IMR: Entries: 2002: October: 08 — Tuesday, October 08, 2002

Intensive Care

Zac is doing okay. I could be doing better. I wasn't, I realize now, ever going to be prepared for this.

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It's a little before 5 a.m. on Tuesday morning, and I've got the Pediatric ICU waiting room — which usually serves as second home to all manner of colorful characters — all to myself. I think I've slept a total of three or four hours in the last 48 hours, but I can't remember. My brain is scrambled, and the makeshift notes I scribbled on the backs of a stack of business cards aren't all that helpful either. Still, I want to recall and record the details, even though part of me knows that there are some things I won't ever forget.

Last night, I didn't sleep at all. I just stared at the ceiling, listening to Zac breathe. And just as I was might have been drifting off, he started to stir. It was 5 a.m., and inside the six-hour window during which he could no longer be fed. So it wasn't long before he was fully awake, and plenty hungry.

Zac was upset, but Jen perhaps moreso. All she could say, over and over, was, "I just want to feed him already." Had she decided to, I think, there wouldn't have been a force in the universe that could have stopped her. But she resisted, and Zac cried and cried.

We calmed him somewhat with a warm bath, and tried to give him a bottle of water. Zac has never been a fan of bottles, so even though he only took a little water, the fact that he drank at all emphasized the fact that he was starving. We watched the clock, frustrated, knowing that it would be nearly four more hours before he was scheduled to go into surgery.

Katie soon woke up, thankfully more excited than confused that grandma was taking her to school that morning. She ate her breakfast, got her dose of "Schoolhouse Rock," packed her Oreo cookies and was practically scratching at the door to go — after all, her boyfriend Michael Curtis needed to get his cookies.

Both Jen and I, in voices tinged with anxiety, asked her to kiss Zac goodbye. She didn't detect our stress, fortunately, and skipped over to give him a peck on the cheek. She didn't look back as I led her downstairs to meet mom.

Then, it was time for Jen and I to bring Zac in. We loaded up and made our way through rush-hour traffic. Even with the unexpected delay, though, the drive was too short. For once I regretted the fact that we lived barely three blocks from the hospital.

We checked him in at the ER, where the triage nurse made sure he was healthy, then at admitting, where the clerk helpfully wrote out my parking pass to be valid for a week and a half. Soon enough, a man came by to take us down to the basement. The "SurgiCenter."

We were dropped off in a waiting room full of toys and shin-high tables and chairs. CNN was on TV, making noises about another suburban D.C. sniper shooting (a 13-year-old boy) and an upcoming live Space Shuttle launch. Zac whimpered as we took turns holding him. Soon, Jen's shoulder and my shoulder were wet where Zac had been gnawing.

A nurse came in to fill out some forms. "So," she said, sounding a bit like a Valley Girl in a 40-year-old Japanese woman's body, "What are you here for today?"

Since we'd spent much of the last week going to several different offices filling out several different forms authorizing the hospital to do what it was about to do, and since we were in the "SurgiCenter," and since I was a little stressed out, I had to supress the urge to growl at her. I thought about saying, "Well, we heard the roast beef here was to die for," though, and that helped.

We ended up answering her questions and finishing the form.

Now, we followed our instructions to the letter. When they said to be at the hospital two hours before his 9:30 a.m. surgical appointnment, we were there at 7:30 exactly. Unfortunately, the instructions were clearly designed to compensate for people who are chronically two hours late, and that meant we had a lot of waiting left to do in the waiting room.

I decided to read everything in the room — from maternity magazines to the instructions on a toy xylophone — and Jen snuck off to pump some breast milk. Soon, my mom arrived bearing breakfast, but because food is basically only allowed in the hospital cafeteria, that's where Jen and I, in shifts, went to eat.

Zac, fortunately, soon feel asleep, dressed as he was in some comfy cotton hospital clothes. Jen read a home-made baby food book she had borrowed from my mom's neighbors (whose 2-year-old son is already a good friend of Katie's), and I helped my mom brainstorm on a "Save Music Education in Hawaii" campaign she was working on.

Shortly after ten, the anesthesiologist, Dr. Alan Britten, came by. It was time.

