IMR: Entries: 2002: October: 11 — Friday, October 11, 2002

The Brink

After a strong Thursday, Zac wavered a little overnight. But today could be a good day.

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The glowing heart rate monitor seems almost "E.T." inspired. Setting up a familiar sight for when Zac can finally see again.
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Staying awake in the Kapi`olani Medical Center cafeteria. My notes, making use of business cards I no longer need.
It's just after 6:30 in the morning on Friday, and the Kapi`olani cafeteria is pretty deserted. I just finished reading through almost every page of the Star-Bulletin as part of my daily 50-cent contribution to the Honolulu Newspaper War.

Yesterday morning, fortunately, did not begin with another wild Jen chase. This time I managed to connect with Jen and Katie at the apartment, and we drove Katie to school. Michael Curtis was there, waiting, to whisk Katie away before we could even say goodbye.

With our empty bank account nagging at me all night, I took a cash advance off a long-ignored credit card and planned to make an early morning deposit at our bank. But we found out that 8 a.m. is too early for bankers, and after visiting three branches (including one in a 24-hour supermarket) with no success, we gave up and just hit McDonald's for breakfast.

We got to the hospital shortly before 9 a.m., and met Zac's nurse for the day, Marci Tapusoa. Warm and patient, I learned that she was from here, but had worked at hospitals on the mainland for some time before coming back to the islands. Next week would be her one-year aniversary at Kapi`olani Medical Center.

Unfazed by the bleeding Zac had overnight, Jen was absolutely committed to making sure today was the day that Zac's conditioned turned around. She was especially affectionate and soothing to Zac, and before I went home to sleep, I joined her at the hospital chapel for some prayer.

(She might try to say I fell asleep in mid-prayer, but she'd be lying.)

I got a couple of hours of sleep before Jen came home for lunch. I talked her into some long-overdue cuddling instead. We stretched out and talked and laughed, mostly about how wonderful our kids were. Again, Jen kept saying, "I can't wait until we're a family again."

We emerged after noon and hit McDonald's for a nutritious lunch. We also made it to a bank and finally deposited some cash, although we were too chicken to check exactly how overdrawn we were. (Today, thankfully, is payday.)

When we got back to the hospital, I saw that Zac had a new bandage on his head. Jen happily told me that she had been there when Dr. Morita came by to replace the dressing, had seen all of Zac beneath it, and was very pleasantly surprised about how good everything looked. Marcy informed us that Zac's sodium level was low and that he was getting regular supplements, and also that Zac's morphene drip was reduced in the hopes of spurring a little more activity.

He was overbreathing fairly well, 23 with the ventilator set to 14. Marci said in the next day, they would be reducing Zac's IV-delivered nutritional supplements and increasing his direct milk intake.

I started flipping through Zac's binders, looking for the latest blood test results. But when I saw no one objected, I sat down and ended up reading through just about everything else.

Most illuminating were the transcribed doctor's notes collected, reviewing day by day Zac's condition, going over various diagnoses. I learned how to spell Versed (the sedative), Ancef (the antibiotic), and Cefazolin (another antibiotic). I found out that Zac received 250cc of blood during the operation, considerably more than I thought. And I learned that "coagulopathy" was the condition they were tracking as far as his clotting times were concerned. I was also impressed to note that the nurses recorded when parents were present.

Marci noted that Zac could use a bath, and Jen jumped at the chance. It was a special experience, despite a brief scare when some pulled tape on Zac's face opened up a small cut. It was stopped with a square of gauze, and for the rest of the evening it looked as if Zac had cut himself shaving.

Mom eventually joined us, and we took turns holding Zac's hand and stroking his arms and legs. It definitely seemed to boost his breathing and blood presure.

We also got a visit from Liching Chen, chaplain with the hospital ministry. I wondered for a moment if she'd tracked us down through the blessing book in the chapel, but I later realized she was just doing regular rounds around the hospital.

At 4:30 p.m., Zac's respirator was slowed down even more, to 10. Thankfully, as expected, Zac's lungs stepped in to make ends meet, and for the most part Zac and the respirator would take turns, netting a breathing rate of 18-22. The chances of having him off the respirator on Friday got just a little better.

One good sign? Marci suggested that Jen start putting her expressed milk in bottles (to which nipples could be attached) instead of IV bags.

When the time came to pick up Katie at school, for the first time Jen decided to stay at the hospital. So, mom and I set off to get her, and fortunately she wasn't all that crushed to not see her mother at the gate. At her request, we went to Zippy's for dinner. Then we went to the apartment to play a little while.

Finally, as bedtime neared, I went to bring Jen home, then returned to the hospital to start my shift. By that time, I knew I was in trouble, expecting to start a night shift despite spending most of the day shift awake and around town.

I acquainted myself with the evening PICU team. The attending doctor was one we hadn't seen before, Dr. Moore. The resident was Ms. Loui. And Zac's nurse was Loretta Estrada, who looked very local but was in fact a Michigan native on her first "traveling" assignment.

Zac was doing pretty well, breathing at 14 to 20 over the respirator still set at 10. (He got up to 33 when they suctioned out his throat, nose and mouth, a regular procedure that he doesn't like at all.) His morphene had been reduced even more, and he was definitely more active, wiggling his fingers and toes and sucking on his tube.

Unfortunately, at about 10:30 p.m., while I was enjoying an icy cold lemonade in the icy cold cafeteria, Loretta called me from upstairs to tell me that they ordered another transfusion. He was to get another 150cc of blood over four hours.

I ran over to study the numbers, from a sample taken at 10 p.m. Compared to the results from tests performed twelve hours earlier, things had worsened a bit. His hemoglobin fell from 8.4 to 7.6 (with 10 the lower limit of normal), his hematocrit fell from 24.2 to 22.5 (with 32 the lower limit). Fortunately, his platelets were still rising, from 112 to 114 (we'll want 212 eventually), and his clotting (PTT) was great, shortening from 37 to 28, smack dab in the middle of normal.

Things overnight were fairly slow, if not quiet: an older child was admitted a few beds down, protesting loudly in Japanese, requiring a nurse from a neighboring ward to come over to translate. With his arrival, there was only one bed left in the PICU, about two fewer than their technical maximum occupancy. Today would probably not be a good day for a school bus to get into a fender bender.

I waited eagerly for Zac's 4:00 a.m. lab results, which came in at about 5:30 a.m. And they were good.

With the transfusion, Zac's hemoglobin jumped to from 7.6 to 11.4 (comfortably inside the normal range), and his hematocrit rose from 22.5 to 32 (a big improvement, also now inside the normal range). His platelets (up from 114 to 160) continued their unbroken rise, although his clotting time got worse for the first time (stretching from 28 to 32).

Almost all of these figures could potentially be coming mostly from the blood he received overnight, so it's his next set of lab figures that will tell us how he's really doing.

Blood issues notwithstanding, it's conceivable that Zac will at least be extubated (taken off the respirator), or have his bandages partially or even entirely removed, or — just maybe — both. If we make those milestones, and Zac's H&H production finally ramps up, I'll dare to say he's finally turned the proverbial corner. The one I was hoping we'd reach yesterday.

I hope so. Otherwise, I'm going to need a new map.


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