“hole” lotta love Part V: The PDA strikes back

I don’t even know where to start.
We slept in this morning (meaning we got up 8) and were in the process of leaving when the hospital called. It’s never a good thing when the hospital calls you. They never call to just check up. It’s never, “Hi, this is Emma Jane and Parker’s nurse. I just wanted to tell you how cute they look. They really love you. I can just tell from looking at them.” No, it’s never that. If they call you it’s always more like, “Hi this is Emma Jane and Parker’s nurse. Are you sitting down? Yeah…things suck. You should get here.”
Well, that’s not exactly how they said it. At about 8:30 this morning Emma Jane decided to “desat” and they had a lot of trouble getting her saturation levels back up. Turning up the oxygen on the high humidity wasn’t working so they put her back on the cpap. By the time we got there Emma Jane decided she was done with the whole breathing, on her own thing and started stopping…a lot. She had a bunch of “a’s and b’s” and just started having more and more trouble keeping saturated. It was decided pretty quickly that the problem was most likely PDA related, however there was some initial concern at how quickly things had changed.
Could there be some underlying problem which was making the PDA suddenly a bigger issue???!!!???
They checked her blood gas and did rule out infection pretty quickly. Her white blood cell count was great. What they did find was that her hemoglobin was a little low, so they decided to give her a blood transfusion. This was most likely just due to the daily taking of small amounts of blood for things like blood gases and the like. Mary Jane thought this was a good idea and that it would help with Emma Jane’s color, which was…very, very pale when we got there. I would have described it as “dusky.” I’ve never seen dusky before. I’ve heard the word used, read it a gazillion times, but never actually seen an example of “dusky.” However when I saw Emma Jane this morning I said to myself, “self…that must be what dusky looks like.” And I was wrong. I kept the thought to myself most of the day, but when I finally let the observation slip from my lips I was promptly shot down by Mary Jane and the fellow (Jagoo….I’m not sure how to spell Jagoo. It is a nickname short for Jagurti. She’s one of the main fellows we deal with, and it turns out from Parma. Small world) Jagoo did a good job of keeping a game face and not laughing at me, but Mary Jane felt free to laugh and mock. Turns out dusky is more of a bluish thing and would have been an extremely bad sign. This was just pale. But pale doesn’t do it justice. Think goth. It was like my little girl had decided to rebel and become a goth chick over night. Well the blood transfusion did the trick and brought pink back into those pale goth chick cheeks (as well as the arms, legs, torso, etc.) but it did not solve the problem.
As all this was going on Dr. Dawson began the process of getting us to surgery. This process fascinates me. The only thing I can think of to compare it to is the episode of School House Rock with the bill sitting on the steps of Congress talking about how he could become a law (You remember… “I’m just a bill”). The whole process is long and convoluted. In many ways the decision is made before you even start. Basically what happens is this:
-- The resident sends in the fellow
-- The Fellow sends in the attending
-- The Attending calls up to cardiology
-- Cardiology sends a fellow
-- The Cardiology fellow sends the Cardiology Attending
-- The Cardiology Attending sends the Cardiothoracic Surgeon
-- The Cardiothoracic Surgeon gives it the official thumbs up and then sends the
Anesthesiologist
-- The anesthesiologist comes in and says a bunch of stuff to you that you don’t understand.
-- They make you sign papers saying you understand all the risks…take away your child
leaving you feeling helpless
-- Hopefully they bring them back all better
That is the way the system is supposed to work. But if your wife just happens to be a Pediatric Cardiac Nurse who works in the Pediatric Cardiac Intensive Care Unit at the hospital your at, and happens to work with those fellows, attendings, and surgeons, and has recently graduated from her Nurse Practitioner program where she worked with some of these people in her clinical hours…if these things are the case then things work a little differently. In theory the above frame is happening but in the background:
-- Attending is waiting to talk to you when you show up. It is decided surgery is going to
happen. He goes off to make the above frame happen
-- Meanwhile wife calls upstairs and says…when is the attending coming down?
-- She doesn’t see him for a while so she goes upstairs, leaves a phone message for the
cardiothoracic surgeon to get once he gets out of his four hour surgery
-- The Charge Nurse in the CICU sends the attending down.
-- Someone says…it will happen after afternoon rounds.
-- You wait while the other steps happen around you anyway with everyone acknowledging
the final outcome.
-- Everyone who comes in from upstairs is partially doing it just to hug your wife
-- People ask your wife’s opinion
Generally it is a much speedier and less scary process. I wouldn’t recommend doing it any other way. So if you don’t have a wife who is a CICU nurse then I would recommend either:
a) get one, or
b) don’t have a child in need of a PDA ligation.
Surgery happened at 5:00 PM. The Lord saw fit to once again bless us with his mercy, things went quick and easily. Now begins the recovery process for Emma Jane. Some of you may remember how much fun it was for daddy when Parker went through that. At least this time I have an idea of what to expect, still, not my favorite thing.
Thank you for all of your prayers. I will blog more tomorrow and let you know how she is doing. I will also try and upload some more pictures.

Blessings.