Unlike the "SurgiCenter" nurse who'd spent the morning blinking blankly at us, Dr. Britten exuded competence and compassion. Zac woke up, and smiled at him. He explained everything, answered our questions, and gave us a few minutes before taking our son.

When he finally came for Zac, I felt a flash of panic, as did, I suspect, mom and Jen. We wouldn't ever be ready to let him go. But Dr. Britten soon scooped him up gently, turned, and walked down the hall. While Jen buried her head in my neck, I watched Zac as he watched me over Dr. Britten's shoulder as they turned the corner and disappeared.

It was to be a six hour procedure, although we were told many times that there would be no need to worry if it goes to eight hours or more. Either way we had a long day ahead of us.

Jen pumped some more milk, and to keep from going stir crazy, we both walked home to put it in the freezer then walked back. Jen read some more, mom and I conspired some more, until Nurse Ditzy came by and told us that we should be now in another waiting room down the hall. Not interested in giving her the satisfaction of making work for herself, we opted to spend the rest of the day in the hospital cafeteria.

We snacked, we rested, we smiled as families in a lamaze class wandered through. I bought a copy of the Star-Bulletin and looked for familiar bylines. Jen shared interesting facts she had learned about feeding carrots to babies. Mom and I redied our opening salvo toward the Board of Education. We ate lunch, paying by the ounce.

Five and a half hours after we'd last seen Zac, Jen and I finally headed down to the correct waiting room while mom left to pick up Todd from work.

Just as we walked in, Dr. James Penoff, one of Zac's surgeons, was walking out. He was just looking for us. We desperately hung on his every word, as he told us that things well, that they'd done most of what they planned to do (but couldn't entirely rule out another procedure in a few months), and told us that Dr. Michon Morita, the lead neurosurgeon, was "finishing things up" and would be by with the official report in half an hour.

Those thirty minutes felt much longer than the six hours we'd just endured.

Finally Dr. Morita arrived. He explained what was done, how things were closed up, and how Zac was bandaged. He also told us that Zac suffered more blood loss during the surgery than usual, requiring a full unit of blood and a little extra post-op care. He answered what few questions we could muster, then directed us upstairs to the Pediatric Intensive Care Unit (PICU).

The PICU waiting room was full of families and rough-housing kids, so Jen and I just stood in the long hallway. We weren't sure when we would be called in to see Zac, or if he'd even arrived yet. Restless, Jen grabbed my cel phone and headed outside to call her parents.

A few minutes after she came back, we heard an elevator open at the end of the hall, and saw a medical team wheeling a long bed toward us. Some of the staffers were pushing separate monitors and IV stands alongside it.

"Is that..." I asked.

"No," Jen said, visibly relieved to see what looked like a much longer, larger patient. "That's an older kid, not a baby."

But as they got closer, I recognized Dr. Britten, and he recognized us. "Here he is!" he called, proudly. "He's doing okay!"

Jen froze, then hid her face, afraid to look. But as they turned the corner into the ICU, she peeked, and saw what I did: a whole bunch of wires and hoses, a huge bundle of sheets and towels around a large, round, sphere of bandages, and an impossibly tiny nose peeking out between them.

Jen started crying. I was just in shock. It's one thing to study dozens of scary pictures of other people's children on the web, and something else entirely to see your own son wheeled past, his little body lost on a giant bed.

We were told to wait outside until Zac was all settled and someone came out to get us, but the person who told us that — a PICU nurse on her way home — also said that they sometimes forget, and that we might want to go in and ask if more than half an hour passed.

Half an hour later, Jen dared to go in to ask. "They said not yet," she said. An hour later she peeked in again, but the folks inside didn't look very receptive to questions. So we waited some more.

Finally I went in, and was again asked to wait a little longer. But as I turned to leave, I recognized the attending doctor, and he recognized me. It was Dr. Rodney Boychuk, the doctor who was in the ER the last time we brought Katie in.

"Hey, how are ya!" he said in his big, booming voice. "How's little Katie?"

He walked over, I thought to shake my hand, but instead he threw his arm around my shoulders and pulled me back into the room. "Can he have a look at his son, just for a minute?" he asked, loudly. "That's okay, isn't it?"

