Saturday - September 08, 2007
Saturday, September 8, 2007
Day +60. Watch and wait. Manage fluids and blood and platelets. Take multiple x-rays. Measure, measure, measure. Tinker, tinker, tinker. Make a conservative management plan. Stay in ICU.
TO SLEEP THROUGH IT ALL...OR NOT: Friday night is quiet once Jessie drifts off to sleep under the spell of propofol and fentanyl, anesthetized. By dawn, she’s connected to 12 pumps with 16 lines, all connecting (some in rotation) to her 6 points of entry (central line, PICC midline catheters, and 2 IV’s) plus the ventilator. She’s receiving fluids, IV nutrition, platelets (lots) and blood. She’s receiving the most important of her transplant medications, and broad-spectrum prophylactic antibiotics because she spiked a low fever a few times last night (although it was probably caused by surgery) and anti-fungals and anti-virals.
She breaks through sedation over and over, resistant. Jessie tries to talk. We can sometimes read her lips. When that doesn’t work, we spell with the alphabet daddy made her. She asks “How much longer?” about keeping the N-G tube and the breathing tube in place. She doesn’t like the foley catheter, either. She asks if mommy can help take it out? Her belly hurts. She hasn’t noticed her chest tube, yet. Or all the IV’s. She yanks her arm away when someone tries to stroke it soothingly. Don’t touch! She shakes her head every time they try to suction or change a dressing. No-no-no!
And we continue to work on her anesthesia. We change it again around shift change, so that she’s on a medication that she can take safely for longer periods of time. She’s on a new-to-Jessie medication called Dexmedetomidine (everyone in ICU had trouble spelling it or pronouncing it just right). They want her to remain sleepy. Hah!
FLUID SHIFTS and FLUCTUATIONS: Her hematocrit (red blood level) drops a few times during the day, but they watch and wait. Drops can also be caused by fluid shifts (we’re back to the concept of third-spacing) where fluid leaks out of blood vessels into other tissues. Other indicators are measured to help determine whether its due to internal bleeding. So far, so good. But after a few transfusions, the hematocrits drift steadily downward, so they come to the conclusion that she’s losing blood someplace. Not hemorrhaging, but “leaking.” Maybe. Overnight, they hope another transfusion may help resolve it.
Her abdomen grows distended during the day, but all other measurements remain reassuring (urine output, heart rate, breathing ability, blood gasses). She definitely has fluid collecting in the belly, but is it excess fluid that her body cannot shed, or is it all or mostly blood? They’re not sure. If it’s blood, it’s not an immediate emergency, because it’s oozing into the belly, as opposed to gushing.
VENTILATED: Not surprisingly, they delay extubation (taking out breathing tube and taking her off ventilator). They wean her settings, so she’s doing most of the breathing independently, but the ventilator assists. But they leave her intubated.
ADHESIVE: Tape. Ugh. She has tape or adhesive over bandages everywhere. Across her belly, ribs, back and face. Her biggest bugaboo. Ggggrrrrr. And we have to pull it off and change dressings for both the abdominal incision and the breathing tube as they adjust it. We try to help her sleep through these experiences. Hah. Jessie is stubborn!
INSULIN: She’s receiving insulin now, too. Her blood sugars are elevated.
MONITOR and MANAGE OVERNIGHT: They intend to watch her overnight. Tomorrow they’ll re-assess. They may have to go into the operating room again with her, and drain the blood out of her belly, to support the healing process. They don’t think it’s like Friday’s situation, which was a true emergency when her body was crashing in lots of crazy ways in a period of a few hours. So they’ll monitor it until Sunday, and re-evaluate at that time.
As we said last night, everything changes, minute by minute, hour by hour. We may have a whole different story to tell by tomorrow. Who knows?
SOCCER: Sarah and daddy spend a hot, dry morning on the soccer field with her team. They play a tough game, ultimately overwhelmed by the Revere team. This is the last year when Sarah can play traveling soccer...the league doesn’t support teams beyond middle school. So she’s out to enjoy every game, win or lose, for the sake of playing!
They exchange text messages with mommy throughout the day. They can send messages from their cell phones, and mommy retrieves them online.
Sarah and daddy stop at Baja Fresh for a quick lunch after the game, then spend the remainder of the day decompressing and resting at home ...They’re exhausted. Gee, what a surprise. In the evening, they share a fresh, locally grown dinner with the Browns.
STAY TUNED and PRAY: We’ll keep you posted. Meanwhile, please keep praying. Jessie sure does need it this weekend! BELIEVE!