August 7: Day +36

Like seeing Bella's face whenever possible...

It's Saturday, right? Doesn't feel like it.

Plan of the day: Ang heads up to the cabin to spend the weekend, daddy hangs with Bella then catches a double feature tonight of Dinner with Schmucks and Inception.

Got to rounds this morning at 8:15, only to find out rounds wouldn't happen till 10:15. From that point on, things have been NON STOP. We have a new Renal Attending doc this weekend. She asks if we can change her dialysis circuit today instead of tomorrow since there will only be one dialysis nurse in the entire hospital. We can do that. So, it's going to be a circuit and dressing change day. Things will be busy, but we'll be done by 3ish and I can be on my way.

The doc also says we need a new Hickman line, that the existing line isn't gonna cut it for dialysis much longer, and that we need to schedule it for next week sometime. So, in rounds we start discussing and arguing all sorts of things about Bella's plan, and that there is no guarantee that a new line will do anything better, but it won't be any worse. Then, while we are discussing a new Hickman, the nurse sticks her head out the door and asks the ICU fellow to come in the room. We keep discussing Bella's plans, and the fellow comes out and explains Bella's PIC line has just failed, and that she needs a new one immediately and is on the phone with surgery...

... 3 hours later, I am in the operating room prepping Bella with the surgery team for:

1. Removal and replacement of her Hickman line

2. Removal of her PIC line

3. Placement of a new central line in her femoral vein

... 4 hours later, I am back in our room doing back, neck, and head dressing changes, trying to get done by 7pm so Bella can go back on Prisma.

At 7:30, the new circuit has a problem and they have to take it down and start all over again.

It's now 8:30 and we are restarting another circuit. (A circuit is a filter and all the requisite tubing, blood, and fluid used by the dialysis machine. There are currently 6 staff in the room to manage this. There were 7 in here an hour ago.)

Aside from surgery, dressing changes, and two circuit changes, here's what's going on under the hood:

Weight: 10.5 (We are now at our admit weight, at long last, even though she still has fluid pooling in her head, neck, and shoulders)

I/O: -260 (Boy, that was a good run... too good as it turns out... keep reading)

WBC: 13.5 (climbing very nicely)

ANC: 10.3 (climbing nicely)

BILI: 1.7 (holding under 2.0 which means most likely that we've kept V.O.D. to a minimum.)

Everyone has been great to work with today, and Dr. Hess, her surgeon, was a rock star, as was her evening nurse, Renee. They both just went above and beyond what is expected. I feel safe when Bella is in their care.

Turns out we dried Bella out too much too fast. That's been the reason for her elevated heart rate. So, today, we've been letting her keep all the fluid we've given her and won't pull it back off. Her heart rate has been in the 170s/180s for over a day now, and that's just way too hard for her to be working. Good thing she has a strong heart. Hopefully, by tomorrow morning, the gain in fluid will help cool her heart rate down. On the positive side, her blood pressure has been way better today, which we are really happy about.

So, it is good to remember that we are not out of the woods, and that while things can change around here in a heart beat, there's a good team here, even on a Saturday. In the end, we have a new Hickman, which the dialysis nurse says works MUCH better, a triple lumen central line that gives nursing a third line for meds, a new dialysis circuit, and new head gear for Bella.

I might still catch a light movie before the night ends. With only time to catch one, the problem remains, comedy, or sci-fi action? :)