Monday, September 19, 2011

Analyzing my Netflix history

I joined Netflix in July 2000, over 11 years ago. In that time, My family and I have rented 481 discs and watched some 462 hours of streaming content. I've rated 2074 movies. I've been a member for so long that my 4-out-at-a-time plan has been grandfathered in at $19.99 for some time, but that ends with my billing cycle next week.

So considering dropping Netflix wasn't really on my radar until recently. But Reed Hastings' recent note got me thinking. Have I gotten my money's worth out of it? So I did some math.

The first chart below shows the 3-month moving average of my rental and streaming history. For streaming, I felt that simply counting shows would overstate my usage for two reasons: (1) We didn't really watch everything we started, and (2) A DVD of a 30-minute TV show typically has 6 episodes, which considering that each episode is typically 22 minutes, works out to 2.2 hours per disc. So instead, I totaled up my streaming usage for the month and divided by 2.2 hours to come up with a "DVD equivalent" metric, so we're closer to comparing apples to apples.



The main point to note from the above is that our streaming usage far outstrips our DVD usage by a significant margin.

Next I took a look at how much my DVD usage was costing me. That's in the next chart.



Hmm. Seems like I could have saved some money by buying discs off from Half.com instead of using Netflix at all. In fact, for my first 10 years as a Netflix customer, I was paying $4.61 per movie. But then it got worse. Since July 2010, my average cost shot up to $8.54 per movie. The bargain rack at Target compares favorably now.

But wait a minute, that's not factoring in my streaming usage. So let's do that:



Better - under $2.00 per DVD-equivalent (remember, that's 1 DVD or 2.2 hrs of streaming). Since July 2010, it works out to $1.57 per DVD.

Factor in that as of next week my price for the same level of service based on the average usage I've had since July 2010, my unit cost is going up to $2.50 per DVD. But that's hiding something else: If I were to drop to the 1-DVD-out plan, and maintain current usage, I'd be paying $3.63 per actual DVD-in-the-mail versus $0.81 for the equivalent via streaming.

So I'm left with a quandry. Is Netflix worth it? Sure RedBox is competitive on price with respect to DVDs, but it lacks the selection and I have to go there. Clearly I've been getting more use out of the streaming side. But I am extremely frustrated with Netflix' patronizing attitude towards its existing subscribers. Will I cancel? I'm not sure yet. I'm leaning towards total cancellation just to register my discontent. Not that they'll care. Clearly they haven't thus far.

Sunday, June 29, 2008

Abraham, Epilogues 1 and 2

This is the 9th and final part of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

One
Christmas Day, 2007, was six months to the day after his surgery. Santa brought him a train table, and from the time he set eyes on it that morning all he wanted to do was play choo-choo. His 2nd birthday was a couple weeks away, and we couldn't believe what a year it had been. To know how close to the razor's edge we had come that year, we couldn't have been more grateful for what we had.

Two
June 2008. It's been a whole year now. You have to actually look to see his scar. The only thing he seems to remember about the whole ordeal is that if you ask him where his "Boo boo" is, he'll point to his chest. Our daughter is just finishing up Kindergarten. We finally got the little guy to keep his life jacket on long enough to go out in the sit-on-top kayak, and he genuinely enjoys it now. Things are about as normal as a family can be.

But the road we took to get here is one that I hope few ever have to traverse. I don't know what happens next, but I know that our family is strong enough to get through it. And I know that there's nothing magical about that. Courage isn't about taking the next step with no fear. It's about taking the next step despite your fear.

Saturday, June 28, 2008

Abraham, part 8: Home

This is part 8 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

Back at home, things started to settle back to normal. We told our friends and family to stay away for a couple weeks because a cold could mess him up. My wife's cousin went home on Friday, and we were back to an otherwise normal family of four.

Except that now we had this turbo-charged toddler to deal with. Remember how I said his heart was pumping about twice the volume it should have been through his lungs? Well guess what -- once the hole was fixed all of a sudden he had this super-duper pump hooked up to an otherwise normal kid. It was like Lance Armstrong training in the Rockies to increase his blood oxygen levels. By Saturday we passed what had been "normal" right up, and he just kept going. Only then did we fully realize just how much this had been affecting him. His energy level was up, he had more color in his face, his hands and feet weren't cold in the morning. In a sense, his temple had been torn down and raised again in three days.

