Today's sign that we've been in the hospital too long: during this morning's rounds, a physician's assistant said to Kristin, "Wow, you really must have been here a long time to be able to ask those kinds of questions." My wife--the self-proclaimed doctor who is 6-for-6 in successfully diagnosing her friends' suspicious illnesses--actually blushed.
A friend of mine told me today that every time we skip posting for a day that her heart skips a beat. Generally missing a post means that either we were so exhausted we passed out early or we were up all night with the little guy. Apologies for making you worry. The last two nights, each portion of the prior statement rang respectively true. Wednesday night was blessedly silent. Kristin and I each passed out around 9:00 and slept through the night. It was awesome.
Of course, Thursday night if we split 5 hours combined, I'd be surprised. Remember the aspiration concern from the last post? Well, Thursday morning around 10:00 a.m. Samuel clearly got milk in his lungs while breast feeding. He started sputtering, his "sats" dropped to less than 40%, and his heart rate dipped to half its normal pace. We had to crank up his oxygen flow (doubling it!) to bring him back. For the rest of the day, he had a terrible, ashen hue. If split-pea soup were blue, that color would best describe his complexion. We spent the rest of the afternoon and evening watching and "chasing" his sats, which had become highly unstable, wavering between 50 and 98 (we want him to stay in the 75-85 range). By evening we thought he'd recovered. So when Anne and Jeff brought over fresh food (mmm...mandarin orange chicken salad and fresh fruit) for dinner, we happily ate and Sporcled the evening away. Here's Jeff with the the little bean. Look for the taller of the two in the Boston Marathon in a week or so. Good luck, Jeff!
But there was more excitement yet to come! You know those volunteer groups that bring animals into the hospital for the delight of their patients? Well, one volunteer showed up with a horse. Seriously! Look at that monster! If it weren't for her glitzy outfit, I'd swear that Great Dane was just sniffing us to find out who was the juiciest... The only reason we (really I mean "I": I'm perhaps a bit phobic regarding dogs, especially this sort of huge, man-eating type) let the behemoth in the room in the first place is that she shares the name Peyton with one of our kitties and our friend's, Cara's, daughter. That and she had her own business card. No joke. Check it out. Anyway, fortunately no one was mauled and we all went our separate ways in peace.
Now back to the other animal in the room: Wolfie. Just as Anne and Jeff were starting to leave, Samuel had another serious drop. Once we stabilized him again and shortly thereafter changed his diaper, the nurse noticed something red in his stool. Sure enough: blood. This time the doctors got involved. They suspended all feeding, ordered a CBC, a CRP, and a battery of other "ER"-sounding tests to determine if he had NEC or some sort of internal bleeding. Naturally, at just this moment, Sam's I.V. line blew, making it much more difficult to get the blood necessary for the tests (don't forget: it took 7 tries to get a viable vein for the I.V. the first time around). An hour later, they brought in a ringer who not only noticed a tiny scratch on Samuel's tushie (explaining the blood) but who also managed to get the requisite blood for the tests (which ended up being negative). Throughout the rest of the evening, Sam "de-satted" repeatedly, causing Kristin and me to gray prematurely. The only thing that seemed to help was to hold him upright and constantly burp him. Kristin and I took turns until somewhere between 4 and 6 a.m. when he finally stabilized indefinitely.
Fortunately, today Samuel had his "swallow study." Check out THIS VIDEO (crank down the volume first) showing what this kind of study looks like; it's pretty amazing, really. They bottle-fed Sam using a variety of thickened milk and bottle-nipple combos. Each time he swallowed, you could see where the fluid went and how. Sure enough: perhaps because of the paresis (not paralysis!) in his vocal cord, Sam aspirates just about every time he swallows. And what's more, Sam currently lacks either the awareness, the strength, or (sadly) the vocabulary to object like you or I would. We would cough, turn red, and complain about something "going down the wrong tube." Sam suffers in silence. These silent aspirations may be responsible for why he can't feed well. They also may be the root cause of his sporadic and uncontrolled saturation drops. When too much fluid builds up in his lungs, they just can't work properly, throwing off the whole synergy of the cardio-pulmonary system.
While this, frankly, sucks, at least we now have a sense of the root cause of his complications. Also, this may be treatable without resorting to more invasive measures such as inserting a G-tube. Silver lining? Check. Armed with this new knowledge, Kristin and I will remain not-so-quietly hopeful that the little guy will start to improve more quickly and that we will get to visit our little Peyton (and Roxie) soon. Good night, everybody.