Which twin is older?

Here's an exchange my wife and I have with strangers all the time that I can't wrap my head around.

"Are they twins?"
"Yes"
"Which twin is older?"

Seriously, they're born on the same day (unless one is born before midnight and one after midnight). One is not older than the other.

Let's say you share a birthday with a friend. You were born at 10am while he/she was born at 3pm. You don't consider yourself older than your friend, right? You're simply the same age and share a birthday. You're not 5 hours older than your friend.

Ok, I get that the real question is "Which twin was born first?"

To be honest, who was born first or second has zero relevance. This makes the question odd and intrusive (coming from a stranger).

Being the first born twin doesn't mean that one is larger, stronger, more mature, or whatever. It just means he/she came out first. It's like being the first user to post a comment on Internet articles. It doesn't make that comment any more relevant than the second, third, fourth, or a hundredth comment.

From a biological/medical/physiological point of view, it makes even less sense.

In a vaginal birth, the baby that's closest to the bottom at the moment of birth will be the first-born. In a c-section, the baby that's closest to the top will be the first-born.

This means that the question now becomes "What was the position of your babies in the womb at birth and what was your delivery method?"
Isn't that a bit personal and, quite frankly, none of anyone's business?

Now, I'm not the type of person who likes to create conflict. So I've developed a peaceful strategy for dealing with the question "which twin is older?". I just alternate my answer every time I get asked. Today, Aidan's older. Tomorrow, Ethan's older. The day after, it's Aidan's turn to be older again.

It's funny how despite who I say is older, the response is always "Yes, I knew it. He's definitely the older one. He looks so much wiser."

Twins Blog - Oct. 24, 2011 - "Fine"

The boys are approaching their first birthday. And I find it frustrating that I still can't answer the question "How are the boys doing?" which just a simple "Fine".

Truth is, they're not fine. Ethan is fine. Aidan is not really. So, they are not fine.

Aidan has some obvious developmental delay. He shows lots of spastic and reflexive behavior. We're told by several medical professionals that it's not too bad. Nobody can comfortably give us a diagnosis other than "developmentally delayed". At this point the diagnosis doesn't really even matter. It doesn't affect the treatment plan or outlook. Using an aggressive and frequent schedule of therapies, we hope to get his development back on track.

Ethan, on the other hand, is the typical cute baby. You know those babies you see on commercials and ads? He's one of those. Just happy all the time. A couple of months ago, he learned how to roll over and he's been doing that non-stop ever since. Lately, he's been able to maintain a sitting posture. He loves to bang things together, put them in his mouth, etc. He's very crafty in that he hides his pacifiers around his bed. We would always find 4 or 5 of them just laying around.

Twins Blog - Jun. 27, 2011 - "How are the babies?"

It has now been exactly 2 months since Aidan returned home to join Ethan.
Friends and family always ask "How are the babies?" to which our default reply is "They're alright."

Actually, they are alright. Not everything is rosy, though. But considering the circumstances, I think we were dealt a pretty darn good hand to play.

So, what's the real answer to "How are the babies?"

They're alright. The boys are nearly 7 months old now but they're smaller than full-term babies at 7 months. They do however, compare more favorably with 4-month-olds which is probably more fair since they were 3 months premature.
Against all odds, the boys:
1. Don't have any signs of ROP (Retinopathy of Prematurity ). The overwhelming majority of babies born at 28-months have at least stage 1 ROP.
2. They were never effected by NEC (Necrotizing enterocolitis). It affects nearly 10% of all babies born less than 1500g. Mortality rate is over 50%. We've personally witnessed several babies in the NICU pass away from this condition. Each of our boys weighed about 1kg at birth. This coupled with the fact that each of them had multiple episodes of distended bowels (ie, possible early indicator of NEC) left us nerve racking for the first few months at the hospital.
3. They never developed meningitis. The boys combined for 5 incidences of fever while in the NICU. Each time, spinal fluid needed to be extracted and tested for meningitis. Thank god the tests never came back positive.

But are they alright in that they're the picture of health and development? Not exactly since there are still hurdles to overcome. But they're alright and it's really all we can ask for.

Twins Blog - Apr. 26, 2011 - "Welcome Home, Aidan"

On April 25 (Easter Monday), the hospital notified us that we may bring Aidan home on hospital leave. That is, we need to bring him back the next morning so the doctors can examine him when they do their rounds. He's not officially discharged, but it was better than nothing.
At around 4:30pm, Aidan finally came home. After 143 days in the hospital, he finally felt the warmth of family.
We brought him back to the NICU this morning, but it's likely he'll be officially discharged later today.

(Aidan on the left, Ethan on the right)

10 situations that are only possible in TVB dramas

1. The Elevator Baby Delivery
Pregnant woman plus elevator equals elevator failure and emergency delivery.
Reality: See here for details. This one deserves it's own little piece.

2. The Ankle Sprain
A female character suffers an ankle sprain while chasing/running in the street. It's not just a minor sprain too. It's a major sprain where the person requires assistance just to stand.
Reality: It's impossible for someone with any motor-skill coordination to suffer a major sprain just from running on smooth pavement. You might trip and scrape yourself, but never to the point where it's difficult to stand.

3. The Rubber Burn
Cars always slam the brakes and burn rubber when they stop. I'm not even referring to chase scenes. I'm just talking about regular pedestrians driving casually.
Reality: It's as if the effects guy gets paid a commission every time he uses that screeching sound bite.

4. The Homemade Takeout
If the breakfast scene is at home, the characters always have homemade congee, fried noodles and fried dough for breakfast.
Reality: I can understand homemade congee and maybe fried noodles. But there's absolutely no way that people fry their own dough at home for breakfast. It's just too much effort and not practical.

5. The Concussion-caused Amnesia
Every concussion injury leads to retrograde amnesia (ie, loss of memories formed before the injury).
Reality: Concussions are fairly common. If all concussions lead to amnesia, a lot of professional sports athletes would be wandering the streets wondering who they were. Besides, even if the concussion lead to amnesia, it's more likely to be that of anterograde amnesia (ie, inability to create and save new memories).