As the days wore on, we found ourselves able to breathe again. We took the kids to see fireworks in a nearby town on the Fourth of July -- 9 days post-op -- and I felt the tears starting to well up when I realized how happy he was to be there, and how differently things might have gone.

Two weeks after his surgery, our neighbors had a picnic and invited a decent sample of the neighborhood over. For many of them, this was the first they had heard that there was anything wrong with our son in the first place. In fact, we had to stop our one neighbor from picking him up under the arms (his rib cage was still healing) -- and folks were absolutely shocked when we told them what he had just been through.

It started to feel like we were just dropping the bomb on folks just to watch their reaction -- "Hey, guess what he had done to him a couple weeks ago..." I suppose we were amazed at the outcome, and wanted other people to feel that same sense of wonder at the little guy's resilience.

A few more weeks went by, and we were at another fireworks show, this time in the town I grew up in. As I watched my son and daughter looking up at the sky, I saw the sparkles in their eyes and knew that we had made the right decision.

Next: Epilogues 1 and 2

Friday, June 27, 2008

Abraham, part 7: Recovery

This is part 7 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

It wasn't long after that that they told us they'd be moving him upstairs to the cardiac unit, which is a "normal" room in the wing that handles cardiac and transplant patients. He wasn't even in the CICU 24 hours when they took him up. We felt like it was a week. They let him take a set of stacking rings with him, since he seemed to enjoy playing with them in his crib.

This was where it started to become obvious just how much better kids can handle severe traumas like this than adults can. For him to be sitting up and playing less than a day after having open-heart surgery was astounding to us. That afternoon, my wife and I went to a local restaurant for lunch. For as serious as the situation was, we finally felt like we could take a few moments just to get outside the hospital. Things were starting to look better.

Tuesday night -- his first night in the cardiac unit -- was my turn to take the night shift. He started the evening with some dry Kix cereal -- this was the first he had eaten since the ice cream he had Sunday evening. We spent a good part of the night watching Animal Planet, as he was drifting in and out of sleep and would wake up to watch the elephants or hyenas or whatever was on at the time.

By the next morning, he was ready for some real breakfast. They brought him scrambled eggs and toast, and he just about ate it all. Later on Wednesday morning they came to take his chest tube out. This was a rubber tube about 1/4" in diameter. He wasn't showing any signs of internal bleeding at that point, so they felt it was safe to take it out. I stepped out of the room while the physician's assistant removed the tube and gave him what would be his only external stitch in the process. (They had used dermabond -- superglue -- on his main incision.) His crying kept me informed of how things were going. I've since had adults tell me that having the chest tube removed is one of the most uncomfortable aspects of recovery because it feels like you're having your insides pulled out. I can only hope his wasn't that bad.

Also that day they took him down to do another chest x-ray to see how everything looked. We wound up right back in the same x-ray room we had been just two weeks earlier. Everything looked good inside, so we went back up to the room. When the surgeon came to do rounds later that afternoon, he told us that while they wouldn't really let him go home two days post-operation, he thought he was pretty much ready to get out of there. They told us that if everything went okay that evening (and by this point he was standing up in his crib and starting to act like the toddler he was) we'd get to take him home the next day.

My wife and I went out to a local Indian place for dinner that evening. Now, not only could we see the light at the end of the tunnel, but we were starting to feel the breeze coming in. As a bonus, our little guy loaded up his diaper while we were out, so we didn't even have to deal with that, either. It's the small things that count. I came home that evening and spent the evening with our daughter.

Thursday morning by the time I got to the hospital they had already taken out the last IV from his ankle. He seemed surprisingly normal for a kid who three days earlier had been lying on a table with a machine pumping his blood and breathing for him. He was standing up and bouncing in the crib. The surgical team came by for morning rounds and said we'd have to take him home that afternoon, otherwise they'd need to put the cage on top of his crib.

After what seemed like an interminable wait (but was really only about 2 hours), they came in with his discharge papers. They told us to be careful with him and not let him climb or fall, as blunt traumas to the chest were the worst thing that could happen at that point. (It would take another 6 weeks or so for his rib cage to seal itself back together.) The only medication he was to have was normal over-the-counter Children's Tylenol as needed for discomfort.

