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Baby T's Story, Chapter 18- Recovery Pt. 2, free from tubes

3/18/12-4/30/12



Baby T amazes us throughout his recovery!
After pulling his NG tube, his weight was monitored
but luckily we did not need to have the NG reinserted.




At a month and a half after discharge we've
had a total of 13 appointments.
Five appointments are scheduled
within the next month.
T see's a neurologist, Occupational Therapist,
Physical Therapist and his regular Pediatrician.








At 9.5 months:
He is nursing well and is making strides
in his ability to eat solids.
He is sitting again, and has
now mastered rolling.




Last week we got clearance to take Baby T out
though the pediatrician encouraged us
to still exercise caution.








Those who know Baby T well comment
on how he doesn't look like
he was ever sick.
He's as smiley and silly as before.


We're waiting for his care team to deem him "fully recovered".
Until then we're enjoying introducing Baby T
to all the firsts that babies his age enjoy.
He experienced his first "swim" in a pool.
He rode on a cable car and a carousel.
He tasted the first strawberries of the season.
And he was finally reunited with his favorite pastime,
the baby swing.




My breath still catches when I consider
how ill he was and how terrifying
some of those days were.







We're so very thankful to everyone
who has helped us get through what
has been the roughest part of our lives.







If your baby has IB we sincerely wish that

Baby T's story gives you

hope for recovery.

We hope that eventually you find peace.






Thank you.













Baby T's Story, Chapter 17- Recovery Pt. 1

3/9/12-3/17/12

I just about jump out of my skin when the NG pump
alarm sounds in the middle of the night.
The only alarm in my home that would be that loud
would be the smoke/carbon monoxide detector.
I refill the bag which feeds the NG pump
as my heartbeat steadily returns to a normal pace.
Baby T sleeps through the whole process.
I crawl back into bed next to him,
cuddle him thoroughly
then return to slumberland.




Being home is freedom.
Except for the mass amount of appointments we've accumulated.
Baby T's first appointment is with his regular pediatrician,
the day after his hospital discharge.

We're his second confirmed case of botulism in
his ten (plus) year span as a pediatrician.
He's been monitoring Baby T's case closely
and we discuss the plan in moving forward.

His weight will need to be monitored,
Baby T lost about a pound in the hospital.
We're also not to take T around any
younger children or public spaces.
The flu & RSV are spreading like wildfire
and with Baby T in his vulnerable state,
avoiding exposure is recommended.
His NG night feeds should continue
but may need to be adjusted based on his weight gain.
The pediatrician asks us a few questions,
answers ours, and then we're on our way.

Our first few weeks home are spent decompressing.
Baby T spends alot of time nursing as he is weak.
At night he has a little trouble going
to sleep and will only settle when
he lays down on me.
We ease back into our lives
but we continue to revolve around Baby T.





His weight fluctuates so we sometimes have to visit
the doctor two times in one week.
Being confined to our home is the most
difficult order to follow.
Luckily, our family is available to assist us.

A neurologist appointment the week after discharge
brings us back to the hospital we'd become so familiar with.
It is odd to walk past it with Baby T
snuggled against me in the ergo carrier.


Neurology is happy with Baby T's progress and
plan to see him again in two months.



On his ninth day home (St. Patrick's day),
Baby T pulls out his NG tube.
Finally, he is free from tubes.






Baby T's Story, Chapter 16- Home

Thursday 3/8/12


Baby T and I experience another restless night in peds.
Our lack of rest solidifies my desire to get him discharged.
I truly feel that he is now ready to recover at home.


The pediatricians visit early and discuss that Baby T seems ready to go home
and likely can be discharged without the NG tube.
I'm so very excited about their confidence in T being ready
and even more excited about leaving the NG tube behind.


Neurology comes and feels that the NG tube is necessary for discharge.
At this point I've already called my family to let them know we
should be returning home later that day.
I'm confused by the differing opinions between the staff.


During rounds I practically plead that they discharge us.
They debate whether his NG tube is necessary.
OT is requested to re-assess his swallow.
The peds concur that discharging with the NG would be
best just to make sure that he continues to gain weight.