6. The Imaginary Restaurant
Characters always meet at a particularly weird non-existing type of restaurant. The entire restaurant consists of small square tables that can only accommodate a party of 2. The lighting is usually dim. Upon sitting down, a waiter (usually dressed very formally) approaches and asks the person what they would like to have. If the fictional restaurant is meant to be a "cafe", the waiter would specifically ask what they would like to drink. The answer is usually coffee. If the fictional restaurant is actually meant to be a restaurant, the main character wouldn't even look at the menu. They'll always have the "set lunch".
Reality: The type of restaurant described simply doesn't exist. There's no other way to put it. There's no restaurant that primarily serves beverages in the format described. And there's no restaurant where there's only 1 set lunch. There has to be at least a choice of appetizer, main course, and drink.

7. The Scenery Shift
In a conversation between two characters (usually romantically involved), one of them might say something like "We need to talk" or "I have something I'd like to say to you". The content of what needs to be said is usually dramatic enough to warrant a change in scenery. Suddenly, the scene shifts to another location which might be miles away.
Reality: Either they teleported there to continue their conversation or they commuted there in awkward silence.

8. The Broken Glass Cut
An item shatters (usually glass). The first person to go ahead and pick up the pieces always gets cut. Always. Seriously. Always.
Reality: In my experience of cleaning shattered messes, it's pretty difficult to cut yourself unless you purposely take a sharp piece and squeeze into it like an idiot.

9. The Imaginary Hospital
Medical surgeries take place in a hospital that can't be found in the real world. If a character requires surgery, the character's family/friends wait directly outside the operating room. There's always a couple of benches but the hallway is always empty except for the family/friends. The door to the OR always has this box with the words "Operation Room" on it and it's always lit from the inside with a fluorescent tube. The light switches off to signal the end of the surgery, the family/friends stand up and the surgeon comes out accompanied by one or two nurses to discuss the outcome of the surgery.
Reality: This type of hospital doesn't exist. Every hospital hallway is always crowded with people and staff. I've never seen that "Operation Room" light indicator in any hospital I've been to. And surgeons never immediately address family/friends right after the surgery.

10. The Incompetent Car
Cars routinely malfunction and break down while being driven. There's only two types of problems. One is a brake malfunction which usually leads to an accident (often crashing into a light pole or road sign). The other type of problem is when the engine sputters and white smoke emit from the hood. Oh, and every single male character is a mechanic. They always pop the hood as if they know exactly what's going on.
Reality: Cars just don't fail that easily. Every car goes through annual inspections to ensure that they are still road-worthy. The brakes are one of the main parts of the car that is heavily inspected. I'm no expert, but the "white smoke from the hood" issue appears to be the radiator overheating. The radiator is also heavily inspected and is routinely flushed. Besides, the radiator never just suddenly fails. There's a temperature gauge on the dashboard that warns the driver of any problems ahead of time. (In fact, I knew someone who drove around a 10-year-old car for months with a leaky radiator. Every hour or so, he would need to refill the radiator with tap water. That car's engine never failed.)

(Bonus)
11. The Unfocused Accident
Characters have dramatic things happening in their lives and often, the show producers would like to illustrate that a character is mentally preoccupied with something. Perhaps the character is deciding how to reject a marriage proposal from a millionaire or if she should arrest her fiancée who is a crime boss. The only effective way to show a character is unfocused is to have her handle a knife and food. She would stare straight ahead while chopping carrots or peeling an apple. She will inevitably cut herself with the knife. This is the only way the audience would know that she is unfocused.
Reality: This is just like #8. You really have to be an idiot to cut yourself with a knife. This just doesn't happen to adults.

Pregnancy and the Elevator in the world of TVB dramas

A common criticism of TVB dramas is that they're basically all the same. They follow a predictable plot. They're full of cliche lines. And they're all played by young aspiring (ie, bad) actors/actresses.

Most importantly, they don't portray the real world and there's no better example of this than the dynamics between the elevator and the pregnant woman.

In the TVB drama world every time a pregnant woman steps into an elevator, the following is true 100% of the time:

1. Shortly after the elevator doors close, the elevator fails due to some technical glitch or power outage.
The probability of getting stuck in an elevator is once in a lifetime for a person using elevators on a daily basis. In other words, this just doesn't happen as often as depicted.

2. The pregnant woman suddenly cringes in pain, her water breaks, and goes into emergency labor where the baby has to be delivered right away.
Labor typically lasts several hours, sometimes days. But on TV, the water breaks and the woman sits down in a pile of sweat in about 5 seconds. This is then followed by 15 seconds of panic to hype up the drama. Then 10 seconds of pep talk. About 30 seconds later, the woman is ready to start pushing.
By the way, the woman is usually in her late 3rd trimester of her pregnancy when she enters the elevator. But this doesn't really matter. She could very well have just conceived the night before and all of this would still happen.

3. A protagonist assists with the delivery of the baby.
The protagonist is never a doctor. Yet, he/she seems to know exactly what to do. He/she just puts his hand between the woman's legs, implores her to push, and then catches the baby as it comes out. Labor is that easy, eh? Makes you wonder why we even need doctors and medical equipment?

4. The baby and mother always turn out alright despite the unsanitary conditions and the inexperience of the protagonist.
Nobody's hands are washed/sanitized. The elevator floor is dirty. There's no clean water supply. Yet, there's no risk of infection. If a woman really experiences such an emergency labor, I'm willing to bet that there's at least some sort of complication with the baby and/or mother. Yet, this is just never the case.

5. Only after the delivery of the baby can the lift doors be possibly opened.
This is like a rule chiseled in stone. Never will you see firefighters pry open the doors during the delivery of the baby. It could be the most epic grueling labor in the history of mankind lasting several hours (breaking rule #2). But by the time the doors are opened, the baby is already neatly wrapped in a mysterious towel of unknown origin. Where did the towel come from? How was the umbilical cord cut? What about the placenta?

6. The father is never in the elevator.
The father character is never the main protagonist. So if he's in the elevator, our protagonist doesn't get enough screen time.

