Tuesday, August 08, 2006

The (boring) suspense continues

Well, all that and some sort of "emergency" managed to delay Woody's eye test until tomorrow. I try to not get too unhappy at any delay; after all, there are probably more immediate crises that are behind them*, but this is a pretty serious condition we're dealing with, so hurry up with that already.

I had rearranged my schedule to be there for the exam, so because of that I missed rounds for the first time in a while, but I did hear secondhand that there is now officially A Debate about what to do with Woody's vent status after the eye thing is cleared up. The nurse practitioners and the doctors and the specialists are now sort of divided into the Optimistic and the Pessimistic camps, with the Pessimists going for trach now and the Optimists pulling for another extubation attempt. I find it pretty curious that the people closest to Woody's care (nurses and the nurse practitioners) tend to be Optimists, while those that see him the least (the neonatologists and the pulmonologists) are more likely to be Pessimists. A notable exception is the split between the pulmonologists themselves; the one that was at last Friday's intervention is the prime Pessimist while the other one is at least a lukewarm Optimist, and has noted at least three different times in Woody's chart that he should get another chance at extubation.

Tomorrow he will get another blood gas test. This one is a little more important in my opinion than most, because however it turns out it will become ammunition for one of the partisans in arguing for Woody's next step. If it's lower than 62, it will be seen as evidence of continued progress, and will strengthen the Optimists' position; if it's higher, then the 62 will be explained away as an outlier blip on his overall CO2 processing, and it will be seen as further evidence that his lungs are too sick to try another extubation. I am heartened, among other things, by the anecdotal evidence I hear from nurses and nurse practitioners about how some babies have completely fooled them, showing even worse signs than Woody but successfully making a transition to CPAP despite it. My position, as usual, is with the Optimists, although I try to remain realistic about his prospects. However, I want very much to make sure that Woody himself has the final say-- his progress will dictate what we do, and I am just fine with that approach whatever it turns out to require.

*After Woody's delivery, Maggie was bothered by her epidural entry point, and the anesthesiologist was going to do a minor procedure to patch it up. So she got into the prep room and then was forced to wait for two hours as nothing happened-- I found out about this because it was only supposed to take thirty minutes and I went out for a burrito or something, and came back and she hadn't been wheeled back in, so I had to go find her. When I did, she was quite literally huddled up on her side in a dark curtained off corner of the general surgery prep room, with "E.R."-like sounds of trauma, distress, and mayhem going on around her. I threw a minor fit, got her into a private room with an actual door, and then we waited around for her procedure. Of course, after all that, it was canceled. The anesthesiologist, turns out, got called off because some poor sap in the cardiac ward had a heart attack and needed an emergency six-way bypass operation. So while I felt bad for Maggie having to wait around, I really did understand why the anesthesiologist didn't show up. Just shows how there are almost always priorities ahead of you in the hospital, and if there aren't, you're probably in trouble.


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