Wagner's Up and Down Day

Wagner’s Up and Down Day

* * * The twins are fine, so fine that I am now writing a post about how fantastic their latest lung x-rays are.  But this is not that post.  * * *

Note: this title was taken from the book Big Brown Bear’s Up and Down Day , which is a GREAT children’s book that everyone should read.  But what happens to Bear is nothing like what happens to Wagner in this post.

* * * * *

“So, Wagner had a bad night.”

Look at the chart.  Cluster of red circles: at 17:30, 23:45, 01:20, 02:40, and again this morning at 10:45.

“Mostly if he de-sats, it’s in the 60’s, but these episodes were apneaic.”

Apneaic.  Not breathing.

Look at the monitor.  Everything’s fine.  Heart rate in the 160’s, breathing in the 50-70 range, Oxygen – saturation rate in the low 90’s.

“Everything’s fine now.  His numbers are good.”

Look at the respirator.  Breaths per minute: still 20.  Oxygen percentage: 25, almost 21%, like the air we breathe.  PEEPs, PAPs, PIPs, all good.

“We have new doctor’s orders.  Limit holding to once a day, no more than an hour.”

Is that the problem?  (Of course, nobody was holding him at night around his cluster of episodes.)

“No.  We want you to hold them, but if they’re having problems . . . “ she trails off.  “Sometimes it’s . . . we just have to see how they handle it.”

Michael’s fine.  Same kind of monitor.  Same kind of respirator.  Same kind of numbers.  Different night.  I take his temperature.  I give him his pacifier.  I change his diaper, put it on the tray so it can be weighed.  I change the oxygen sensor from his foot to his wrist. 

Hey!  The PICC line is out!  (That’s good news.  Really good news.)

“Yes, they took it out last night.  The boys are up on their feedings, down on the TPN.  They don’t need their IV’s anymore.”

So maybe that’s why Wagner had a bad night?

“Could be.”

As I adjust Michael’s pacifier again, I hear it first from Wagner’s monitor, then see it on Michael’s.  The high-pitched alarm of a de-sat beeps from the front monitor.  Wagner’s readings pop up on Michael’s monitor.  48.

48.  Wagner has dropped from a “safe stage” somewhere between 80 and 97, triggered the alarm and in two seconds (literally two seconds), he’s now at 48.  In all of their daily de-sats, I’ve never seen it drop so low so quickly.  The room is dark.  The nurse has stepped out.  I’m alone with the twins.

In another second, a nurse rushes in.  I’m still changing Michael’s bed.  Because I’m at Michael’s isolette, she thinks the problem is with Michael.  I nod toward Wagner to indicate that the problem is with him.  Before she can ask I tell her, “He’s at 48.”

Our primary nurse comes in.  Calm.  Too calm? 

I finish with Michael. 

More flashing numbers: 43.  38.  33. 

“He’s at 9,” says the first nurse.  “Breaths.  He’s at 9 breaths.  25.  He’s back to 25.”

“Give him some more oxygen.  I upped his oxygen but give him some more.”

“Come on, Wagner.  Breathe, honey, you’ve got to breathe.”

“Tap him on his back.”

38.  44.  55.  56.  57. 

“Give him a little more oxygen.”

55.

“Breathe, honey.  Come, on.”

Oh, please, breathe.  Please breathe.

67.  73.  78.  85. 

The monitor stops flashing.

The nurses discuss whether the episode was apnea or not.  His heart rate only dropped to 119.  Technically, an apneaic episode would have had a heart rate of 90s or lower.  But given the cluster of apneas last night, we’ll count it as an apnea.

The monitor beeps again.

97.  98.  99.  100. 

We smile.  He’s fine.  The nurse lowers his oxygen again.

That was the day nurse.

“I think we should do some tests.  There could be an infection from taking the PICC line out.  All it takes is one little germ.”

The doctor agrees, shrugging, “Sure.  You never know.”

Take a blood gas.  The results come back great.

Snap an x-ray.  The lungs look cloudy, but nothing too different from yesterday’s x-ray.

The next step is to take some blood, some for tests, some for a culture.  The artery spasms.  Another nurse is called in to try.  Another spasm.  They try another limb with a tourniquet this time.

Matt and I watch Wagner’s arm, strangely listless.  It doesn’t even react to the needle prick.  Too cautious to pace, we stand there, arms crossed, brows furrowed, lips tense.

Finally, they find an artery.  The blood goes from Wagner’s ankle to a thin tube to a strip of paper.  The results come back picture perfect.  No infection.

And the listless arm?

“Sucrose.  A drop of sucrose on the tongue for infants acts like a pain killer.”

That was the afternoon nurse.

Finally at the end of the day, Wagner’s saturation rate is high and his oxygen percentage rate is low.  (Both very good.)

We still have to wait for the results of the blood culture, but it looks like we’ll never know what caused this cluster of apneas.

“Sometimes that’s just what preemies do.”

That was the night nurse.

A day later, remembering, recording.  Like a balloon letting out air, I finally cry.  Little, simple, relieved tears.  I’m OK.  It’s just what parents of preemies do.

© 2010 Janine Kovac