The only problem is that the NG training and equipment take a day to order.
This would delay our discharge until tomorrow.


IB Dad and my parents arrive and are confused by the change of plans.
I'm upset since exhaustion is now really catching up with me
and I feel that he is so very close to coming home.
Our bags are packed.
I try to chin up and convince myself that one more
day wouldn't be terrible.
But it is.
We need to go home.


Luckily, a sympathetic nurse hears me (and my family) out.
It turns out that her daughter was hospitalized as an infant and
discharged with an NG tube.
The nurse understood our urgency to return home.
She put rush orders in on our equipment and facilitated
a quick NG feed training session.


I requested to see the pediatrician once more and
we went over the discharge orders.
Baby T is to get weight checks weekly,
will have Occupational and Physical Therapy appointments.
And will need a pediatrician appointment the next day.
He will get 800 ml of breastmilk in the NG tube over
an 8 hour period at night.
Otherwise he can breastfeed on demand and
be supplemented with baby food.


Many of the PICU staff hear about our imminent discharge and make their way
over to peds to say good-bye to Baby T.

Last nap in the hospital



The equipment arrives.
Papers are signed.
The IV is pulled.
We load up all of the frozen breastmilk (over 100 oz)
which requires a cooler for transport.
We dress Baby T for the first time in over 2 weeks.
Soon we are discharged.


Walking out with him feels surreal.
I walk him down the corridors that I've previously
walked in such a sad state.
We pass the parent room where I've slept
many nights during our stay.
We take the common elevator
and Baby T catches the curiosity of many
since he still has his NG tube.


Every step we take puts more distance between him
and the machines, needles, dressings, medications, health care workers,
cribs, tests, lights and tubes.
Soon we settle him into his car-seat.
We put miles between us and the hospital.

Ready to go home!



I cannot stop myself from repeatedly commenting to IB Dad about how
strange it feels to be finally leaving the hospital with Baby T.
We arrive home and are greeted by our girls and IB Dad's mother.
Baby T lights up when he sees his sisters
but he's easily overwhelmed with their exuberance.


We quickly settle into our home once more.
IB Dad and I set up the equipment for the
overnight NG feeds.
While we're waiting for the breastmilk to thaw,
we talk and marvel at our sleeping Baby T...
and end up falling asleep together.


We wake up a couple of hours later laughing at
how tired we must have been in order to fall
asleep in mid-conversation. 
The milk is thawed so we
set up Baby T's first NG feed at home.


Being reunited with my family,
Baby T sleeping at my side,
in my own bed,
in our home.


We are
finally,
unbelievably

Baby T's Story, Chapter 15- Breastfeeding reunion

Wednesday 3/7/12


Baby T and I are adjusting to life in Peds.
It's so nice to be going from him being so intensely monitored to nearly nothing.
After a weight check in the morning they leave his leads off so I can pick him up whenever I wish.
It's much easier to pick him up with only an NG tube to negotiate.
It is relieving to be able to comfort him in my arms.


I meet Baby T's new care team in the morning.
Rounds are done in the hallway as the room is too small to hold everyone.
I get the news that RT will remove his nasal canula
and that I can breastfeed my baby once more!!
My excitement is contagious.
When rounds are over I burst back into the room, and skip over to my baby's bed.
I encounter his smiles and tell him that he gets to breastfeed again.
Then I realize that he may not remember how to breastfeed...


One of my favorite RT's comes by to remove his nasal canula.
She's thrilled by his progress and enjoys freeing him from another tube.



I request the nurse to stop his NG feed.
I decide to nurse Baby T before IB Dad arrives so that he won't be so distracted.


Our nursing reunion is far from the glowing reunion I had envisioned.
He bites and can't seem to get a good latch.
His suck is weak and he gags a bit which causes me alot of anxiety.
He improves quickly though.
Reuniting with my nursling is bliss.

OT and a pediatrician visit during our nursing session and feel that he is doing well.
OT explains that he may take a bit longer negotiating breastfeeding
since milk/thinner fluids take more muscle coordination than solids.
They both feel that he may not need his NG tube upon discharge.


