Tuesday, January 29, 2013

Surgery and What Happened Next

August 16, 2012 is easily the worst day of my entire life so far.

At around 8am, we got the OK to head down to pre-op.  My little guy looked so little in the big bed they wheeled him down in.

 Steve and I waited with him until they were ready in the OR.  The anesthesiologist and fellow came to chat with us and then walk to the OR doors.  I had held him on the walk there and had to physically hand him over to the anesthesiologist.  I was shaking.  Nothing can prepare you for that. One of the most horrible moments of my life.... the worst was to come later in the afternoon.

Steve and I didn't know what to do with ourselves.  Nothing felt right.  Eating felt wrong, reading felt wrong, sitting and worrying felt wrong, texting friends felt wrong, going on facebook felt wrong, laying down to rest on the bench couch felt wrong.  It all was just so wrong.
We got updates throughout the whole 6 hour process. He was prepped for surgery.  They opened his chest.  He was on bypass.  The procedure was done.  They were starting his heart.  He was off of bypass.  They were rewarming him. he would be headed to ICU soon.
Dr. Starnes came to talk to us.  The surgery went very well and he was very happy with how things went.  The donor valve that was put into Hunter's pulmonary position was bigger than he planned (hopefully allowing more time before it needs to be replaced again) and his own pulmonary valve that was put into the old aortic position went in beautifully.  His heart started on it's own after they trialed him off of bypass and he was able to come off successfully.  They decided to leave his chest open for a few days because of swelling.  I was hoping it would be able to be closed, but this was best.  I hadn't looked at post op pictures of babies after heart surgery by choice. I wanted my first experience to be seeing my own son for the first time..... and nothing could have prepared me for this....

 He was not the same baby I handed to them just 6 hours before.  This was not my Hunter.  But what is amazing is that the above image didn't bother me as much as the entire hospital tray FULL of crash meds just waiting to be used.  Sadly, most of the tray was used shortly after.
 He was on all of these drugs.  Later in the afternoon he was on almost double of this.  I didn't get a picture of it all as the afternoon was pretty traumatic.

As soon as we walked in the room, our nurse Kenny started explaining everything we were seeing to us.  He was absolutely amazing.  He had just gotten this baby back from surgery and while he had a room full of people helping he took the opportunity to brief us.  I will never forget him, I sure hope he is still there for Hunter's next surgery.

We sat back and observed as everyone got Hunter stabilized. Things definitely felt critical but felt controlled. They were on top of it.  No one seemed frantic and we were able to relax a bit.  Well as much as you can when you are sitting in the CTICU with your freshly out of the OR baby.

At around 4:30pm, Kenny, our nurse went on break.  Another nurse was in the room continuing to organize things and keep Hunter stable.  The ICU attending doctor was in the room monitoring things and making small talk with Steve when I decided to lay down and try to rest a bit.  I heard them discussing how Hunter's arms were twitching.  I figured he was just waking up from the anesthesia a bit and it was no big deal. I heard Steve saying that the somantic monitor numbers (infrared sensors that monitored his blood flow to the brain and kidneys) were getting lower.  That alerted me to sit up... I couldn't see any of the monitors.  Dr. Rambod told Steve he needed to focus for a minute.  I saw his face drop as he was watching the monitor.  The next thing I knew Dr. R was shouting "epi epi epi!!!" Indicating that he needed the epinephrine shots.  My son was going into cardiac arrest and epinephrine is designed to increase the heart rate.  Next was the shouting of "press the button! press the button!" meaning press the Code Blue button.  This baby was going down and fast.

As the high pitched bell began to ring, Steve told me "let's go".  I was so confused.   I didn't know what was happening.  Now I know that he believed our son was about to die and he didn't want me to watch.  He pulled me into the hallway as Dr. Rambod began chest compressions on my 5 week old son.

