Thursday, December 14, 2023

We Made it Through the Night

He made it through the night.

Even sorta stable-ish. 

If you've got medical trauma, please stop reading. It's not worth the PTSD. 

The room we were in until last night.


I guess I'm naive. I mean, it's the flu, the plague, influenza A. I remember reading something my grandma wrote one time describing how she felt when she had it: "I felt like I was going to die and was afraid I wouldn't."

Somehow I was hopeful that having gotten here relatively early in the process and on antivirals would mean that it would be fairly straightforward and not that big of a deal.

I was so, so, so wrong.

I'm not going to detail everything that went down last night. I actually can't. It happened so fast, but it was Ugly. Yes, with a capital U. 

Background: he's been on 100% FiO2 just to maintain his sats the whole time we've been here. That's not a great sign. We needed to (and should have been able to) wean his oxygen after the first couple days at least. His temps have trended down and have even been normal the majority of the time. But he became less interactive over the past two days.

His CBC showed his hematocrit and hemoglobin (and red blood cells and platelets) were trending down a bit. That happens when he gets sick and he needs (another) transfusion to keep enough box cars on the train to move his oxygen around. So yesterday before work, I signed a consent for blood. 

And then as I got back from work, everything went to hell in a hand basket. Really.

He started coughing and coughing and coughing. He also pooped, which didn't help his hemodynamics but probably helped his tummy.

But the sats dropped, and dropped some more. He had two pulse/ox probes on to monitor his pulmonary hypertension. For him, a typical split is somewhere between 5 and 10 points. We're not as concerned about the lower number because the upper number is the oxygen getting to the brain, heart and lungs. His digestive system, kidneys, etc do take a hit from the lower number, but not quite as critical. 

We saw upper sats into the 40's, and lower into the teens. Even when we got his upper sats into the upper 60's, his lowers stayed in the teens. His heart was in a lot of trouble. 

I honestly thought we might lose him.  

The team was amazing. They worked quickly. He was sedated, chest x-rayed (that was also ugly), pushed meds, sedated him heavily, put in an arterial line, turned nitric up, and moved us from overflow to the center of the unit. 

He didn't need paralytics. This morning the split between his two numbers is nine. Just nine. He's doing better. I'm taking my victories where I can find them.

And my dream of a quick easy path forward is well and truly gone. But he's still here, still breathing.

 And funny note, when he was tanking last night, spiraling down, he looked at the RT that took over bagging and smiled big at her, almost started laughing. My bug...

"Recovery is about progression, not perfection."

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