IB Dad arrives and we decide to celebrate Baby T's progress by eating take-out greek food.
It feels good to enjoy the strides he is making.
We feel confident that he'll be coming home soon.


A dr. feels that discharging T soon would be best since
the peds floor is rampant with RSV patients.
Baby T likely isn't strong enough to handle
any kind of respiratory problem.


Discharge.
It sounds too good to be true!
We continue to work on breastfeeding though Baby T is given
some breastmilk through the NG tube at night.










Baby T's Story, Chapter 14- Goodbye PICU!

Tuesday 3/6/12

A restless night is met with even better news in the morning. 
Baby T is moved from a high flow canula to a regular one.
He is breathing well so less assistance is expected.
The footwork to move us out of the PICU is underway.

His NJ tube is pulled back to become an NG tube.
His compromised airway made the NJ (goes further into his intestine)
necessary but now it was time to see if he could handle the NG.


An occupational therapist is added to T's scheduled visitors.
She evaluates his swallow as he takes some solid food.
He does well so she says we can work on breastfeeding soon.
This news couldn't be more welcome.
Pumping, while completely necessary for maintaining my supply, is WORK.
I've gained a new sympathy for moms who need to maintain a long-term relationship with a pump.

Baby T also gets his Arterial line removed.
This free's up his left arm which has been
tied up by lines ever since we arrived.
Losing this line means stability,
they no longer need to do blood labs!

Soon, we get approval to leave the PICU.
After 2 long weeks Baby T is well enough to move to peds (literally across the hall).
The massive amount of stuff we've accumulated is packed up.
I miss the nurses and doctors but know that I'll never ever wish to return there.
That morning we overheard a mother being told that her child's "options" are now severely limited.
I'm reminded once more of how lucky we are through this entire ordeal.


Peds is small.
Our space is about 25 % smaller and we're wedged between two other patients.
No security is necessary to enter our room which means our neighbors
can invite their entire extended families into the room (and they do!).
The nurses & RT's only need to visit every 4 hours now.  


Baby T is in good spirits and handling his NG transition well.
They try bolus feeds to see if he tolerates a larger amount in a shorter timeframe and he does great.

I'm anxious for rounds the next morning as one of our neighbors (a 3 yr old) has white-coat syndrome and screams through her CPT, waking Baby T & I every few hours through the night. 


Click to continue reading Baby T's Story, Chapter 15

Baby T's Story, Chapter 13- Extubated for good

Monday 3/5/12

Baby T before extubation #2



Baby T has a decent night but loses one of his IVs so will need it replaced at some point.
Rounds are made and he is cleared to be extubated.
IB Dad & I are excited but our experience from last week forces us into "wait and see" mode.

















His IV is replaced and miraculously only takes an hour.

Soon we're told it's time to go while they extubate.
We give him lots of kisses and encourage him to be strong.








The procedure is quick and we walk in and immediately see our happy little guy beaming back at us. Seeing his full smile without the vent tube melts our hearts!

What's the big deal guys?
Giving daddy some big smiles



He doesn't whimper or seem to be struggling.
He is so happy!


I quickly go pump while IB Dad & the nurse give him a bath.
Very soon we each get to hold him
(while we joke with staff about having to fight over who gets to hold him first).
It is pure bliss!





As the hours pass we get our usual visitors (peds, neurology, physical therapy, etc)
and they are all overjoyed to see him off of the vent.
The nurses change shifts and a new crew is thrilled to see him thriving.
I'm so very proud of my strong chubby guy.


Our excitement is muted in the evening as our neighbor (a 5 month old) gets intubated.
Usually they have everyone on the floor leave but no one asked us to leave
 so we stayed and saw nothing but heard everything :(.
It breaks our hearts to hear another baby get that procedure done, and reminds us of how unpredictable this whole ordeal has been.


We squeeze Baby T alot and hold him tighter.
I get to sleep bedside again which is great but T is too excited
and doesn't sleep well that night (his glowing toe was quite distracting!!).


