No one should have to watch their child go through morphine withdrawal. After weaning her slowly for the past week, today was Nyana’s first day without morphine since that horrible encounter with the oscillating ventilator two weeks ago. While she seemed to be handling it moderately OK, she was definitely irritated and preferred we all just leave her well enough alone today. I sat by her bedside for a few hours this morning, watching her sleep and watching her monitors.
As reported by Don this weekend, Nyana has graduated to a crib, which means we’re also able to begin swaddling her tightly, something that would have completely overheated her if we’d tried it in her temperature-controlled solarium. As it turns out, the combination of the crib and the tight swaddle has been doing wonders for her O2 requirements. Her ventilator was set to 47% oxygen when I arrived this morning and she’d been satting high all weekend, so I chalked her beepy morning up to morphine agitation and set about my afternoon.
The phone rang around 5:30. CHLDRN&WMEN HLT. My heart raced.
The resident doctor was calling to let me know that because Nyana had been intubated for nearly six weeks with the same tube, it had become clogged with mucus and other secretions and wasn’t doing the job it should be. The decision had been made to extubate her. (This is another of my will-never-happen-but-nice-to-dream-about moments, that they’ll extubate her for some reason, only to find she can suddenly do without supplemental oxygen.) In the blink of an eye I went from panicked to elated and back to deflated. Once extubated, they tried her on the CPAP, to no avail. She was able to take the breaths she needed, but her poor lungs were just too weak to be able to sustain the effort needed to breathe. The whole process took about 45 minutes in total, before the new, clean tube was inserted. Of course, she was given a small dose of morphine for her troubles.
Don and I had a quiet visit with her tonight, marvelling at how awesome it was that she had a crib, yet sad that it had to be another “look, but don’t really touch” kind of night. We were warned that the NICU was a roller coaster; I’m surprised that I’m still surprised at how quickly emotions and situations can change.
I’ve been talking with the RTs about having Nyana off of the ventilator and onto the CPAP in another week or two, then she’ll likely need the CPAP for a month or more. I’m curious to talk with the doctors during rounds tomorrow and find out what their thoughts are on extubation, after seeing how she handled herself this afternoon. The resident who called told me that today’s chest x-ray doesn’t look much different than the one I was shown two weeks ago. So her lungs aren’t getting any worse, which is good. But they’re also not getting any better.
I’ll bet her new crib in the NICU will look fantastic all decked out in Christmas garlands.