I've never experienced anything like the next 10 minutes.  My eyes started blacking out and I knew I needed to sit down.  I started to just sit down on the floor because I knew I was about to pass out and I didn't want any attention on me and I wanted everyone focused on Hunter.  Someone slid a chair underneath me and there we were.  Sitting in the hallway in the Cardio Thorasic Intensive Care Unit watching an entire room full of doctors and nurses work on our son.

I have a few vivid memories of that time.  The first is the dad of the patient next door to us coming out in the hallway to see what was going on.  Yes, I am the mom of the little boy whose bell you hear.  Yes, my son is knocking on death's door.  Yes, I am that mom.  I probably would have done the same thing, so I wasn't bothered that he stepped out to look at us.  It didn't bother me, just is a vivid picture.

The second is the very tall blond haired surgeon, Dr. Harrington, RUNNING down the hall shouting to get ECMO (full life support) as "this kid has misbehaved twice" (we later found out he gave them a scare on the way back from the OR when he was dropping his blood pressures very low).  I think it was then that I had to put my head between my knees or I would have vomited.

The third is the angel of a nurse, Neda, who sat with Steve and I holding our hands repeating over and over and over "he didn't die, he didn't die, he didn't die"  Yeah, imagine hearing that about your child.  You'd think they would be the most comforting words.  Sure they brought hope, but nothing about that situation was comforting.

The fourth was all of a sudden Dr. Starnes was standing in front of us.  He told us they thought Hunter had a seizure which sent him into cardiac arrest.  They didn't know what caused the seizure and we wouldn't know for many days, but for now he was stable.  As quickly as he went down they got him back.  He was on a LOT of heart support medications as well as some heavy sedatives to keep him from seizing again.  Our little boy was in very critical condition.

The days and, more importantly, hours to come were very touch and go.  Usually about 12 hours after surgery they expect a dip in condition.  Hunter sailed through that window.  He seemed to be doing well.

At around 2 am Steve and I tried to get some rest.  The little couch bed in the ICU room only fits one person.  Steve let me sleep there.  He got so tired that he layed on the floor next to me and fell asleep.  Totally not allowed, but after what we had witnessed just hours before, no one was going to make him get up.
We both slept about 4-5 hours that night. It's amazing how you can rest even in a situation like that.


Pre-Op

We arrived in LA on the afternoon of August 14.  We were scheduled for a full morning of pre-op procedures for Hunter and then to bring him back for surgery early the morning of August 16.  We now know he was starting to show signs of his milk protein allergy (more on that later) and was so miserable.  Take the stress of two parents, a state away from their toddler, about to send their 5 week old into open heart surgery, staying at the Ronald McDonald House (RMH) , PLUS a baby that screamed pretty much non stop.... yeah.... not our finest moments.

The morning of pre-op fun
The pre-op stuff went just as expected.  He had a blood draw (not fun) an x-ray, an echo, as well as a consult with the surgical nurse practitioners.  We were all finished by lunch time so we headed back to the RMH and went to run a couple of errands then take a drive to the coast for the afternoon.
RMH is amazing for families of kiddos in the hospital.  But, the towels are horrible.  So we went to Target so that I could buy some bright colored soft towels. It was a small thing that I knew would help me relax when I went to shower in the mornings after rounds.

 On the way there, the hospital called.  Hunter's blood showed that he was extremely anemic and they wanted to admit him to the hospital that afternoon and give him a blood transfusion before surgery.
UGH.  Talk about reality smacking you right in the face.  I was ready for surgery TOMORROW. I was not ready to go to the hospital TODAY.  No no no.
But we did as we were told, skipped our coastline exploration and headed back to the RMH so I could gather my things for a couple of days at the hospital and prepare to check my son in.

We got checked in and settled into our room on the CV Acute floor. At first they went to put us in a double room and we asked if they had space if we could have a private.  I had a grumpy 5 week old that was going to be NPO after midnight (not allowed to eat).  It would be better for all if we were alone.  They were able to move us.

