Extubation and what you get when you say 'ouch' to a young doctor

They came by yesterday to review a list of patients waiting to be transferred from PICU to NICU and at first we thought Ford was not going to make the cut. All our begging and pleading went unheard and while I'm inclined to believe they had something like a triage assesment of who was in the most need (to not go, in this case), I was assured they merely pulled straws.* And so off Ford went.

Seriously, it is a good thing because it means he is in a somewhat less critical condition, although you might not guess it from looking at him.

So we got up bright an early for NICU rounds this morning (got to the hospital at 9am - not really early, I know. But hey, it's Saturday) and we even managed to catch the cardiology rounds, which happen much earlier than the ICU rounds. Cardiologists, I guess, prefer to skulk around in the early morning gloom.

It was all good news.

First up was the removal of the PD catheter in his abdomen, which was unceremoniously yanked out about 3 seconds after he got a shot of ketamine. That drug works quick and our little astral traveller was no doubt crusing some parallel dimension when it happened. Then they pulled off the bandages from his incision, to check how the wound was healing and all appeared well.

Since I am wont to make fun of the doctors, I feel the need to throw in this anecdote, however likely it is that I am the only one who finds it funny:

The NICU doc on rounds this morning was pretty young, relatively, and fun to chat with. Prior to pulling off Ford's bandages he asked the nurse (who had at least 25 years on him) whether they ought to use _______ (chemical name) to help soften the adhesive first, to which she replied: Oh god, we haven't used that since before you were born! We found it took off more than just the adhesive.

Ouch! I said.

The young NICU Doc quickly looked over to me and fumbled through the explanation: I only asked her, because she's got so much direct experience with these sorts of things!

He seemed genuinely embarrassed by the nurse's comment and my reaction to it, which had me momentarily confused, because I was thinking 'ouch' as in: yikes, that hurts! and he was thinking something like: Ohhh, Snap!

The jist of it being that he seems the pleasant sort who would cordially banter in colloquialism, fondly calling the nurses "my bitches" and shouting things like "you got served!" whenever someone made a mistake. I liked him.

Maybe i'm reaching too far for things these days. I probably need to ground myself some more.

Second order of the day was extubation, which is a big step for Ford. Basically ever since birth he has been on a respiratory machine to assist (and in some cases completely control) his breathing. It's quite a complicated machine and its effects were balancing the effects of certain medications, but then they were using other medications to balance the effects of the machine, and it was all a whole tangled mess. With the tube out he is now breathing entirely on his own, and this will be the big test to see how is heart is going to handle the distribution of blood from lungs to body. It is likely that he will react badly to it and they will have to reinsert the tube and ween him some more... wow, just as I finished typing that sentence Christa text messaged me from the NICU to say they had to put him back on.... so, umm.. that sort of derails the rest of my explanation.

two steps forward, one step back.

I gather it was expected, so its just another hiccup on his long road to recovery.



*(refers back to first paragraph) Dr. Cave also admitted that most of the fuss and equipment in the PICU was for show and that it was all really just witchcraft - some room in the back, with candles and incense, a stone deity of the pagan variety and a whole lot of chanting was what was really keeping everyone in there alive. FYI.