Downstairs, we got him into the car seat, being extra careful not to over-tighten his car seat harness, and left Children's Hospital behind. During the drive home I couldn't stop looking in the rear-view mirror to make sure he was still there. When the week began, we didn't know if we'd be coming home with an empty car seat or not. Now we knew.

Next: Home

Thursday, June 26, 2008

Abraham, part 6: Just Breathe

This is part 6 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

They had patched the hole. He had been on the bypass machine for about 20 minutes. His heart started right back up. They had already closed him up and were getting him ready to move into the CICU. We'd probably be able to see him in about an hour. That was all good news. In fact there really wasn't any bad news, but the surgeon did tell us that the hole was a lot bigger than he expected it to be based on the echocardiogram. He said he was surprised that our son hadn't already been showing symptoms -- and that if we had waited much longer it's likely that he would have been a noticeably sick kid. We already knew we had dodged a bullet -- but now we realized just how close it came.

Right on time, about an hour later the cardiologist came in and said they were getting him settled into the CICU. The doctor was really upbeat about how well our son was doing, and led us back to the CICU to see him. I'm not sure anything could have prepared me for what came next.

Now, not two hours earlier we had walked down this same hallway, into the very room where my son now lay. But this time around the whole room had changed. Whereas the first time through it was just another hospital ICU room, now it was the room where they were keeping my son alive. Getting through the surgery was a big step, but the next 24 hours were just as important. There was still the risk of clotting, internal bleeding, strokes, and various other horrible things that could go wrong. But there he was, laying limp on the sheet. He had a central line IV in his neck, one in his arm, and one in each ankle. There was another tube coming out of his belly to drain his chest cavity of fluid. And the incision looked like it took up his whole chest. One of the IVs was connected to a bag of blood (his own) that they were putting back into him.

I was pretty much overwhelmed at this point, and had to sit down for a minute to keep from throwing up. I've seen plenty of folks in worse condition in the ICU. But when it's your little boy who just a few hours ago was bouncing on your lap, the whole world changes. You realize just how little control you really have over life -- both your child's and your own.

He opened his eyes, and gave us a look that simply said, "Mom, Dad, I don't feel very good." Then he went back to sleep, apparently satisfied that we were there and had everything under control. If he only knew. At moments like this, your entire existence is distilled down until only these three remain: faith, hope and love -- and the greatest of these is love. I understand that now.

The best thing for him at that point was to get some rest, so I left with my wife's cousin to meet my mom at home -- she was bringing our daughter home. That night we had burgers at Red Robin. Meanwhile, my wife spent the night in one of the parent's rooms at the hospital. The best description I can give is that it was basically youth hostel accomodations -- a single bed, a phone, a 13" TV, and an overhead light. The helicopters landing on the roof (and their landing lights shining in the window) didn't help her get much sleep.

The next morning, when we were on our way in to the CICU to see our son, we saw something in the hallway that I'll never forget. The day before when we were in the CICU waiting room, there was another family there with a newborn baby in the NICU. That morning the baby's father was out in the hallway with his pastor at his side talking to a doctor. Judging by the way he slumped into his pastors arms, we knew from the other end of the hall what he had just been told. I felt guilty being happy to see our baby when they had just lost theirs. Once again, we were reminded that as hard as what we were dealing with was, it wasn't the worst thing happening there that day.

Back in the CICU, our son was starting to come out of the super-drowsy medication, and was just laying there watching the tennis at Wimbledon for a while. My wife got to hold him a little later in the morning. He watched Dora the Explorer on her lap. It was an episode with Rojo the fire truck, and he was with-it enough to say "woowoo" whenever he saw Rojo. He was even sitting up a bit on his own in the crib. We could hardly believe it.

Next: Recovery

Wednesday, June 25, 2008

Abraham, part 5: The Knife's Edge

This is part 5 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

The strange thing is that even at this point there was no visible indication that our son had anything wrong with him at all. He was just a normal looking 17-month-old toddler. If it weren't for all the tests leading up to this point, there would have been no way to tell what was really going on.

We got up the next morning and drove to the hospital. We started the check-in process, and the waiting began. From one perspective, the entire day can be summed up as a series of waiting rooms each with chairs that were uncomfortable in entirely different ways. My wife's cousin got there while we were in the room getting our son out of his clothes and into a gown. This was the first time she had met our son. I think that made it just that much harder for her having just met this cool little dude and knowing what was coming next.