7. The dramatic event sparks a relationship between the protagonist and the romantic interest.
The elevator doors open. The baby and mother leave with the paramedics. The protagonist and the romantic interest character looks and nods at each other. Somehow the experience changes them and they have a new found respect for one another.

Any more that I missed?

Twins Blog - Apr. 10, 2011 - "Cake"

Today is day 128 in the NICU for Aidan. There's still no end in sight but it does feel like we're at least heading in the right direction. Aidan is still on nasal cannula but the settings are minimal (ie, 0.5 liters per minute flow at only 21% O2 concentration). Apnea episodes still come and go but they're happening much less frequently and he recovers much more rapidly with fewer assistance.

Ethan recently went for his 2nd immunization shot. The doctor warned us that from his experience, babies tend to cry really loud because this shot hurts more, compared to the previous one. Ethan cried for about 45 seconds for the 1st shot. This time, he wailed for just about 15 seconds. It was cake.

A couple of recent shots. (We like dressing them this way; long sleeve inside with short sleeve outside.)

Twins Blog - Mar. 27, 2011 - "This was nothing"

They reduced Aidan's oxygen supplement levels to about 30%. A few weeks ago, my wife and I would take this as good news. But now, we can't help but think that this is just a ploy by the doctor to make it seem like he's doing work. It's complete BS, of course. Adjusting the oxygen levels is as simple as putting a note in the chart to instruct the nurses to do so. It doesn't do anything about his apnea episodes. He only had 1 episode over the last 24 hours and didn't need to be bagged. But our hopes aren't up because last week, there was an instance where he didn't have one for over 24 hours only to have multiple episodes the day after, and the day after, and the day after, etc. We'll still be pushing the doctors for treatment plans and tests until they exhausted all options or until Aidan outgrows the apnea himself.
On a lighter note, Aidan has been very alert and adorable the last few days we came to visit. He looks very much like Ethan except for a few differences: a birth mark on his left temple, he has less hair, and his hair is more curly.  Most of their expressions are fairly similar.

We took Ethan for his immunization shot yesterday. A few items of interest to note:

• We watched as the doctor inserted the syringe needle into Ethan's thigh and we didn't really feel anything. We didn't cringe or felt sorry for putting our child in pain. We just looked at each other, smiled and shrugged. It may sound like we were being emotionless parents but it's just that we've seen much worse when Ethan was still in the NICU. This was nothing. Ethan still carries the battle scars from numerous IV sites where multiple catheters was left in place for days. This doctor made a single insertion and the needle was in&out in 2 seconds. Seriously, this was nothing.
• Ethan took the shot like a man. That's not to say he didn't cry or feel any pain. He cried when the syringe was inserted obviously because it was uncomfortable. But the volume was tolerable. We've heard him scream louder at home when he's hungry. The crying continued for less than a minute. By the time I had him back in my arms, he was quiet and happily sucking away at his pacifier as if nothing happened. I've seen children at age 1 or 2 take shots and then just wail all out for 10-15 minutes. In comparison, my boy is less than a month old adjusted.

Twins Blog - Mar. 24, 2011 - "Trust"

 Ethan is just too cute and adorable at home. We can't wait for Aidan to finally join him. I think we've finally gotten the hang of caring for Ethan. Adding Aidan to the mix should be pretty seamless. It wouldn't be exactly doubling the workload. We'll just be doing everything twice.

Aidan is still experiencing the occasional apnea spells. Every time we go visit him, we ask the nurses how many apnea spells he's had in the last 24 hrs. These days it's usually between 3 and 5. So, we're still praying for his apneas to go away and stay away.

A  revelation hit us in our last hospital visit. A nurse pulled us aside and cryptically suggested that we make an appointment to see Aidan's attending doctor. The message came as a shocking surprise but at the same time, it was clearly evident: Aidan was not getting the medical treatment he deserves.

We had trusted our doctor and it was clear that this trust has been abused. Aidan has been off the vent and suffering from apneas for a month. There were no interventions during this time. About three weeks ago, we asked the doctor for his treatment plan. His response was basically "wait-and-see". It's a fact that apneas tend to just go away on their own, so we accepted this response at the time. We also suggested that perhaps it may be reflux but he brushed it aside saying that it was unlikely. Again, this was almost 3 weeks ago.

Just a few days ago, the nurses informed us that diuretic drugs were prescribed after the doctor personally witnessed one of Aidan's apnea episodes. We didn't think too much into this at the moment but now, it's clear that this was a reactive response and I have reason to believe that the prescription may not even be appropriate.

The next 24hours were truly hectic. We requested an emergency meeting with the attending doctor. Then we were told that the attending doctor was unavailable and that the on-call doctor would be able to see us. So, we agreed but demanded that a more senior doctor was present. We were told the senior doctor was unavailable. So, we decided to consult the hospital's social workers to see what action we can possibly take if we're unsatisfied with the doctor's medical treatment. But apparently, we contacted the wrong department and they subsequently led us to the hospital's public relations officer who handles complaints. We told them that we're not here to complain but we did express our frustration to them. We asked if we can request a different doctor or even move to a different hospital because we have reason to believe that our current doctor is incompetent. It didn't seem like we were able to accomplish much because they kept telling us that we need to meet with the doctor first. So we asked if they can send someone to join our meeting because we felt that a 3rd party needed to be present. They said no but suggested that we ask the head nurse of the NICU to join the meeting.
Shortly after, we received a phone call saying that the senior doctor has agreed to meet with us along with the on-call doctor. Clearly the public relations officer tipped them off which was to our advantage. We arrived for the meeting and asked the head nurse to join us. She agreed. The tables were now set. As Han Solo would say, "This is where the fun begins."

A couple of highlights from the long meeting:

• The doc kept going on and on about Aidan's underdeveloped lungs. In less colorful language, my wife basically told him to shut up and stop blaming everything on his chronic lung disease. CLD is such a general condition that you can use it to explain everything.

