Monday, October 15, 2007

Code blue

I'm writing this from the nurse's station, sneakily using their computer, so apologies for its brevity and ineloquence.

On the eve of discharge from hospital, whilst we are busily making preparations at home for Reuben's homecoming, transforming a little used apartment into an oasis of delight and comfort for Reuben, we get a call from the social worker at Children's to say that Reuben has stopped breathing for "a few minutes". We recall Jiffy's information on the length of time it takes for the brain to be starved of oxygen, 4-6 minutes. Dr Kevin who'd been called up from the PICU as part of the crash team, gets on the phone and explains the Code Blue.

A Code Blue was called whilst Reuben was struggling to breath during his bath. He was deep suctioned, but the nurse was unable to remove the secretions from his trach. They just kept coming and were blocking his airway. The Code ensures that every available Dr and nurse, the crash team, rushes to the scene to resuscitate and administer oxygen. The Code is communicated to the experts in the PICU.

Dr Kevin Madden to whom we are so gratefully indebted for his compassionate care over these past 3 months, along with Dr Charlie Golden (Reuben's new paediatrician), have quite simply been amazing, healing both Reuben's and our own heavy hearts on so many occasions in the NICU (May-June) and PICU days. Always going above and beyond.

The incident is a worsening of that which befell when I arrived at Reuben's bedside on the Bad Day. We clarify that it wasn't minutes, but less than a minute, the time Reuben was unable to breathe. Our relief is that it wasn't his heart. I guess you could say it was a mechanical obstruction caused by a blockage in his airway.

I've stayed by Reuben's bedside during the night and he's slept through blissfully whilst on the humidifier, requiring little suctioning beyond the deep suction at bedtime and this morning, whilst Jason returned home so at least one of us was fit today to look after him.

The mucus plug, a heavy build up of secretions, caused the suffocation incident. Dr Charlie came up later to talk to us, to ask us how we feel about discharge today. Whilst racing along the Freeway to the hospital yesterday brought feelings of "this will delay his discharge considerably and we wouldn't want to take him home whilst he's unstable anyway", the realisation now is that this is the trach. It's something we just have to get used to dealing with at home, without the protection of the Code Blue crash team. We have specialist CPR training under our belt, we will have a nurse for 16 hours a day, Jason is on compassionate leave finally and previously untaken vacation, until the end of the year.

I thank everyone for their help in a rapidly deteriorating situation and thank too the wonderful PICU nurses who heard "Code Blue 632C? That's Reuben!!!" and shortly afterwards came up from the PICU to the floor... Tonette, Carole, Rachel, Jennifer and later Susan. It was most overwhelming to see your faces, to have that neck massage Tonette with thanks, to have your messages of support and empathy regarding the m/c which you'd read about on the blog.

I've missed seeing you all. Wayne (RT) got a few tears from me down the phone the night Reuben left the PICU. The last 3 months has quite simply been the happiest worst experience of our lives.

For now, we await the Drs decision re discharge whilst Reuben gazes around the room, Daddy having just arrived, suck, suck, sucking on not only his thumbs, Reuben that is, but 2 soft fists stuffed into his mouth...


yp said...

Manually protecting an airway is serious and sombering business. Keith came home with the unnerving abiity to positionally occlude his airway, even with a tracheotomy. The monitors will help - though normally by the time they are alarming, things have moved further down the slippery slope than I am happy about. Knowing how to properly hydrate Reuben for optimum secretions is also key. Different diets and medications can affect the viscosity and tenacity of the secretions, as can any change in level of hydration (though we are oddly blessed to be able to bolus water whenever we please without the compliance of our cmall Kings). Two other key things are (1) nursing - we came home with 24 hour RN nursing, weaned after several months to 18, then to 12, then to alternate nights.....completely removed after one year and (2) the mist collar (a medical grade air compressor with a heating element put into the water resevoir to deliver constant misted air through the thick corrugated blue respiratory tubing which hung in our second bathroom in various states of re-sterilization anddrying for months). Though our ENT thought it wildly unneccesary, the mist collar kept the secretions runny and safe. We kept it on all the time at first, and then after a few months, only at night (the amount of use was in direct proportion to how much Keith was able to move about by himself, and how strong his own cough became). However, I recall on a rainy night inthe first few months home, our misting maching broke, and we (and the drable medical equipment supplier) felt it warranted an emergency back up delivered within an hour.

And lastly - sleep. It can be nearly impossible to forgive oneself the simplest error made from being over-tired....the same drive that can maks us over-vigilant and willing to sacrifice our own biological needs will be the same that can make us "what if" ourselves into misery.....

so much love to you all - y

MK said...

Truly again the reality and rawness of your lives and all things in it are mind boggling. I eagerly wait to hear the verdict. It maybe now or never, Applauding you and your husband for your efficiency and readiness at any given moment. You are ready, equipped and able with nursing care for the first critical hours home. We also had a breathing scare with lucas and albuteral treatment saved the day, especially on the feeds where oddly enough never make sense,,he just gets upset and his breathing gets off and fast the secretions are very difficult for him to handle, so he swallows hard and chokes. the albuteral does help and my holding him thru the feed calms him down. You are precious people, i am truly sorry for the code blue and pray that knowledge is gained and still going home is an option soon. mk

yp said...

Congratulations on Jason's compassionale leave and ability to use previously unused vacation time! "The happiest worst experience of our lives" sums it up beautifully. Being completely broken made us hwole. oxo,y

mighty max and mommy said...

Oh my dear dear heart sank as I read your post. How terribly frightening. You are in my thoughts and prayers.

Love, Amy and Max

Eva Nichole said...

I am so sorry all this happened so close to being able to go home and have somewhat of a "normal" life. My thoughts and prayers are with you and I hope things turn around soon.
Crystal and Eva

ellen charge said...

echoing yuka a blocked airway is very scary no wonder the inevidble happens to some i wont say what that is but i feel sure u know what i mean praying that that inevidble never happends to ur darling fam adthatr r r home when ur eading this message love u hepas ellen if u want go c my pics on m blog

Kristi said...

UGH...Good grief. I sure didn't expect to see this when I popped onto your blog. If home is what the destiny of yesterday was, then that's where I hope the three of you are. If they decided to wait, then I am so sorry for what must be a big disappointment, but also will take peace in knowing that all are looking out for what is best for Reuben.
Yuka (as usual) said it perfectly... "manually protecting an airway is serious and sombering business." That small little airway is a lifeline... and must be well guarded at all times.
I held my breath as I read your post about how you walked in and found Reuben nearly drowning in secretions... and I held my breath on this latest post. You are absolutely right - you will have to get used to the demanding care of a life with a trach. Hopefully, the emergencies like Reuben's experienced are behind you. But preparation to handle the situation is key and you have that. I do hope the next post is one from home... but more than that, I hope it is one without any more emergencies.

With love,

Geraldine said...

So sorry that you were so near to getting Reu home and having some normality, to this terrifying experience. Perhaps the next step is to discuss the possibility of increasing the care to 24 hours, as Yukka has mentioned in her blog? I pray that the doctors can give you some reassurance and confidence to bring Reuben home soon.
Love Geraldine

Lisa said...

I am so happy you will have nursing care and especially Dad home with you for a while to get into your groove together. Must've been so scary for you to get that call...I do NOT miss those days. On a happy note, things just seemed to immediately get better when we got her home...everything was lighter and we got into our own rhythm and it was much nicer (although no nursing or anything like that...)

Best to you all...