2/21/09
Saturday in the Park (er...Hospital)
Bobby continues to recover nicely. He just started his first feed since surgery - he gets 10 ml (1/3 oz) of formula every hour through his feeding tube. Not much, but they will increase things pretty quickly if he does well.
He's staying awake for longer and longer periods of time, showing off his bright blue eyes. He's obviously uncomfortable but is being very brave. Much much braver and more tolerant than I would be.
He had a xray yesterday that showed that his upper right lung wasn't working great. It hadn't collapsed like last time, but the air sacs weren't fully inflated. He is getting some respiratory treatment every 4 hours where they put a little vibrator on his chest and back to break up any congestion. Then he gets a dreaded suction. Its hard on him, but it is working very well. This morning's x-ray looked great.
Our major concern is that his oxygen saturations are still a bit low. They went down to the high 60s this morning. They think its caused by a couple of things - Bobby's breathing is a bit shallow because its painful for him to take deep breaths with a broken sternum and his lungs are still mad about the bypass surgery.
The doctor ordered a bolus of 40 ml of saline solution to be put through his artery. When I asked the nurse why she was doing this she said it was because Bobby was 'shunting'. When I asked what 'shunting' was, she responded with an answer that made me question whether she really understood what shunting was. Comforting. But he immediately relaxed after the saline went in. Apparently it fixed the 'shunting'. Later, she gave him a big dose of morphine to help him relax and he's floated off to la-la land.
Lest I complain too much about my nurses, I should say that we have had the Mary Poppins of nurses the last 2 nights. She largely took over the respiratory treatments last night, and that made a huge amount of difference in the junk that came up from his lungs. Chris has been a nurse over 20 years and the experience shows. Every time I woke up in the night she was standing over the crib, caring for him or just comforting him. I'm in awe of how she moved him around and how comfortable he is with her. With her help he sat up for a few minutes last night.
I helped her give Bobby a bath. It was wonderful to touch him. It's so hard to be close with all the wires about. Speaking of cleaning up the Bubs, we had a little scare yesterday when Valerie found a brownish-gray growth on Bobby's scrotum. The nurse didn't know what it was. The APN checked it out and identified it as just a bit of residual betadine from the surgery. False alarm. But it reminded me of when Bobby was first born and I asked the nurse about a little brown spot he had growing on his pee-pee. She was very kind not to laugh at me as she suggested it might be a little dab of poo.
For all this, the doctors are optimistic about his progress. If all goes well with the feeds we'll move towards having his chest tubes removed tomorrow or Monday. That is a very exciting time because we will then be able to hold him.
He's staying awake for longer and longer periods of time, showing off his bright blue eyes. He's obviously uncomfortable but is being very brave. Much much braver and more tolerant than I would be.
He had a xray yesterday that showed that his upper right lung wasn't working great. It hadn't collapsed like last time, but the air sacs weren't fully inflated. He is getting some respiratory treatment every 4 hours where they put a little vibrator on his chest and back to break up any congestion. Then he gets a dreaded suction. Its hard on him, but it is working very well. This morning's x-ray looked great.
Our major concern is that his oxygen saturations are still a bit low. They went down to the high 60s this morning. They think its caused by a couple of things - Bobby's breathing is a bit shallow because its painful for him to take deep breaths with a broken sternum and his lungs are still mad about the bypass surgery.
The doctor ordered a bolus of 40 ml of saline solution to be put through his artery. When I asked the nurse why she was doing this she said it was because Bobby was 'shunting'. When I asked what 'shunting' was, she responded with an answer that made me question whether she really understood what shunting was. Comforting. But he immediately relaxed after the saline went in. Apparently it fixed the 'shunting'. Later, she gave him a big dose of morphine to help him relax and he's floated off to la-la land.
Lest I complain too much about my nurses, I should say that we have had the Mary Poppins of nurses the last 2 nights. She largely took over the respiratory treatments last night, and that made a huge amount of difference in the junk that came up from his lungs. Chris has been a nurse over 20 years and the experience shows. Every time I woke up in the night she was standing over the crib, caring for him or just comforting him. I'm in awe of how she moved him around and how comfortable he is with her. With her help he sat up for a few minutes last night.
