Sunday, February 17, 2013
Up & Down Valentines
Yesterday Gabriel was moved from his semi-private room (one roommate) to "The Pod" (a large room in the CVICU filled with 7-8 infants recovering from cardiac surgery). Lots of activity and a ratio for most patients of 1 nurse to every 2 patients, so generally a place where patients are progressing forward or at least moving into a stable region.
They literally received boxes and boxes of valentines, gifts, balloons and candy.... thank-you all. We had a grand time adventuring and playing and received 8-10 hugs prior to leaving. The kids didn't want us to leave and we're all ready to hang out as a family but at least they're with my folks and close. Beth and I returned to the hospital to see Gabriel and meet our friends Rich and Kelli who were coming in from Boise. Rich and I met in our Fire Dept. recruit academy 18 years ago and work together at Firehouse 2 (along with our other friend Greg who also went though the same recruit academy with us). Kelli is a dancer and choreographer that I've collaborated with on several art projects. Needing to escape the cold of Idaho they flew out to San Jose to visit us and Gabriel and Kelli found a flamenco workshop to attend in Santa Cruz.
The nurses cut the adhesive tape into little hearts, evidently it is the CVICU trademark. Rich and Kelli made it to the hospital to meet Gabriel and hung out with him and us until he drifted off to sleep.
What firemen do on their off time.
Beth and I returned to our little apartment and prepared to crash, this had been a long day. About 15 minutes after we walked in the door the phone rang at 1130pm, the Dr from Eagle was on the other end, my heart sank and I could see fear in Beth's eyes when she realized the call's source. The Dr advised me Gabriel had pulled his RA line himself. He had wrapped the line around his foot and pulled the line out of his right atrium, mind you this line was coiled and taped to his stomach, entered through the skin of his abdominal cavity and then entered his heart. The Dr was thus necessitated to remove the line completely. Gabriel was clotting well, another round of FFP was administered and his chest tube drainage was looking ok. She also notified me of an echocardiogram which had been performed earlier this afternoon (while we were visiting the kids). This echo discovered the AV or tricuspid valve was leaking. She didn't believe it was a mechanical problem with the valve but rather caused by hydraulic complications (these words and explanations are my way of interpreting and explaining what she said). The primary problem was back pressure in the vasal system which was exerting enough force to overcome the AV valve and force it open, the heart doesn't pump hard enough (due to one ventricle and significant surgery) to overcome the back pressure. The body is not receiving enough blood and therefore the oxygenation level it wants so it tells the heart to pump harder, but it can't pump harder so it pumps faster. Kind of a self-defeating system which results in an elevated heart rate and blood pressure. So the Dr recommended an increase in catopril to lower his blood pressure. What a crazy pharmacological game these people play, less than a week ago they had extended his epinephrine by a day to elevate his blood pressure slightly to better perfuse kidneys to flush the additional fluids caused by surgery required to fix his heart. I hung up the phone and relayed the news to Beth. We were both devastated. A few hours ago everything had been as swell as Beaver and Wally Cleaver eating ice cream on a front porch swing. Beth cried. I felt bad for Gabriel, myself and Beth... I started to think about the timing though, why hadn't the Dr called us earlier? The echo was performed in the afternoon and the RA line was pulled several hours ago. I realized it was because she had time. If the issue had been a significant priority they would have called us while it was occurring, but she had waited to call until all the rest of her work was finished and she had time to sit, chart, review and make low priority calls. Another lesson in perspective; a huge issue to us was something they needed to simply keep an eye on. I explained this to Beth but she wasn't accepting my revelation so readily. She slept poorly and spent the next day at Gabriel's bedside. The next day was pretty uneventful.