Settled in
They had to set an IV for the blood transfusion and Hunter FLIPPED out.  He wouldn't stop screaming.  We tried everything.  Would not stop crying.  Thankfully Steve was in there because I had to leave the room.  I witnessed a lot and stayed strong for a lot, but THAT evening was a little much.  Add in my pre surgery jitters and I was super on edge.  They finally calmed him and into the night we went.

He started getting his transfusion and that was a bit unreal.  Watching a bag of blood being drained into your newborn.  I wanted to unhook him from everything and go home.  I didn't sleep a minute that night.  He was a trooper though.  For not eating the entire night, he was such a good boy.  I got lots of time to hold him.

Early in the morning, we gave Hunter his anti-bacterial bath and got his little surgical robe on.
Then we waited for them to come get our son.......

Our second short stay at home

After we went to LA the first time, we had about 10 days at home before we had to be back.  We really enjoyed our time.  As the day was approaching, I had to plan to say goodbye to my 18 month old for most likely a  month.  More to come on big brother Corben and how he was a rock star throughout all of this....but from a mommy perspective, it is so hard to know that Hunter needed me more, but I know Corben missed me as well.  Going through all of this is hard enough, add another little one into the mix, plus the fact that he was in another state....ugh not fun.  But we rallied and did what we had to do.  I had no other choice.  Here are some photos of our short time at home. Many of our amazing friends brought dinner to us. I didn't have to cook dinner one time.  Such a huge help!!!











Children's Hospital Los Angeles

On Wednesday, August 1, Steve, Hunter, and I packed up and headed west.  We had a cardiac clinic appointment on Thursday morning as well as a consultation with Dr Vaughn Starnes, who would be performing Hunter's Ross Procedure.
                                                 
We stayed at the Ronald McDonald house which was just a block away from the hospital.  We enjoyed the cooler weather and walked to dinner.  On the way, we walked past the hospital.


                                                

The next morning they did an echo on Hunter, as well as a physical assessment.  Then we met with Dr Starnes.  We sat in a little conference room and he came in, introduced himself, and sat down along with his assistant, Pam.  As soon as everyone was settled and ready to hear what he thought, Hunter let out two HUGE burps.  Like I've never heard that sound out of any baby in my life.  Thanks for breaking the ice Hunter, and reminding everyone that you weren't just a case on paper.  You were a little burping, farting 3 week old baby boy!

He was comfortable scheduling Hunter's Ross Procedure for 2 weeks from that day. The sick feeling I had when we met with the surgeon in Phoenix was not felt.  Dr. Starnes was exactly who should be operating on our son.  We both knew it was the right decision and place for Hunter.  He felt fine with us going home to wait for surgery, but I took Hunter to the cardiologist every few days to be checked on.  I had all of the signs to look for of heart failure and off we went...... see you in 2 weeks LA.

 A little lunch in the cafeteria.  This picture is crazy to me because it was the first and only time that Hunter was with me while I ate there.  I had many meals sitting right there, but this is the only time it was with my son.

More info on Dr Starnes:

and The Ross Procedure:





Home

On July 28, 2013, knowing that we wanted to take Hunter to Los Angeles for a consult and surgery, everyone felt comfortable letting him go home from PCH. 

 During his car seat test
 All dressed and ready to go 


 Finally everyone is home!


My dear friend, Kelly came to take photos of our new family the next day.  I am SO happy we have these.  It was important to me to have pictures of Hunter's chest before surgery.  Pictures of his beautiful, smooth, unscarred chest.
                                      

Just enjoying time with my boys.....

 First Bath at home


 Brothers

We went home on a Saturday and headed out to LA on Wednesday. We had just a few days at home that were busy with cardiology visits, pediatrician appointments, and preparing to go to LA, for which I packed for a month, not knowing if they would want to keep him....

But we thoroughly enjoyed our days at home.

The following week...

