.  I had never seen a cranial ultrasound before but I had an idea of what we would be looking for, and I didn't see it.  I could see Liam's ventricles (the spaces inside the brain that contain cerebrospinal fluid) and they were thin, slit-like, clearly not dilated.  If hydrocephalus were the cause of Liam's seemingly rapidly expanding noggin and widening sutures, there would have been dilation of the ventricles.  They weren't dilated.  No hydrocephalus.  Of course we had to wait for the official read of the scan from the radiologist but the ultrasound tech, as she was wiping the goo off of Liam's head, said she was pretty sure he was fine, that he seemed to have a perfect brain.  A few hours later, we got the official read from the radiologist who declared the scan "negative".  

I did continue to measure Liam's head every day for the next week or two, just to be sure, but my fear had almost completely evaporated with that ultrasound and I was merely left with some curiosity as to what had caused the appearance of a dangerously expanding head in the first place.  My best guess is that Liam's head may have still been somewhat molded from his birth at the last hospital measurement and that the seeming "widening of the sutures" as well as the rapid increase in circumference were merely the effect of that molding going away.  There's also a significant potential for error on the part of those taking measurements.  And finally, Liam seems to have inherited the big, bulbous head of his father (all the better for containing those big, perfect brains of theirs!)

The humbling thing about this experience is realizing that it was just a tiny taste of what countless other parents have faced.  When I told my dad about it, he reminded me that he and my mother knew a thing or two about that kind of fear (I had a serious case of spinal meningitis as an infant) and theirs had lasted considerably longer than the few hours that mine did.  But of course my parents' experience had a happy ending too.  Here I am, alive and well, with none of the probable neurological outcomes of which the doctors had warned them. But what of the parents whose children do have hydrocephalus?  Or cancer?  Or the myriad other life-threatening illnesses that can affect a child?  What of those parents that lose their children altogether?

I have had a mere glimpse at what it is to have a sick child.  I have experienced merely the suggestion of the possibility that my child might be really sick and it was terrifying.  When I was nearing the end of my pregnancy, I briefly met a doctor at the hospital where I was doing a clinical rotation who told me how wonderful it was to become a parent.  "But," he said, "nothing makes you as vulnerable as being a parent.  Nobody can hurt you like your child can."  I feel as if, when I gave birth, Liam and Eva didn't stop being a part of me.  They just became a part of me that is on the outside, like two vital organs I didn't know I had and rather than keeping them in my body, protected, I have to let them exist outside of me, knowing that if something happens to them, it will hurt me as surely as it would hurt to have an injury to my own heart or brain.  Being a parent is amazing and wonderful and incredibly scary.

* Babies always lose weight in the first few days after birth and are expected to recover their birth weight by 10 to 14 days.

** Babies' skulls are composed of a number of separate bones that have not yet fused into the one-piece brain bowl we are familiar with in adults.  This allows their heads to be molded into interesting shapes for the purpose of squeezing through the birth canal.  The seam between these un-fused bones is known as a suture and a "widening suture" may be evidence that there is increased pressure inside of the skull, such as would be seen in hydrocephalus.