Eventually they led us to the pre-op room, where our son got to play with some Fisher-Price little people toys (the tractor was his favorite) while we talked to the anaesthesiologist and the surgeon one last time. We were way beyond the point of having any questions to ask. We mainly just told them we were trusting them to do their job and fix his heart. There wasn't much else for us to do, really. We watched as one kid after another went through the doors to the operating rooms. Some went on gurneys, others in the arms of nurses. One little boy who had been through more surgeries already than somebody ten times his age should have was pretty at ease with the process -- the nurse asked him if he wanted to give his mom a kiss before she took him back for his operation. He thought about it for a second, and then "Well, not really." It was cute in that "kids say the darndest things" sort of way, but if you listened real close you could hear her heart breaking. The Children's Hospital Vibe was going to be with us for a while.

Meanwhile, our little guy had no problems at all filling up his diaper while he was waiting. He didn't know it yet, but he was about to get one of the most expensive diaper changes ever.

Finally, it was our son's turn to go through the doors. The nurse that came to get him was extremely nice, and he took right to her, giving her a kiss on the cheek before leaving us. We said our goodbyes, wished him good luck, and walked out into the hallway before the nurse had him out of the room. It's funny how in situations like that your brain just focuses on taking the next step. And the one after that. There was nothing else to do but wait. We had just handed our baby off to a complete stranger so they could do unthinkable things to him. And yet we did it because we had to. This is what being a parent means -- you take into your charge this helpless little thing, and turn it into a human being. That's your job. Sometimes that means you make decisions for that other person that you'd have a very hard time making for yourself. It doesn't matter how much you'd rather it be you than them going into that operating room. You can't go through it for them. No, you have to make the choice to put them through it. And that's not an easy call to make, even when the reality is pretty clear cut.

The simple fact is, we walked out of that room not knowing if we were ever going to see our son alive again. The odds were in our favor, sure -- there was a 99% chance everything would be fine. But that one percent left over is pretty big. If they do 5 surgeries a day, 5 days a week, then 1% means once a month there's a kid that has serious problems. When you're gambling with your kid's life, even 99% odds aren't good enough - but that's what you're given.

Eventually we made it to the waiting room, which seemed like it was miles away. Another room, another set of uncomfortable chairs. My wife's parents were there, as was her cousin. We chatted a little bit about who knows what, but our collective fear was never far from the surface. The whole room was filled with folks going through the same thing -- granted, it wasn't all heart surgeries, there were kids having their knees repaired, and all sorts of other things. But you could just feel it in the air that for each set of parents there, they were going through one of the scariest moments of their lives. It certainly qualifies as that for me.

After we had been there for an hour or so, one of the hospital workers came along to give us a tour of the cardiac intensive care unit where our son would be taken after his surgery. On the way there, we bumped into the nurse that had taken him into the operating room. She was just coming out of the room, and said he went right to sleep. They were just getting him onto the heart and lung bypass machine when she stepped out. She was very nice and positive, but we knew this was the riskiest part of the whole process.

Our tour continued -- we were introduced to yet another waiting room which was shared between the cardiac ICU (CICU) and the neonatal ICU (NICU). Through a couple more doors, and a doorbell on the wall got you into the CICU. There was a sink where you had to wash your hands before visiting your patient. We saw the bed where he was going to be placed. Then we went back to the waiting room.

We hadn't been back for long when the surgeon came in to give us an update. In this kind of situation, all you can do is hold your breath. It's pretty much involuntary at that point. We went into a small conference room and sat down.

"He's doing great."

Next: Just Breathe

Tuesday, June 24, 2008

Abraham, part 4: Anticipation

This is part 4 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

We went to visit family. It's pretty unsettling to watch your parents say goodbye to their grandchild, not really knowing what was going to happen next.

Part of our bedtime routine was singing Eidelweiss to the kids before they went to sleep. Two nights before his operation, I was putting him to bed, and couldn't finish the song. I had this image in my mind of singing it at his funeral later that week. We had been told that "of all the open-heart surgeries you can have, this is the easiest". But regardless what the statistics say, you can't help but consider the possibility that things could go horribly wrong.

