When I finally got to the hospital with Max, I couldn't find any parking that remotely close to the entrance. So begins the 200 yard walk with Max all the gear in tow. When I got inside, I was initially disoriented since the main entrance is on the second floor. The building is on a hill, so not every entrance is on the same floor. The main entrance is on the high side of the hill. It was 8:22am when I walked up to admissions desk #5 (the one to which we'd been assigned in advance). Two other sets of parents were in line ahead of me.
After filling out reams of paperwork, we're finally in the elevator on our way up to the sixth floor: Pediatric pre-op testing. Before the operation, Max needs to have blood work done - CBC (complete blood count) and LFT (liver function test). Due to the number of times Max has been "stuck" in the last few months, most phlebotomists have been drawing blood from a vein in Max' scalp. This is not uncommon for infants as the veins in their almost hairless scalps are near the surface, very visible, and blood supply to their head is strong. I mentioned this to the nurse who came in to draw blood, but she had never drawn blood from the scalp before and insisted on trying an arm stick. First, she put the rubber tourniquet on and immediately Max began screaming. The nurse was thumping the area in the crook of his elbow trying to get a vein to rise to no avail. Within 20-30 seconds large patches of petechiae began appearing on his arm from the tourniquet on down. After a few minutes, she gave up and tried the other arm with the same result. While Max was alternately screaming and holding his breath, petechiae also started to appear on his face and torso. Finally, she decided to call another nurse who had a reputation for being able to easily draw blood from infants with hard to find veins. I wish I knew about this person in the first place, or I would have insisted on her from the outset.
About this time his Mother arrived to provide both Max and I much needed emotional support. The phlebotomy ninja nurse came in and was able to get three vials within a couple of minutes and with only one stick. Whew! After another 45 minute wait it was time to go to the final pre-op area.
The operating rooms are in a separate building, so we had a 10 minute walk with Max' gurney. Once in the pre-op area, we're met by the anesthesiologist. We review basic information and and glad to hear that Max should be extubated almost immediately after surgery. One of the risks associated with having another surgery is that Max would need to be intubated, and might become "lazy" with his breathing and resist coming off the ventilator. While we were talking to the anesthesiologist, the lab results came back and Max had a platelet count of 166k! That's only about half of normal (250-400k)! This was great news considering he spent most of his life so far at 18-32k. Only the last few weeks has it begun to have any optimistic increases. However, based on the new petechiae that morning, the anesthesiologist cautioned that although the count was encouraging, the function of the platelets was still not normal. We signed an additional release (third of the day), to approve administration of blood products if necessary. This was no big deal since Max has already been the recipient of over 40 blood transfusions; platelets, FFP (fresh frozen plasma), you name it.
Soon the surgeon arrived and noted that there were no open beds in the PICU for post-op recovery. So far, we were only 45 min behind schedule. This would push the surgery back even more. Fortunately, it only took another half hour to open up a spot. It was time to kiss Max and go out to the waiting room.
This hospital has a new system that allows those waiting on a patient to follow progress of the surgery on a system of screens throughout the hospital similar to flight schedules in an airport. Each surgical patient is assigned a unique identifier (for privacy) and appears as an entry on the scrolling status screens. An icon next to the id indicates what phase of the operation is currently underway: a "scalpel" icon for surgery, "stitches" for closing, "bandage" for recovery, etc. Although it's minimal information, it's still reassuring to see things progressing.
We went to the hospital cafeteria to have lunch, and it's a good thing we didn't wait to eat since the surgery took over and hour and a half. Max was taken to PICU immediately after to be extubated and post-op observation. For whatever reason, we had to wait almost two hours before we could get in to see him. Finally, we were escorted into Max' room and we got to see his new G-tube for the first time. Here's a picture. Sorry for the quality, but it was taken by my cell phone with an unsteady hand.
The dressing on his navel is because Max had laparoscopic surgery (through his navel) to minimize scarring. So that's the tube that will provide most of Max' nutrition for the foreseeable future. Sorry for the delay for this post, but it took me that long to get all of this written.
No comments:
Post a Comment