Chapter Eighty-Four-Little Angels

"For He shall give his angels charge over thee, to keep thee in all my ways."~ Psalm 91:11

Time is an interesting, complex, contradictory, necessary part of life. While it flows smoothly from seconds to minutes to hours, it can also appear to stand still. That was very much how Ashley felt, sitting between her nephews' incubators while an army of medical experts flowed through at a steady pace. Although their movements were fluid and swift, the minutes only seemed to inch by as Ashley looked on helplessly, unable to do anything but worry and pray. She used to think the phrase 'hurry up and wait' was rather foolish, but that expression perfectly detailed the situation.

Ashley wanted to jump out of her skin, or at the very least accessorize the hospital walls with some holes, yet the team of doctors and nurses carried on as usual, as if nothing had changed for them. She knew they were just trying to be professional and yet, it drove her cray that they could remain unflinching in what was the worst conundrum of her life. She rested her head in her hands, the adrenalin long since evaproated from her body and replaced with a heavy feeling of fear and dread. As much as she craved updates about her family's condition, her stomach still coiled whenever a doctor or nurse approached the incubators. When she felt a hand on her shoulder, she jumped, her nerves on edge. She looked up and found herself met with the kind eyes of Dr. MG.

"How are the boys? How is Lila?" Ashley asked, imploring Dr. MG with wide, terrified eyes, yearning for and dreading whatever news was in store.

"The boys' condition hasn't changed, I'm afraid. They are both in precarious health, but Baby B is the one that most concerns me. Donor twins are at risk of heart failure from pumping too much blood in order to provide nutrients to the recipient and that is what we are seeing. Dr. Gubler and I are monioring the situation and giving him medication in order to avoid surgery. It's very possible he may need an operation in the future, but I am afraid that at the moment he is simply too weak to undergo such a procedure.

Like his brother, his lung function is minimal so he will be kept on oxygen for the time being. Prolonged use of oxygen has it's own complications, the most common being possible brain damage, but right now it is imperative for his survival. He also has anemia and jaundice, which is quite common for premature babies."

"What about Baby A? Why is his skin so red?"

"Baby A is also on oxygen and he is being treated for anemia and jaundice as well. The rednesss you see is a result of having too much blood in his system and increased blood pressure. Because of the increased blood volumn, the recipient twin may develop cardiac failure and also require medications to strengthen heart function."

Ashley remained silent as Dr. MG continued speaking. "At twenty-four weeks, their immune aren't fully developed, so there are several things we need to watch for. As I've said before, there are risks involved with keeping the boys on a respirator for an extended period of time. Babies kept on a ventilator for more than twenty-eight days are at risk for developing Bronchopulmonary Dysplasia, also known as BPD. This occurs when a baby's lungs have shown evidence of deterioration. Unfortunately, preemies sometimes cannot withstand the constant pressure of a respirator. Preemies do recover from this, but it may take some longer than others."

"Pneumonia can also occur," Dr. MG continued. "Pneumonia is an infection in the area of the lung involved in the exchanging of carbon dioxide and oxygen and causes inflammation which reduces the amount of space available for the exchange of air. This results in inadequate amounts of oxygen to the body, Treatment involves antibiotics as well as supplemental oxygen and intubation."

The nurses had already explained infection, Jaundice, inability for maintain body heat, anemia, and sepsis to Ashley's satisfaction, so Dr. MG could move on to other matters. "Babies born at less than thirty-four weeks have an increased risk of bleeding in their brain. This happens because immature blood vessels may not tolorate the changes in circulation that take place during labor. Intracranial hemorrhage occurs in about 1/3 of babies born at 24-26 weeks gestation."

"If that happens, what complications can arise?" Ashley asked.

"Cerebral palsy, mental retardation, and learning difficulties. It will be some time before those issues present themselves, however."

Another complication the twins faced was Patent Ductus Arteriosus, which Dr. MG had already discussed with Lila and Ashley. She also explained Retinopathy of Prematurity, which is a potentially blinding eye disorder, which can be treated with laser surgery or cryosurgery. Necrotizing Enterocolities is a condition that occurs when a portion of the newborn's intestine develops poor blood flow that can lead to infection in the bowel wall. Treatment includes intravenous feeding and antibiotics."

"Will he need surgery?" Ashley asked.

"Surgery is only needed in severe cases."

Ashley nodded and rested her hand on Baby A's incubator as Dr. MG continued speaking. "I know the wires, IVs, and machines scare you, but the babies weren't hooked up to them to inflict pain. They help monitor their progress and alert us when they need our assistance."

Dr. MG pointed to the monitors and explained. "Apnea and Bradycardia are common in preemies. Apnea is the absence of breathing and Bradycardia is the reduction of heart rate. An alarm will sound if they have an irregular breathing pattern of intervals of pauses lasting longer than 10-15 seconds. An alarm will also sound if their heartbeat falls below 100 beats per minute."

"What will you do for them if that happens? What is a normal heartbeat for a baby?"

