Zac's improving, slowly, though needing more blood. I, meanwhile, am slowly getting the hang of this.
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| The nurses appreciate the ability to see the real Zac. | The much-watched respirator. Here Zac adds 10 breaths to its 20. | |
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| Lingering anemia prompts yet another blood transfusion. | The view of the PICU that Zac will see, hopefully soon. |
I didn't get the sleeping room last night, but I found a nap venue preferrable to these stiff padded chairs: I got over an hour of shut-eye in the back of my van, with no aches to complain about and only a barely-noticable imprint of a seat belt buckle on my cheek.
I think I'm too exhausted to recount the past day — or rather, night — with any coherent style. So I'm going to just do it chronologically.
Yesterday morning, at the last minute, I decided to surprise Jen by going home and helping by driving Katie to school and dropping Jen off at the hospital (tasks she was planning to do by bus). But, eager to see Zac again, she got the jump on me by about ten minutes, and I ended up instead on a wild Jen chase. I got to the apartment and could tell they just left. I got to Katie's school to find she had just been dropped off. And on my way back here to the hospital, I passed Jen's bus a mere block away.
By that point, I was so tired I honestly was afraid I'd fall asleep waiting to make the left turn on Punahou Street. For those 90 seconds, I turned the radio way up and made myself recite the alphabet.
I don't really know what I blubbered at Jen when we finally connected, but I finally returned home and crashed at about 8 a.m.
I woke up at about 1 p.m., and went back to the hospital. Mom was there with Jen. They brought me up to speed on the developments since sunrise.
Launess (pronounced, I think, "lah-neece," a phonetic inversion of sorts of "Lacene") was Zac's nurse, a sturdy short-haired blonde with a southern accent who was a permanent Kapi`olani staffer. She was actually there when Zac was first brought in, although I didn't get her name at the time. The attending was again Rupert Chang, and there was no resident on duty.
The news that made me the happiest was that Zac was now getting breast milk, albeit through a tube in his stomach. While I'm sure science has yet to catch up with me, I'm confident that it's a big help for Zac, and certainly a boost for Jen, too, allowing her to be more active in sustaining her son.
I went to talk to Zac, and noticed he had some bleeding through his bandage, a small spot seeping thorough on the top left of his head. Jen, and soon I, became pretty obsessed with it, measuring its size every ten minutes. Fortunately, it didn't seem to be growing at all, although why it developed was a mystery.
Dr. Morita stopped by to check on Zac. He agreed with Dr. Chang that Zac would need more blood product to help clotting and boost his low hemoglobin. Fortunately his blood pressure was good, at 100/44, and despite his "crash" on Monday they were no longer worried about it.
Figuring we'd just be in the way during the shift change at 7 p.m., we all went to get Katie and grabbed dinner at Zippy's. Katie was in a considerably better mood, and was reassuringly happy to see me. With me on the night shift at the hospital, I realized that I must seem about as absent from her life than Zac is.
Back at the hospital, I again acquainted myself with the night staff. Zac's nurse was a Jennifer Gardener (one of four Jennifers in total that work in the PICU in a given week), a long-haired blonde with sharp features who was also a Kapi`olani native. (I've now picked up the habit of asking every nurse whether they're permanent or traveling.) She was pleasant enough with a seemingly trained tendency to touch parents "comfortingly" whenever nearby.
Christine from the night before — so far my favorite nurse — was assigned to other beds but was still around, though, and as a result, I often went to her for help without thinking. The attending doctor for the night was Dr. Lane.
I noticed the spot on his bandage was larger, apparently growing a bit when he was rolled onto that side. Dr. Lane explained, not quite reassuringly, that at least it was not an "active bleed, but rather more of an ooze." I didn't know the difference, but I was glad for it.
Zac was slowly getting 100ccs of blood. Instinctively I went over to the hanging bag to make sure it was A-positive, even though I had seen first hand that the PICU has a NASA-like triple-check procedure to verify patients and blood types before beginning any transfusion.
They conducted another lab test at 10:45 p.m., but it still showed low numbers, so the doctor ordered another 100cc of blood transfused. In short, Zac finished the unit of they blood brought in. Fortunately his blood pressure was good, around 96/28, and they were checking it less and less often.
While this is not news, I will still note for the record that there is nothing on television between 1 and 4 a.m. I was unable to nap in the waiting room with a Samoan woman snoring nearby, so that's when I decided to check into the Chalet Caravan.
Another blood sample was tested at 4 a.m. this morning, and when the results came in, Dr. Lane took a moment to try and help me understand more of the specifics of blood. I'm still not sure I got it all, but what I thik he said was this: Zac's clotting time (PTT) was getting better, but was still very slow — it went down from 63 to 51 since Monday, but we want it at around 25. His hemoglobin and hematocrit (H&H) is also a top concern, coming in low at 27 when 33 would be better. His platelets, fortunately, were slowly climbing, now at 91 (though he'll have to be closer to 200 when he goes home).
They said he'd probably get even more blood this morning. I'm not looking forward to telling Jen.
Just a moment ago they reduced the respirator to 20 breaths per second, down from 30 a day prior. The hope is to lower it slowly, encouraging Zac's lungs to kick in to get what he needs. He was breathing a little on his own, maybe four independent breaths a minute, as many as ten if he is annoyed at something.
Basically all his vitals are looking great, except for his bloodwork and perhaps his breathing. With more mother's milk and more annoying one-sided conversations with his parents, though, he should keep improving.
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