Sunday - September 09, 2007
Sunday, September 9, 2007
Day +61. How do we characterize today? Well, we wish we weren’t in this acute situation. On the other hand, she’s “holding her own” within the spectrum of extreme medical crises. We want a slow, conservative approach to resolution of this situation, if possible, and that’s the ICU team’s preference, too. Barring sudden emergencies, which are always a possibility around here.
SHOWING SOME EQUILIBRIUM: Today Jessie demonstrates again her ability to defy the odds and stabilize. Between Saturday and Sunday night, her blood loss slows down. Her belly grows larger and more distended, but stays somewhat soft. Blood is probably collecting in her belly, below her diaphragm. But the pressure of the spleen’s presence and the volume of blood actually slows down and stops internal bleeding (when it’s oozing, as opposed to gushing). Other factors that they watch to measure stability, such as urine production and output, pulmonary function (breathing), heart rate, blood gasses, and coagulation, are reassuringly stable.
MEDICAL MANAGEMENT in ICU, VERSUS SURGICAL INTERVENTION: The team concludes that — for now — they will medically manage her immediate situation in ICU, and try to avoid a surgical intervention. Abdominal surgery would be more dangerous, with uncertain outcomes. Managing her condition in ICU is a joint decision by intensivists and surgeons. Transplant team is consulted, but this situation is really out of their hands. They simply give input on maintaining baseline transplant medications and practices (Cyclosporin, Methylprednisone, and infectious disease coverage).
We expect to remain in ICU for another 5 days, at a minimum. With a slow healing process afterward, even once we’re transferred back to 6West at some point.
EXTUBATION: Since she won’t be going to the operating room soon (unless an emergency arises) and because her left lung seems stable post-surgery, they remove the endotracheal tube. They really don’t like to have patients intubated longer than necessary, and she’s truly breathing on her own. So they take it out. Ouch. She has a sore throat...to say the least. She has to use nasal cannula instead, to provide some extra oxygen and keep her O2 sats elevated, but otherwise she’s breathing independently.
With the extubation comes the end of true anesthesia. She’s exhausted, for the moment, she sleeps anyway. Meanwhile, the team’s goal is to keep her pain controlled and comfortable with continuous Dilaudid and occasional Ativan, if needed. Though tired, she’s more alert and communicative. Which means that sometimes she’s talking — well, whispering hoarsely — to us, and letting us know her opinions about everything. She hates any sort of extra O2. :-)
She’s ba-a-accck!
PAIN MANAGEMENT: She has a lot of painful places. Chest tube’s exit site, where the tube is sutured in place. And 2 additional thoroscopy incision sites between her left ribs. Plus where the lung itself was excised and biopsied and stapled together again. The throat, from prolonged intubation. Her belly (inside and out) from repair of the spleen, and all the muscles and tissues cut and then sutured again for surgical incisions and procedures during Friday’s emergency. Where the IV’s and arterial line are placed (hand, wrist and foot). Where the foley catheter irritates her. Where the N-G tube comes out her nose and where it bothers her throat. Where there’s tape. And other irritations.
Over time, she’ll notice more and more of these sites. For now, she focuses on the absence of the breathing tube (good), the irritation of the N-G tube (bad), and her dislike of the nasal cannula (bad). Love that Dilaudid.
RAINY, QUIET, AT HOME: Daddy and Sarah’s plans for today are rained out. Or “lightning and thundered” out. That’s okay. They’re catching up. They stay home. Find friends. Stay in close touch with mommy, ready to come down to Boston if events get dangerous again, but hoping to stay up North and get ready for the week ahead.
HOW DO YOU THINK ABOUT IT? Lord, who would ever think of this string of complications, of how touch-and-go the past 48 hours have been — between ICU and surgery — as anything except a small slice of hell? Yes, hell. You can substitute X%^$&&$ if this word offends you, but sometimes we get to points in this experience that give us a taste or a glimpse or a feel of a bad place.
And yet, the same requests and prayers work in a waiting room or in ICU, just like they do in the oncology world or the transplant world. We don’t ask for big miracles and sudden magical disappearance of these complications. We ask for something that is equally hard to achieve, but is the difference between life and...well, something worse. We ask for stability.
Stability. Maybe it comes when so many small blessings line up, just the right way, and protect Jessie. Something is working in her favor, too.
Maybe it’s the skill and knowledge of gifted medical practitioners of all kinds: surgeons, anesthesiologists, nurses, oncologists, intensivists, and others. Maybe it’s the amazing ability of her body, mind and heart to rebound. Maybe it’s the right team at the right time. Maybe it’s a spark of the “divine” holding her up to the light. Maybe it’s every prayer and wish and good thought and positive image you are sending to her, along with her own feisty spirit, and our Creator’s healing presence.