Rocking him in his room that night, I felt like I knew what Abraham was feeling on the way up the mountain with Isaac. Was I ready to offer up my son for the sacrifice in order to save him? Could I look him in the eye and say "Trust me. We're going to let these people cut into your chest and stop your heart, but it's for your own good?" It really wasn't much of a choice -- but anyone familiar with game theory knows that small probability of a large impact can still have a significant influence on your actions. We could concentrate all the risk now into the surgery, where he'd be in a controlled environment and they'd be prepared for contingencies, or we could wait and let the risk accumulate as he got older and his heart became more defective. The risk was there either way.

This was one of those times where you recognize that if people really knew what being a parent meant before they had kids, we'd be extinct within a generation.

The next day (one day before surgery), we got a call from my wife's cousin who volunteered to come stay with our daughter for the week while we went back-and-forth to the hospital. At first my wife was hesitant to have her fly in (she lives a few hundred miles away), but after a few minutes, we decided that it'd be good for our daughter to have some special memories from the week that didn't involve her brother's surgery. And since we couldn't be sure how any of it was going to go, having somebody who was a little more detached from the situation than our parents seemed like it'd be a good idea, too. So while my wife was still on the phone with her cousin, I was on the Southwest Airlines web site booking her a ticket for the next day.

The night before his surgery, our daughter went to stay at grandma's house. We took our son out for ice cream. He devoured his own vanilla cone, and then finished the dish of cappuchino ice cream my wife was having. To anyone at the ice cream shop, we looked like just another family out enjoying a nice evening. They had no idea what we were going through.

That evening, while I was giving him a bath, I looked at his perfect little chest and just thought "What are we going to do to you, kid?" My wife put him to bed that night. I wanted to make sure she had all the time she needed with him.

I don't know if either my wife or I slept that night.

Next: The Knife's Edge

Monday, June 23, 2008

Abraham, part 3: Choices

This is part 3 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

Then May came. We'd had four months to absorb this new reality, to collect whatever research we could to understand the condition and our options. To come to grips with the fact that we had no choice but to get through this, one way or another. We went to his checkup with the cardiologist holding our breath while he fell asleep on the ultrasound table. This time around, the technician explained what she was looking for...how big is the hole now, has it changed, and what's the blood flow through his heart like? What had been a centimeter and a half in January was now approaching 2 centimeters in May. So we were probably looking at surgery, but maybe the catheterization option would work for him.

When we saw the doctor, he told us we should be thinking about when, not if, we were going to have the surgery done. He didn't rule out the catheterization, but he didn't think it'd work in this case -- but he would defer to the surgical team to make that call. We didn't have to have it fixed right away, he said we could wait a year or even a few if we wanted to. But in his current condition he would be more susceptible to upper respiratory infections during cold and flu season, and there was no way to tell when or if he would start having more symptoms from the enlarged heart or increased blood pressure in his lungs. He gave us the contact info for the surgical team he worked with at the local Children's Hospital. We left that day determined to see this through, whatever might come next.

One day shortly thereafter, our 4-year-old daughter was playing out on our deck. My wife and I were in the kitchen, and I asked her, "Could you tell her at her age that she had to have heart surgery?" That cinched it for us. We weren't going to wait to get this fixed. We were just going to charge ahead with it, whatever it took.

Scheduling the surgical consultation took a couple weeks. His appointment was in mid-June. By the time we got there, we knew this was getting serious. But we didn't expect things to move quite so quickly. My wife had to use the restroom while we were waiting for his appointment. While she was in there, the nurse came out and started telling me that his case had been presented to the surgical conference, and the consensus was that he was not a candidate for the catheterization & device closure option. My wife rejoined us right around the point when the nurse asked if we wanted to go ahead and schedule his surgery -- we hadn't even seen a doctor yet. This was all pretty overwhelming. We had already decided that if he needed surgery, we'd take the first available time. There was no sense in waiting any longer, so when she said she had an opening in 12 days, I told her we'd take it. At the time, I couldn't bring myself to actually think about what I was committing to -- just that we had another appointment to bring him in 12 days later.