• I asked him what are they doing about his apnea. The doc insisted that it's not apnea and that it's a behavioral thing. I called his BS and told him that it is apnea because he's not breathing. That's the definition of apnea. Before his rebuttal, I told him, "Ok, you say it's behavioral. What are you doing about his behavior?"
  The doc said that they were monitoring Aidan's stats and adjusting his oxygen supplementation accordingly. He also said that Aidan's condition is fairly consistent with what similar preemies experience. This was complete crap and we need to look no further than Ethan's condition. I told him that means they're taking a wait-and-see approach and this was not acceptable at this stage. My wife asked them why they were not proactively trying to determine the cause of the problem and then specifically targeting the cause with the appropriate treatment.

• I then asked "Shouldn't you be running all sorts of whatever-tests?"
   Perhaps trying to poke fun at my lack of medical terminology the doctor actually asked me "What whatever-tests?"
  I counter with "You're the doctor. You tell me!"

• The next part is just fun. The doctor goes ahead and mentions several possible tests that they can conduct but seems to suggest that now was too early a stage to warrant them. We knew that was BS. We did our research and knew exactly what those tests were. After he was finished, we basically said something along the lines of: "Ok, all those tests you just mentioned? Do it."

• Then it seems he was trying to buy some time by saying, "Ok, but I'll have to consult with this doctor and that doctor before I can run those tests."
  We responded with, "Ok, go set up those meetings. Consult them. Do whatever you have to. But do it now"

• Towards the end of the meeting, I told him that I would like a another meeting a week from today to followup on everything discussed. His initial look and response was that of "Seriously, is that necessary?". But my and wife and I stared at him with dead serious eyes to let him know that the request was not a question. Game, set, and match.

It's just utterly ridiculous that we needed to push the doctors for treatment. I thought ethics were one of the first things that's taught in med school.

10 habits of Hong Kong drivers that boggles the mind

In no particular order:

1. Sabotage the effectiveness of the seatbelt.
This really applies only to taxi drivers. I've never seen a HK taxi where the driver's seatbelt is properly worn. It's always worn too loose with the help of a wide assortment of tools. I've seen the following items used to keep the seatbelt loose for the driver: binder clips, bag sealers (ie, those things that you use to seal an opened bag of chips), folded pieces of cardboard, tape, safety pins.
He's essentially not wearing the seatbelt at all. It's just draped over him. In an accident, it would probably be a choking hazard (if he's not thrown through the windshield).

2. Flash emergency lights when hard braking.
I suppose the driver's intent is to warn the car behind so that it doesn't slam into him. But the logic just doesn't make any sense. If the car behind is going to rear-end you, blinking yellow lights at him won't do anything. Besides, every car already comes with a feature that warns other drivers when brakes are deployed. They're called brake lights. If the driver behind isn't pay attention to your brake lights, they sure are not paying attention to your emergency flashers. How's this for an idea? If you want to minimize the risk of someone rear-ending you, don't hard brake.

3. Flash turn signals when going through bends.
Turn signals are meant to notify other drivers of changes in directions of your vehicle; not changes in directions of the current road. Steering left through a bend is not the same as making a left turn. It's not like you have the option to go any other direction. It's like telling the drivers behind "Hey, the road is bending left. Rather than driving my car off the road and down the cliff, I will be following this bend. I just thought it would be good to let you know that."

4. Flash turn signals midway through a lane change or a turn.
Why bother? This is like calling someone 29 minutes into your appointment to say you will be 30 minutes late. Don't even call. There's no point. You've already pissed someone off, so you might as well just show up.

5. Shift to neutral and apply hand-brake when stopped.
I suppose the driver's intent is to save fuel. This is an ineffective habit and is often used in combination with numerous other fuel-wasting behaviors. For example, hard braking, hard accelerations and tailgating.

6. Fail to shift back to drive and release hand-brake prior to stepping on the gas pedal.
This poor habit just damages and shortens the lifespan of the transmission and brakes. If you're going to practice the ineffective habit of shifting to neutral and applying the hand-brake, the least you can do is to be able to properly reverse your actions to get the car moving again.
On a related note, I've seen some drivers shift to park as an alternative to shifting to neutral and applying the hand-brake. They do so even in stop-and-go traffic. I can't even imagine the type of wear-and-tear their transmission goes through.

7. Occupy two lanes for the longest possible time while changing lanes in stop-and-go traffic.
I can't even rationalize why people do this. When changing lanes in slow moving traffic, either do it by steering hard into direction of the lane you want to switch to or don't do it. Why do people think it's ok to merge gradually into a lane when it's obvious that they're just holding up both lanes unnecessarily.

8. Line plush dolls across rear window.
I don't mean one or two plush dolls. I'm talking about the entire cast of Winnie the Pooh and all the variations of Disney's Stitch. If it's a woman behind the wheel, this gives off the impression that she's childish. If it's a man, it makes him look like a sissy. In terms of safety, it compromises the driver's ability to see through the rear window.

9. Line figurines across the dashboard, often right on top of where the airbags deploy on the front passenger side.
Again, I don't mean just one or two of those bobble-head things. I'm talking about every single McDonald's Happy Meal toy ever made. First two sentences of #8 applies here as well. In addition, people who do this are just putting themselves at risk. In an accident, I can foresee two deadly possibilities. The driver/passenger may ram their head against the figurines. Or the airbag will deploy which will launch the figurines as high-speed projectiles in random directions at everyone inside the vehicle.

10. Flash the right turn signal when entering a roundabout.
The car is steered to the left direction when entering a roundabout; so why does the driver think flashing the right turn signal is appropriate?
In fact, why flash the turn signals at all? #3 applies here as well. There's only one direction to go. It's not like it's possible for the driver to enter the roundabout going counter-clockwise against the flow of traffic.
Perhaps the driver wants to signal to the cars already in the roundabout? If they flash the left signal, it won't be visible to cars already in the roundabout; so they flash the right signal. But it's not necessary to signal to the cars already in the roundabout! Your car is not invisible. They see your car. They know you're looking to enter the roundabout. It's not like they see your car and think to themselves "Hey, there's a car at the entrance to this roundabout. But he's not flashing his turn signal. I guess he's just parked there enjoying the show."


Obviously, not everyone on the road in HK do these things. But enough of them do (especially taxis) to be enough of an annoyance. Are there any more that I missed?

