Thursday, June 15, 2006

A game of inches

Reading Woody's test results is sometimes like calculating trajectories of a NASA probe to Mars: the tiniest differentials can mean the difference between the decision to increase, decrease, or remain the same on any of the technological settings he is subjected to. For example, yesterday Woody's vent setting wean was determined to not be taking when his blood pH and CO2 readings showed up as bad. A smaller change was made today and his blood gases level were different from the bad ones yesterday by .01 on the pH and 4% on the CO2 levels. Yet today we are re-testing and keeping the vent change, while yesterday they changed it right away.

I had a somewhat extensive discussion with the doctors today on rounds on this point, and for most of it they didn't even understand what my concern was: they seemed more apt to assume that I was just asking what a "bad" reading was, or why the reading looked bad yesterday, as opposed to my real question, which was given the margin of error here, why keep today's change and not yesterday's?

In retrospect, I think the answer is mostly that taking care of a NICU preemie of Woody's size is really a whole lot of judgment calls and trying to finesse the art of what he can be pushed into tolerating. While the data looks pretty similar to me (and to them, too, as they eventually admitted) sometimes they will just try to go with a marginal test result in order to see if Woody can be coaxed into better territory. I don't really have a problem with this-- especially if they think I was arguing that they should have put his settings higher again to fight the bad test results. Quite the opposite: I think that if those results were good enough to keep the change today, then they should have kept the change yesterday too. But now we're into some serious esoterica, because the difference between yesterday's discarded change and today's kept one is .2 of tidal volume, and neither change is that huge in the scheme of things.

I admit to being worried about the long term. Maggie has already told me that I'm violating my own rule about not worrying about things beyond tomorrow, but there it is, and it's tough not to.

Instead, I will worry about work and phlegm balls and other silly things like that. Carry on.


At 9:58 PM, Anonymous Dad/Sherri said...

Can't offer much help with phlegm ball discussion but I do know something about living one day at a time. Even if all you can see on the horizon is endless joy, no one is guaranteed more than the current moment's experience. One of my favorite verses in the Bible is Matthew 6:34; "Sufficent unto the day is the evil thereof" (which follows Jesus' admonition not to be anxious about what will happen tomorrow.) It's not that bad things are going to happen for sure in the future; it's just that if, right now, you had to face everything in the future that could possibly go wrong, you'd run out of resources in a few seconds.
This is really hard stuff for those of us (me/me/me) who like to plan ahead and get there on time.

Hang in there...


At 1:43 PM, Anonymous jared said...

That's a good verse. Note that the admonition includes tomorrow's worries as well as worries about the amorphous "long term." Some other quotations I've had occasion to run across:

"Heavy thoughts bring on physical maladies; when the soul is oppressed so is the body." ~ Martin Luther ~

"People become attached to their burdens sometimes more than the burdens are attached to them." ~ George Bernard Shaw, "Family Affection," Parents and Children, 1914 ~

"He who fears he shall suffer, already suffers what he fears." ~ Montaigne, Essays, 1588 ~

"With the past, I have nothing to do; nor with the future. I live now." ~ Ralph Waldo Emerson ~

Much love to the three of you Nathan Maggie & Woodrow, you are all in my thought


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