"120 to 150 beats per minute. Usually a little tap or simple rub on the back helps remind them to breath or increase their heart rate. If the situation is more serious, we are more than equipped to deal with it."

"How is my sister?"

"Lila experienced severe hemorrhaging during the c-section. She has lost a great deal of blood and I'm afraid there is more. You sister suffered a heart attack and stroke and she is in a coma."

"A heart attack and stroke?" Ashley exclaimed, jumping from her seat. "my sister is a young woman! That isn't possible for someone her age!"

"I know it's shocking, but our research shows an increase of strokes in women before and after childbirth. They have increased by 50% and that is from rising rates of high blood blood pressure, among other things. We are giving her Alteplase, a clot-busting drug to dissolve the blood clot that is causing the stroke. We are also giving her Heparin to help thin the blood, as well as oxygen and a blood transfusion. When she is discharged, I will most likely prescribe blood pressure medication, even if her blood pressure is at an acceptable level."

"What is being done about her heart attack?"

"We have performed an ECG to evaluate how much damage has occured to the heart muscle and where it has occured, as well as monitor her heart rate and rhythm. In addition to blood tests, we also performed an echocardiograph and she is receiving drugs. In addition to the Alteplase, she is also receiving Plavix and Thrombolytic therapy. Thrombolytic therapy, also known as "clot busters", are used to dissolve any blood clots in the heart's arteries."

"When can I see her?"

"Her condition is still critical and we are still working to stabilize her condition, so I would recommend waiting a few more hours. In the meantime, you can stay with the babies as long as you like."

Dr. MG and Ashley turned their attention back to the babies, who were blissfully unaware of all the turmoil surrounding them. Ashley lovingly stroked the incubators, silently willing them to recover.

"It's alright if you would like to touch them," Dr. MG replied.

"Really?" Ashely asked, looking up at her. "that wouldn't be too much for them?"

"Touch is one of the best things you can give a baby. You will need to handle them gently of course, but physical interactions is vital to their recovery. Not only does it facilitate bonding, but study after study has shown that premature babies that are held and touched on a regular basis recover more quickly."

"If they know someone loves them, they will want to fight," Ashley replied.

"Exactly. Not only can you touch the babies, but you can be as involved with their care as you would like. Parents or caregivers of preemies are encouraged to help with diaper changes, baths, feedings, whatever your comfort level is. We are here to help you and will answer any questions you may have."

"As you know, Lila very much wanted to breastfeed the boys. Is it possible you could have her milk pumped? Could I pump some for her?"

"With everything that is happening to your sister, I would advise against trying to extract milk from her. Her body doesn't need the added stress and the medications in her system could harm her babies. As for you nursing, you milk hasn't come in yet, and it won't fully until a few days before the birth of your own child. Even if your milk supply was available, I wouldn't advise pumping because that would trigger contractions. Your only twenty-three weeks along, so you need to keep that baby inside of you for as long as possible. The hospital does have donated breast milk if you are interested. It is perfectly healthy for mothers to share milk and we test the women carefully before their donation is accepted."

"That would be wonderful," Ashley agreed. She knew how vitally important breast milk was for a baby's developement and the boys needed all the help they could get.

Since the boys were both on ventilators, they couldn't be held, but Ashley was able to touch them. The feeling of their warm, delicate bodies beneath her hand was something she had never before experienced. She already loved them, but establishing physical contact with the boys deepened their bond. Feelings the rising and falling of their chests and tininess of their fingers and toes helped her see past the monitors, wires, and everything else attached to them. She helped her mother care for her brothers when they were born, but this experience was completely different to her.

For one thing, Lila's babies were much smaller than Antonio or Hayden had ever been and they were much more fragile. They were so small and helpless, so completely dependent on Ashley. She lowered her face so she could give them each a kiss. The boys' heads were so small that Ashley's lips seemed to eclipse their entire heads. As she gently stroked their tiny faces, Dr. MG looked on.

"Did Lila and Spencer ever decide on names?"

Ashley grimaced at the sound of her douchebag brother-in-law's name and Dr. MG felt badly for causing the discomfort. The doctor knew what was happening between the newlyweds since Ashley had called her when she needed Lila commited.

"No, they didn't," Ashley said. "Lila and I were considering her options, but nothing ever stuck. I have to come up with something though, because they cannot go through life as Baby A and Baby B. I know I'm not their mother, but considering the circumstances would it be possible for me to fill out their birth certificates?"

"Yes Ashley, that will be fine," Dr. MG assured her. Shortly before Lila's health crisis she named Ashley her power of attorney and guardian of her babies should something happen to her. She rested a hand on Ashley's shoulder and used the other to gently touch each twin.

"Lila and the babies are lucky to have you, Ashley," she said.

"I'm the lucky one," Ashley replied, her gaze fixated on the babies.

"I need to check on Lila," Dr. MG said to Ashley. She looked at the twins and rested a hand on each of their bodies. "be good for Aunt Ashley, little angels."

