December 21, 2012
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the tiniest things…
The surgery on Monday lasted 20 hours. I stayed for 17, but finally caved and called back another member of the heart team. My eyes burned from fatigue, and the roads were dotted with crazy folks – darting out between the cars traveling towards home. My heart pounded against my chest, powered by the adrenaline rush from slamming on my brakes. So much for my day off.
Tuesday saw me work a 10 hour shift. I have to get to work early again, and it’s all I can do to drag my weary self out of bed. I called PICU twice to check on the baby I nicknamed “Peanut”, whispering into the phone during a case. The intensivist mumbled into the phone, “She’s still on ECMO, but she’s stable.” She remarks that I’m the only one who calls. When S sees me in the hallway, she smiles broadly, “Did you work on Baby _____? They said that someone called to check on her, so I thought it might be you.” I’m so fatigued when I get home that I can’t eat, and sleep will be fitful and filled with worry.
Wednesday brings a frantic call, “Come in early, please! There is a heart!” I’m sent to NICU. The baby is smaller and much sicker. When I arrive, they take her off ECMO, and the Respiratory Therapist squeezes oxygen into her tiny lungs with a tiny ambu bag. A tech runs a transducer over her, looking concerned and sad. Then we wait. The radiologist is going to confirm that she’s suffered a major hemorrhage in her brain – a fatal stroke. My eyes prick with tears, and I step close to gently touch the tiny feet and toes. They’re blue and a little cold, but that is to be expected. We are waiting to hear that she’s gone so we can shut off the machines and say goodbye. She weighs 2400 grams (a little over 5 lbs). The call comes, “No stroke. Proceed with surgery as planned.” We bustle about, opening supplies, prepping and draping.
She was operated on the day she was born, moments after the helicopter brought her young and ignorant mother to the trauma center. Her bowel formed outside of her body, so the pediatric surgeon wrapped it in sterile gauze and drapes, forming a “silo”. We prep and drape around it. Her tiny head turned to the side, large catheters carry blood to the machine that oxygenates her blood and pumps it back. It takes pressure off her lungs. We work for 5 hours, repositioning the ECMO catheters, and then cracking her tiny chest to cut a “window” in the membrane that encloses the heart. She’s bleeding into it. The pressure could stop her heart and kill her.
The pediatric cardiologist leans over and whispers, “All this effort, but the ‘head’s gone’.” He’s referring to her mental capacity. I shrug. How can we say “no”? The mother stops by to visit, but isn’t allowed in to see her baby. The nurse waves me over to tell me that the unit is “closed”, and shudders, “She asked if she’ll be able to feed the baby soon.” I shake my head and look at Angel me, who stands near the surgeon, intent and serious. She looks up, then points to a plaque on the wall, a prayer from a long ago Pope. I nod. She knows my beliefs. She also knows that I’m more spiritual than many of my Catholic colleagues, who are wrapped up in the rote and rules. She tells me later, “You were like a guardian, a sentinel. I was comforted to see you there.” She wasn’t the only one.
As we left with our carts and equipment, alarms sounded on an isolette. The nurse exclaimed, “You behaved for the last 5 hours! I thought you were getting ready to transfer out, Missy!” Angel me gives me a look. I ignore her.
I manage to get a little time off today. I head over to D’s after I drop my oldest off at the bus stop. He’s happy to see me, but dallies over the restaurant choices for lunch. We end up at a funky diner with heavily tattooed waitresses. The food is excellent. Unfortunately, I get called in after we order. D’s eyes widen, “I didn’t think you’d actually have to GO to work!” I had suggested that I bring my own vehicle, but he talked me out of it, “I want to be able to talk to you. I want to be with you.” I shrug, but I know I’m doomed. We rush away with boxed lunches, D apologizing all the way home.
I share a little about what I’m doing at work. My friends are a little overwhlemed at what I see as an interesting twist on a day’s work. I’ve got other projects to finish. I’m serving on a committee to improve surgical start times. The committee is lead by a team of consultants who have an incredible reputation. They’ve been hired by the corporation that owns our hospital. When we prepare to present our findings to administration I’m asked to be a presenter. I’m called to meetings when I’m tied up in a case. Before our consultants leave for holiday I’m given the task of creating a poster that can be posted department-wide. It will be submitted to the graphics department of the consulting firm. That lets me breathe a sigh of relief. I’m sure that they’ll completely revamp my humble offering. I still think my effort is pretty good for someone who is just fiddling around with Power Point.
Then I think about D. He was happy for whatever time he had. I look at Devil me, “He found the gift. I didn’t hide it that well. He’s wondering about it, but he seemed a bit upset that I wouldn’t be around on Christmas. I thought that was odd.”
She smiled, “I don’t.” She giggled, clear as bells, “He doesn’t say it yet, but he loves you. He’s taking it slower now.”
I snort in disbelief.