We saw the physician's assistant next. She was both compassionate and knowledgeable, so by the time the surgeon came in I felt like we projected this image of aloofness because we didn't ask many questions of him. It was just that by that point we had read so much about the process and the outcomes, and confirmed all of it with his assistant that we didn't really have any questions left to ask. Plus, we realized that we were at a point where we were just going to have to trust the judgment of the professionals involved to do what they did best. They recommended that we go ahead and have his pre-op bloodwork and a chest x-ray done so we wouldn't have to come back for another visit before his surgery.

Off we went to the radiology waiting room to get the x-ray. This was our first encounter with what we later would refer to as the Children's Hospital Vibe. Here you are, in a room full of sick kids and scared parents. And you realize that almost regardless of what's wrong with your kid, there's somebody else in the room who's probably dealing with something worse. Maybe it's the mom and dad in the hallway being told that their daughter's tumor hasn't improved with the radiation. Maybe it's the mom wiping off her quadriplegic son's tracheotomy tube. You can get post-traumatic stress disorder just from spending a few minutes there waiting for your name to be called.

The x-ray room itself was decorated in a cartoon jungle theme. The stuffed animals on top of the metal cabinets softened the room a little, but there was no hiding the fact that this was a place where serious things were done. The lead apron I had to put on while I held my son's shoulders still against the table so they could get their picture was the least of the weights I bore that day.

After the x-ray, we went to the phlebotomy lab for the blood work. This was a series of progressively smaller waiting rooms, the last of which held a collection of moms and sometimes dads (rarely both) with their kids, all mostly older than our own. All the kids were fine while they were waiting. Then their name was called, they disappeared around the corner, you heard a yelp or two, and out they came in tears. Some in their parent's arms, others trying (usually unsuccessfully) to be tough and grown-up about it. An eternity later and it was our turn. My wife waited in the chairs while I took our son in. He sat on my lap and was fascinated with the giant clown fish stuffie hanging from the ceiling. The nurse that drew his blood started on his right arm. When the needle went in, he flinched, then looked up at me as if to ask "Dad, is this alright?". I told him it was okay and she was almost done. He didn't cry. He didn't cry when she had to stick him in his left arm because the right arm came up dry. He didn't cry when she went back to the right to try for another vial when the left went dry. He didn't cry when she went to the left (again) for the final draw. I couldn't believe it. Four sticks, two in each arm, and this seventeen-month-old was not screaming. He didn't like it one bit, but he didn't cry. Wow. This is one tough kid.

When I took him back out to collect his mom, there was a little boy who was pretty rattled about what was happening to all these kids when they went into the back room. He was concerned that it was going to hurt really bad. I got down on his level and showed him my son's new boo-boos and told him that if this little baby (from his perspective, at least) could have that done and not cry, I bet he was going to be just fine. That seemed to help him out quite a bit. Of course, we left before he came back out so I don't know how it turned out for him -- I just know that it seemed to calm him a little right then, and that seemed to relieve his mom a bit since she didn't really know what to tell him to assuage his fears (when it was obvious she had quite a few of her own, as did probably every other parent in that room).

Once we got home, we put our son down for his nap. He was exhausted after a morning of examinations, x-rays, and needles. He had been down for an hour or two when we got a call from the surgical physician's assistant. She said that his bloodwork came back with an extremely low platelet count. She was concerned that he might be at risk of bleeding, possibly needing a transfusion to get things back to normal. I mentioned to her that he had had four sticks earlier in the day, and had no problems with clotting. Still, she recommended that we go to a nearby hospital to have more blood drawn so they could confirm the results. We let him finish his nap, then took him over to the hospital. It was pouring down rain, so we just ran for the nearest door when we parked. But the hospital was undergoing renovations, so the only way to get from the lobby we entered to the lab was to go back outside and re-enter through the main doors. We were soaked by the time we got there.

For the second time that day, I held my son while a nurse tried and failed to get what she needed from the first needle stick, then had to switch to his other arm. This time, he had just had enough. He started to cry, and it was all I could do to not just bawl along with him. At the same time, I realized that having him turned into a pincushion was nothing compared to what we were going to put him through in a couple weeks' time.

