Tuesday, August 22, 2006

Down the flow chart

I have long used the metaphor of the flow chart to describe the various steps that it is going to take to get Woody out of this NICU, starting with step one, get intubated, step two, breathe, step three, survive getting some IV lines installed, step four, survive the trip into NICU, step 785, get a full ride scholarship to college. Of course it doesn't exactly look like the neat flow of progress, because there are always things that can cycle you back up the flow chart, such as 'get re-intubated', and then you get this feeling that you and your wife are going to be coming to the NICU to visit your child until the end of time. Today was not one of those days. Woody got moved back to the nasal cannula, which marks a high water line of his time in the NICU. The nurse on today re-strung his gastric line through his nose, too, which means that for the first time he has, as a matter of course, nothing in his mouth. We are very happy with the progress, although it's still pretty tenuous in the sense that Woody could still decide to go back up the flow chart and get re-CPAPped or worse, so it's hard to be as happy as we could until it's clear that he can handle the changes.

Woody's oxygen needs are a little higher on the cannula, which is to be expected. The CPAP was blowing (theoretically) 7 units (cm H2O) of pressure, and the cannula is a high-flow variety that maxes out at 4, although in practice it's only blowing about 2 in equivalent PEEP (an acronym that, regrettably, does not refer to marshmallow birds). So the difference in the pressure support means that he's doing that much more of the work of getting the air into his lungs, so it makes sense that as he does more of the work he needs a little more oxygen in order to get to the same equivalent blood saturations. Nonetheless, he's still been under 50% for the most part, as low as 40%, so it's not that bad. Prior to the switch off the CPAP, he was averaging in the low 30s with his best periods in the high 20s. I expect to see him come down on his O2 needs slowly but steadily. He also didn't get a blood gas test today, but will tomorrow, so we'll continue to be able to follow the raw objective statistics for comparison purposes. The subjective observations, however, continue to show that he's doing pretty darn good, so we're happy about it.

Woody's great grandmother in Corpus Christi has had some health issues and some surgeries herself recently, but it sounds like she's doing better. We are, of course, thinking about her every day and feeling great solidarity for the time she has to be in the hospital. I understand that in mentioning her theory about kids needing to cry to develop her lungs she was non-plussed at the idea that it was a "theory." I assure you, grandmother, in the strongest possible terms that I meant that being a theory in the same way that gravity is a theory, i.e., the scientific use of the term.*

*I was going to try to explain this further, but I had this prescient vision of Bill Hooker, the Woodyblog Comments resident pedant (xoxoxoxox), correcting me for a poor explanation. Bill, wanna take this one?


At 9:13 PM, Anonymous Aunt Susan said...

Glad to hear all is going so well. The picture of the family is fabulous!! He is so chubby!!! I love him and wish I could give him a squeeze.

At 7:07 AM, Anonymous Anonymous said...

I too love the new picture.

Much love to Woody and Grandmother.


At 7:55 AM, Anonymous Grammie said...

You folks clean up real nice. Love you!

At 2:12 PM, Blogger Bill Hooker said...

Being a Resident Pedant and Full of Vegemite Besides, I cannot resist an invitation to mount a favourite soapbox. "Theory" is a very different word in different settings: in casual conversation, it often implies a certain looseness or uncertainty, whereas in scientific terms it means "as nearly certain an idea as we can get hold of". The problem is that, contrary to popular misconception, science is not about certainty -- you won't get a scientist to say, except as a convenient conversational shorthand, that we "know" anything. The most we'll usually allow is that all the information we have supports this or that particular model of how the world works. When we have a very great deal of supporting information for a model, we refer to it as a theory. When the supporting information amounts to overwhelming evidence, it used to be common to refer to the model as a "law", such as the "law" of gravity. The fashion has largely changed, and modern science seldom if ever refers to the "law" of anything; it's too definite-sounding a term for minds that, for instance, watched Einstein revise Newton's ideas and then found themselves mired in quantum mechanics. This is pretty much the only reason that no one refers to the "Law of Evolution" instead of the "theory of evolution", and it's why, when the Intelligent Design (aka "Establishment Of Religion By Stealth") crowd repeats ad nauseam that "evolution is just a theory", they betray a profound misunderstanding of what a scientific theory is.

Wikipedia is pretty good on this topic, for those who are interested in more detail. The bottom line is that Woody's great-grandmother need not be offended if her grandson describes one of her ideas as a "theory"; indeed, it's a compliment.

At 2:34 PM, Blogger Nathan said...

Thanks Bill!



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