Post Glenn

I almost feel guilty about singling Manju out from all the rest of the nurses that have cared for Gabriel, they are all fantastic but Manju was the most perfect of the fantastics for Gabriel on that evening. A silver lining of this trip is getting to see many of the staff we became acquainted with a few months ago during Gabriel's Norwood procedure. It's been nice to see them and hear them exclaim with real joy about how big Gabriel is and how healthy he looks. I mentioned Manju's proficiency to one of the nurses who had looked after Gabriel for several nights in February, he remarked "Oh Manju is one of the best, when I can't figure something out I ask Manju." So maybe, I was justified in singling out one of the fantastics.  The next day Gabriel was doing much better and had slept through most of the night.

Gabriel was doing better but still getting hit with some serious pain killers every few hours. The nurses had created a kind of baby straight jacket and placed "no-no's" (splints) on his arms so he would not pull any of his lines out. If you've read many of the previous blogs Gabriel is a strong willed little guy that pulls whatever line he feels is uncomfortable (which is probably most of them).  The splints keep him from bending his arms and clawing at the cannula in his nose, the feeding tube in his nose or the lines which enter his abdomen and go straight to his heart.

 They did bring a pretty cool mobile that spun and had 4 different music settings; Bach, Mozart, Nature and Island. After some classical I flipped the switch to "Island" and disappointingly heard tropical birds  instead of the reggae I had hoped for.

A new nurse brought out mittens to replace the no-no's and baby blanket restraint system. I love the tropical themed mittens! 

 Still a bit of the restraint system as the mittens are not foolproof. Beth and I commute the 4 or so blocks and around the area on bicycles. After a couple of days I noticed her helmet and asked if drivers on the road had given her any extra consideration while she was riding. We both thought it a little too coincidental that the SPECIALIZED name would fail so perfectly inappropriately and determined Beth was probably collateral damage. On occasion I ride my bike to work at the Firehouse and must have grabbed Beth's helmet one day which one of my creative buddies couldn't resist manipulating.

The day after surgery Gabriel was urinary catheter and rectal thermometer free! The following day they removed the atrial line (IV) from his wrist, one of the IV's in his foot and his RA line.

 The RA line is an inter cardiac right atrial line (or for Gabriel's kind it could just be an A line as there is no right and left anymore), meaning an IV that goes through a hole in his belly and plugs directly into his heart. Accompanying the IV line are two pacing wires that also pierce his belly and attach to his heart. To remove the RA line the surgical fellow removed the dressing over the line and wires, clipped the suture that kept the line from moving and slowly extracted the line until it popped out of the small hole in Gabriel's belly. The CVICU was almost quiet while the Surgical Fellow was removing the RA line so I had a chance to chat with him and the Nurse. He is leaving LPCH after a 2 year pediatric cardiac surgical fellowship to become the junior attending surgeon in Portland. LPCH requires a 2 year adult cardiac surgical fellowship prior to the pediatric fellowship. All of this after he had completed a 5 1/2 year general surgical fellowship and because he completed medical school in India he only attended med. school for 5 1/2 years instead of 8 in the states. So 15 years of training just to begin his career! The sobering aspect of all this is that he was looking forward to leaving this area and moving somewhere more cost effective. This is not the first time we've heard a Dr comment on the high cost of everything in Palo Alto. The real estate market here is absurd, nice average bungalows sell for several million dollars. This is all generated by the Silicon Valley cash flow, the massive amounts of money dumped into the tech and dot coms and funneled to their engineers and share holders. The more I thought about it the more I thought how indicative this is of our values as a society. The Silicon Valley economy is really based on frivolous nothingness; Facebook is a means to chat, Google allows people to slightly more rapidly find what they're looking for by personally tailoring searches and advertising, Yahoo is similar, Wikipedia grants immediate somewhat reliable info. None of it is necessary or even significant. If serious research is required none of the above fits the bill, they are all just cursory sources, basically the virtual equivalent of the tabloid and gossip rack. This though is where our culture elects to dump massive quantities of our money and make multi-millionaires out of 20 somethings that can produce the next emoticon or virtual widget. The Doctors saving the lives of hundreds of children per year though (the cardiac case load alone runs 400-500 annually) can't afford to live in the same area. Don't get me wrong I'm not a curmudgeon begrudging a soft ware engineer's cute little piece of code. Maybe that yellow smiley face cheers up millions of people each day when they see it embedded in someones message. Beth and I also personally benefit from the connectivity and support which social media provides and appreciate staying in contact with all of our friends and family. I also love wikipedia and the cursory search engines which allow for rapid retrieval of almost anything and let me sneak nifty almost relevant tidbits and links into the blog. But... are they on par with saving a child's life?

 Gabriel had to be kept calm for the next hour allowing his heart to clot and not bleed excessively (at the point where the RA line had entered his heart). After that he was finally able to be placed in the best place possible, his Mother's arms. This made them both very happy.

 With the RA line removed and Gabriel doing well he was ready to move up to 3 West, the convalescent ward for cardiac kids. Gabriel missed the scenery outside the window as he vented his displeasure, probably thinking he was being wheeled to another traumatic occurrence.

 Finally in place in 3 west and double mittened he was able to take a nice long nap. While sleeping a   "Child Life Services" attendant poked her head in and asked if we needed anything. She returned with some toys, a mobile and a white noise machine.

After seeing the mittens on Gabriel though she told us she didn't really approve of either the mittens or no-no's and parents should be much better about  allowing their children to manipulate their fingers and that parents should interact with their children more, touching hands and allowing the child to explore. Beth and I listened with some level of incredulity as she chastised our parenting skills in a bubbly lilting  falsetto. A few descriptive terms filled my head which through a little self-control I kept to myself, little was needed as I felt little could be absorbed so I listened amused. As she clumsily connected the mobile to the hospital crib she grabbed the side rail and raised it briskly. The vertical lift bars objected loudly with a metal on metal screech (as they do on every crib we've encountered here). Gabriel's eyes shot open, immediately joined by an open mouth and a wailing cry. The digital zealot's eyes grew big and she stammered in shock "I'm so sorry, I didn't mean to..." Beth and I looked at her and didn't say anything and comforted our tactile neglected child; as the person who fit all the terms that had been buzzing through my head departed the room. 

Gabriel's next benchmark is removal of the chest tube. Last time he had two tubes, this time only one. The tube enters his chest cavity just below the rib cage and allows for drainage from the surgery. The tube can be removed when the 24 hour output of the tube does not exceed 2 cc's/kilo of body weight. For our chunky 6 kilo boy that magic number is 12 cc's or less. They monitor his drainage via a low tech fancy looking bucket.

 To date Gabriel has lost almost 120 cc's of blood and fluid, about 1/3 of a Coke (12oz. variety not the gargantuan gas station super guzzlers.) The talk is that possibly Friday (today) the tube could come out and along with it the pacing lines. After that the only thing left is for Gabriel to function well and receive a final chest x-ray and ECG. He is healing well and his pain is more manageable,  no morphine in the last 12 hours.  Less than 72 hours after open heart surgery and all he needs for pain is tylenol and motrine. Makes super whiners out of the rest of us!