Rebecca Continues to Challenge

I arrived at Rebecca's Pod this morning to find her getting an X-Ray. This was ordered to check the growth that they found on her ovary. She also was to get several blood cultures taken and a urine analysis. Soon after they finished her X-Ray at 9:15 she had to get her eye drops to dilate the eyes. The Ophthalmologist came around an hour later but one eye had not dilated so they gave her another drop and came back a little later. In this time her nurse and another nurse were working on setting up her IVs to be able to take her to get her MRI. They had redo the setup because they had to have 30' of tube because the pumps couldn't be in the MRI room. The eye doctor returned and he said she went from a zone 2 stage 1 in one and a zone 2 stage 2 in the other eye to both eyes being zone 2 stage 2. Still no big concern, but will check again next week. He explained the worst case scenario to me but I won't bother with that now. Her first field trip was down to the first floor to radiology at 1:00. She received a dose of sedation before she left her pod so she would be still during the MRI. Her nurse and I stayed in the room with her to watch her vitals and more importantly her O2 sats which usually fluctuate. She actually did surprisingly well through the whole thing which lasted about 40 minutes. When we got her back to her Pod and got her settled it was around 3:00 and I hadn't been to see Joanna yet.

When I got to see Joanna she had just finished assessment so I got to hold her for about 2 hours. While I was holding her they moved her isolette out and replaced it with an open top bed that has a warmer above it. She isn't needing the warmer but they didn't have a regular bed available. They also moved her down one spot because she got a next door neighbor that was just too close for comfort. They put her back in bed while I stepped out for shift change. While I was out I called Children's to find out about the results of the MRI. The doctor in RCNIC couldn't really tell me anything more than what we already knew. She wanted to let the surgery team look at it and discuss the plan tomorrow at rounds. After shift change I went back in and decided I might as well hold Joanna again since it is so easy now to get her out of her new bed. About 8:20 Children's called but I couldn't get it because I was holding her and you're not supposed to use your phones bedside. I figured they were just calling with some more information about the MRI. About 9:45 they called again. I was getting ready to leave anyway but now I knew something else was up because they wouldn't have called twice unless it was something significant. I put Joanna back in her bed and went to call them back. Her nurse explained what had just happened. Apparently, some time after I left there, she showed some respiratory issues. They pulled a blood gas and her CO2 was 130 which is extremely high. They also had a chest X-Ray and she had a lot of fluid on her lungs. They were going to give her sedation to help relax her so she wouldn't fight the ET tube. They also were going to give her lasix to get rid of fluid. I left UC and went to Children's. When I walked in there were about 6 people around her bed, again, not a comforting sight. Worst of all there was a big, ugly, loud machine called the oscillator chugging away beside her bed. We are very familiar with the oscillator since Joanna spent several days on it. The doctor met me and said the attending doctor that was on call decided this was the best for her. They had maxed out the normal ventilator settings and it was not correcting the lung issue. They are running all types of tests to check for infection again. Proactively, they are treating with antibiotics, again. Seems like I use again a lot. They did another blood gas and chest X-Ray about 30 minutes after being on the oscillator and her CO2 had dropped into the 70's which is still a little high but much better. Also, her chest X-ray showed improvement. Things seemed to be headed in a better direction when I left around 11:30 with the only issue being a low blood pressure which is a side effect of the oscillator and pulling off the fluid. They were going to talk to cardiology to see what they suggested if it continued to stay low or drop even further. I pray I don't get any calls tonight.

Now to clarify the heart procedure issue that came up yesterday. At rounds with Rebecca this morning I counted 18 people. There are usually 13-15 I would say. They went through their usual routine then cardiology got to explain the plan. They described a miscommunication on their part, with too many communicators not communicating. The whole explanation was about a 20 minute conversation but basically the plan has always been to do the procedure when she is around 2.5kg or 5.5lbs. More specifically, the plans is to wait as long as possible while at the same time trying to get her extubated. When she gets to the point where she is ready to be extubated they will do the procedure then. During this conversation, the senior cardiologist said he expected this to be late next week or the following week. That was until tonight's episode, which is sure to affect that schedule.