I helped her give Bobby a bath. It was wonderful to touch him. It's so hard to be close with all the wires about. Speaking of cleaning up the Bubs, we had a little scare yesterday when Valerie found a brownish-gray growth on Bobby's scrotum. The nurse didn't know what it was. The APN checked it out and identified it as just a bit of residual betadine from the surgery. False alarm. But it reminded me of when Bobby was first born and I asked the nurse about a little brown spot he had growing on his pee-pee. She was very kind not to laugh at me as she suggested it might be a little dab of poo.
For all this, the doctors are optimistic about his progress. If all goes well with the feeds we'll move towards having his chest tubes removed tomorrow or Monday. That is a very exciting time because we will then be able to hold him.
2/20/09
Better Afternoon
Things are progressing nicely. The breathing tube came out about 10 am and Bobby has been holding his own since then. He just opened his eyes for longer than a flutter for the first time since his surgery. Overall, he seems to be tolerating the tubes and stitches a lot more easily than last night. They have reduced his morphine a bit and he seems fine. The diuretic has helped his swelling.
He is still getting a lot of oxygen help. We'll probably spend tonight into tomorrow lowering that gradually. Once that's done, he can start eating.
And the nurse just said to us, 'all babies have a mohawk at that age'. I find that offensive. I defy you to show me a better mohawk on anyone of any age.
Back when we were nanny searching, we interviewed a woman who, a few days after the interview, sent us a note asking 'do you accept me as your nanny?' (We did not). After the nurse uttered those heretic words about Bubs, I felt like saying "I do not accept you as Bobby's nurse". Or at the very least, "I do not accept you as Bobby's coiffeuse".
He is still getting a lot of oxygen help. We'll probably spend tonight into tomorrow lowering that gradually. Once that's done, he can start eating.
And the nurse just said to us, 'all babies have a mohawk at that age'. I find that offensive. I defy you to show me a better mohawk on anyone of any age.
Back when we were nanny searching, we interviewed a woman who, a few days after the interview, sent us a note asking 'do you accept me as your nanny?' (We did not). After the nurse uttered those heretic words about Bubs, I felt like saying "I do not accept you as Bobby's nurse". Or at the very least, "I do not accept you as Bobby's coiffeuse".
Good Morning
We made it through the night OK. I woke up at 11pm to Bobby's breathing tube being suctioned for the first time. That is a pretty horrible sight. The poor little thing is screaming with discomfort but you can't hear him because the tube blocks out all sound. You have to go by his furrowed brows and red face to know when he's beginning to relax. All I can really do is stand by him and push the voluntary morphine hit every 8 minutes.
They are going to try to extubate him this morning. He is breathing over his ventilator with no problems. Right now his respiratory rate is 21 and only 6 of those breaths come courtesty of the ventilator. The main problem is that he is not maintaining his oxygen saturation. Along with the ventilator pushing air into his lungs, he's also breathing in air that is 45% oxygen. Normal room air is only 21%. With this extra help he's only at minimally acceptable oxygen saturation in his body. None of this is new - we went through it when he was born and when he had his last surgery. His lungs just need a few days of help to get back at peak efficiency. Once the breathing tube is removed they'll give him the oxygen cannula for a bit of extra help.
He started his diuretics this morning. That will help reduce the swelling. His poor little eyes are almost swollen shut this morning. They are covered in goo from all of his crying but we don't want to wipe thim off because even a light brush makes his eyelids swell more. Right now he is getting some extra blood to help his heart healing along. Its going to be a very sore - and when the tube is removed - very loud day for Bubs.
For our part, Valerie and I did manage to get some sleep last night. Bubs was very comfortable between suctions and he has a nurse all to himself so I was able to let her attend to him. Only one parent can stay in the room at night so Valerie ended up on a cot in the waiting room. She is happy to report minimal snoring on the part of her fellow sleepers.
They are going to try to extubate him this morning. He is breathing over his ventilator with no problems. Right now his respiratory rate is 21 and only 6 of those breaths come courtesty of the ventilator. The main problem is that he is not maintaining his oxygen saturation. Along with the ventilator pushing air into his lungs, he's also breathing in air that is 45% oxygen. Normal room air is only 21%. With this extra help he's only at minimally acceptable oxygen saturation in his body. None of this is new - we went through it when he was born and when he had his last surgery. His lungs just need a few days of help to get back at peak efficiency. Once the breathing tube is removed they'll give him the oxygen cannula for a bit of extra help.