Twins Blog - Mar. 16, 2011 - "You can do it, Aidan"

Poor little Aidan is actually larger than Ethan but is still on the nasal cannula while going through several episodes of apneas and bradycardias every day over the past few weeks. There's not much that can be done. We're told that Aidan just needs to "outgrow" his As & Bs (as they're known).
As & Bs are very common in preemies but it doesn't make them any less scary to witness, especially for parents. The infant's face would suddenly turn purple. Reviving the child generally involves physical stimulation like striking the foot. If that doesn't work, the Ambu-bag is used. It literally feels like the baby has died for a moment before being brought back to life. I'm sure that statement makes no scientific sense, but it really does feel that way.
Fortunately when we visited Aidan on the 15th, we were told that he has not had a single A&B episode in the past 24hrs.
On the 16th, he had a single apnea episode. But his blood oxygen concentration levels looked much better than several days ago. Our fingers are crossed in hopes that he's in the process of outgrowing his As & Bs. In other good news, Aidan is pretty good at oral feeding; that is, much better when compared to when Ethan started.


Ethan has now been home since the evening of Mar 13 and he has been more adorable than we ever imagined. A couple of things we noticed about him:

• He's very used to noise since things get quite loud in the NICU.
• He sleeps through much of the day, waking only during feeds, changes, baths, and occasionally random periods where he would just look around.
• He likes to be held for a while after each feeding session. If we try to put him down after we burped him, he'll cry to be held.
• He especially likes the baby room which we wallpapered and floored with some colorful patterns.
• Sure, it's been just a few days, but he doesn't appear to just cry for no reason. He doesn't even cry if he has a poopy diaper. The only reason he would cry is because he's hungry or he wants to be held.
• He loves to be talked to. He would listen intently with his eyes opened. When I run out of things to talk about, I just count to him.

Twins blog - Mar. 14, 2011 - "Welcome home, Ethan"

After exactly 100 days, Ethan is finally discharged from the hospital last night!
Needless to say, we're ecstatic. Yet, Aidan remains in the NICU so we're not fully out of the clear yet.

Twins Blog - Mar. 7, 2011 - "Apneas and Bathtime"

Huge advances for Ethan lately. His feeding tube was removed and he's been feeding orally exclusively for the past few days and getting quite good at it. Previously, he would be winded after a meal. Just yesterday, he finished the bottle and not only was he not winded, he seemed to want more!
We also bathed him for the first time in the NICU (Not his first time being bathed; just our first time bathing him). He seemed to like being in the warm water. He certainly didn't like being taken out of the water where it was cold...

Aidan is still on nasal cannula. His progress continues to be a tad behind Ethan. He would still suddenly stop breathing and would require the NICU staff to use the Ambu-bag to revive him. This happens about once a day. We're told not to worry about it much as babies tend to outgrow this tendancy.
Aidan loves being held, seriously. He has always been very fussy inside his incubator when he's awake. He'll be twisting and turning, pulling on anything within reach. But once held, he'll be calm and quiet. Everytime we put him back into the incubator, he'll cry and squirm about again.

Twins Blog - Mar. 5, 2011 - "Together at last"

Today was the first time since birth that our twin boys got together!

Their beds are situated in separate areas of the NICU (so that the staff doesn't mix them up). I was bottle feeding Ethan at the time when a nurse asked me to leave the area because they had to perform an x-ray on a baby nearby. I asked playfully whether I can take Ethan with me. To my surprise, she said okay. So, I brought Ethan over to Aidan's bedside, where my wife was at, so the brothers can finally meet!

Twins Blog - Mar. 2, 2011 - "Now is the time"

Today is our boys' due date. That is, it's been almost 3 months since birth but their adjusted age is 0 right now.

Here's Aidan:

and Ethan:


Aidan's color doesn't look as well as Ethan's. It takes a while after babies ween off the ventilator for their color to look more "normal". Ethan has had a head-start but Aidan will soon catch up.
For the first time since birth, we've held Aidan for the first time. Another milestone checked! Our fingers are crossed for them to keep progressing!

Twins Blog - Feb. 28, 2011 - "Bye bye vent 2"

Recap of events

Weight
Over 5lbs each now. Aidan looks particularly chubby.

Breathing
Ethan was breathing without any assistance whatsoever until just recently when he contracted some sort of bacterial infection. They put his nasal cannula back on but it's on extremely low flow. It will likely come back off in a few days.
Aidan was on CPAP for quite a while. It was an awkward stage. Babies generally don't like CPAP. The apparatus has to be pressed up tight against the nose making it uncomfortable and the hose greatly restricts movement. Back when Ethan was on CPAP, he didn't like it but he was too small and weak to do anything about it. Aidan is now large enough and strong enough to be able to consistently (and constantly) tear away from the nose-piece. He doesn't understand that the only way to get rid of that nose-piece is to keep it on!
Fortunately, he's on nasal cannula since Feb 28. This marks the first time in a long time that we have 2 comparable pictures of the boys taken on the same day.


Misc
For a few days Ethan was removed from his incubator and placed in a bassinet wrapped in blankets. We were free to hold him as much as we wanted during visiting hours. We also got to try to bottle feed him. First time didn't go too well. But soon enough, he downed nearly half his bottle before tiring out.

On Feb 21, Ethan moved into another ward which is "less intensive" (as opposed to neonatal intensive care unit). But I guess he didn't like it there because his bowels became distended. As a result, he required multiple IVs inserted back into him. And they placed him back inside an incubator (probably because it's more convenient due to the imminent IV lines).
A doctor attempted to insert the IVs but was unsuccessful for over an hour. Ethan literally had wounds on multiple sites on each of his limbs from this. I had full intention on filing a complaint on this idiot, not for his incompetent skills, but for not requesting assistance after failing numerous times for over an hour and for keeping my boy cold outside his incubator during the whole time. A meeting with his supervisor calmed us down enough to have mercy on that moron.
But seriously, that imbecile just gives the paediatrics staff a bad name. If it were not for my wife insisting to spare him, I would end his medical career right now. Nonetheless, we passed our complaint letter privately to that idiot's supervisor for him to deal with it (as opposed to letting the hospital deal with it).

