Flapping Your Wings in Hard Mode

Dear Ellie,

Last night was long.  Your mother and I stayed at the NICU until 3:30 A.M.  We knew we wouldn't get any sleep if we went to bed.  Not while you were flapping your little wings for the first time.  It was going to be hard for you.  We knew that right away.  Going from the endo-tracheal tube to CPAP demanded more of your lungs and your brain.  The training wheels were off.  You'd kicked the difficulty level in the NICU up from "beginner" to "hard mode," skipping a good bit in-between.  And what's more, all of your respirator stats before hand indicated that you were a long way from ready.  Your mother and I have wanted you extubated more than anything, but I also didn't want to see you struggle and exhaust yourself pointlessly.  When the respiratory technician took the initiative and put you on CPAP, I didn't know whether to hug him or kick him in the groin.  "She needs a chance to fly," he kept saying repeatedly, partly to encourage us, but perhaps also to hedge his bets for when you would assuredly crash and burn.  And who could blame him?  That is, after all, the likely outcome.

Not long after you were born, you extubated yourself by accident, and the doctors decided to give you your first chance to fly.  And try to fly you did.  You flapped your featherless little wings for three hours, but I can't exactly call your attempt a soaring trip through the clouds.  It was more like a tumble through tree limbs on the way to the forest floor.  The endo-tracheal tube was right back in your airways in no time.  

Last night, we were expecting something roughly the same.  A struggle of desaturations and constant attention from the nurses who would rub your back and try to remind you to breath.  But that didn't happen.  Instead, you opened your wings, lept from the tree, and the wind carried you away.  We sat and watched for hours.  No desaturations.  No irregular breathing.  No apnea.  Your heart rate was finally normal.  For the first time, without a tube jostling in your throat, you looked comfortable.  You still did your twitching and wiggling which was good, but you didn't writhe in pain or squint your eyes.  Remarkably, against all of my expectations, you were doing better on "hard mode" than "easy."  But would it last?

Your mother and I finally left at 3:30 A.M. and tried to sleep.  All I could dream about was heading back to the hospital to see whether you were still flying.  While I was walking to the hospital, I was certain that something had clipped your wings.  That you were on your way down.  There must be excessive C02 in your blood, or you were exhausted or apneic, but when I finally arrive, there you were, still flying.  

We're all still quite certain that you won't continue to fly forever.  Even now, you are losing some of your altitude.  The pressure given to your lungs is incrementally higher this morning than last night.  Your C02 is, in fact, higher than it should be.  Your breath rate has climbed since last night, surely because this marathon flight is wearing you out.  This is a practice run, for you.  A literal breath of fresh air and an opportunity to avoid, for some small time, that nasty ventilator that has been wracking and damaging your lungs.  The longer you can fly, the better.