Déjà Vu

Dad gets to write this post because he seems to be the one who gets to be at the hospital every time Averi decides to crash.  It was last Friday when Averi’s health took a nose dive and she was transferred down to the Pediatric ICU (PICU).  She quickly improved, was brought back up to the oncology floor, and had a relatively good week.  Friday rolls around and here we go again…

I showed up at Children’s after work.  Tiffany informed me that they had started her oral feeds again and she took 2 ounces really well.  Despite doing well with her feeding, Averi had been grumpy most of the day and she looked tired, so I did what any other father would do.  I took my little girl and held her tight.  Averi loves cuddling, but doing so with her daddy makes her feel even better.  Sorry Tiffany, Averi is a daddy’s girl. J

After Tiffany and Kaili left for the evening, I held Averi some more until she fell asleep.  I was planning on trying to feed her again in the evening, but she was too tired and didn’t want to sit up.  Averi hadn’t thrown up all week, so I wasn’t worried about her crashing due to severe dehydration like last week.  I just thought she was tired, so I let her sleep.

An hour or so later, she woke back up irritated and upset.  I held her again in the recliner and rocked her backed to sleep.  This time I just held her, hoping she would sleep better in her father’s arms than in a hospital bed.  I turned on the t.v. and to my enjoyment, the Texas Rangers were playing in Game 6 of the American League Championship Series for a chance to go to their first World Series ever.  Around the 4^th inning I quietly put Averi back in her bed.  She was so sound asleep, she didn’t move a muscle.  She needed the rest.

I watched the rest of the game in the room so I could keep an eye on Averi, trying desperately to keep quiet.  I’ll tell you, I must have looked stupid whisper-screaming (if there is such a word) while jumping up and down celebrating the Rangers victory over the hated Yankees.  Being from Texas, I grew up watching and cheering for the Rangers, and if you know anything about the team, there hadn’t been much to cheer for in the past.  But I stuck by my Rangers, and all that disappointment washed away with last night’s victory.

That rush of excitement, happiness and joy was short lived.

I was elated when I went to bed just after midnight – my Texas Rangers were going to the World Series and Averi was happily sound asleep.  Just after 2a.m. the nurse woke me up telling me that she had asked the doctor to come in and evaluate Averi as her vitals were a little off.  To be honest, I don’t remember the details much, but I eventually went back to sleep. 

About 3a.m. I was woken up again.  This time the doctor who had evaluated Averi earlier was hovering over me.  It kind of freaked me out.  I sat up and realized there were about 4-5 other people in the room and Averi was being held by the Respiratory Therapist.  What was going on?  The doctor informed me that he had called for the Assessment and Consultation Team (ACT) to come and reevaluate Averi as her temperature was over 103, her respiratory rate was over 60, her heart rate was over 200, and her blood pressure was a little high.  Déjà vu all over again – except her breathing and blood pressure were high this time.

Averi began coughing.  I jumped out of bed and called for a towel, “she’s going to throw up.  Quick, get a towel!”  I kid you not, two seconds after putting a towel over his shoulder Averi threw up all over the Respiratory Therapist.  Luckily most of it was caught by the towel.  We had to use suction to clear her airway as she was having a hard time breathing afterwards.  I took Averi in my arms and tried calming her down.  She felt warm.  When the PICU physicians showed up I had to lay her down so they could evaluate her.

Long story short, they decided she needed to come down to the PICU as soon as possible because she was in sepsis – again.  I do have to note that the response was much quicker this time and she was transferred almost immediately.  Because the nurse and physician on the oncology floor had been monitoring Averi closely that night, they had started her IV sooner, thus preventing her from going into shock this time.  I thank them for their vigilance and quick response.

(And you thought her concoction of meds was crazy last week... 

I don't think they could have fit more pumps onto that pole.)

When we got to the PICU they put Averi on a CPAP machine to blow air into her lungs as she was having difficulty breathing.  Her core temperature strangely enough had gone back down to 99 but her legs and arms were cold – the physicians were concerned about her blood circulation.  Then they proceeded to hook up a tri-port to each of the 2 broviac catheters and then connect them to various machines to give her numerous medications to fight off the infection and fluids for support.  All in all Averi received Cefepime, Tobramycin, Vancomycin, Fluconazole, Hydrocortisone, Epinephrine, Fentanyl, Versed, packed red blood cells, platelets, Potassium Chloride, Calcium Chloride, and Sodium Chloride this morning.

The physicians were worried that Averi was expending too much energy trying to breath (she was fighting the CPAP machine) instead of relaxing so her body could fight the infection in her blood stream.  They decided to sedate her and put in a breathing tube.

(Averi with her breathing tube.  Even in the PICU she looks cute.)

I felt so helpless watching them put a breathing tube in.  Averi’s body was limp as a rag doll.  Her heart rate dropped to below 40 due to a sensitive vagal nerve and her O2 saturation dropped to 80 before they could get the tube in so they had to pull back out and use an ambu bag to get her stats back up.  In round two, they got the breathing tube in and hooked her up to the machine.

Averi woke up a couple of hours later unaware of where she was and what was happening to her.  She was in restraints so she wouldn’t pull on the breathing tube.  Now that everything has slowed down, Averi seems to be doing better - of course I would be feeling better if they gave me some Versed too.  We’ll see how long they keep her in the PICU.  She is a fighter so hopefully she’ll be able to go back to her room on the Oncology floor sooner than later.