On Feb 22, they moved Ethan back to the ward he was in initially ie, the "intensive" ward. We're told he's alright and that it's just that he's probably too tired to poop. The NICU nurses shared with us a very odd observation regarding preemies. Most of the time, an infant would either be great at breathing and poor at digesting or great at digesting and poor at breathing. It's rare for a preemie to excel at both feats at the same time. This is certainly the case for our boys. Ethan has got the breathing part, but just not very good at the digestion. We're told Aidan digests everything they put down his feeding tube and poops just fine. But he's still working on the breathing part.

On Feb 27, Ethan had a mild fever and his eyes looked glassy. This means yet another spinal tap to rule out meningitis. This would be his 2nd one. Aidan has had 3 of them already.

There's not much news for Aidan other than he's progressing steadily. We actually would prefer if Ethan was just as newsworthy as Aidan is. In the NICU, no news is good news...

Twins Blog - Feb. 18, 2011 - "Gaining separation"

Feb. 13, 2011
We had our first try at bottle feeding Ethan today. It was a humbling experience and at the end of it, my wife and I were left feeling like we've completely failed at parenting.

What's so hard about bottle feeding, right? Hold the baby, put the bottle in his mouth and he'll happily feed away, right? Not with preemies apparently.

He would suck on the bottle but then couldn't handle the swallowing part as milk would gush out from the sides of his mouth. A few minutes later, he would finally suck and swallow, but would forget to breathe. His whole face turned horrifically blue.

In 15 minutes of bottle feeding, Ethan took in about 5ml while choking back up about 10ml. He was then tube-fed the rest. Sigh...

Feb. 15, 2011

A couple of days ago, Aidan regressed from CPAP back to the traditional vent because of some sort of infection. Today, he's back on CPAP for another go.

Feb. 17, 2011

2 huge milestones for Ethan. He's taken out of his incubator and seems to be just fine regulating his own body temperature. Most importantly, he's taken off the nasal cannula. For the first time ever, he's breathing efficiently on his own without any aid. Now, he just needs to work on feeding!
Aidan is still hanging out in his incubator with CPAP. But he has shown substantial improvement in all areas. I'm estimating he's probably 2 weeks behind Ethan in terms of progress.

Cleveland Cavaliers - 55?

55.

First thing that I associate that number with is the number of points Michael Jordan scored against the Knicks in his comeback game. This number could soon have a new association.

If I was a fan of the Cleveland Cavs, I would shudder at the mention of the number 55.

It's not because of the game on Jan. 11, 2011 when the Lakers decimated the Cavs by 55 points and then Lebron made that karma tweet. (That along with James' dropping 38pts on them in their first matchup has to be the low points of the year.)

It's just that they're currently on the longest single-season losing streak in NBA history at 25 losses in a row and they have 30 games to go in the season. This means they have the potential to push this streak to 55.

While I understand that there's always going to be bottom dwellers in the league, you never want to see a team get deflated like this. I'll be rooting for the Cavs to somehow get a win. All this losing is just depressing. Unfortunately, it seems like loss number 55 in a row is in the rear-view mirror of these guys. That is, it's closer  than it appears.

Update: It appears the Cavs won't reach 55 losses in a row after their win against the Clippers. The season doesn't get easier though. Hope they have the guts to tough it out.

Twins Blog - Feb. 7, 2011 - "Are we there yet?"

Recap of Events


Weight
Almost 4 pounds. They're really starting to pack it on now. They're fed about 40ml every 3 hours. No problems with digestion.

Breathing
Ethan is off the vent and on nasal cannula. They use it to supplement additional oxygen to him. He started with 30% and it gets dialed down daily. Once he hits 21%, he won't need it anymore. (ie, ambient oxygen concentration is 21%)
Aidan is still on CPAP. But he's not struggling with it. He'll also be off the vent soon in another few weeks.

Behavior
Neither of the boys have any more IV lines connected to their limbs, so they're free to move their arms and legs around. Previously, the boys had all their limbs occupied with IVs which was definitely not pleasant.

Aidan is now less sensitive to loud noises. He still prefers quiet but he won't overreact to sudden alarms and crying anymore. He likes having his hair gently stroked while light pressure is applied to his abdomen area. He doesn't like having his foot held, but if you insist on not letting go, he eventually submits. He certainly hates his vent tube which restricts his head movements. But at least he doesn't extubate himself as often nowadays. It's probably because of the vent tube, but he seems to be a very sleepy baby. We'll see if this behavior persists when the vent goes away.

As soon as the vent tube went off, Ethan quickly showed his inquisitive personality. He'll touch and grab anything within reach. If we're by his side, he'll show us a variety of facial expressions. It's just brilliant! If no one is visiting him, he'll either sleep or explore his incubator with his hands. Perhaps it's because of his feeding tube, but he likes to make a face as if he's whistling. For whatever reason, he likes to place both his hands on his face.

As mentioned in a previous post, we've finally held Ethan in our arms. He appeared very confused of the world outside the confines of his incubator. It was funny as he maintained a very puzzled expression during the whole time. As soon as he was back in his incubator, he was back to old self, making weird and cute faces.

Both of them are now capable of crying but they only do so on rare occasions. I wonder if they'll stay this way even when they come home.

Today is day 66 at the NICU. No signs of PDA (patent ductus arteriosis), jaundice, brain bleeds or ROP (retinopathy of prematurity). Relief! Bad news are now a rarity in our last few visits and we're finally starting to see the light at the end of the tunnel. It seems likely that Ethan will be coming home first and Aidan will need an additional couple of weeks.

Twins Blog - Feb. 6, 2011 - "Hold me"

Today, my wife and I celebrated our 1-year marriage anniversary by splurging at Spa L'Occitane. We each had a body massage and facial done. After a couple hours of relaxation, we were back to our daily routine in preparing for our visit to the NICU.

(This "daily routine" takes quite a toll on the body. Lots of things to bring and pack every day. Eg, milk, diapers, wipes, etc)

Upon our arrival at the NICU, we were greeted with a reminder of why all our efforts were worth it. We were able to hold baby Ethan for the very first time.