Dr. MG turned and left the room, leaving Ashley alone with the babies. "You'll always be my little angels," she murmured to the twins. She continued staring at them, rubbing their little feet as she found herself lost in thought. There was very little she could control about this situation, but she could at least give her nephews proper names. Naming them would humanize them and make people realize they were human beings deserving of life.

Ashley turned her attention to Baby A, the donor twin, the brave little boy struggling so hard to survive. Although fragile and tiny against the medical equipment, he held his own. He had a fighter's spirit and Ashley knew from looking at him he wasn't going to give up. He reminded her of Dr. MG in that sense: no matter how grim the situation appeared with Lila and the babies, as well as Ashley and her own baby, Dr. MG remained a calming, stoic presence. Although she never sugarcoated the seriously of the situation, she gave them reason to hope.

Quick as she was to give them the unvarnished truth, she was just as quick to offer solutions, patiently explaining their options and their liklihood of success. Dire as the situation was, Ashley believed it would be a lot worse if they didn't have Dr. MG's calm, professional, steadfast presence in their lives. Ashley gently touched the little boy's head and whispered the name, tentative at first, as if gaging his reaction to it.

"Matthew," she whispered in his tiny ear. To her surprise, the baby seemed to move his head in her direction, as if responding to the name. "Matthew," she said again, a little louder this time and again, he seemed to respond.

Not only was Matthew part of the good doctor's surname, it was the name of an important Biblical figure. Saint Matthew was one of Jesus's twelve apostles. According to the New Testament, he was one of the witnesses of the resurrection and the ascension. He preached the Gospel for fifteen years to the Jewish community in Judea, as well as the Gentile nations. He also spread the word to the Ethiopians, Macedonians, Persians, and Parthians before dying as a martyr. Just as Saint Matthew died for his convictions, baby Matthew risked his life to nurish and protect his younger brother. Matthew was a Hebrew name meaning "Gift of God," and to Ashley he certainly was. As Ashley looked at baby Matthew, another name came to mind.

Saint Alexander of Jerusalem is a martyr and saint in the Roman Catholic Church. He died in 251 AD, during the persecution of Emperor Decius. He was the first Bishop of Cappadocia, as well as coadjuster with the Bishop of Jerusalem. He had been imprisoned for his faith and after his release, came to Jerusalem and stayed to assist the government. In addition, he was praised for the library he build in Jerusalem, ordained Alban Butler a priest, and permitted layman Origen to speak in the church.

When he was taken into captivity, he was tortured, but survived each affliction. Despite his death, he was steadfast in his beliefs, never waivering. Alexander was a Greek name meaning "defender of man," which also fit with Ashley's oldest nephew. After saying the name aloud, Baby A officially became Matthew Alexander Reid.

Ashley then turned her attention to Baby B, the recipient. Like Matthew, he was strong, fighting against the odds. With soft blonde hair and blue eyes like his mother, he looked to Ashley like a sweet, beautiful angel. His sweetness and strength were soothing to Ashley and when he moved, he seemed to be telling her he would be alright. During Lila's pregnancy, he was the most active, kicking the most when Ashley and Lila would rest their hands against his part of the womb. Despite the grim circumstances, he seemed even then to try to reassure his mother and aunt. A soft smile spread across her face as his name was revealed.

Saint Gabriel was a messanger of God, telling the Virgin Mary that the Lord had chosen her as the mother of his child. Although Mary accepted her role as Blessed Mother, she was still afraid of what was to come. Saint Gabriel assured her of the Lord's protection and also told her husband the truth about the child. Saint Gabriel also told Mary of her cousin Elizabeth's pregnancy with John the Baptist. In addition, he first appeared in the Book of Daniel, delivering explanations of Daniel's visions. Saint Gabriel is an archangel, which is an angel of high rank.

In keeping with the angel theme, Michael immediately came to mind. Like Gabriel, Michael was an archangel, described as a "prince of the rank." In the Old Testament, Michael was described by another angel as the protector of Israel. The Book of Revelations described a war in Heaven in which Michael, the leader of God's Army, and his angels fought against Lucifer and his army of fallen angels.

Michael, the strongest of the archangels, defeated Satan and drove him and the fallen angels out of Heaven. Michael was one of Ashley's favorite Biblical figures. She admired his strength, courage, and dedication to the Lord. Among other things, Saint Michael was the patron saint of sickness, so it was to him Ashley offered her prayers. She hoped Saint Michael would bestow his strength onto her nephews and heal them.

"Gabriel Michael," Ashley murmured to the baby. At the sound of his name, the little one moved his legs, as if offering his approval. With the deal sealed, Ashley looked up, searching for their nurses.

"Excuse me," she said, when one came near. "I just wanted to inform you that a decision has finally been made regarding their names."

"That's wonderful, Ashley," the nurse said, giving her a smile. "what have you decided?"

"Katie, I am proud to introduce Matthew Alexander and Gabriel Michael."