As neither of us were able to go in to see the girls last night, I planned my morning around going in to see the girls if I was feeling well enough. I woke up and decided that I had just eaten something yesterday that I shouldn't have, so I went in to see the girls with the intention to go to work in the afternoon. Poor Jan felt she had to stay away again today... Being away from these girls seems to be having an even harder impact on her than it was for me, if such a thing is possible. She is just aching to be with them.
When I arrived, I discovered that Heather was not doing well... lots of apneas and bradycardias overnight. She came out of most of these spontaneously, but her alarms were sounding every 5-10 minutes and were troubling the nurse and the neonatologist. Eventually, they did some bloodwork and an x-ray on her abdomen. While all of this was going on, I decided that work would have to be a scratch today. I just could not imagine focusing on work while Heather was having such a struggle.
The neonatologist ordered her air flow turned up from 1L to 2L to add more stimulation for her breathing, and they adjusted her caffeine dosage as well. Heather's blood tests soon came back negative and the x-ray showed that she had a small obstruction of gas in her belly (Dr's theory: swallowed air). The neonatologist believed that this might be related to her apneas and bradycardias. They ordered her off "solid" (good old mom-2-0) feeds for a bit, until she clears this bit of gas. Hopefully, it will pass and she'll be back on solids soon, and she can resume her weight gain reign.
In the meantime, the nurses had to start an IV on Heather, but this has proven a notoriously difficult exercise over the past few weeks and, after a number of good tries, they abandoned the effort. They called in an expert from the Transport team, who had to come down from Foothills Hospital.
In the meantime, I went for a drink of water late in the day. Our spectacular nurse of the day, Stephanie, had departed for her dinner break while I was gone and I returned to the Fraser suite and no nurse was to be seen. This is not unusual: usually, when a nurse goes on break, she is covered by another and they give each other a brief report of what, if anything, might need attending to on their babies while they are away.
In any case, as I stood quietly observing Heather, she began to have a bradycardia. I waited to see if, as usual, she would come out of the bradycardia by herself; however, she appeared to be struggling to do so -- her numbers would not come back up. The monitor which normally sounds an alarm during these events kicked into a higher state of alarm and I looked out into the unit to see if a nurse was coming. I had just seen a nurse moving a couple and their baby from the closest station into the room adjacent to the girls', and I knew she was changing linens in the now vacant station. Normally, when an alarm sounds in the unit, the alarm also shows in the other monitors throughout the unit, so I was expecting one of the nurses to come see what was going on; however, and it seemed an eternity, nobody came. This was going on being the longest bradycardia I had/have ever witnessed and I could see Heather's oxygen saturation levels dipping, and staying, down. When the girls do not resolve these events on their own, the nurse usually reaches into the isolette, sits the girls up and, while holding their heads up (and airways open) with one hand, they rub their backs with the other and encourage them. There may be more to it than that, I don't know but, while I had the briefest impulse to do this, Heather is still on isolation and I was not gowned and gloved (and there were no gloves that would fit my hands close at hand); and besides, I was not sure I would do it right. I left the room to get help. I ushered the linen-changing nurse from the closest station into the room and she sat a by then pretty lifeless Heather up into a sitting position. At some point she also turned Heather's oxygen up full. I glanced up at the monitors and saw that Heather's oxygen saturation level was 36 (the lowest I have ever seen on any monitor, ever). Heather's heartrate and respiration recovered reasonably quickly, and her saturation level slowly crawled out of the basement.
It turns out that the linen-changing nurse had been covering for Stephanie and I guess she had not heard the alarm. It's not quite clear to me at this point why she wouldn't have been aware of the alarm. In any case, at that point the specialist from Foothills arrived to start Heather's IV, and I was overdue to leave and pick Jennifer up from daycare, so I left the unit... but by the time I got to the elevator I had a very uneasy feeling. It occurred to me: what if I hadn't been there? What if it happened again? I did an about face and marched back into the unit and asked to speak to the charge nurse.
When she appeared, I told her that I was upset and, explaining the events that had just transpired, I told her that I was afraid to leave. She reassured me that she would speak to the nurses and ensure that the monitors were appropriately adjusted. Expressing these concerns feels like such a tricky bit of business. We want to ensure that we advocate clearly and unequivocally for our daughters' best interests, but we also want the staff on our side and we don't want to antagonize them by being picky about inconsequential slips or mistakes. In the end, I felt that I just had to speak out: after all, what if I hadn't been there?
Anyways, after picking up Jennifer and bringing her home to a wonderful dinner prepared by Jan and her sister Cindy, I headed right back to the hospital to spend a little evening time with the girls and say good night. In speaking with nurses later, I was told that the oxygen desaturation that Heather experienced would not have any long-term impacts on Heather's well-being. I can tell you that it felt like an eternity, but I'm sure it was not as long as I felt it was. Also, despite the oxygen saturation level being quite low, Heather's colour did not appear (to me, at least) to change that dramatically, as I understand can quite often happen in these situations. She was pale, yes, but I could not visually sense her turning blue, which can certainly happen.
When I returned to the unit, Heather seemed tired, but alert and active. She tried to follow me -- or, at least, my voice -- with her eyes when I moved along the side of her isolette, squinting at the bright lights when I wasn't hovering over her. I got a reminder about overstimulation tonight, because I put my hand on Heather's back and she kept decompensating with shallow breaths and oxygen desaturation, but when I removed my hand from her isolette, she was much more stable. I must be more mindful to limit the stimulation!
It seems to me that my words with the charge nurse made a difference in how the nurses were approaching the girls. The tolerances on Heather's alarm settings had been changed. When her alarms sounded, I noticed other nurses drift by and glance in the door, making sure that the girls' nurse was present and aware of the alarm. At one point, the girls' nurse stepped out to get some milk for one of the girls and the alarm sounded just as Heather was (already) recovering from a very brief bradycardia. Another nurse came in sharply to ask if everything was okay. When I told her that it seemed to be, she cast an eye at the monitor before departing. When taken as a whole, the staff are dedicated and focussed, and I certainly appreciate their commitment and care for the girls.
Anyways, Heather had a pretty exhausting day and now she is coping with not only the chore of clearing this gas out of her system (one day I'll show her a few tricks in that regard), but recovering from the numerous pokes and prods she experienced during the day.
Her pops is pretty pooped too. Whether I head to work tomorrow, or not, will depend on how the girls -- and especially Heather -- do tonight. Cross your fingers folks...
I haven't really mentioned Emily and Caitlyn yet, mostly because they were thankfully pretty much stable all day. Caitlyn and Heather (who has, ironically, grown the most) have both exceeded their birth weights now, and Emily is catching up -- she is only a scant 10 grams away from meeting her birth weight, so she should exceed it by the time they weigh her tomorrow night. Emily came off her nasal prongs today, and she was tolerating that well, so that was a definite step forward.
You gotta love these girls!
Anyways, that's all the news that's fit to print at the moment, I think. Thanks again to everybody for their well wishes, generosity and patience!
Cheers,
Jer
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