03/12/2007

Okay, please forgive the short update this morning. I started work and realized I couldn't handle it. I needed to go to Iowa City and be there for rounds to find out what the game plan was for Emery. My boss allowed me to go. I got up there and Emery was resting very comfortably (on the vent). His last dose of steroids was discontinued as there was no need for it really. Dr. G felt that Emery needed to be on a jet ventilator because it was more gentle on the lungs since he felt Emery would be on the vent for another 3 to 4 weeks at least, maybe even more. He did say that he felt Emery had made 'definite progress' since the last extubation. The RT today said that Emery looked like crap the last time he was extubated and he got bad blood gases. Yesterday, he looked good and handled it well. His highest blood gas was a PCO2 of 66, which is actually what he averages anyway. He did good, but he just tuckered out. The hope is in a month or so he will have new lung tissue growth and more strength for respiratory muscles of breathing. The doctors all remain optomistic for Emery, and one doctor today said she really didn't think he was going to need a trach. Now, my thing is, I don't care if he gets a trach. Give him one now and send him home. Unfortunately, it doesn't work that way. Emery is pretty stable but he's not even ready for home ventilation. He still needs to grow even for that. I got to kangaroo him, though, and it's so wonderful I can't even expres it. He and I both slept through it, and I held him for nearly 2 hours. It could have been longer but I had to get up. Erik and I both were a little down today, but I feel a little better after being there for rounds. Emery really has made progress. Yesterday was so joyful and stressful I will never be able to express it. The staff yesterday so flipping amazing yesterday it was unreal. I believe I had said in an early post that Emery was nearly reintubated right away, but Dr. W gave him a chance. Emery was so angry and agitated that it took all of us to help calm him. Throughout the day, even though he was sedated with chloral hydrate and Ativan, he continued to wake periodically and cry immediatley upon awakening, almost in a startled manner. He held his sats fairly well, but again, I really don't think he could have handled much more off the vent than what he did. The chances of him making it off the vent yesterday slightly resembled the scene in Finding Nemo where Gill was trying to explain to everyone in the tank how Nemo would squeeze through the tube, clog the ventilation with a rock, the dentist would take them all out and put them in bags... you all remember that part? It was going to take so many things to gel and work together in order for Emery to make it that it was nearly an impossible hope. He had to stay off the vent, maintain good blood gases, and manage to get through his steroid rebound to make it to inhaled steroids and even then the swelling in his lungs would be there, but hopefully not as bad, and then there was the fact that he had to tolerate it every time he cried. It was just too much. Anyway, keep little man in your prayers and let's hope the next time he comes off and stays off. The 11 hours he had yesterday was more than double what he did the first time, and he did much better than the last. Hope all is well! Love Sarah, Erik and Emery