He still had his nasal cannula attached along with various other monitoring equipment, but the nurse was able to route them out of the incubator to accommodate us. My wife and I were pretty much speechless as we have been hoping for this very moment for as long as we can remember. I'm not sure how to describe the moment. Remember the ending of that episode of Friends where Marcel (Ross's monkey) ended up in the hospital after swallowing some Scrabble tiles? Marcel reaches out and grabs Ross's finger. It's like that, sort of...

Being the terrible parents that we are, we almost neglected Aidan today. He's still on CPAP, but he's definitely showing improvement. The vent settings are being lowered daily. At this rate, he'll be off the vent and on nasal cannula in about 2 weeks. Then, we'll finally be able to hold both our boys!

Twins Blog - Feb. 4, 2011 - "Bye bye vent"

A pleasant surprise awaited us at the NICU today. For the first time, Ethan is off the ventilator! They've attached a nasal cannula to supplement some oxygen for him, but he's completely breathing on his own. This is the first time we've seen an entire shot of his face.

Aidan is still on CPAP. But he deserves a break. He did just recently go through surgery. And he's in an area of the NICU that's particularly noisy. Hopefully, he'll soon follow suit and we'll get to see an unobstructed view of him for the first time!

Twins Blog - Jan. 31, 2011 - "Between those NICU walls"

The NICU is a very unique place. It's a melting pot of emotions. Each infant is going through something different which means each respective parents have their own unique set of feelings. Fortunately, the average person would never see the inside of a NICU. But just to share what's going on in there, here's a list of typical emotions felt in that miracle room.


Shock
Usually this happens to parents who see their child for the first time. Society has imprinted into our minds the image of a newborn. When these parents see that the image of their child differs so much from what they're expecting, it just sends a wave of shock through their system.


Guilt
Often after all the medical stuff are settled into the parents' mind, guilt sets in and they start to ask themselves things like "what have I done to deserve this?" or "did I cause this?"


Helplessness
In some ways, feeling helpless may be the worse. One particular child in the NICU suffers from a condition where he can't move. I don't know the name of the condition but it's a nerve condition rather than orthopedic and extremely tricky to treat. His mother comes every day to massage him and move his limbs around. The child never even flinches. The emotionless expression on his mother's face is just heartbreaking.

Despair

After a doctor/nurse presents negative news to parents, it just feels like everything is falling apart. We've been through our share of this. But even when it happens to someone else, we actually feel it too. I've overheard a nurse tell a couple that their child might not make it through because of necrotizing enterocolitis (NEC). I could literally see their wills shatter before my eyes as both of them were reduced to a crying mess of tears and their speech becomes incoherent.

Hope

It's empowering to parents if the doctor/nurse have positive news to report. That's why it's always important to get daily updates even though this puts you at risk of hearing negative news. Every bit of improvement adds to the "we just might make it through this" feeling.

Joy

There are babies who are off the vent, out of the incubator, and are fed via bottles. They have parents who come to feed them, burp them, cuddle them, and play with them. Their faces are just beaming as they use baby-talk and tell their child about how life would be when they get to carry their bundle of love home.

Twins Blog - Jan. 27, 2011 - "It's my party and I'll cry if I want to, cry if I want to..."

We heard Ethan cry for the first time today. He's been pulling out his vent tube everyday. Sometimes, twice a day. So they put him on CPAP which freed his throat to enable him to make noises! Needless to say, it was music to our ears. Sounded like a tiny little kitten. We're told that we should rest as much as possible because once the boys come home, their crying will be non-stop. In response to that, I say bring it on. I would rather be annoyed by constant crying than be worried about their ventilators and feeding tubes, etc.

Aidan is still on the vent. But he's improving steadily. That is, the vent settings are decreasing everyday. Hopefully, it won't be long before we hear Aidan's cry.

Life after birth of the boys

• Diaper changing.
• Baby sleep patterns
• Feeding the baby.
• Bathing the baby.

These are some typical things that parents worry about when they have a child. Oh how we long to be concerned with those things right now. But that's just looking too far down the road. Our boys were born 3 months premature and will be in the NICU for quite some time. Since their birth, here's a sample of things that we worry about everyday:

Heart murmurs, brain bleeds, blood pressure, body temperatures, meningitis, pneumonia, spinal taps, ventilator settings, red blood cells count, blood transfusions, whether or not they're digesting, blood oxygen concentration levels, etc

It's enough to drive anyone mad. You know those parts that you tend to skip over when reading pregnancy books? You figure that it's just talking about things that won't happen to you, so you jump ahead to the "normal" stuff. I had to go back to read those sections because it's actually happening.

"When are the babies coming home?"
That's the question we get asked a lot and it's awkward for a two reasons.
1. The truth is we don't know. The doctors don't know either. Each child is different and there's just no timetable that can be given to us. Some babies spend a month in the NICU, others are there for over half a year. There's just too many variables at the moment. In order for the boys to come home, there are a couple of things they must be able to do:
-Breathe efficiently on their own. That is, they have to ween off the ventilator.
-Regulate their own body temperature. That is, they have to be able to keep warm outside the incubator.
-Feed. That is, they have to be able to take a bottle. For a full-term infant, this comes as a natural instinct. But for a preemie, this is quite a task since feeding is actually a complex synchronization of sucking, swallowing, and breathing.

2. One would assume that having the babies come home from the NICU would be what we're longing for. Sure, that's the ultimate goal but for now, we just want the simplest of things:
-We want to be able to see our babies' faces. We've never had an unobstructed view of our boys' faces. The vent tube is always on them.
-We want our boys to meet each other for the first time. As of now, our boys have never seen each other. Their incubators are situated in different sections of the NICU.
- We want to be able to hold our babies. Since they're attached to the vent, various monitors, and IV tubes, we've never been able to hold them. The most we can do right now is to reach into their incubators and wrap our hands around them.