Baby T hypnotized by the magical glowing toe


I don't know at that point, but this is our last night in the PICU.
No wonder Baby T wouldn't settle down!



Click to continue reading Baby T's Story, Chapter 14

Baby T's Story, Chapter 12- Mustache & CPAP Sprints

Saturday- Sunday, 3/3/12-3/4/12







The last of the long term patients has left.
We have now been in this PICU longer than any other patient. I dream of the day when we can leave.

Everyday we see the excited patient families leave along with the anxious families
who are new, tender and quite traumatized.
The PICU itself is bi-polar; Calm one minute and then manic the next.


We’re humbled by the conversations that we have with other families
and realize despite the ongoing fear, we are lucky.
Many of the admits have a long history of PICU visits and other hospitalizations
and will continue to be frequent inhabitants.
Many of them have terminal illnesses or have been sick for the majority of their lives.
Our stop here is temporary and YES it is awful,
but it could be so much worse...





Baby T is gaining strength once more. It is nice to see his feistyness return.
We add a mustache to his vent tape for morning rounds suggesting
that T has been here so long that he’s growing facial hair. The staff enjoyed the laugh.
His lung continues to open so CPAP sprints are planned for the
entire day Sunday with the goal of extubating again on Monday.
This time they want to test his strength by decreasing the support in "sprints"
and monitoring his reaction.





He does well on his sprints so the NPO orders are in.
IB Dad & I anxiously await another extubation,
set for 3/5.

This time feels different.


We really feel like he is ready.

Baby T's Story, Chapter 11- Rest

Thursday-Friday 3/1/12-3/2/12


Baby T is exhausted and takes a couple of days to recuperate.
All of the nurses who come onto their shift and see him re-intubated are sad to see him back on the vent.
They take time to speak with us about what happened and let us know that they are cheering him on.


 Initially the dr.’s are worried about needing to refer to a pulmonary specialist who can
send a scope down and potentially remove mucous from the collapsed lung.
The Dr.'s warn that the lung remaining closed puts Baby T at risk for infection. 
The vigorous CPT and respiratory treatments do their job and x-rays reveal that
the lung is opening slowly.

The dr.’s continue to warn us that the recovery time may be weeks to months.
We stay by Baby T's side and wait for him to get stronger.



T slowly regains his strength on the vent and we see more of his smiles.
His resiliance and positivity are contageous

.



After all, if he can smile after all he has been through.......
.....how can we not?




We smile for him and he lights up
even more as if he's saying




"See mom? I'm alright.
Don't be scared, i'm not."




Baby T's Story, Chapter 10- Lung Collapse

Wednesday 2/29/12








After an uneventful night, all seems well. 
Everyone encourages us that the likelihood of Baby T being
intubated decreases as more time passes. 
I leave for home in the morning while IB Dad stays with Baby T.
As I am getting our middle child settled for her nap,
I text IB Dad to check and see how T is doing.
IB Dad calls me back immediately and is distraught. 
He explains that Baby T was doing fine, but then had started to destat
(his respiratory rate/oxygen monitors were indicating that he was heading for respiratory failure).
Doctors and nurses rushed in and they worked to get T back into normal range.
They couldn’t so he is being intubated once more. 

I rush back to the hospital.

When later getting the details of this event IB Dad described how scary it was to see Baby T in good shape one minute but then all of a sudden he looked "out of it".
His eyes began rolling around and his palor totally changed.

His second intubation wasn’t as smooth.
I join IB Dad in the hallway outside and we wait a very long time. 
When I see Baby T again he has another tube in the other nostril
which is draining his stomach contents. He has another machine to add breathing assistance
and more closely monitor his vent settings.

Seeing him back on the vent is terrible.
We thought that his progress was a one way street,
but he seemed to have U-turned and retraced his steps.
An xray revealed the cause.

His right lung has collapsed.

RT’s begin vigorous CPT and breathing treatments to try and open it.
 Xrays become a regular part of his schedule now.

