New Ideas

Today has been a busy day here at the hospital. (First let me thank Jennifer G., Mom, and Mickie for taking my kiddos today so that I could be here, you guys were lifersavers today!) A new Attending came on today and had lots of changes in store for us. At one point my jaw dropped with a few of his recommendations and thought, "Oh no here we go again". There was quite the discussion in rounds between R.T., pharmacy, the n.p. and him. I stood and listened and commented occasionally. Things got a little heated a few times. When a couple of his ideas were met with significant resisitance he sighed and said, "look everyone status quo is not helping this little one, we need to find new solutions." He made a good point, doing nothing is not getting Aaron better. After rounds he pulled me aside and said that any of these changes could put Aaron over the edge and we may not get him back and asked if I was comfortable with what he recommended. I told him I needed a few minutes to think and to talk to Ronny. We talked and decided to go forward. We feel that we would rather work towards making him better and possibly loose him in the process than to stand by and watch him continue to deteriorate. I returned to speak with the Dr. and told him to go forward but at any point I felt uncomfortable I would stop him. He agreed, so forward we are going.

His changes have included: tapping his abdomen (inserting a needle and drawing fluid out), taking him off the oscillating respirator and moving him to a jet today and hopefully by Friday a conventional respirator, upping his calorie and fluid intake, and stopping the dopamine. He feels that each of these will help him to start to flush fluid, the tap obviously to draw fluid off and then test it for infections, the change in repirators to allow his heart to fill better, and upping the calories so his body comes out of starvatioin mode. He also recommended that the antibiotics be stopped tomorrow pendinig normal levels from the abdominal fluid. (More to come on that topic!)

I was in the room for the tap (in my designated corner) and watched him draw multiple syringes of fluid off, 110 cc's approx. I watched Aaron's monitors closely and he did great through the procedure and then immediately high stated after, allowing his O2 needs to come down to 23. Just after the tap, Infectious Disease made their daily rounds. I spoke with the I.D. Attending and he recommended that Aaron have laproscopic abdominal exploration. He had called the surgeons and wanted them to come and evaluate immediately (he called the same surgeon Sam had). That made me extremely nervous! He examined Aaron again and just as he was finisihing our Attedning came in. The two of them started a conversation which was extremely interesting. They both had valid points for their point of view and I agreed with mostly everythinig each of them said. I really felt like they were both committed to helping Aaron and having the back and forth discussion was heartening to know that they were truly trying to figure out a solution together. In the end surgery was called for a consult but they agreed to hold off on anything until he is less edemedas. I was fine with that. They also discussed removal of the antibiotics as early as tomorrow night but want to wait and see how things go and see what the test results look like.

In the end Dr. Barnhart (Sam's surgeon) wasn't able to come as he was stuck doing another appendectomy (go figure) so one of his residents came. He did his thing and eventually came over and started to ask me questions about what had happened with Aaron. At one point he asked if I was a nurse, I laughed out loud and told him no but that I have learned a great deal in the last 3 months.

So as of right now Aaron's urine output has improved. Still not to where we want it but enough to start making a slight improvement. At this point he has lost 280 cc's of fluid from where he was tapped today, (its been a bit leaky to say the least!). The hole where the needle went in is still open as all the fluid is now trying to rush out. Unfortunately leaking too much fluid is a problem as we now need to watch his electrolyte levels. We would much rather have him pee the fluid off. His blood pressure is high so we need to keep that under control. We think its pain related so we are trying to find the right thing. He was changed from morphinie to a fentinol drip in hopes that will work better.

Its been a long day and will be another long night and there will most likely be several more long days ahead. Today though we are relieved these big changes have gone smoothly and are crossing our fingers and saying our prayers that they continue to do so.