She's fine now, but...

Sara had one of the hardest days in months yesterday.

I was awakened by a phone call from Dr. Hospitalist to tell me what had "just happened" with Sara. I started shaking before he even started telling me.

"She went into respiratory distress this morning. Sweating profusely, struggling so hard to breathe, and was very agitated. Her vital signs were significantly changed and she was getting really scared. She de-SAT'd (her oxygen saturation went down...supposed be 100%) first into the mid 80's then down into the low 70's. We had multiple RTs and her nurse in the room working with her. The lead RT has worked with Sara before and he was trying to calm her stroking her forehead, but she was way too agitated to calm, so we gave her some Ativan to calm her and make it easier for her. It took us about 30 minutes of bagging and suctioning her before her SATs climbed up and stayed up. They would pop up for a few minutes then go back down the whole time. Then once we were able to clear the mucus plug and her SATs stayed up I decided to put her on the ventilator. Want to just provider her some pressure support. She's exhausted and we gave her the Ativan, so we just want to give her a rest and let her recover from this episode"

I asked him if he had asked her if she wanted the ventilator, which he said No. I asked him to go and ask her and also ask her if she wanted me there. (Her dad was on his way for Saturday visit). The doctor called me back in a few minutes and told me that she indicated she was OK with the ventilator and she did want me there. I told him we'd be there in an hour and a half and hung up.

We arrived to find her still in 3N, on the ventilator. A quick check of what was hanging (on IV poles), the vent settings and putting my hands and eyes on Sara told me the story of how she was at that moment. It was obvious she was relieved to see me (although brother and father had diverted from going home to go make sure she was OK and getting what she needed until I could get there. Her brother, according to one nurse, was amazing. Communicating with her, stroking her head and looking into her eyes, making sure people were communicating with her. She noted a deep bond between the two of them.)

After talking to Sara for a few minutes and getting to the heavy sigh of relief state the manager of the unit came to see me. I'll spare the details of the conversation, as it would be redundant. Same concerns and objections I've always had. Same resolve not to let them do it again. Same tasking the manager who wanted to make the situation "right" by telling him to just help us get her home...

He also told me, which I had already noted, that she was being ventilated with a rhythm. In simple terms, that means she was not supporting her own life functions, breathing. I asked him if she knew that, which he said no.

I walked over to the bed and looked into her eyes. I asked her questions to see if she understood what was going on and what condition she was in at that moment. I asked her if she knew that she was being kept alive by the ventilator, and she said No. I told her that she was, that she was right then unable to breathe on her own. She indicated OK. I asked her if she wanted to be on the ventilator right now for this reason and she indicated Yes.

I explained to her what this means in terms of setback and how we have to quickly get her back off this vent. I told her that days on the vent can mean the difference between this being a temporary setback or never getting off the vent again. She understood.

We spent several hours there. I talked to her mainly, but also RTs, Nurses, the doctor. Before we left we had a plan of attack for this episode.

Sara needed rest. The entire ordeal had exhausted her to the point she couldn't maintain her own fuctions, that was clear. She's also a knuckleheaded teenager who refuses to close her eyes and rest. So we were going to have to force her. We asked the doctor to order her something to actually knock her out for the night. The risks to her were VERY minimal, as she was already on the vent. He agreed. He also stated he wanted her off as soon as possible. We talked about ways this has happened before and how to mitigate a repeat. And how to get her off the vent as quickly as possible.

So, lastnight at 8pm they gave her a real good bath. The RTs did all of the ordered treatments and worked at length with her, both before and after the lift team moved her (in case moving her dislodged some secretions that would travel). Then, at 10pm they turned off the TV and administered Versed to her, to make her sleep. She was nitey nite not long after.

She passed a very uneventful night - but I still kept checking every few hours anyway.

This morning she woke up just after 8am and they had initially planned on taking her to pressure support then trying to take her off the vent a day later...but she exceeded what they thought she'd do and they ended up pulling her off the vent entirely.

So, she took a deep nosedive for less than 24 hours and managed to pull up just in time. She's still pretty tired today, nappy, sleepy. But that is normal for her for days. While we can drug her to make her eyes close, the only thing that brings her strength and brightness back is several days of rest.

Daniel is on his way to see her now, and spend the day. She'll love it. I know he'll just crawl in bed with her and they will nap.

Better than what the doctor ordered...