No one was talking much about his prognosis so we were very anxious the rest of the evening
until a pediatrician came by and discussed with us what they believed had happened.

Basically he was too weak and they extubated too soon.
The doctor’s had felt he was ready when he really was not. 
Breathing took too much effort thus the decreased movement in his limbs.
His full recovery is still expected and isn't necessarily in jeopardy
but he now had more hurdles to cross.

IB Dad and I are devestated but do try to remain hopeful.


Baby T continues to have periods of struggle through the night as adjustments to the vent are made.



Baby T's Story, Chapter 9- CPAP Struggles

Tuesday 2/28/12


Baby T is still struggling on the CPAP but the blood gases are returning
within the normal realm so the day continues.
The dr’s are wary of him needing to be intubated emergently, and wish to avoid it.

We get to hold him more.
He is difficult to hold with the various tubes and his complete lack of tone
(imagine holding a 25 lb newborn!) but it feels good to feel his weight again.
The CPAP settings have been adjusted so the machine isn't constantly going off.
We encourage him to continue being a strong little fighter.
He is very tired so PT is quick.
Neurology comes by and they feel he is struggling off of the ventilator
but agree with the pediatrician's "wait and see" approach.

In the evening they are able to resume NJ feeds.
At this point he has been only receiving IV fluids for nutrition for 24 hours.
I'm hoping that getting some food in his tummy might settle him as he is increasingly agitated.
They are wary of sedating him since it may cause respiratory problems.

The next 24 hours are draining, a constant touch and go.
It is hard to see him weak once more, especially since 48 hours ago he seemed stronger.


Baby T's Story, Chapter 8- Extubated

Monday 2/27/12

CPAP involves them turning down the vent settings so that Baby T is encouraged to breath more on his own.
The NPO order stands to allow them to extubate without complications
(if he vomits his stomach contents he might aspirate and develop pneumonia again).


During the morning rounds they go over the plan to extubate as CPAP is going well.
 We leave so that they can remove the vent. IB Dad and I are giddy and can barely contain our excitement.
Soon we are requested and we go to his bedside, we're so anxious to see him.


Baby T is struggling on the CPAP machine since it fits poorly and is leaking.
Intubation + botulism cause his cry to be little more than a raspy "mewwing" sound.
Frequent blood gases (labs which in his case always involve alot of pokes) are done to
make sure that he is tolerating the transition well.
There is a flurry of activity surrounding his crib but I kiss his cheeks
during the first opportunity I get.


IB Dad & I get to hold our son after 5 long days of being unable to.
Holding him is bittersweet.
He is putting so much energy into his breathing. 
He seems as weak as when we first brought him here. 
Our reunion isn't what I expected, was he stronger yesterday or did I imagine it?
The CPAP machine is constantly beeping (alarming) making it even more
difficult to relax and soak in this moment.






Respiratory therapists, nurses and pediatricians continue to monitor Baby T closely.
The decision to switch him to a high flow nasal canula is made and he seems slightly more comfortable.
The need to get frequent blood gases means another decision to
put in an arterial line in order allow easier lab draws (less pokes).



They warn us that Baby T may need to be intubated once more. He is struggling to breath without support
but with the blood gases coming back in the ok range, they continue to "wait and see".
 A rough night is had by all as we anxiously await the next day. 
IB Dad stays the night in the hospital with us since we’re terrified of him being intubated once more.

We sleep in shifts since now one of us can be bedside through the night but sleeping next to him during such an anxious period of time is a near impossibility.


Click to continue reading Baby T's Story, Chapter 9


Baby T's Story, Chapter 7- Smiley Guy

Sunday 2/26/12


Typically when babies Baby T's age are intubated, they need sedation
 so that they do not compromise (pull-on) their tube.
Verced is given and it can make them a bit loopy.
We’re lucky as T rarely requires any sedation. The doctors are impressed by his demeanor
and that despite his returning awareness, he is handling his tube well.

Baby T is gaining strength! Smiles have been more frequent now and we even get to see that classic T tongue action. He likes licking the tape on his tube. More tongue dexterity is a good sign!


