Back to Square One

Josephine had a very rough morning.  When Michael and I arrived back at the hospital at 7:30 a.m., three to four nurses were in the middle of intervening for another drop in blood pressure.  Josephine looked a bit pale and was unmoving because of the paralytic (which they explained was given so that she could completely relax and they could do all of the work for her.)  A few of the stitches in the middle of her chest had come loose and were covered by a piece of gauze spotted with blood.  The right side of her abdomen where the chest tube had previously been removed was bruised and swollen. Needless to say, to see her this way was upsetting...particularly when she had been moving and responsive less than 12 hours prior.

As we waited for them to stabilize her, it became evident that things were not improving.  Pretty soon more nurses entered the room, followed by doctors.  Josephine was now surrounded on all sides, waiting for blood to be delivered from the hospital pharmacy to compensate for her low hemoglobin.  (The acceptable level, we later learned, is 14 - 15.  Josephine was at an 8.)  For the first time since Josephine's treatment began, the Attending Fellow turned to us and said she was "worried", her thoughts amended only a few minutes later to "very worried".  Soon after, Dr. Forbess entered the room.  He took a quick look at Josephine, glanced at her stats and decisively announced, "It's not what you think.  I'm going to fix this."  Michael and I were then escorted from the room as they prepared it and Josephine for emergency surgery.

So where do we stand now?  When Michael and I left the hospital this evening, Josephine was stable.  As it turns out, during one of the early morning blood pressure episodes the nurses began to suspect that Josephine's shunt had clotted - a catastrophic event.   To remedy this, a bolus of heparin had been administered.  The heparin thinned out Josephine's blood and caused some small undetected bleeds in her chest to bleed out of control.  As the blood filled her chest cavity, it compressed the shunt and surrounding arteries and veins, including those that supply blood to Josephine's lower body. Dr. Forbess absolutely made the right call.  By acting when he did, he was able to relieve the pressure in Josephine's chest, clear out the excess blood and suture the bleeds before supply to Josephine's head or gut were compromised.

While I'm so thankful that our sweet girl has been given a second chance, I'll admit that I am also disappointed - we're now back to square one.  Due to the high risk of further bleeding and swelling, Josephine's chest was left open after today's surgery.  She now has a 1 -1 1/2" tape-covered window that extends from just below clavicle level to just below sternum level.  She is back on the paralytic, totally dependent on the ventilator and all of the medications from which she had been weaned are back at full strength.  They've told us that her chest will likely be closed this weekend, after which they'll begin to deescalate treatments just as they did before: first by eliminating the paralytic and gradually lowering the dosage on the dopamine and epinephrine, and eventually, by removing the breathing tube.  But instead of moving to the step-down unit tomorrow, it will be at least another week (if not more) in the CICU.  All of this, of course, depends on how well Josephine's body reacts. 

Today was rough.  Tomorrow will certainly be better.  Please keep our Josephine in your thoughts and prayers.