Twins Blog - Jan. 19, 2011 - "Going under the knife"

For a while, I've been logging every single detail of each of the boys' conditions. I've discovered that this just wasn't practical. It places too much emphasis on daily changes rather than overall progress. For babies in the NICU, daily fluctuations are not very significant. They may look alright today, but then will plummet tomorrow, only to rebound the following day. Expecting daily incremental progress is unrealistic. We now fully understand why the NICU is described as a rollercoaster ride (ie, up and down) or a tango (one step forward, 2 steps back)

So, rather than focus on daily changes, I'll just recap every few weeks.

Weight
They're now about 3.5 pounds each. Their growth rates were really slow in the first month, primarily because their bodies were struggling with things like breathing and circulation. We've noticed just a few weeks ago that the boys finally look like they're really starting to grow. Each of their bodies look significantly larger than before and their color looks much better.

Patent Ductus Arteriosus
Both the boys were diagnosed with patent ductus arteriosus (PDA) which is very common in preemies. Short bio lesson:

While the baby is inside the mother's womb, the ductus arteriosus is a blood vessel that allows blood from the heart to bypass the lungs and travel to the rest of the body. The baby gets its oxygen from the mother so, the blood doesn't have to go to the lungs to pick up oxygen. When the baby is born, this blood vessel is suppose close so that the blood from the heart would get to the lungs. This often doesn't happen with preemies. As a result, this places additional stress on their heart and lungs to work harder, hindering development of other organs. When a doctor hears a heart murmur with a newborn, it's usually because of PDA.

Ethan was diagnosed first and we had quite the scare. He was put on a 3-day course of NeoProfen. The ductus closed after the 2nd day of treatment and hasn't returned since.

A few days later, Aidan was diagnosed with PDA. He had just started to digest milk but because of the drug NeoProfen, he wasn't allowed to have any more milk during treatment. His ductus just would not remain closed even after a second round of drug treatment. Surgery (ie, PDA ligation) was our next option. Fortunately the procedure went smoothly. Prepping for the surgery and post-op procedures were actually more extensive than the surgery itself. Still, that was the scariest and most anxiety-filled moment of our lives.

Pneumonia
Both the boys were also diagnosed with pneumonia, which is also very common in preemies due to premature lungs and the use of the ventilator. There's not much that can be done other than giving them a steady diet of antibiotics. Fortunately, both of them has shown significant improvements on this front.

The pneumonia caused both boys to have a slight fever at one point. In order to rule out meningitis, the doctors had to perform a spinal tap on the boys. Prior to doing so, they need the parents' approval. This was yet another scary moment for us.

Jaundice
Another common condition that the boys suffered from was jaundice. For this, they were given UV light therapy. This was on and off. It just seems very random. They would need it one day and not need it the next, only to need it again the following day.

Feeding
Both the boys are fed through a tube that goes directly into the stomach. They're supplemented with IV nourishment. Both appear to be able to digest fairly well, considering the circumstances.

Behavior
Both the boys have developed an attitude that has become infamous among the NICU staff. Neither one of them likes to be fiddled around with. They don't like having their temperatures checked. They don't like having their diapers changed. They don't like having their blood drawn. Every time a nurse or doctor has to work on them, the boys' blood oxygen concentration would worsen and their ventilators would have to be dialed up. But if it's quiet and they're left alone to sleep, their breathing improves significantly.

Neither of the boys likes having tubes and wires stuck on them everywhere. There are 4 sensors on each of their chests that are held in place with just a piece of tape. These get yanked out easily with their bare hands. Ethan is always yanking on his ventilator tube that goes down his throat. Fortunately, this is held in place quite securely. Aidan does the same and in one instance, he succeeded in dislodging it. A team of staff had to revive and retube him. So, nowadays, the nurses like to wrap them in blankets to keep them from tampering with their equipment.

Ventilator
Both boys are still on the vent to help them breathe. Weening off the vent is a major obstacle for the boys.

Ethan used to flail about quite a bit inside his incubator. A baby that moves is always better than one that doesn't. But this does expend energy that would be better used to develop his lungs. Every time after one of his flailing episodes, the nurses would have to turn his vent up. Fortunately, he appears to now understand that flailing about is not very fun. He's much more calm now and as a result his vent settings have gone way down.

Aidan seems to be very sensitive to noise which is not great if you're in the NICU. There's always some sort of alarm going off. He makes wild movements with his limbs when there's a lot of noise. Lately, we've been able to calm him down by placing a bean bag on him and covering his ears. His vent settings have also shown improvement.

Today is day 46 at the NICU. It has been an emotionally draining experience for us. Each setback hits us like a ton of bricks. Positive progress is few and far between. But we have come to learn to take the hits in stride while celebrating each tiny victory along the way, regardless of how small it is. At this point, we're not even hoping for the day the boys can come home. That's too far away. We're just hoping for the boys to get off the vent. That way, they can be held by mom and dad for the first time. And they can see each other for the first time. (They're incubators are actually located in separate locations in the NICU, so they've been apart since birth. This was done so that the hospital staff doesn't mix them up.)

Obi-wan Kenobi vs Darth Vader...yawn!

Remember that duel between Obi-Wan Kenobi and Darth Vader on the Death Star where Obi-Wan sacrificed himself to allow Luke to escape?

That was such a slow fight. I've always thought it was because Obi-Wan was such an old man. However, there were several duels in the prequel trilogy that involved older combatants where the speed of the fight was far greater.

According to Wookiepedia, at the time of their duel on the Death Star, Obi-wan was 57 and Vader was 42.

Qui-Gon Jinn was age 60 when he perished at the hands of Darth Maul (age 22). (Phantom Menace)

Dooku, age 80, defeated Obi-wan (age 35), severed Anakin's arm (age 20), and dueled with Yoda before escaping. (Attack of the Clones)

Dooku was age 83 when he lost his duel to Anakin Skywalker (age 23). (Revenge of the Sith)

Palpatine was age 63 when he killed Saesee Tiin, Agen Kolar, Kit Fisto, and Mace Windu (age 53). (Revenge of the Sith)

Sir Alec Guinness, God bless his soul, was a brilliant actor. But that duel on the Death Star was quite underwhelming.

Twins Blog - Jan. 3, 2011 - "Made it through first month"

Our boys one month since birth. The only way we can tell them apart in photographs is by recognizing the stuff in the background...

Aidan.


Ethan.