Zac hit a little speed bump this morning. But he's doing better than he looks.
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| Warm afternoon sunlight streams into the PICU. | One of two hefty patient record binders full of Zac facts. | |
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| Jen brings her parents up to speed on Zac's condition. | Zac's lungs kick in more, requiring less help from the respirator. |
Part of the problem, I'm sure, is that I shortchanged myself yesterday on sleep. When I went home Wednesday morning, I made the mistake of checking my e-mail at work, and spent a couple of hours catching up with things and forwarding the occasional crisis to my very overworked coworkers. So I didn't get to bed yesterday until about ten o'clock, and I only slept a little until Jen came home at noon to eat lunch with me.
When she headed back to the hospital, I slept a little more, but found myself wide awake before 3 p.m. So I headed back to the hospital as well, and found Jen standing by Zac's bedside, holding his hand and singing "You Are My Sunshine."
The day nurse was Launess again, and she helpfully reviewed the day's developments. As it turns out, they decided against giving him the blood they were planning to give when I left in the morning, as lab figures were showing everything either holding steady or dropping at a smaller rate than before. The hope was that we were seeing the early hint of a turnaround, and thus Zac was left to fight on his own.
Zac's ventilator rate was also dropped again, now to 14 breaths per minute. I was disappointed to see that he wasn't overbreathing much (like he was when it was set to 20), but Launess explained that he had stirred a bit so they sedated him again, obviously reducing the need for his lungs to seek out more oxygen than the machine was providing.
Dr. Rupert Chang then came by to give me the general overview. As I suspected, the main concerns were his blood work and his breathing (stealing a glance at his notes, I shuddered when I spotted the phrase "respiratory arrest"). He was apologetic when he said that they wouldn't be removing his bandages nor his ventilator today, adding, "Perhaps tomorrow."
Launess said earnestly that the third post-op day — which would be Thursday — is when kids usually turn the corner for the better. I was thankful to hear it, even though I suspect she'll be saying the same thing about the fourth day tomorrow.
She also spent some time prepping us for how things will look after the bandages are removed, talking extensively about bruises and colors and fluids. Jen, being strong, didn't turn pale at all.
Launess also noted the short-term effects the surgery and time in the ICU would have on Zac's weight and muscle strength. (I immediately remembered how Zac would stand on my chest as I held his fingers. I can't wait until he can hold himself up on those giant legs again.) And she mentioned that the effects of the anesthesia, although not outwardly visible, will probably linger and be detectable for about a year. Fortunately, she said, Zac's ordeal shouldn't affect his future develoment. "Kids get back on track fairly quickly," she said. "A year from now, it'll be as if nothing happened."
That afternoon, the nurses finally changed the tape holding the tubes in Zac's mouth and nose, offering a brief opportunity to see a little more of his face. It was swollen, and impossibly round, but still distinctly him.
Eventually, mom came, and she and Jen left to pick Katie up at school. I also left to pick up my own neglected prescription at Longs (discovering to my embarrassment that my checking account was and I guess is still overdrawn), and we all met at the Ala Moana food court for dinner together. Jen and I had Coco Ichibanya curry, while mom and Katie shared a big bowl of ramen. While still technically fast food, compared to the hospital food and McDonald's combos we'd been subsisting on, it tasted great.
While we were eating, Launess called from the PICU to ask me to bring more milk (Zac, wonderfully, had drank most of what we'd brought), but also said that Zac's blood numbers were dropping again and that they would be giving him more blood after all, later that night.
We said goodbye to mom, I dropped the girls off at home (picking up four more bags of mom juice), and I went back to the hospital.
I noticed immediately that they had changed the bandage on Zac's head, and Launess was very proud, although she was sad that I wasn't there to see him with them off, however briefly. She did say things underneath didn't look bad at all, not as bad as she was expecting and much better than the horror she was trying to prepare us for. There was a small bit of bruising around his eyes, but that was essentially the worst of it, his scalp looking good and his stitches clean.
