Monday afternoon

Monday night

3.16.06: hospital, take two

Once an entire week had passed after the onset of Mason's respiratory distress, we actually felt that we were in the clear and Avery was going to escape illness. Just as we were beginning to breathe a sigh of relief, the coughing started. Avery's nurse Barbara happened to be working with us on Saturday, the day he started having symptoms, and she noted the tightness in his chest which she could hear through her stethoscope. She increased the frequency of his breathing treatments, and we continued that routine overnight. However, Avery's breathing became even more labored overnight, his coughing was stronger and more frequent and he wasn't holding down food. I stayed up with him all night and Mary took over first thing in the morning. We both realized where this was going. Mary called the pediatrician on call at our office as soon as the sun came up and she started packing a bag. She took Avery in to see him right away, and he confirmed it was necessary to get him over to the place we know so well (but wish we didn't). Avery took an ambulance from Davis to Sacramento and he was admitted before noon on Sunday. (And here it is, Thursday night, before I'm finally able to post the news. It's been a fairly crazy week.)

Avery is getting a bit more attention than Mason had during his visit. He's in the Pediatric Intensive Care Unit (PICU) with a room of his own. Even though it's essentially the same exact thing that Mason suffered from (acute bronchiolitis triggered by an unidentified virus), Avery's lungs are just that much more fragile.

The doctors and the respiratory team did all they could in the first two days to prevent Avery from being intubated. He was on heliox (30% helium, 70% oxygen) through his nasal cannula while also receiving blow-by O2 through a mask that also delivered constant xopenex to help keep his airways open. He was also prescribed a round of steroids to give his lungs a big boost. He was fairly stable and resting Monday and it started to look like maybe he already hit bottom, so we were hopeful that he would get through this without the help of a ventilator. Instead, on Monday evening he took a bad turn and within the span of only a half hour, he went from stable to severely struggling to breathe. It became evident that the only option was to relieve him from the effort of breathing.

I can't explain how emotional it was to see him go back on that ventilator. When he said goodbye to it at 88 days old, we were all hoping it would be the last time we'd ever see it. Besides the ventilator, he has many other tubes and attachments. At the same time he was intubated, they did a procedure to insert a central line. This is basically an IV catheter that goes into a deep subclavial vein close to his heart. He also has an IV in his scalp, and they recently discontinued a urethral catheter. Of course, he still has his handy dandy pulse oximeter that we're very familiar with at home, as well as the 3 leads to monitor heartrate and respiratory rate. And finally, he has a nasal gastric feeding tube (aka NG tube) which he is currently consuming 720 mls per day of formula through.

There is so much I could write about the series of events and the progress since Avery was admitted on Sunday morning, but for now, I will keep the details brief.

Avery is healing with each day and able to gradually take on more of his own breathing while all of his stats and vitals are looking good. He's showing signs of wanting to be playful and active, which is great, but also challenging because we have to be careful that he doesn't pull out any tubes. He's successfully yanked out his NG tube a couple of times already. He's kept moderately sedated most of the time to keep him comfortable, resting and prevent him from struggling against the ventilator.

Weaning from the vent will probably take a few more days and we're hoping he is off of it by the beginning of next week. At that point, it will probably be another couple of days before he is discharged and the four of us are back home together again.

For now, we continue the Mommy tag-team routine, switching off between the hospital with Avery and home with Mason. We've been getting extra help from several people to make it all happen as smoothly as possible and to minimize the disruption to Mason's routine at home. We definitely don't want to bring him into the PICU and expose him to germs.

Avery will get through this! (and so will we!) I will do my best to post an update over the weekend.