Not quite over the hurdle yet...

Tough day today.

I'm pulling blogger duty tonight because Jessica wasn't really feeling up to reliving today's events. Alexander is doing OK right now, sleeping the night away with the help of some strong sedatives, but he had a really rocky day. We are hoping for an uneventful night, but the past has taught us that those expectations might not be the most realistic.

Today's plan of attack was to have his pacemaker installed late morning, and hopefully resume weening him from the respirator starting in the late afternoon or into the evening. He was scheduled to be the second surgery of the day, with the surgical team estimating that he would go in around 11:00ish. The doctors anticipated no significant setbacks to his recovery, and with luck Jessica would be able to hold him for the first time on Friday - her birthday.

Come 12:30 they finally took him from his room, it seems that the morning surgery ran a bit late. During the delay, Jessica and I could only watch the nurses prep the equipment, and wait for the inevitable. It seemed to take forever. Once they finally came and gathered him up, we followed down the hall to the threshold of the OR, then kissed him on the forehead before he was wheeled inside. We left and met with our moms and my brother, who had all come to help support us and see Alexander post-surgery. We were given a 2 hour estimate and a pager, to notify us when he was safe and sound back in his room.

After about 3 hours, the surgeon found us in the waiting area and sat to talk with us. An earlier X-ray had caused some concerns that the PA band (the compressive band on his pulmonary artery installed last Thursday and readjusted on Sunday) may have slipped and caused some blockage to one of his lungs. The surgeons evaluated the position, and were content that it was where it was supposed to be. The pacemaker installation went as planned and they closed him up without any issues. He was being transported back to his room and we should be able to see him in about 45 minutes.

45 minutes passed, and we received no word from the CTICU staff. We decided to check in on him ourselves to get a status update. Once inside, we found that his room was abuzz with doctors, nurses, x-ray and ultrasound technicians, all working furiously around our pale little man. The bedside nurse quickly told us that Alexander's blood pressure and oxygen saturation had crashed during transport back from the OR. We were asked to wait in the waiting area so they could work. I managed a glance at his vitals, and they were not good. Oxygen saturation was in the low 50%s, meaning that the blood supplying oxygen to his body and brain had only 50% of the oxygen wold normally have. The alarms are set for around 65%, so he was way below where he should have been.

We went back to the waiting room to let everyone work without our interference. Another 45 minutes later (as if an eternity could last only 45 minutes), a pair of cardiologists came in to talk to us. Their evaluation was that, as a reaction to the stress of surgery, Alexander's pulmonary artery has a tendency to constrict a bit, which cuts down on the oxygen his lungs receive - hence the drop in oxygen saturation. This behavior is consistent with what they observed after his first surgery, so they felt that they could handle the situation. We were invited to rejoin him in his room.

Once in the room, we were given the rundown by the floor attending doctor. Basically, he was back on a strong dose of Dopamine, a small dose of Epinephrine (the two heart drugs we celebrate weening off of only one day prior), as well as full respirator support. With all of that, he was barely maintaining minimum oxygen saturations, frequently dipping into the mid-50% region. They were pumping him full of fluids to help boost his blood pressure encourage oxygenation. Respiratory therapists were constantly tweaking his breathing machine, suctioning his lungs and readjusting his breathing tubes. Nurses were still working nonstop to address him constantly, tweak drug dosings, and check vital signs. He was also put onto a painkiller drip, as he appeared to be regaining some form of consciousness under the regular administration of painkillers and having to endure some (hopefully only very little) of the pain and discomfort of the surgery.

Now we are back into the balancing game we played before. Little Alexander's heart is requiring a lot of support to prop it up. His oxygenation saturation dips frequently, and his blood pressure varies from too high, to too little. The doctors and nurses are trying to balance his fluid input, renal function, and medical dosings to give him the support that he needs without over doing it. Right now they do not have a lot of room to operate, as Alexander's stats are on the very edge of where they should be. Most of what they are doing is monitoring and reacting, as any small adjustment can cause his stats to jump from one extreme to the next. They are rechecking his blood and medication hourly, and hopefully he settles out sometime though the night, allowing them to get a manageable grasp on the situation.

Jessica and I are camping out in his room with him tonight, since the last two nights like this (post surgery and post sternum closure) were very rough. We are not out of the woods yet, but we hope that we are getting there. For now, I expect a long and sleepless night, listening to the beeping of the pumps and monitoring devices.

 - Wes