Friday, March 14, 2014

The Hail Mary Pass

Dear Ellie,

I hate football analogies, but a moment ago, you just threw a Hail Mary pass.  Remember how we wanted to get the endo-tracheal tube out?  Well, its gone now.  For one reason or another, it was in the improper place in your trachea, so it had to come out.  Immediately.  Unfortunately, you weren't anywhere near the recommended respirator levels for removal of the tube, but for reasons that are complicated to explain, they went ahead and removed it anyway.  

When they popped out the tracheal tube, it was horrifying to witness you without any respiratory support.  Seeing you gasp for air.  It was like watching you float through space without any oxygen in your spacesuit.  Your blood oxygen levels plummeted.  50 percent.  40.  30.  You started turning that dreaded blue color again.  The RT, nurses and doctors moved briskly.  There were a lot of hands over that isolette of yours.  They plugged in a CPAP to your nose and cranked your oxygen percentage up on the respiratory support to 97 percent.  Why 97 percent?  Because they were shooting for 100 percent, missed the mark, but didn't want to waste that extra second reaching back to the dial.  Despite near 100 percent oxygen pumped straight into your lungs, there was nothing.  No improvement.  You dipped down to 20 percent blood oxygen.  You were suffocating.  Were they to try to reintubate you at that point, who knows how long it might take.  Could you last that long without any oxygen, I wondered?

But then they realized that the CPAP wasn't attaching to your face properly.  Your blood oxygen level slowly came back up to 60 percent, then back down to 50, then back to 60 again.  Neither was high enough.  The prongs of your CPAP were too big, so the doctor replaced them.  But then it was to small, so they replaced them again.  Then you wiggled about in your isolette furiously because you'd never felt a CPAP in your nose.  The wiggling was causing air leaks.  Then, suddenly, like magic, your blood oxygen surged up.  100 percent.  You were pink again.  Only after it was over did the panic I should have felt caught up to me.

They tuned your oxygen percentage down from 97 percent to 80.  Then 70.  Then 60.  A nice, comfortable number.  But after everything had calmed down, a frightening thought suddenly occurred to me.  You were "breathing on your own."  Granted, you were being given 3 times the amount of oxygen we breath in the atmosphere, the ventilator was no longer taking any breathes for you.  Not like before.  Suddenly, I felt like you were on a plane that had cut its engines.  That was gliding.  If you suddenly decided to stop breathing, nothing would be there to stop you from falling to the Earth.

It's 10:20 at night, now.  It's been an hour since the ordeal.  You are breathing slowly.  Deeply.  Your blood oxygen is high.  You look more comfortable than you ever have before.  Everything is unexpectedly... perfect.  For now.  If the endo-tracheal tube remains out, it will be the single biggest development we've had to date.  In all likelihood, though, it probably won't be out for very long.  It's just too early.  Even if we can keep your blood oxygenated, your lungs might still be too damage and immature to purge CO2 sufficiently.  It could collect in your blood and acidify it, forcing the RT and nurses to put you back on the ventilator.  But... who knows?  Perhaps there is a small chance that it will remain out.  That you tossed a Hail Mary pass and someone was there to catch it.  But even if you could last only a few days without intubation, that would be a good thing.  That would be a few days for your lungs to grow without being relentlessly assaulted by the ventilator.  

Your mother and I have slammed down sinfully large energy drinks and we're settling in for a long night.  A lot of firsts happened in a very short period of time.  You were extubated, for real, for the first time.  I can finally look at you without that terrible tube snaking down your throat.  And then there was a first that took me completely by surprise.  A few moments ago, while I was sitting by your isolette, I heard something beneath the hiss of the CPAP.  A tiny little whimper.  For the first time since the day you were born, without the endo-tracheal tube pressing against your vocal chords, I heard your voice.


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