By the time we left the hospital that day, the rain had subsided. The next couple weeks went by pretty quick. We tried (mostly unsuccessfully) to ignore the sword of Damocles hovering over our family. We took the kids out on our sit-on-top kayaks at a local lake on Fathers' Day. Our son was riding with me, and started to panic in the middle of the lake, so I pulled alongside my wife's boat so she could console him (he wanted nothing to do with me at that point). He started to calm down, but it was obvious he wasn't going to leave mommy, either. She wasn't going to be able to paddle back in, so we hooked up her bow line to my stern, and I towed all three of them (wife, daughter, and son) back to shore. That was quite a workout, but it was nothing compared to what was coming.

Next: Anticipation

Sunday, June 22, 2008

Abraham, part 2: Fear

This is part 2 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

His pediatrician was surprised when she listened to his heart and heard the murmur -- she had listened to his heart many times previously and never noticed it. But when my wife mentioned what the NP at Children's had told us, she picked up on it immediately. "Well, it's probably nothing to worry about -- lots of kids have murmurs, and it doesn't affect them at all. But I want you to go see a cardiologist just to be sure."

So about a week later he had an appointment at the cardiologist's office. I worked from home that day with the intent that I'd stay with our daughter while my wife took him for his appointment. For some reason, at the last minute, I decide to go along and take our daughter with us. I will never regret that decision.

My advice to dads everywhere: If your kid has to go see a specialist for something that even remotely has the possibility of being serious, you need to be there. If it turns out to be nothing, no harm done. But if it turns out to be something more, you are going to want to be there, whether it's to ask questions, or just be a second party to hear what the doctor has to say.

When we got there, they did an EKG on him. The doctor came in and listened to his heart, confirmed the murmur, and said he wanted us to have an ultrasound (echocardiogram) to see what the cause was. Would we have to come back for that? No, they had a machine right down the hall.

I have been present for numerous ultrasounds while my wife was pregnant with our kids (they did one earlier than usual with our daughter to see how far along she was, then the normal one at 20 weeks, then another one when she was a week past due to make sure she wasn't getting to big to come out). Also, while my wife was pregnant, she had a couple bouts with kidney stones, so she had way more than the normal amount of ultrasounds done during that one pregnancy. Being there with your wife to get a glimpse at your unborn child is exciting. Waiting to find out what's wrong with your kid's heart is something else entirely.

The ultrasound technician was busy with her trackball, zooming in and out, making distance and area measurements, checking blood flow using the doppler effect (as a physics geek I have to admire the simplicity of the red/blue overlay to convey a whole lot of data). Our son dozed off on the table, which let her do what she needed to do without much resistance. My wife and I asked questions -- so what do you see? Can you tell what the problem is? Is it bad? "I'm going to let the doctor explain it to you."

Surprisingly, at least looking back at it, the foreboding in that deferral didn't really sink in at the time. I figured, okay, she can't say anything since she's just the technician, and the doctors probably get mad when they blab to the patients. It didn't register to me that she was avoiding telling us something she already knew.

"Your son has a hole in his heart."

The doctor explained, "It's called an Atrial Septal Defect." As the blood comes back from his lungs into the right side of his heart, instead of going straight out to the body the way it should, some of it is recirculating to the left side of his heart and back to his lungs. The murmur was in fact a secondary effect of one of his heart valves being over-pressured due to increased blood flow to/from his lungs. Since the heart is a muscle, and his was doing so much extra work with the increased flow, the right side of his heart was enlarged as well.

While we were still reeling from this minutes-old news, he asked our daughter to come over to him. He got his stethescope out and listened to her heart. My wife looked at me with a glance that screamed "oh god, not her too." But he didn't hear anything abnormal. Deep breath.

Finding it at this age meant that it wasn't an emergency situation (ten or twenty years later would be a different story), but the effects are cumulative over time, so it's not something you can ignore indefinitely. The cardiologist told us it'd be safe to wait four months to see if it improved on its own, but that if it didn't we'd probably be looking at a surgical repair. His hole in particular was relatively large -- about a centimeter and a half -- so it wasn't likely to close entirely on its own in that time, but we could afford to wait and see. If it didn't show any sign of progress on it's own, it was possible that he'd be eligible for a catheterization-based procedure in which they close the hole with a mechanical device without having to stop the heart. Otherwise, open-heart surgery would be required.