I was convinced the PICU staff now officially hated at me, but I was glad for the chance to see Zac. Dr. Boychuk led me to his bed, where a nurse was sorting through a tangle of tubes.

Zac was uncovered now, cathetered but diapered and lying on his back, his arms outstretched and tied down to the bed. He had monitors taped all over, two tubes going into a foot, one into an arm, two into his collarbone, one in each nostril, and a big respirator hose going down his throat. In addition to tape holding hoses in, his head was completely bandaged from his nose up — his eyes were covered, and the bandages were so thick he looked a little like a giant Q-Tip. His face was already swollen, his neck and chin essentially nonexistant, and he was bleeding a little through his nose.

"He looked okay," I told Jen when I went back outside, not sure what else to say. "But they're still not ready for anyone to be in there." I was barely sure I was ready to be in there.

We waited some more. The kids that were running around started grating on my nerves. One guy's unilateral decision to switch the TV from CNN to a show about motorcycles didn't help my mood either. Mom joined us, and tried to distract us with copies of neighbor-island newspapers. Jen and I dove into the Hawaii Tribune Herald, fantasizing aloud about being able to live in Hilo again someday.

Well over an hour passed, and soon it was almost time for Jen and mom to go pick up Katie from school. After that, we knew, someone would have to stay with Katie and thus not see Zac until the next day.

I swallowed hard and went back in, going straight to Dr. Boychuk. "We're going to have to leave soon to pick up Katie from school..."

"No, come on," he said. "Bring your wife in, I want you to be able to see your boy."

I went out to get Jen and mom. I frantically tried to think of something to say as they followed me back into the PICU. All I managed was, "There's Zac."

As we stood at his bedside, Jen grabbed my hand and nearly broke it.

It took a while before we noticed that we were surrounded. Altogether, there were perhaps eight people in Zac's bay, working and speaking quietly but urgently. Instinctively, I pulled mom and Jen back, and more people moved in.

Things got exciting very quickly. People tried to explain in bits and pieces, but of course concentrated mostly on Zac. His blood pressure, which had been low ever since the operation, had started dropping rapidly. Extensions and extra joints were being added to the mess of tubes on Zac's bed, and a blood transfusion was being readied.

"You two better get Katie now," I blurted out, not very subtly nudging Jen and mom toward the door. "Go ahead and go to Zippy's for dinner, I'll stay." And silently, they left.

Soon Dr. Boychuk and another man were pushing down hard on two separate syringes filled with blood, calling out orders and watching the monitors. How many CCs? Which line? Should we order another unit? Everyone in the PICU, it seemed, was involved.

And they were trying very hard to make it look like it was all routine, because I was still standing there.

The realization hit me so hard it hurt. The urgent, but ordered way people were moving around Zac's bed was distressing enough, but the harder they tried to look casual, the more I realized something was really wrong.

And I noticed that everyone kept glancing at me, wondering what I was wondering, or perhaps wondering if they should shoo me away, and I realized at the same instant that I was starting to shake, and that my presence at that moment was, at best, distracting everyone from their jobs. I lowered my head and walked out, walked down the hall to the foyer by the freight elevator, and finally started to cry.

Perhaps some things you just can't be prepared for, no matter how much you read, no matter what else you do. Like becoming a parent, maybe nothing really counts until it finally happens. Even though I thought I was readying myself for this day for over three months, all of a sudden I felt as if nothing was real until that moment, that minute, at the end of the hall.

Feeling weak, I took the elevator down a floor to the cafeteria, suddenly craving something sweet. I sat down, inhaled a Coke, took a few deep breaths, and headed back up to the PICU, not sure what I'd find.

Zac, fortunately, had been stabilized, and his blood pressure was still rising even as I walked up to his bed. "He's okay," Dr. Boychuk called from across the room, where he was meeting with the attending PICU doctor for the night shift. A handful of staff members came by to pat me on the back and make reassuring noises.

"That's probably about as rough as it's going to get," one said. "So I hear you had a pretty big start to your evening," said another. A couple of people, though only to each other and not to me, referred to the incident as a "crash." And I learned later that the "crash" was Zac's blood pressure falling within minutes to 40/18 (whereas 100/40 might be normal).

