Saturday, August 7, 2010

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? :)


  1. comedy - you need a break! Your life is intense enough right now.

    still praying....

  2. I was going to say comedy but then thought about it. What would your wife want to see? Go the one Ang would enjoy the least. That way, if you get a chance, you can see the other one together.
    Now, I know they say there are no dumb questions. I am sure you explained it before. But when you say weight and its 10.5...back to what is was...what does that mean exactly?

  3. Jack and Molly's NanaAugust 7, 2010 at 8:04 PM

    Good answer on the movie debate, Sara.
    I'm so happy that you're comfortable and secure with the weekend staff. It surely must make all those scary changes a bit less stressful for you, so HOORAY!
    Hope your ladies enjoy the respite, and that you find some Tim Time this weekend, too.

  4. What an eventful day. I say you've had enough action for one day. Go to the comedy. I'm glad Bella is still improving. Good to know what's causing the high blood pressure so it can be fixed. Lots of prayers still going your way. Stay strong.

    Take care,
    Amber McLaughlin, CA

  5. Looking good Bella!
    Now for the pee pee dance.
    I'll check in when I get back to civilization Friday of next week.
    I hope you have a great week!

  6. Wow, seems like the staff has become much more efficient at handling Bella's care: 2 new lines and headgear, dressing and 2 circuit changes...all in one day! And no one got upset?? Great improvement over the last weeks. Yay! Still keeping all of you in my prayers. Seems like little Miss Bella just runs throught my mind in a constant prayer all the day long :) Did you pick a movie after all? I saw Inception Friday night, great flick, but requires a bit of attention. The comedy looks funny too...hope you had a chance to enjoy some "me time", no matter what you chose! Blessings to you, hope Ali and Ang have a wonderful weekend at the lake. And Bella, beautiful baby girl, will be well!

  7. She is so beautiful. I will continue to pray for her and your family.
    A Momma in TX