I had no trouble with sleep Wednesday night. Most days are long, but in that never-ending sort of way. Wednesday seemed to fly and by the time I got a chance to sit-down, I was too exhausted to even begin to write. Yep, that’s right I was exhausted. The little babe ran me (and everyone else) ragged.
So our day started at 4am with the loss of the arterial line. During rounds, it was decided to replace the arterial line. He also needed his dressing change with the Shriner’s doctors and then he needed a bronchoscopy. His CT scan from the day before showed what was described as ‘ground-glass’ areas of haziness. In other words, there was stuff in his lungs that shouldn’t be there. So the ‘bronch’ is a flexible camera that goes down his breathing tube and can grab a sample to be tested. It can determine if there’s infection in the lungs that isn’t being detected in the blood.
I was tired just listening to what needed to be done over the course of the day.
So from 2pm until almost 8pm, we had a revolving door of people and activities. I liken it to a clown car full of doctors and nurses. We easily had 25 people in the room at one point and his room is not that big.
The Shriner’s doctors said his skin looked good, that we were doing a good job with the dressing.
The re-insertion of the arterial line didn’t go as well. In fact, the Attending, the Surgeon, the Surgical Fellow AND the ICU Fellow ALL tried and none of them could do it. They finally gave up around 6pm, so the Pulmonary doctors could come in and do the ‘bronch’.
The ‘bronch’ wasn’t pretty, either. The flexible camera has to go down the breathing tube – well it takes up about 80% of the tube, so he wasn’t getting very much oxygen while they did the procedure. They had to pull out several times, so that he could catch up. He had quite a bit of bloody secretions in his lungs. They’re not sure if it’s an infection or something else. The sample they took will help figure it all out.
David has been assigned 2 Chaperones during the day shift since they started these dressing changes, but usually only one at night. Last night they needed two. There was just so much that still needed to be done.
Needless to say, by 9:30pm I could no longer keep my eyes open. I crawled onto my little cot and passed out, exhausted. To be honest, I thought I would be able to write this on Thursday morning, before his dressing change.
He had other ideas.
So here I am at 11pm, Thursday night, trying to catch up on both days’ events. In essence, you get 2 posts for the price of one.
Fortunately, nothing catastrophic happened to wake us up early. No, he waited until mid-day to drop his heart-rate. We’re used to him being tachycardia (fast heart-rate) but brachycardia (slow heart-rate) is a new phenomenon.
Around 11:30am, the eye doctor came in to dilate his eyes. They needed to check his eyes for any evidence of the fat-loving fungus he has acquired. Right after he put the drops in his eyes, his heart-rate dropped. So the Fellow runs over, yelling for resuscitation drugs to be drawn up, the RT came in to draw the bedside blood gases, the nurse was drawing blood to send to the lab. He dipped below 60 beats per minute for about 5 minutes, then he slowly came back up on his own. They did not have to administer any drugs. But there was concern that he may have had a stroke or a brain bleed, so they ordered another head CT scan. They couldn’t go by his pupils because they had just dilated his eyes.
So the afternoon was almost identical to the previous day. They still needed to re-insert the arterial line, they needed to do his dressing change and now he had to have another head CT Scan.
Our days have become a cross between Bill Murray’s character in Ground Hog Day and a Three Stooges short. The daily doses of frying pans to the head are starting to wear me out.
2 Attending’s and a Fellow attempted to re-insert the arterial line today.
David said no. Access de-nied. It’s heartbreaking to watch them stick him over and over and over. But I agree that it needs to be placed. The arterial line gives us a constant blood pressure, heart-rate and it’s a better sample of blood for the blood gases the RT needs to run. So it’s a must have. The Surgeon’s will try again tomorrow. They may have to do a ‘cut-down,’ actually make an incision to visualize the artery. I feel another repeat of Tuesday coming on…
His skin continues to improve. We didn’t need to use the gel-sheet on the soles of his feet. The were all pink and pretty!! This is tremendous news – the soles of his feet were, by far, the worst affected area.
Go! Baby! Go!!
His CT scan also came back as normal. Round of applause, please!
They think he may have ‘vagaled’. When the eye doctor was mucking around in his eyes, he could have put pressure on the eye which, in turn, caused the drop in heart-rate. Sort of like the Vulcan death grip Dr. Spock used on Capt Kirk, only not quite as cool.
The fat-loving fungus started to show up at the same time the GVHD flared. We know the Adenovirus triggered the GVHD in the first place, so I wonder if this fungal infection triggered this episode.
Regardless of the reason why or how, I will continue to gather my scraps of hope. Like fabric scraps for a quilt, my hope is accumulating.