But he was okay.

At 8 p.m., Dr. Boychuk handed things off to Dr. Paula Vanderford, a tall, very European looking blonde. I also met Zac's nurse for the night, Christine Johnston, who was assigned to him alone. The PICU resident, from UH, was Reid Hamamoto, who looked right out of central casting. One at a time they came over to introduce themselves, explain things a little, and answer questions.

Christine took the time to spell out everything Zac was getting. The basic dextrose/saline solution, an antibiotic (Ansef?), Zantac (for his empty stomach), morphene (for pain), Versed (a sedative), calcium and vitamin K. He was also still getting "blood product": separated platelets and plasma.

Soon Jen came back, explaining that mom was watching Katie at our apartment. I filled her in on Zac, and she reported on Katie (who was, understandably, being very grumpy). Then we just stood silently by Zac's bed for a while. Jen, as a nurse suggested, tried at one point to talk to Zac, but she couldn't keep from choking up.

I turned on the TV over the bed, and tuned to the Oceanic Cable program guide for the background music. They were playing contemporary country music, and I imagined that it was soothing to both mother and son.

Eventually, Jen went home to be with Katie. And it was just me and Zac.

Children are magical in so many ways, and even though Zac was about as still as any creature could be, I could stare at him for an hour at a time. His lips would suck slightly, like they do in his sleep, and his little cold hand would still instinctively grip your finger if you pressed it into his palm. It was great to see something, however little, of Zac in there somewhere.

A ventilator was breathing for him, but he would fight it once in a while, which was good. They tested his blood every couple of hours, concerned about a couple of low numbers and somewhat slow clotting, and they would give him a little extra painkiller or sedative if he got too active or distressed. The mission, I soon observed, was a delicate balancing act, almost a sort of dance, to keep Zac comfortable (with painkillers and sedatives) yet also encourage him to move a little, keep his heart rate and blood pressure up, and breathe more on his own.

I watched the displays until my eyes dried out. Like every parent, I'm sure, I was soon able to just glance over and process the numbers automatically. Heartbeat at 130, blood pressure settling down to 90/40, breathing holding even at 30, and blood oxygen holding at 100.

Trying to stay awake, I chatted with Christine. She said she was "from all over the Northeast," but grew up mostly in New Jersey. It turned out she was a traveling ICU nurse, a "traveler" (but not anything like an "Irish traveler"). She explained that given the nationwide nursing shortage, an industry has developed to fill positions nationwide, such as for staff maternity leave and vacations. A nurse can put in for a temporary assignment in any city she likes, and usually cycle through two out of any three on her preference list.

Obviously, Hawaii is in demand and harder to get, but Christine had been dispatched here once before, and that apparently gave her an advantage in coming back.

She and her colleagues work three 12-hour shifts a week, with four days off. She noted that with the right scheduling, she could bunch her work days together to make for an eight-day break. She also explained some of the clear advantages little patience have over grown-up ones.

Eventually, I started to fade, and figured I'd try to sleep sitting up in the uncomfortable vinyl seats in the waiting room. But Christine said there was a slight chance that they might have someplace better.

It turned out that the PICU has a "sleeping room" tucked away on the second floor. Of course, it is in high demand every night, and is often sought out by other hospital departments. And even when it's available to the parents of PICU patients, priority is given to visitors from the neighbor island, or from faraway neighborhoods.

Seeing as how I lived just down the street, I didn't have high hopes.

But just as I was about to pass out, Christine told me they'd gotten the room for me. The next thing I knew, I was in a small square room just big enough to fit aorund a small bed, with a private bathroom with a shower.

I figured I'd just rest my eyes a bit, or at most take a short nap, so I skipped the shower and just spread out on the bed, shoes on, clothes on, and leaving the lights on.

I ended up sleeping more than three hours. A deep, dreamless sleep that felt like a blink of an eye.

I emerged, a little flustered, at 3:30 a.m., and went back down to the PICU. Zac was fine. He even had a bowel movement, which was good news, signaling the return of stomach function. He was now getting "food" (in the liquid form of Pedialyte), and Christine said he might be able to get breast milk (albeit through a tube) before too long.