Unfortunately, more facial control also means that he can cry.
His cry breaks everyone’s heart as it is soundless (his breathing tube prevents sound)
but involves his facial features and sometimes tears as well.


Seeing our guy emerging from lifeless to a more vigorous state is so encouraging.
As compliant as he is, there are still times where he
genuinely is upset and we're limited in our ability to comfort him.
CPT brings on coughs and tears.
Doctors checking his breathing or PT doing his exercises cause him to smile.
Lifting his bum to put on a fresh diaper often stimulates him to poo more
(making a messy situations which makes all of us laugh).
Tests results or analysis can bring us to extreme sorrow or intense relief.
Experiencing such constant varying emotion is tiring for all of us.

His recovery seems painfully slow, although
we're just relieved that he is moving in one direction.



The doctors give the orders that Baby T can go NPO the next morning
and then will be prepped to go through some CPAP tests
to see how he handles being off of the vent.
He also seems to be getting over his pneumonia as his secretions
have decreased and the fever has disappeared.

Another uneventful night and T rests well. 
IB Dad stays close this night so that he can be there early for the big day.
IB Dad and I are full of anxiety about tomorrow.

Click to Continue reading Baby T's Story, Chapter 8.

Baby T's Story, Chapter 6- Improvements!

Saturday 2/25/12

A very sweet nurse decides that Baby T's crib is drab
looking so she gathers toys from the floor and decorates his crib with them.

This gives him more to look at which
will encourage him to open/exercise his eyes.
He follows people with his eyes (within his line of vision).
Movement is increasing.
He can move his arms and feet now though movement is limited and is only more apparent with pain or irritation.
The doctors are optimistic that in a few days he may be strong enough to try breathing on his own.

IB Dad and I have gotten into a routine of sorts. I'm still staying the night at the hospital but every couple of days I go home to get a break for a few hours. We've worked it out so that Baby T is never alone. Either IB Dad or I are always at his side. Our families have visited him as well.

I feel so much guilt at times for being unavailable for my other children. I've begun to try and make a point of calling them once a day. Our family has circled the wagons and done a great job of keeping our kids on their regular schedule.
There's been so much disruption in our lives so knowing that they are in good hands puts us at ease.

One unexpected perk to being a breastfeeding mom, they feed me breakfast/lunch/dinner while I'm at the hospital.
For the first few days I couldn't eat much. After realizing that I needed to eat in order to provide Baby T his breastmilk, I started convincing myself to eat at least half of my meal.
Then I discovered that I can choose my own meals
(a menu is dropped off every morning), and my eating continued to improve.

Tonight a chocolate cake slice appears with my dinner tray. I stash the cake for later.
When the sun is set I head to the parent room and make my bed.
Other parents are already in bed so the room is dark. 
Only here would an 8pm Saturday night bedtime seem completely reasonable.

Our hospital has an amazing view of a popular west coast city.
I sit on my chair-bed eating my cake while watching the skyline.
I'm celebrating Baby T's improvements,
relieved to have a moment to myself (IB Dad is with Baby T).
Part of me is sad, watching the cars wizz by and wishing I
were one of them, free and moving far far away from here.

I think of what we might be doing at that hour in the evening.
How much I miss my bed at home, but more than that, how much I miss
being able to roll over and snuggle my sweet Baby T.
I miss morning coffee with my mate while our kids quarrel.
I miss driving my eldest to school.
I miss seeing the youngest two nap together.
I make a mental note to remember how much I miss the ordinary.
At the moment I feel like "ordinary" has been sorely lacking in our lives. 


How strange, to be eating cake on my bed with a chorus of tired fathers snoring.
Baby T's presence in the PICU pulls me back.

And there, despite his predicament, I find him wearing a smile.

Click to Continue Reading Baby T's Story, Chapter 7

Baby T's Story, Chapter 5- Hello there baby blues!

Friday 2/24/12

Everyday in the PICU feels hours longer than any day outside.
When we realized that Baby T would be staying for a lengthy period of time,
we brought from home some of his blankets, toys and books.
We spend alot of time reading, singing and talking to him.
We caressed him and snuggle him as best as we can.
His sisters write him notes which are taped to his crib.
Our efforts don’t change where he is but we keep fervent hope that
they will help him move closer to getting out of there and back into our arms.

