Variability

Dear Ellie,

I may not have mentioned this before, but in the NICU, the goods and bads don't always come in tidal waves of fear or relief.  Every day there are dozens of tiny ups and downs and its rare to go 15 minutes without experiencing one of these upsets.  Your oxygen might get adjusted in one direction or the other by a point or two.  Your respiration might spike dangerously high for one second, then go back to normal.  Your heart rate might suddenly collapse to one third for five second.  And of course, your blood oxygen might be too low or conversely, trending high.  Most of the time, these little "hiccups" are just temporary flukes that correct themselves.  Expected variability.  Still, every time they happen, we wonder whether each new tick toward improvement or deterioration is the tip of something disastrous.  Afterall, every catastrophe started with some small incident, like these.

Today, for instance, your oxygen needs grew steadily larger.  From 32 to 34 to 37 percent.  Your breath rate grew faster, an indication that perhaps you were beginning to grow tired and might need to be reintubated with the endotracheal tube.  Then your heart rate collapsed for a few seconds.  The symptoms didn't look encouraging.  

"Is she finally losing steam?" your mother asked while I was off at work.  I tried to comfort her, though I wonder if I was trying to comfort myself, too.  

"A thousand little things will happen that she'll easily recover from," I told her, not fully believing my own words.  "It's just variability."

Sure enough, by the time I got back to the hospital from work you were back to where you were this morning, as though nothing had happened.  So what caused the upset?  Who knows.  Maybe your nasal canula wasn't on properly.  Maybe you needed your nose suctioned.  Maybe you needed your head adjusted.  Maybe you just needed to take a nice, big dump.

I suppose the take away message should be "don't sweat the small stuff," but as always, advice like that is easier to give than to take yourself.  In truth, there are few moments in here where we aren't tense.  If there are, they are tragically short.