NICU Day #65 - Timmy's Reanastomosis

Thursday, June 24, 2010

An absolutely enormous thank you to James's mom and Ammon for driving in early Thursday morning to watch the kids so we could be at the hospital by 7am for Timmy's surgery.

A little anxious for the day, hating the thought of Timmy going through another visit to the operating room but ready for him to have his intestines reanastomosed so he could start healing and progressing to normal feeds and excretions.

James was only going to be able to meet the surgeon and then head out while the surgery was taking place so we drove separately.  Just as I was climbing into the car at 6:45 (we only live about 7 minutes from the hospital) my cell phone rang and it was Timmy's night nurse asking where we were.  Apparently the surgeons were there and waiting.  I told her that I had been told 7 and that we were on our way.  She said, no, you were told before 7.  Could we be a little more vague?  And could we not tell me what I was or was not told by someone else?  Yes, I was seething.  So glad it was shift change when we got there.  (Fear not, when we visit again tomorrow during rounds, I will ask that Timmy not have her again.  She is a great nurse, but not a great match for this mommy.)

We walked into Timmy's room about 6:48am.  Technically, we were early.  Dr. Cosentino was sitting there, but she didn't seem the least bit annoyed.  Instead, she just got right down to business.  The first thing she did was review the lab results with us.  She said that there were ganglionic cells present throughout his descending colon, which is not consistent with Hirschsprungs and generally an indication that the baby will be able to move things through his intestines and out anally.  However, there was also an increased number of nerve fibers, which is associated with Hirschsprungs.  So "exactly what that means, we don't know".  But her feeling, and we agreed, is that she should proceed with the surgery as planned because there are ganglionic cells present, which is what we were looking for to start with.  We won't know what the nerve fiber count indicates unless we do anyway.  Hopefully nothing.  She told us that it may take a little while for Timmy to pass things through his rectum and that he may have some diarrhea to start with.  (The large intestine primarily absorbs liquid from digested materials.)  I asked if he would have any dietary restrictions or complications in the future and she doesn't think so.  Always nice to hear. 

In performing the surgery, she told us that Timmy would likely lose a little more of his intestines on both ends to freshen up the ends for reconnection.  All the warnings - blood loss, transfusion, morbidity, etc. - still very low, but repeated.  Following that, she headed downstairs and the anesthesia team came to get Timmy.  They were very nice, but the head anesthesiologist had quite an accent and there were times I could not understand him.  He was very thorough in asking his questions and looking through Timmy's chart.  He asked what the reason was for Timmy's prematurity and when James told him I had ruptured, he and his partner both were very impressed that we had made it 8 more weeks.  Having met other people online going through it at the same time and after, I feel very very lucky to have my little guy here and doing as well as he is; PPROM can be wickedly cruel at any stage and there is only so much a mom can do once her water breaks.  There are definitely angels watching out for Timmy.

Pre-surgery

It took two tries to get Timmy out the door; the first time the isolette was still plugged in and the second time the nurses had to replug the isolette in to lower the top to get through the doorway.  Had it not been shift change and so much going on, I might have been worried.  However, every other time Timmy has had to be taken for surgery, x-rays, etc. everything has been flawlessly executed and I really felt he was in good hands.

Timmy was taken down to surgery at 8am and brought back at 11.  In the meantime, I hung out in Timmy's room and worked some more on the pony blanket I started weeks ago and chatted with Dana (she only had Timmy that day) and Sandy.  (She's had Timmy before and I really like her.)  I also got to meet Dr. Maciulla's wife, Sandra.  She is the volunteer coordinator for the NICU and came in to put away some linens and mentioned the Wimbledon match that had finally concluded, breaking all sorts of records but particularly the record for most games in a set.  (At Wimbledon, there is no tie-break to end a 5th set for the men.  They just play it out game after game until somebody wins by two.)  So glad James told me about it the night before as I haven't watched much of anything but Super Why for weeks now and I was able to not sound uninformed.  Apparently she played tennis for CDO High School back when they played Safford.  We exchanged numbers.  Hope we can actually get to hit someday.  Sounds like she's not really wanting to play matches right now and neither am I!  But I could use some exercise.  Not quite ready, but getting a little closer every day.

At 10:50, every squeaky wheel had Dana and I ready to see Timmy come through the door.  Dr. Cosentino had said three hours again and we were getting close.  Sure enough, Timmy came back in at 11:00 looking very peaceful.  She said that he did well.  Once again, he hadn't lost a lot of blood so she didn't think he would need a transfusion.  (Sometimes babies have a hard time after surgery making up what they lost so that's why Timmy had the transfusion the first time around.)  She had had to freshen up the ends of his intestines to reconnect them and he did have some adhesions and would form more with a fresh surgery.  I asked if she meant adhesions to his abdominal wall or inside his intestines.  She said to the surrounding organs, liver, kidneys, stomach, wall, inside the intestines...  That's just what happens anytime you perform surgery. These may cause some minor discomforts later on or they may never bother him at all.  Obviously if there are adhesions inside the intestines... 

She told me she would check Timmy later when she sees him in her office.  It's a comfort to know that she will continue to follow him for a while after he is discharged.  Not too exciting to add more doctor visits to plan, but I really do feel that she is incredible at what she does and like the thought of her being on top of anything possibly going wrong inside Timmy's GI (gastrointestinal or digestive) tract.  She doesn't mess around.  Not really one for small talk and doesn't take lightly to stupid answers.  (No, I didn't invite her to the s'mores parties.  Not sure she'd be too impressed with those.)  She also asked the name of Timmy's pediatrician and that was the extent of her visit with me.  Dr. Bedrick had come in with the team as well and asked about Dr. Parry doing the bronchoscopy for extubation on Friday and the answer was an immediate and emphatic NO.  As eager as we are to have Timmy extubated, that really did seem like way too much to ask of him in one week.  They had already tried extubating on Monday and, combining that exertion with the trauma of surgery three days later, it only made sense to give him a week or so to heal and recover before making him do all his breathing on his own after being aided for so long.

Post-surgery.  So peaceful.  You can see a little adhesive on his right eyebrow.

I hung around for a couple of hours after Timmy had returned to kiss his head and talk to him.  (And pump, of course.  Gotta have that stuff ready when he is!)  Always hard to leave, but especially hard when he's been through surgery.  The only comfort is knowing I get to go back every night.