Xrays and spitum tests confirm that Baby T has aspiration pneumonia.
It’s common in intubated patients but scary to see your child deal with.
The peds plan to monitor him closely with the RT’s spending more time managing his secretions.



I leave the hospital for a short while so that I can shower and pick up my eldest child from school. I’m still in a haze and feel detached from the whole
experience as I run into friends and they hug me and ask how T is doing.



As the day goes on the secretions become clear and the fever disappears.
It seems that the antibiotics are working but the 10 day course will need to continue.



When I return I discover that Baby T is now opening his eyes!


He reacts to our voices and tries to lift his eyelids more as the night goes on.
We gently assist him in opening them and he seems happy to see us.
It feels good to see his strength.
The shell is cracked and our little guy is slowly hatching back into his former self.



This night is uneventful and Baby T rests well.

Click to continue reading Baby T's Story, Chapter 6

Baby T's Story, Chapter 4- Big Baby meet BabyBIG

Thursday 2/23/12


The routine of PICU life become more apparent as the days go on.
Every 2 hours, or so, the nurse takes vitals and moves Baby T 
(switching sides while immobile is important!).
Our nurses typically have one other patient so if we need something while our nurse is absent,
we can flag the nurse or another available nurse will help us.
Shifts change at 7am and 7pm, the new nurse is given the latest news and current care-plan.
The pediatricians visit before rounds and throughout the day.
Rounds occur with the pediatric care team (peds, neurology, residents, physical therapy, charge nurses & respiratory therapists) at 9am. Rounds is basically a very detailed report of each patients health.
 Big decisions are discussed and questions answered during rounds.
 I often record rounds on my phone so that IB Dad can hear the dr’s comments later.
Neurology & physical therapy usually visit in the morning.
Respiratory therapists visit T often to monitor his breathing assistance.

PICU life forces adjustments. It is odd to need security clearance to see your child and need to wash your hands whenever in their proximity. IB Dad and I help where we can (and beyond) but even the simplest diaper change requires a nurse or RT’s assistance.
I feel I’m almost as needy as Baby T since I need access to the “pump” room across the hall every 2-3 hours. Pumping involves a whole process including cleaning the pump parts and labeling/pouring milk then requesting that it be ran to the freezer. It's a chore to pump but I don't consider it an option as I'm committed to exclusively breastfeeding Baby T as my other children were.
I feel lucky that my supply has improved despite the stress that has become a part of my daily life.

I greet Baby T's nurse change at 7am with the news that the BabyBIG arrived earlier that morning and was immediately injected intravenously. BabyBIG is a drug which neutralizes the botulism toxin thus allowing the body to resume communication so that the muscles can contract again.
It feels much better to know that the anti-toxin is now working its way through his body.
Now we wait for him to come back around.


Also new this morning, Baby T begins continuous NJ feeds of breastmilk.  The tube in his nose goes into his intestine thus enabling him to receive nutrition (since he cannot breastfeed).
 He is started at 10 ml/hr of my breastmilk, and gradually increased to 50 ml/hr (his goal).
It feels good that they can finally start using my milk. I feel like he is receiving all the hard work I've put into pumping, with the 3am pumping session being especially hard.
Besides reading him books, talking to him about his sisters and how much everyone care about him, I'm finally able to do something for him that no one else can.
Provide him my milk.

Fevers, high respiratory rate and high heart rate are all causing more anxious moments. A stool sample is collected and later comes back to confirm the diagnosis, Type A Infant Botulism.

More blood is drawn as the day goes on.
The dr’s want to rule out flu, RSV, & “C. difficil” which can cause diarrhea.
The secretions become thicker and yellow so a test for pneumonia is sent.
They begin antibiotics intravenously as a precaution and increase the frequency of “CPT” (cardiopulmonary physical therapy) done by the respiratory therapists. CPT involves the RT knocking on his chest wall for 5 minutes or so to loosen mucous.