With the new wrap, you could see a little of his eyes, puffy and sewn shut but still beautiful. Being able to see that extra half a centemeter of face improved my mood by a mile.
The new shift for the evening was getting settled. The PICU attending doctor was Dr. Alan Britten, the same charismatic guy that took Zac into the operating room and handled his anesthesia. Zac's nurse was Julie Brindley, a serious-looking blonde with her hair tied back and stylish but properly conservative glasses. She, like Zac's Monday night nurse Christine, was a traveler, originally from Houston and three weeks away from her next assignment, hopefully in Austin.
I was unsure about her at first. She gave Zac tylenol for a fever of 100.1, even though I remember Launess saying the doctor's order was to not give for anything below 101. Julie answered by explaining that temperatures taken externally (under Zac's arm with the same sort of digital thermometer we have at home) read lower than they actually are, which I knew. The thing was that everyone else went by the numbers given, and I figured the doctor would have accounted for the built-in discrepancy.
Also, when I started to lower the side of Zac's bed, I noticed too late that the strap restraining his left hand had been tied to it, instead of to the non-moving undercarriage of the bed. To keep myself from pulling Zac's hand off, I had to call for help from another nurse to untie the strap before I could let the rail all the way down.
As it turned out, though, the Tylenol seemed to help. And I later learned that Julie wasn't the one who tied Zac's strap to the rail. (I'll be nice and not say who did.)
Eventually, Zac got more blood.
As Zac slept, quite deeply, I indulged and watched "West Wing" and "Law & Order" and enjoyed the local political advertising a bit too much. Lingle's attack ads on Hirono are so mean, but yet so good! (And Hirono's attack ad already has a response, with three times the airtime.)
I also went over to chat with Dr. Britten, and complimented him on his G4 PowerBook. (Julie, too, was coveting it from afar.) When we realized our mutual affection for Macs, we immediately launched into the quintessential Mac conversation, trading our credentials by listing past machines. He was a veteran of veterans, starting off with a Mac Plus. He said, though, that he only became a true believer when he went to his university store to buy a Mac IIsi and found himself twenty-fourth on the waiting list. He now had not one, but two G4 Powerbooks. I resisted the urge to ask him for one of them.
He also said, with a degree of satisfaction, that Dr. Chang — on regular rotation as the PICU attending doctor — was also a Mac person. "I'm even more confident now that Zac's in good hands," I said.
He said that Zac was doing okay, and that they were hoping to have the ventilator out tomorrow.
We waited for the latest lab results, delayed until midnight, after the blood transfusion had finished. His clotting (PTT) was down to 35, and with "normal" defined as a range of 25-35, he was technically in the clear there. Unfortunately, his hemoglobin and hematocrit (H&H) were still low, and his platelets, although up to 113 from 96 the day before, weren't rising as fast as they were.
At around 2 a.m., I started to feel woozy, so I again checked into the Chalet Caravan for a couple of hours of sleep. When I returned to Zac's bedside at 5 a.m., things looked very different.
Apparently, shortly after I'd left, his head had started bleeding again. It was pretty sudden, and bright, causing quite a stir. But as soon as it started, it stopped. I could see blood had soaked nearly a third of the brand new, beautiful white dressing he'd just gotten, but the edge of the stain was still neatly bordered by the green line they'd drawn around it soon after it appeared.
And his 4 a.m. lab results showed that he had fallen back a bit. His H&H had gone down from the midnight reading, and everything else had stalled.
The doctor said his disappointing blood work figures, though, could be attributed to the mild blood loss he'd suffered. In fact, had he not lost any blood, the doctor said he was confident the test results would have shown the same slow but consistent improvement Zac's seen for a while now.
He also said the bleeding, because of it's sudden start and sudden stop, was probably just a blocked vessel finally opening up, or a pocket of blood that had collected under the pressure bandage and finally escaped.
It still didn't sound great, but again, against the much-feared "active bleed," it wasn't a disaster. And I'm sure glad his clotting times had just gotten to where they should be.
Heading into "Day Three." Let's hope Launess was right.
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