He started his diuretics this morning. That will help reduce the swelling. His poor little eyes are almost swollen shut this morning. They are covered in goo from all of his crying but we don't want to wipe thim off because even a light brush makes his eyelids swell more. Right now he is getting some extra blood to help his heart healing along. Its going to be a very sore - and when the tube is removed - very loud day for Bubs.
For our part, Valerie and I did manage to get some sleep last night. Bubs was very comfortable between suctions and he has a nurse all to himself so I was able to let her attend to him. Only one parent can stay in the room at night so Valerie ended up on a cot in the waiting room. She is happy to report minimal snoring on the part of her fellow sleepers.
2/19/09
Pediatric Intensive Care
We're settled into our new home away from home. Bobby is doing OK. As we'd expect, he is in a lot of pain and is taking quite a bit of morphine. He has three tubes inserted into his chest to drain off excess blood and fluid.The nurses know from talking to older kids that the tubes are excruciatingly painful. They have to be shaken and wiggled every hour or so to keep the fluid draining. Bobby winces everytime it happens. We have to balance the comfort of the morphine against the benefit of getting him off the breathing tube. Morphine suppresses the respiratory system, so they can be more aggressive with the medication as long as the ventilator is doing the work of breathing for him. But, the air blowing in through the vent puts pressure on the heart and arteries that have already been through so much today.
Bobby is just starting to take a few breaths on his own over and above what the ventilator does for him. Right now, the vent is giving him 16 breaths a minute which is almost enough to keep his carbon dioxide levels at an acceptable level. The doctors will slowly lower the number of breaths he gets from the ventilator. Fewer breaths means the carbon dioxide will rise and Bobby's body should compensate by taking some supplemental breaths on its own. If he doesn't start breathing more, that will tell us that he's too sleepy to breath on his own. At that point, the doctors will decide either to keep him on the morphine and vent for the night, or lower the dose and wake him up some more.
He is a bruised little boy this evening. His face is swollen from the bypass surgery, but that will go down in a few days. He has a central line in his chest that they use to put in IV fluid and medicines. He has an IV in both wrists. He has those horrible chest tubes. He wakes up for a few seconds here and there, but I hope he's mostly oblivious to what's happening now.
In other news, Bobby's mohawk continues to proudly rise above it all.
Bobby is just starting to take a few breaths on his own over and above what the ventilator does for him. Right now, the vent is giving him 16 breaths a minute which is almost enough to keep his carbon dioxide levels at an acceptable level. The doctors will slowly lower the number of breaths he gets from the ventilator. Fewer breaths means the carbon dioxide will rise and Bobby's body should compensate by taking some supplemental breaths on its own. If he doesn't start breathing more, that will tell us that he's too sleepy to breath on his own. At that point, the doctors will decide either to keep him on the morphine and vent for the night, or lower the dose and wake him up some more.
He is a bruised little boy this evening. His face is swollen from the bypass surgery, but that will go down in a few days. He has a central line in his chest that they use to put in IV fluid and medicines. He has an IV in both wrists. He has those horrible chest tubes. He wakes up for a few seconds here and there, but I hope he's mostly oblivious to what's happening now.
In other news, Bobby's mohawk continues to proudly rise above it all.
The Surgeon
Dr. Backer just updated us. Bobby is off of the heart-lung machine and is all sewn up. The surgery went well.
He will be on a breathing tube for awhile - either getting off of it later today or tomorrow morning. They will keep him sleepy until that happens. Then, they'll slowly start taking him off of the pain medication, to his tolerance.
The scariest part is over. Now we wait to see what, if any, complications come up. We have been given a hospital stay estimate of 5 days to 2 weeks, which is indicative of how our Bubs likes to draw out these hospital stays.
We'll pass on an update later once we've seen him.
He will be on a breathing tube for awhile - either getting off of it later today or tomorrow morning. They will keep him sleepy until that happens. Then, they'll slowly start taking him off of the pain medication, to his tolerance.
The scariest part is over. Now we wait to see what, if any, complications come up. We have been given a hospital stay estimate of 5 days to 2 weeks, which is indicative of how our Bubs likes to draw out these hospital stays.
We'll pass on an update later once we've seen him.
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