Tuesday, July 27, 2010
Lots of big thanks today. First off to the women of the University 5th Ward who came over this morning in greater numbers than my kids. Four came so they could watch my kids while I took a nap. The previous two weeks, Karen has come by herself and somebody inevitably decides they want to take a nap with me but won't actually nap. So very nice to get an extra hour this morning. It almost boggles my mind how quickly I can fall asleep these days. If I'm up and going, I'm fine. Seated or laying down, once I'm relaxed I'm pretty much gone.
Another thanks to Marianne for watching the kids this afternoon in a huge chunk of time so James and I could get our trach care class done. I was a little concerned that we weren't going to. Laura had told me that the class normally takes about 6 hours (most people break it into two classes). Marianne needed to be home around 6 and I was, as usual, running behind and didn't make it to the hospital until a little after 1:00 and was desperate to squeeze in a pumping session first so we didn't meet up with Laura until almost 2:00.
When I arrived in the NICU, Dana was holding Timmy and he was just finishing a bottle. Which helped because then I wasn't torn betwen pumping and nursing and I really needed to just get the job done. Dana told me that Timmy had his first tub bath. He wasn't sure about it until she poured the warm water on him and then he decided he liked it. He hasn't been able to have one until now because of the broviac line in his leg. Being on the ventilator didn't help much either, but it was only the line that kept him out of the tub. Now he is completely batheable but now with the trach, he won't be able to go swimming or get dunked under the water until that comes out. (He would drown if anyone stuck his neck under water.)
His bilirubin level had also come back and was down. Not much, but 6.9 is a definite improvement over 8. Hoping it just continues on that trend. Timmy was definitely looking less jaundiced, but to James, who didn't see him over the weekend, he looked very yellow. Still waiting for the GI doctors to take a look.
We didn't hang out with Dana long. Laura called with our room number and bless the woman, she is not the type to drift long into tangents. We got started right away. There is a rather old-school video and course book (which really could use some editing, but I'm sure will be updated soon enough anyway) to watch and follow along with. They cover reasons for trachs, where the trach is placed, how to suction the trach, change out the trach, the trach ties and clean the stoma. It is a bit of information to absorb all at once but I've been watching and assisting the nurses for a couple of weeks now and that helped me immensely. James is just gifted. So somehow we blazed through this "6-hour" course in just over 3. (Started around 2 and were back in the NICU around 5.)
We opted to not take a break but head back up to the NICU and try our first trach change on Timmy. Once we were all set up (thanks for your help, Dana!), James performed the stoma care, Laura pulled the trach, James placed the new one and I put on the ties. It went very smoothly. I was rather proud of us and already checking things off in my head. With the classwork done, James and I have to perform each of the following tasks three times each: 1) stoma care, 2) trach change, 3) trach cleaning, 4) changing of trach ties and 5) suctioning. Sounds like a lot, but Timmy needs suctioning rather frequently and the other requirements can all go together.
James was just called to be our new ward executive secretary on Sunday and had his first meeting tonight so he left after the trach change. I stayed to nurse Timmy and then checked off my first suctioning (on watch, that is =) ).
Returned to the NICU around 10. Stephanie and Melissa were taking care of Timmy tonight. Chris had the other boys again. Timmy was a champion nurser yet again and pooped again as well. Seems like he feels the need to clear out the old stuff as the new stuff is going in. While I was changing him, Moe and Allison came in. Moe asked if I usually pump after nursing Timmy. Honestly, I don't. I will if I feel pretty full, but I don't always and I usually don't have time to nurse for 25-40 minutes and then pump for another 15-20 on top of that. However, I know he doesn't usually clear me out so after a few nursing sessions, I do have to pump and can clear out about 4 ounces. (I know, it impresses me too. I am honestly just so glad to have had the people I had at 6 weeks postpartum to encourage me not to give up when I was only pumping about 20 mls in any given session. Very depressing. But sooooo worth all the hours and effort now! What a prize to continually hear how amazing it is that Timmy is breastfeeding so well and even more so that Timmy is breastfeeding so well!)
I think the big concern is that Timmy was down another 60g (2 oz.) tonight. It may be that my milk just isn't high enough in calories at this point. Not sure how well he took the bottle today either. I know that the twins did really well with my milk so I'm hoping that Timmy just needs to be home where he can eat to his little heart's content whenever he wants.
Bless the nurses who were there tonight. They were all very willing, encouraging and supportive of my checking off more trach tasks. Melissa (another one, not Timmy's primary) assisted me through another complete trach change. She was wonderful. Chris took pictures and they both offered me any tips or thoughts that they could. I definitely need to go faster, as I know Timmy could sense his airway being cut off, but, on the whole, things went smoothly and I was able to get all my firsts checked off. I also suctioned Timmy twice tonight so that requirement has been met by me. So James and I now stand at:
Suctioning:
James (0) Wendy (3)
Stoma care:
James (1) Wendy (1)
Trach change:
James (1) Wendy (1)
Tie change:
James (0) Wendy (2)
Trach cleaning:
James (0) Wendy (2)
Once we have completed checking things off, we will each room in (stay over at the hospital) with Timothy for 24 hours by ourselves (or we could do 48 hours together) with his home equipment and he is clear for discharge. If all goes really smoothly and all the equipment comes in by Monday's monitor and CPR class, we could be bringing Timmy home by next weekend. Really hoping we can, but not going to get hopes up too high. Timmy didn't handle my trach change as well as he did James's so that may mean he isn't up to multiple changes in a day and that will slow things down, but we aren't going to push him. He only needs to have us do it four more times in the next week and we can definitely spread that out.
The heavens smiled down one more time tonight. I brought in another bag of breastmilk and thought the nurses heard me make the announcement that I had more. Apparently not because when I went to take the "empty" bag home, it was still full. It had been sitting out for four hours. Fortunately, it is insulated, so all the frozen bottles on the bottom were still frozen. The four on top, however, had completely thawed. Sad because they are only good for 24 hours once thawed but, happy day, there was only one bottle left in the fridge and they will definitely need the 4 ounces that were thawed accidentally throughout Wednesday as I don't think I'll make it in at all to nurse during the daylight hours.
Overall, just a great day. I feel like James and I finally have some control in when Timmy might be coming home. I do believe we are also very much on the same page in wanting that to be as soon as possible so are working together to help each other check off the requirements and figure out how we can each room in while the other takes care of the other kids and not have to have James take extra time off of work.
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