SuperPowers.

Kendall had a really good nite in the grander scheme of things. She only needed blow-by oxygen for a couple hours to get her sats (saturation of oxygen in her blood) back into the 90’s.  Heartrate was still elevated all nite, but was staying in the 180 range – nice and far away from the 200’s! She had a mild spike (up to 103.5) that was much easier on her than the one from the afternoon, but again loading her up with tylenol/ibu, pushing some zofran to stop the vomiting that the spikes induce, and soaking her in cold wet rags allowed her to get some good rest. (And momma too!)

In fact, it was SO quiet all nite after that point (from about 1am – 6am) that I thought we might possibly get a negative culture this morning, and be able to start the countdown to discharge on Sunday! (someday I’ll learn to stop thinking so positive!)

Instead, i was woken up by the fellow  telling me we needed to have a chat. And the main point of that chat was that I was told we were going to remove her line. Her labwork today has literally thrown off docs from top to bottom of this hospital. The most notable oddity being that on her CBC (a complete blood count, one of the routine tests we run every time she’s sick – they run it on pretty much everyone who is sick enough to need bloodwork), instead of just having red cells/white cells/ and how much of each, she actually had yeast spores on the “smear”. i don’t fully understand how this is possible, other than, remember the petri dish thing I talked about yesterday where they have to “grow” the blood with special stuff? Yeah, Kendall’s doesn’t need the special stuff. It’s just growing and overtaking her blood. And along with that, taking all of the good blood. In essence, not a good situation at all.

Our attending came in shortly after that and said “ I do not know what kind of superpowers this kid has, but they are amazing. According to her bloodwork, she should be laying in a PICU very very sick right now. I do not have any idea how she is managing to function right now, let alone sit up and interact.” I corrected him and said they were SuperNatural Powers.

The bottom line though is that the only prudent and wise thing to do right now will be to take this line out. He doesn’t want to, the fellow doesn’t want to, not even ID really wants to – because no one thinks the line itself is the problem. But she has gone septic (again according to the labwork – not how she’s acting!) – and one of her counts is extremely elevated indicating that she possibly has a clot somewhere (or another massive source of inflammation that we cannot obviously see). Remember her whole “arm hurting” episode last week? Yeah – one of the first thoughts I had was that she had a clot. It could be a whole lot of nothing, but given what we are dealing with now, its worth checking out. Now our two residents were not understanding what i meant when i said “well what if we pull this line, and there’s still a clot somewhere, and we haven’t really solved the problem?” – they are acting as if the clot (if indeed one exists) HAS to be in the line itself, so if we pull the line, we pull the problem, and off she goes good as new.

Finally when they came on rounds and I asked the attending and the fellow, they said, that is what we are talking about (to the resident – who they had obviously had the same conversation with!). Anyways – it was all very confusing but I THINK now that the right people know what we are trying to do. We need to figure out if there is a clot somewhere in her upper vasculature that is NOT in her line. I am not sure if that would still save the line – but it might at least help us figure out a little better what is going on. If there is a “clot’, it could be leftover infected blood from the last infection, or it could be one of the “fungus balls” we were looking for on CT yesterday. The fellow is more afraid of it being a fungus ball, and if we try to break that up – all hell will literally break loose in this kids body. At least that is the fear.

She is still firmly stuck between a rock and a hard place. Our docs are definitely very wary with her “good” behavior, that it is a very false sense of comfort we have right now. We have all seen her go tumbling head first down a steep hill of “crashing”, and right now, she’s basically walking a tightrope across the Grand Canyon. Somehow she is staying on that little tightrope and doing a pretty good job at it – but the slightest little thing could be the tipping point for her, and right now she does not appear to have many (or any) reserves left. Complex Care has already begun making contingency plans for the weekend as we are going to be in a very tight corner. On the one hand, we hope that she starts making good improvements once the line is out and the yeast can’t attach to the plastic anymore and the anti-fungals start doing a better job of killing them off. On the other, she will be HOPEFULLY getting 2 PIV’s placed while she’s under anesthesia. Last time they could only find a spot for one, and that was what led to the horrific nite of begging pleading and praying that someone could get some access. I admit that I am very nervous about the situation she will be in going into the weekend. 

I’ll continue this later – they are here to get her for surgery…

 

thank you for praying!

 

terra