Dr. Vanderford explained Zac will remain on the respirator for a little while longer than expected, and thus will be kept sedated (since no one, including babies, really enjoys having a tube stuck down his throat). Therefore, she said, he could stay in the PICU for another three or four days before getting moved out "on the floor" for at least another two. He'd have to be eating and acting normally before getting the go-ahead from the surgeons to go home.

So that was the last 24 hours. Who knows how many more to go.

In a couple of hours, Jen will take Katie to school, then come down to the hospital (and maybe join me for breakfast). Then, while she stays with Zac, I'm going to go home and shower and sleep a little more, and hopefully return in the afternoon.

I think we can work out a decent day/night shift system, minimizing disruption to Katie's routine while also ensuring that Zac always has someone nearby. The girls can pretty much live on a normal schedule, but I'll flip things upside down and start my day with dinner.

We'll get through this. But, as Jen said maybe twenty times today, "I can't wait until we're a family again."


Ryan & Jen & family: Best wishes for Zac's speedy recovery. Hang in there! xox
Claire (October 9, 2002 1:39 PM)

What an experience. All of you are in my thoughts and prayers.
kane (October 9, 2002 2:54 PM)

Best wishes for you & yours, Ryan.
SuiJuris (October 9, 2002 3:59 PM)

I'm off to buy more candles. Thinking of you guys. Big love. Big big love.
Jolene (October 9, 2002 4:21 PM)

Hang in there, Ryan. You and Jen and Katie and little Zac are all in my prayers.
Mary Ellen (October 9, 2002 5:37 PM)

Sending warm fuzzies your way.
Samantha Ling (October 9, 2002 5:42 PM)

Take care of yourself & the family, my prayers are with you!
Donna (October 9, 2002 7:25 PM)

Plenty aloha from here, folks. Trust the docs and nurses.
Linkmeister (October 9, 2002 9:51 PM)

Ryan, this has been one heck of a roller-coaster ride. I'm glad that things are stabilizing for Zac, but I'll keep praying for you and your family. Take good care of yourself and hugs for everyone.
Stella (October 9, 2002 10:13 PM)

I can't think of a thing to say. Oh, yes I can... Ryan: Stay calm, do what you need to. Jen: You've been the best mama so far; you'll always be the best mama I can think of. Zac: Pull, baby! Pull! Katie: Understand. Things happen. Love, -N&J
Lusus Naturae (October 9, 2002 10:23 PM)

I wish Zac and your family the best during this most trying of times.
mel (October 9, 2002 10:37 PM)

Reading all of that makes me want to share this. I have CMV-negative blood, a rare but important blood type, and every so often the blood bank gives me a call when their supply runs critically low. I just gave blood last Monday. The main thing that CMV-neg blood is used for is for procedures involving infants. Makes me really glad that I gave when I did. I'd like to think that, maybe, my pint may be coursing through Zac's veins right now. But I'm sure that my thoughts and best wishes are with you all right now. God bless.
Keith (October 9, 2002 10:51 PM)

OMG! So glad to hear about the great but guarded condition of little Zac! :)) <-that's a double smile
Cheyne (October 10, 2002 12:58 AM)

Aloha to you, Jen, and family, with lotsa warm thoughts and prayers for Zac.
mark (October 10, 2002 11:56 AM)

our 5 mt old son needs surgery asap for fluid in his head. do you recommend dr morita or dr donovan? very urgent, need to make a decision today asap. praying for guidance and then read your diary obout your son's surgery and thought I'd write for advice. I am so nervous about surgery for my precious baby. he is a twin and our first children. already been in the hospital twice. please write back or call 383-8630. thank you and god bless. Sharolyn.
sharolyn (March 1, 2007 11:02 AM)

E kala mai! Comments have been disabled due to overwhelming abuse by spammers. Please click through to any of the video hosting services linked above to leave a public response, or feel free to send an e-mail. Mahalo!

© 1997-2008 Ryan Kawailani Ozawa · E-Mail: [ PGP ] · Created: 13 November 1997 · Last Modified: 14 January 2008