Post-Surgery update

The surgery, over all, was a success. They took him in at 7:30 and paged me at 12:30 to tell me he was out. By 2:00, he was set up in his room, and I was allowed in to see him. He was still out of it from the anesthesia, and hooked up to all sorts of things. Intubated, with two drainage tubes, a Foley catheter, pacer wires, quite a few IV lines, and, of course, the incision itself. He's not a very pretty sight right now. His nurse was Terry, a very sweet lady in her fifties, who kindly but bluntly told me that I have a very expensive, very thoroughly trained babysitter that I should probably take advantage of, because there was nothing I could do for him as he began to wake up. So I stayed last night in a hotel a couple miles away, and slept in a bed that doesn't double as a couch. It was pretty great.

But reality calls, so I'm back on my little perch in the back of the room again, watching as nurses and doctors and respiratory therapists and nutritionists and nurse practitioners dodge in and out in their yellow gowns and masks, doing what they need to to get Brandt fixed up and out of the ICU.

The actual update on Brandt is essentially a good one, but there have been some complications. Not big enough to panic anyone, but big enough to need dealt with. Around 9:00 last night, they called me regarding a pneumothorax that he had developed, or, in layman's terms, a pocket of air between the lung and the chest wall. One of these will inhibit proper lung expansion, which causes all of the obvious issues, low sats among them. So after getting my permission, they placed a smaller third drainage tube in his left side to let off some pressure.

Getting rid of the pheumothorax does seem to have helped, but his sats still aren't as high as they'd like. Pre-Glenn (and pre-hospital) his sats were running 75-85. During our stay, they've been trending downward to the 65-75 range. The Glenn is supposed to bump the sats up to his old normal, but they don't seem to have changed at all. They think that the issue is caused by the breathing tube, ironically enough.

Breathing tubes work differently than a person would breathe on their own. Rather than pulling the air in when the diaphragm moves down and creates a vacuum, an intubated person has the air pushed in. It's effective in that oxygen gets into the blood, but problematic based on his idiosyncratic anatomy. The way a single ventricle, post-Glenn heart works, blood is passively flowing through the lungs, rather than pushed at it, like it would be if it was being pumped through the PA. As it gently flows into the lungs, then, the force of the air being pushed in quite literally stops the flow of blood momentarily. As the air is released, the blood flow picks up again, and with every breath the cycle repeats.

The task for today is to wean him off the tube and get him breathing on his own again. They tried to last night, but the unexpected procedure threw that off track. It's a kind of touchy thing for a lot of reasons. First, they aren't quite positive that taking the tube out will cause his sats to go up. It may be that the tube is keeping his sats up where they are and that taking it out will cause them to drop as a different issue makes itself present. He's also got a lot of fluid build-up left over from the surgery, that was exacerbated by the cold that he was almost over. It collects in different places around the body: some in his face (his eyes are pretty swollen), and some in his chest cavity, surrounding his heart and lungs. That causes issues with the lungs, so they're giving him Lasix (a diuretic) in the meantime to help his body pee some of that off. After his first dose, he let loose 250cc, which, if I've done my math right, is a little over six ounces, or almost as much as he eats every meal. Considering he hasn't had anything to eat in about 36 hours, that's pretty impressive. Dehydrated he most certainly is not!

So they're turning down the oxygen flow bit by bit to encourage him to breath some on his own, as well as to see how he reacts to it. If his sats start dropping, they'll turn it back up a little and take it a little slower.

Brandt in general is not a happy kid. They're keeping his pain levels under control with a combination of Tylenol and morphine; the latter makes him blessedly drowsy. Often when he wakes up, he begins to get madder than a hornet, from any combination of issues, and as he cries, he doesn't get enough oxygen, and then he panics and makes it worse. It's hard to watch. I'm sure he's hungry as well, because, regardless of the electrolytes he's receiving via IV, his stomach is still empty. He can't eat until the tube is gone, though, so it's all a big old entangled mess. Thankfully he's still tired and sleeps quite a bit.

All in all, we're in for a rough couple days, but hopefully we'll see some progress in the right direction soon.