Friday, April 1, 2011
A Snail in a Well
It's Jason. Though I will say that I want to keep this short, my students might say I have a hard time so doing. We'll see. Only three notes tonight:
1. Hotel: Thanks again, Lisa. Kristin hasn't left the hospital in almost three days. Somehow I convinced her (more likely, she simply decided) to leave and spend the night in the hotel room provided by our friend. A number of our friends and several of you have suggested that Kristin and I are somehow imbued with a preternatural strength of character to handle all of this. I believe that all of you would do the same. That's what people do. As Cristof claims in The Truman Show, "We accept the reality with which we are presented." You would handle it, too, if you had to. That said, there is something to be said about the stamina required to cope on a daily basis. I'm glad my wife is taking care of herself tonight.
2. AHS: Wow. We are speechless. Thank you for your generosity.
3. Q (a classic riddle): A snail is at the bottom of a well and wants to get out. He manages to crawl up the wall 3 feet each day, but at night he must rest (after all that work during the day ) and so he slips back down 2 feet, netting 1 foot per day. If the well is 30 feet deep, How many days will it take him to get out?
A: 28 days: Assume it does not slide back once it reaches the top.
The answer, of course, is not what is important here. What is important is the concept. Progress-regress. Progress-regress. Et cetera... Now, as far as our little snail goes, we have officially regressed. Wolfie's back on the sauce. Oxygenated air. He's also regressing with his feeds. We like to think of medicine as an exact science, some sort of alchemical algorithm that inevitably turns lead into gold. Unfortunately, that's just not true. For example:
Samuel needs food. He needs to keep his respiratory rate down. He needs to keep his "sats" (oxygen saturation levels) in a very specific range. Problem. To get food, he needs to eat, but eating tires him out, decreasing his sats and leading to tachypnea. So, we put breast milk through his NG tube right to his stomach. But his stomach is not used to processing food (which was given him via IV and a trans-pyloric tube). Guess what happens...he throws it up. Which makes him angry which makes him breathe faster and skews his oxygen saturations. Vicious cycle the last couple of days. The chemical adjustments (how to feed, breathe, and saturate in the correct ranges all at once) are proving more complicated than the mechanical adjustment (the Norwood surgery). Remarkable.
Can't wait for rounds with the alchemists in the morning. Here's my thought: if the snail's foot had better traction, it wouldn't backslide as much; therefore, it wouldn't take 28 days to climb out. So...add salt. Think about it: increased traction would keep it from falling back, right? But...how do you do that without shriveling the snail?! Tough little conundrum, eh doctors? If they can't solve it, it's looking more and more like we're simply going to have to wait the full 28 days. We've gotta figure out how to either quit sliding back down the well or how to simply wait. I'll steal from Matthew McConaughey from Dazed and Confused here: "Patience, darlin'. Patience." (that one's for you BSimp)