September 8: Day +68

Heaveno! (see last night for explanation if you missed it)

Anyone have any dramamine? I am SEA SICK from the roller coaster ride we were on today!

Whew!

Okay, how to recount the day...

We started off with a pressure support trial at 8:30 am right after rounds. We did one yesterday and Bella did extremely well. This is when they have Bella initiate all her own breaths for an hour and see how she does. This morning, right as we were going on, she started to fall asleep (the best way I can explain), and I had to keep stimulating her to keep awake and alert enough to keep her breaths going faster than 15 per minute. We did wound care, physical therapy, singing, anything I could think of to keep her slightly agitated and in gear. Every time I took a break, within 10 seconds her breathing rate dropped below the minimum acceptable.

1 long hour later, we were done, and so was Bella. She was snoozing at this point. So much so that the nurse didn't even give her her scheduled sedation meds. Bella didn't need 'em; she was OUT! Problem was, she was so cozy, her breathing rate never really bounced back, and by 10:30, her blood pressure was in the toilet and her CVP (central venous pressure - basically measures volume in the vasculature) was a 4. She likes it to be 8-10. So, in went the fluids, down went the sedatives, up went the presser. Well, she really didn't respond to much, so Sam CRANKED up her phenylephrine, stopped her precedex completely, added vasopressin, all within about a 15 minute span. Well, about a half hour after that, WOOSH! It all hit.

I left to go to the restroom while the alarm was beeping for low blood pressure. When I returned, it was beeping for HIGH blood pressure. Seriously. It was like 60/40 when I left, and when I walked back in the room it was 110/80. Crazy, right? So, they cut the phenyl a bit, and added half the precedex back to the mix. Now her pressures are quite generous, but no one is really pulling off fluid or weaning back down on the pressers. So, if THIS amount is okay, why haven't we been rocking this level all week? We've been scraping along with barely acceptable pressures, and now we have head room to spare. Go figure.

Incidentally, I have a feeling we'll do at least one pressure support tomorrow. They wanted to do 3 today, but I had to draw the line. We pushed too hard too fast a month ago and look where it got us? Why push now when Bella has twice the atrophy and 3 kilos of water to lift up and down with every breath?

In addition to all this yo-yoing, yesterday, Sam postponed Bella's trach surgery till Tuesday. This morning, he said they would probably extubate her on Monday. Folks, those are two VERY different plans. See where I'm going with this roller coaster analogy? He said they would do it sooner except the weekend is coming, and they'd rather do it when everyone who is anyone is on at the same time (read: weekdays).

So... I don't know what to call today, a win, a loss, a draw. I just hope tomorrow is a little less exciting. I'm beat. Gonna hit the sack now. Thanks for being here.

Bella was looking past me... at what, you ask?...

At her butterfly wings and balloon from Ali! (picture represents Bella's view; I took it next to her cheek to see what she sees...)

Breanna was nice enough to volunteer to get one of us together...