Off Cannula, Back on Cannula, and Two Huge Bradys

Karen was Henry's nurse today. She has taken care of him a couple of times before. One of the nice things about Karen is that she is the mother of four children, two of whom were preemies (her oldest is now 25 and was a 32-weeker, and her youngest was a 33.5-weeker), so she has inside experience from the parent side of things.

The morning was fine. I believe that my dad came in early. I arrived before Henry's 11AM meal time. He nursed for 13 minutes. The doors to his room were open, but the curtain was closed while we nursed, so I overheard bits and pieces from the rounds discussion. During rounds, the residents report on the babies. There is a new group of residents today (month change). The person reporting on Henry's arithmetic was off, but not in a way that is really detrimental or anything. She reported that Henry gained 23 grams per day on average (it's actually 20 grams on average). That's a bit different when you are talking about preemies. Hopefully, her arithmetic will improve over the month. Long story short, Dr. Catherine Tsai decided that Henry should attempt to be without his cannula, just as a trial. She also described me as an "anxious mother" (might have something to do with the number of questions I ask, and that I have questioned when and why certain labs have and have not been done).

After rounds, Dr. Tsai came to tell me in person about the room air experiment. I had a chance to ask her about the calcium labs. She said that they hadn't changed previously from week before last to last week and therefore she is basically operating under the assumption that his alk phos test is still high. That test is one of the indicants of metabolic bone disease. However, Dr. Tsai said that some studies suggest that the correlation between the alk phos test and bone density isn't great. I strongly suspect that Henry does have bone problems. Most small preemies do. And, Henry was on Lasix for a long time, meaning that calcium was constantly being stripped from his system. Dr. Tsai clarified that the fortifier wasn't likely to make any major dents in his bone density right away. We'll have to make sure he is always handled carefully, because he will fracture easily. I appreciated Dr. Tsai's candor. If Henry has bone disease, there really isn't any point to drawing blood each week to confirm what we already know. Also, Dr. Tsai said that I shouldn't worry about such things, leave it to the doctors. I think that Dr. Tsai is a good doctor. That being said, I will always inquire about such things being: (1) the doctors rotate a lot in the NICU, and (2) the experience we had with my negligent OB has left me jaded about the medical profession. When Henry goes home, he'll have to take at least two bottles a day with the fortifier in them.

Karen waited until 12:30PM to take off his cannula. She wanted to give his stomach a chance to settle a little bit. Henry looked great without the tubes.

My memory of the day is a bit hazy, but I think that Henry nursed another 5 minutes about two hours later. Then, a little before 2PM, he nursed another 5 minutes. So Karen gave him half an NG feed (about 18 mls).

Henry was doing a lot of surfing. Unfortunately, Karen had to put the cannula back on him at 2:45PM. When a lot of food is in the stomach, the stomach expands and sometimes makes it harder for babies to breath as the stomach pushes against the lungs.

Jeff came around 4PM. He was hoping to see Henry without the cannula.

Dr. Heather Cahan stopped by to talk with us. She said that the blood bank called because the donor of Henry's platelets (given to him a while ago) has reported that s/he has a tumor in his/her mouth. They gave Dr. Cahan the option to inform us or not. She chose to inform us, which I appreciate. She said that she could find no studies to suggest that a person who gives platelets will transmit a tumor growth (or potential tumor growth) to recipients. She also made some calls, because she knows that I operate best when I have facts and figures. Hopefully, it won't be a problem. So there it is.

I nursed Henry a little after 5PM for 20 minutes. Took at 15 minute break. Then, he wanted more. So, we nursed for another 20 minutes.

Around 6PM, Henry had took huge bradys. One with sats down to 39%, and another with sats down to 42% (I think). The first one was probably 1.5 minutes long. Both required blow-bys for him to get back up.

We are definitely requesting a monitor for home. I was talking to Kathy about it last night. She's from Ohio, where she said that insurance companies won't pay for baby monitors unless the mother has already had one baby die from SIDS. That's messed up. There are many staff members who say, "Let's hope you don't have to go home on a monitor." I want one. After all these bradys, there's no way I'd be able to sleep without one.

In other news, two babies in Pod Three went home today. One is Floyd. His crib was right near Henry's door. The second baby, Maximus Hector-Trinidad Rangel, also went home. His mother, Melissa Bolivar, gave me some spiritual books last night, which she said gave her strength through her baby's ordeal. Maximus is indeed named after Russel Crowes' character in Gladiator.

I learned today that one of Henry's former podmates has died. While I filled out some breast milk labels on the desk at Henry's station, I saw a card that was left on the desk for nurses and doctors to sign that was addressed to the baby's parents. The baby, Nathan, is one that I've mentioned before. He had the most amazing head of hair that I'd ever seen on an infant. His hair got so long that his grandmother had to give him a haircut during his stay in the NICU. He went home a few weeks ago. He'd been one of Henry's podmates back in the Pod Two days. And, more recently, Nathan was Henry's podmate in Pod Four. Words cannot adequately express how profoundly sad this news has made me. Nathan was a beautiful boy.