On the brink

A day of near misses, slow declines and tears. He is very swollen today, a sign of sepsis, he cant get his sats higher than the high 70s, even though he is on full ventilation, maximum support, They told us there is nothing more they can do for him, now it is up to him. If he can fight this, they will support him, if not…the despair overwhelms me.
I cannot help him, I cannot fight his fight. He looks so ill and I can’t even hold him. I can only stand back as they try to bring him back time and time again. And believe, I can believe in him, and that he can win. A long night lies ahead, will he make it?

Hold on tiny warrior, this is a battle worth fighting,

Hold on

So, hes stats aren’t dropping as fast, they called the doctors at Alderhey for advice on his bleed. Although it was resolving, the fluid is building up in his brain, putting pressure on his brain and causing damage. After much discussion, they decided to put a needle into his ventricles to drain the fluid, I was terrified. but they did one scan before beginning and saw it had shrunk, so there was no need for the big brain needle for now.  But the damage is done though, we know this and accept this. His sats are still dropping when handled too much, they often drop really, really slowly, like going 88, 87, 88, 87, 88, 87, 87, 86, 87. 86. 87. 86. 86, 86, 85 etc, etc. until they are really low after about an hour and then they use the neopuff to bring him back. And when climbing back it takes that long too. His oxygen is still near 100% on his vent, which I don’t think is necessary, even if you reduce the oxygen it makes no difference at all to his stats, same with increasing the oxygen, it does not increase his stats.

It has been really hard, they didn’t let us know just how close they came to losing him this morning until we spoke to the doctor later. We were outside and no one came out to tell us what was going on, we had no idea. The doctor in charge was actually stopped working on him, because he’d had 3 shots of adrenaline, they’d bagged him and were doing compressions, so they thought it was over. When they stopped he picked right back up. I was really angry to discover they hadn’t called us in, I would want to try kangaroo care to bring him back, or at least to hold him.

But he is doing a bit better, he is still really unstable, this infection is being  kept very hush hush. No one has even mentioned it to us directly, instead I read his chart! No one has talked to us about it, no one has even tried to explain what it is, where it came from and his prognosis. What’s more, another baby on the unit is under “barrier nursing” and no one is talking about that to her mother either (I asked the mother – she had no idea her baby had an infection). The other two are not well either, and no one is telling the twins mother anything. I asked directly about the infection and it was glossed over. No one told us he was on antibiotics, we found out on rounds, no one told us his CRP was 47!!! I overheard doctors talking! This infection is pretty bad from what I’ve read and I wonder if there is an outbreak in the unit, and they are trying keep it hush for now.

Either way my dear Gideon is in a lot of trouble, he is trying so hard still. He is heavily sedated but when I fed him he tried to respond to me, tried to wriggle. I left him at 92% sats, but I am not planning any time in the future, just hour by hour. My Gideon, I love him so much.

And he’s back on vent

He lasted 4 hours, 4 hours of mania and panic. he then vomited his feeds and they gave up and put him on vent. He tired himself out with his frantic insanity stubbornness, so he happily accepted the vent and morphine. Of course the doctor on rounds today didn’t see just how bad he was, so is reducing the morphine again, giving him caffeine, and trying to wean him off vent for tomorrow! It’s just insane to think about trying again so soon! They can’t see a reason for him to struggle off vent, they say his lungs are a little small, but he is breathing, and he is able to breathe alone. But I don’t think he likes CPAP, in fact he hates it. That is unlikely to change, and he is so stubborn, he just doesn’t stop fighting. We pushed for a head scan today too, just to make sure that none of this was caused by his bleed. They’re probably doing it soon and we’ll know soon enough whether he is OK, it didn’t look like he was fitting like before, but better safe than sorry.

He has had 4 poos in the last day, which is brilliant, all that milk is now coming out. He is on 5ml still after his vomiting on CPAP, and they will put it up every 12 hours, I am making an average of 30ml every 2-3 hour pumping session, and first thing in the morning I made 66ml today. I am eating my way through many lactation cookies to help.

He looked so much more peaceful this morning, still twitchy from his bad night, but certainly not really angry. I so want him to thrive on CPAP, so I can kangaroo care him. I have managed to hold him twice, and we never managed a kangaroo care because he went back on vent. Haven’t held him for ages, and I think kangaroo care would do him so much good right now. But I have to be content with containment holding, where I hold his head, and/or stomach. He does like this, except when angry.

But seeing him today, looking all pink and cute, I just craved holding him. I just wanted to pick him up and I couldn’t. It makes me ache. This must be hard for Gideon too, not getting lots of cuddles.

2lb 2oz?

Yup, Gideon weighed in today at 2lb 2oz! That’s pretty amazing, he’s not even 2 weeks old yet.

I was relieved this morning to see they had upped his morphine, but during rounds they decided to reduce it and stop it, and then give him more caffeine! The poor guy just doesn’t need hyping up! He’s already trying to pull out his own tube again, and he’s on morphine. Of course their aim is to get him on CPAP by tomorrow, my aim is to leave him be until that PDA gets sorted.

PDA wise, they are pretty sure the meds are not going to work, and the only other med safe for him to take is not available in the UK. So their high tech plan? Feed the little guy up so the PDA will become smaller in comparison to his size. He is currently on 3ml every 2 hours, upped by 1ml every 12 hours if tolerated. Now they are upping it by 1ml every 8 hours in the hope he will gain weight fast and out grow the PDA. Otherwise it’s the surgery.

I hope they don’t put him on CPAP today! He isn’t ready with all his desats!

He could be off the vent again

During the ward rounds today, the doctor asked if he was always so active, I had to laugh as he was being particularly quiet at that time. The nurse said he was always wriggling. They said that they either need to sedate him further (he is already on a fair amount of morphine) or extubate him, because they can”t keep him on vent when he is wriggling all over the place. They obviously would prefer not to sedate him even more, so they are going to give him another chance on CPAP. The doctor isn’t convinced he will make it permanently on CPAP yet, nor am I, but he may surprise us all. So in a couple of hours they will repeat his blood gas, if it is good, then they will caffeinate him and remove his tube a few hours after that. It is very exciting. I hope he can make it a few days at least, my main concern is his de-sats, it’s normal to get them, but because of his PDA it takes a while for him to bring himself back from them, and on CPAP this could tire him fast. Today when they were taking his blood gas, (heel prick) he de-satted all the way to 60%, and his oxygen had to be put up to 80% from around 50%, it took him like ten minutes to bring himself back. So it is a worry, but I know he is strong and a serious wriggly fighter. Hopefully he can make it.