Josephine's surgery on Monday morning went exceptionally well. They got started on time, were able to get Josephine prepped and to sleep without issue, and performed the procedure almost exactly as expected: Dr. Forbess ligated the PDA and placed a 3.5 mm shunt between the carotid artery and the pulmonary artery. (This was a slight deviation from the original plan, but it turned out it worked a little better with Josephine's anatomy.) They had her cleaned up and back in her room by around 12:30, and although it was extremely difficult for us to see her laid out in the bed with all manner of tubes and wires connected to her, we felt fortunate in that they were able to close her chest. (Sometimes the surgery requires the chest be left open for a few days. Yikes.) Her vitals, even immediately after surgery, were all really good. She didn't appear to be too swollen, was a fairly nice rosy color due to better-than-average oxygen saturation levels, and had a decent heart rate that didn't even require pacing. Our one disappointment was that she had to be placed on a breathing tube which went through her mouth instead of her nose. The next several hours were entirely uneventful. We celebrated that Josephine had made it through the procedure, blissfully unaware of what was to come in the night ahead.Around 5:00 p.m., the dinging began. Out of basically nowhere, Josephine's blood pressure started falling and a cascade of medical interventions were set into motion: calcium was administered, epinephrine and dopamine drips were started, and three rounds of packed red blood cells were infused. Because many of the treatments were designed to counteract each other, it was a delicate balancing act which danced back and forth over and over again. With every added intervention, a new series of alarms dinged and beeped, letting us know something was out of balance or needed attention. This went on well into the night. Needless to say, very little sleep was had by either of us.
Almost as suddenly as it all started, everything evened out and the alarms finally stopped. While I can never know for sure, I feel almost certain I know the reason for all of the drama. During the quiet time early Monday afternoon, a nurse made the mistake of calling Josephine "boring" - compared to most other heart patients, she had needed little care and required few interventions up to that point. I quickly corrected the nurse and said that Josephine was just an A+ baby, but Josephine had heard the slight and didn't take kindly to it. Our feisty little one then proceeded to show that nurse just how entertaining she could be. In the future, I imagine the medical staff will think twice before offering any blatant challenges like that to our Josephine. :p
Today went mostly well, in spite of another rather frustrating round of repeat interventions that took place in the afternoon. Josephine was briefly taken off of epinephrine, dopamine and the pacer, but was placed back on due to falling blood pressure. On some very positive notes, her foley catheter was removed, the paralytic was stopped, and she began to move and initiate breathing on her own. She even opened her eyes and wiggled her toes a little.
As we head to bed tonight, we know without a doubt we've got a long road ahead...but Josephine is definitely moving in the right direction. We're so proud of our little fighter!
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