T is moving a little more and even gives his aunt  (my twin sister) a smile later.

Another roller coaster night occurs with Baby T's fevers
and high respiratory rate putting us all on edge.

Click to continue reading Baby T's Story, Chapter 5

Baby T's Story, Chapter 3- Intubated

Wednesday 2/22/12

Curtains divide the four beds in our area of the PICU.
Two private rooms flank each end but we've occupied the last stall, the floor is full.
Privacy is an illusion.
Rounds are done in hushed voices but Baby T's case has attracted a crowd with heads peaking over others to catch a glimpse and many doctors/residents wish to assess/reassess him.   
We walk them through his 24 hour decline before the ER visit and answer the same questions.
The plan is to continue to offer supportive care while the BabyBIG (the antitoxin) has been ordered.

T no longer opens his eyes, he doesn't move and his response to pain is minimal.
 I don't understand at this point but he is paralyzed.
A toxin has invaded his system, flourished and blocked his ability to move.
Paralysis typically moves from the head down.
His brain is not affected meaning he can feel happy/sad/scared/pain but he just cannot move.

Supportive care is the standard in treatment for botulism.
Essentially, there is no time frame for recovery, each baby is different
Getting the BabyBIG sooner can aid in a swifter recovery but does not ensure any certain
time frame. BabyBIG rids the body of the toxin allowing the neuro-pathways to reconnect.

The decision to intubate is made during morning rounds. 
They are worried that his airway may become compromised by his inability to cough/gag thus putting him at risk for aspiration.
This is the first procedure that we have to leave for.
It breaks our hearts to leave him for what must be a scary intervention,
but we take time to kiss him/let him know that we love him.
Then we are led away.
IB Dad and I take the opportunity to update our family.

When we're reunited with him he has gained another set of monitors and a vent tube plus an NJ tube (a nasal feeding tube inserted beyond the stomach to decrease the chance of vomiting).
He is sedated from the procedure.
The machine is assisting his breathing, they explain the settings.
Xrays are ordered to make sure the NJ tube and Vent tubes are properly placed.
The NJ has to be adjusted many times.

Seeing our baby like this is unbearable.
IB Dad and I struggle with the weight of the situation.
Baby T looks so much more vulnerable when intubated.
The machines relay if T is stressed or unhappy, and my addiction to watching them begins.

Every call or text to my cell phone brings my screen saver to my attention. 
The baby smiling back at me from my cell phone looks nothing
like the frail, bedridden infant in front of me. 
Babies cry in other beds, I find myself wishing to hear Baby T cry . . .
something I haven't wished for since his first breath.

With T stable once more I leave for a brief trip home.
My heart is left behind in the hospital.
I navigate myself home somehow and encounter the harshness that life is going on everywhere else. Our alternate universe is left behind once you leave the PICU floor yet a haze covers me.
I cannot escape. I cannot fix my baby.  
This is reality.


 My parents arrive (they drove straight from their home 15 hours away).
My sister and IB Dad's mother are caring for our girls.
My friends are helping them navigate our old life.
I feel I cannot focus on much else and am grateful that my immediate worries have been remedied. Pumping negates my schedule plus I am eager to return to Baby T.


 IB Dad and his family stay in the PICU. 
Baby T is tormented for hours as they try to find a place for an IV
while also attempting blood draws for labs.
Even the most experienced hospitalist has trouble.
A PIC line is attempted for a while. An ultrasound is brought in to assist but no remedy is found.
His chubbiness has always caused us to giggle,
we never imagined that it would become such a liability.
When I return there are multiple pokes in his ankles, feet, wrists, arms, fingers and toes.
A central line is debated, finally they get what they need
and more serious intervention has been avoided.


 IB Dad and I have a late night with Baby T.
I cannot sleep next to him while he is intubated so IB Dad returns home 
(one parent per patient in the sleeping room).
Between pumping every three hours and my frequent visits to Baby T, sleep is not plentiful.

Continue Reading Baby T's Story, Chapter 4