Everytime we thought we had a plan at PCH, Hunter showed us otherwise.  We tried to get him on a medication, Captopril, to help his heart function with the amount of leakage the balloon cath caused.  Everytime he had a dose of the medication, his blood pressure would drop very low (like 35/17 low....yeah...not good).  
Then the plan was to just let him not be on any medication.  He was tolerating it decently, but then his heart started having ST segment elevations.  Basically "pre heart attacks".  awesome....
It was then that they determined he would need surgery.  Ok, not what we wanted to hear, but we could handle it.  So what's the plan?  No one knew
They didn't think he needed surgery in the next couple of days, but they also didn't feel comfortable sending him home to wait for surgery.  We were at a standstill.  They just wanted to observe. 
We met with the surgeon who would have done his surgery.  Talk about sick to my stomach.  I knew it wasn't right.  I knew it couldn't happen there.  Nothing about it felt like a good idea.  

The next day our insurance company called Steve out of the blue.  They knew what was going on and wanted to let us know that our insurance would cover surgery out of state, just wouldn't pay to transfer him.  
Steve talked to our good friend's dad who is an adult cardiologist here in AZ.  He suggested we talk to Dr. Teodori in Tucson for a second opinion.  He is an amazing, humble man who talked to Steve on his way home from work.  He told us he would love to take Hunter's case down in Tucson, but if it was his son that needed this surgery, he would take him to Dr. Vaughn Starnes at Children's Hospital Los Angeles.  That he was the best for the procedure that Hunter needed.

Steve called our insurance company the next morning to see if Dr. Starnes was covered, and sure enough...he was!  Awesome!   We scheduled a consult in LA for the following week.Only problem, we had to get Hunter OUT of PCH in order to get him to LA.










 

July 18, 2012

This morning was awful.  Just awful  I arrived at the NICU around 6:30 am.  Hunter hadn't been allowed to eat past midnight.  He was being given IV fluids, but it's not the same and he was a grump.  I held my 6 day old baby and rocked him for hours.
 His little arm board so that he couldn't bend his wrist that had the IV

At around 9:30, they finally came to get him.  We walked him to the cath lab and met the anesthesiologist at the door.  She had paperwork for us to sign and as Steve was signing it, I lost it.  We said our "see you laters" to Hunter and he was wheeled away from us.  I began to hyperventilate and thankfully Steve got me under control.  Everything feels wrong about letting someone take your 6 day old and put him under anesthesia so they can balloon open his bum valve.  

At about 11:30, the interventionalist who performed the procedure came out to talk to us.  In hindsight, I could see on his face that it didn't go as well as planned.  They got the valve open beautifully, but it caused moderate/severe regurgitation (or leakage) back into his left ventricle.  He seemed optimistic that it would buy us a good amount of time before Hunter would need surgery to replace the valve and with medication, he should be able to tolerate the leakage.  We would be able to see him soon.....

 My strong boy right after his procedure

 Hunter's first home
 
Hunter had to lie flat for 4 hours post the procedure because of where they went in through his groin.  After that we were able to hold him.  All was looking great, so Steve left around 7:30 to go home and I was preparing for a quiet night in the CVICU (Cardio vascular intensive care unit).
Shortly after Steve left, Hunter began to struggle.  His breathing started getting labored, his heart rate was over 200, he just wasn't doing well.
A lot of people were coming in and out of the room...hooking him up to iv medications, putting oxygen on him, looking at monitors and then leaving the room.  No one was telling me what was going on.  Clearly something was wrong but no one was communicating it with his hormonal, just had a baby less than a week ago mom, who was standing and watching in tears.  Yeah..... not going to turn this post or blog into a bash on PCH's CVICU, but I will say that I know I got the crazy mom mark on Hunter's chart.  I never knew I had that kind of fight in me.... mama bear definitely let loose.

Hunter's issue was that his little body was really struggling with the amount of leakage that his heart was left functioning with.
They got him stabilized and we would wait and see.