The floor dropped out. The lights went out, and everything was silent, save the echo of the words "open heart surgery". At least that's how it felt. Devastated, we got the kids' coats on, stopped by the front desk to scheduled a followup appointment for May, and got the kids into their car seats. As the minivan doors closed, I met my wife at the back of the van (where the kids couldn't see us), and we hugged. She was already full of tears as soon as I came around the corner. We took a few moments to pull ourselves together, then got into the van and went home.

We didn't tell anybody that evening. We were just too stunned. I called my mom on the way home from work the next day and told her. The silence on the other end of the line was to become a recurring theme over the next few hours and days as we told the rest of our parents and other family and friends. It got a little easier to tell people the more we told. It's as if by repeating the information over and over we became acclimated to it -- it didn't sting quite as much to admit that our kid was probably going to need to have surgery.

Then we waited. For four months. Life progressed -- he went from taking a few steps here and there to full-blown walking and running. Winter gave way to spring, and spring started to feel like summer. For a while, we almost forgot what we were facing, but it was always there in the background, the white noise that saturates your hearing when all other distractions have gone.

Next: Choices

Saturday, June 21, 2008

Abraham, part 1: Discovery

This is part 1 of a 9-part series describing my perspective as my son was diagnosed with and treated for an Atrial Septal Defect. Other installments: Preface, Discovery, Fear, Choices, Anticipation, The Knife's Edge, Just Breathe, Recovery, Home, Epilogue

On a chilly December Saturday morning in 2006, about a month before my son's first birthday, he had a particularly nasty diaper blowout. As any parent can tell you, these things happen on occasion, and you just have to clean it up and move on. But this one was fairly insidious. My daughter and I had gone to Krispy Kreme that morning to get some donuts, and we brought some home for Mom and baby brother. He had been eating a donut with chocolate icing, so when we saw his pinky was covered in brown, we wanted to believe it was just donut mess. But, curiosity got the better of us and my wife and I found ourselves having a "does this smell like sh*t to you?" conversation over by the sink. When I went back and picked him up, it was obvious what had happened. It was everywhere -- on his back, on his leg, all over the high chair cushion. So I took him straight to the bath tub and rinsed him off while my wife took all the fabric-based stuff off the high chair -- both the pads and the seatbelt straps -- so they could go into the washer. We had a good laugh about our plight (we've developed a saying that "There are four body fluids of the apocalypse: pee, poop, blood, and puke. On a good day, you only have to deal with two.").

The next day, the high chair straps still weren't dry, so we just put him in his high chair and figured the tray would keep him in well enough (and he wasn't known to climb anyway). Being Sunday, we were getting off to a slow start, and he wound up dozing off in the high chair after breakfast. So we took the tray off to give him a little more room -- both of us having forgotten that he wasn't strapped in. I went upstairs to do some Christmas shopping on Amazon.com, and a few minutes later I called my wife in to look at something we were considering for one of the kids. Then we heard it: Thump. Waaaaaaahhhhh!

I think we might have touched maybe 3 stairs on the way down to the kitchen. He was laying on the floor screaming. He had woken up and leaned too far out over the side of the chair, falling about a foot and a half to the floor. But the bad part was that his head appeared to have hit first. Within moments, he developed a goose egg the size of a golf ball above his left ear. We called the ER, and they said we should bring him in just to be sure. By that point he was back to playing with his big sister, but we packed up the family and drove to the ER at Children's Hospital.

Once we finally got in to an exam room, a nurse practitioner came in and gave him the once-over. The bump on his head was high enough above his ear that she knew it was over the thick part of the skull. Also, since it was bulging out (no dents) and not really bruised, it wasn't likely to be a skull fracture. So she suggested we keep an eye on him, but didn't recommend we get any X-rays or anything. While she was getting his vitals, though, she just nonchalantly tossed out "oh and you guys know he has a murmur, right?"

Well, no. We didn't. Should we be concerned? "No, probably not a big deal. Just have your pediatrician check it out on your next visit."

So we left the hospital, happy that our kid wasn't broken. By this point he was exhausted, and our daughter had been very patient for a 4-year-old, so I took her to a local park to play for a bit while he took a nap in his car seat with Mom in the front seat.

We decided pretty quickly that we were just going to keep the murmur to ourselves until after we knew what it was -- no sense worrying the grandparents and the rest of the family over something that might be minor. Christmas was rapidly approaching, and we mostly didn't think about it again until his 1-year checkup the next month.

Next: Fear
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