24 Hours… of ECMO
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Part VI: A New Day & Definitely a New Beginning !
Coffee, Bugles, and McyDee’s
I know it’s a bad example, but the hospital cafeteria is being remodeled, so I stocked on provisions for the long term. There are only so many hot dogs and burgers from the pantry that a person can take.
My bud Ashley just looks at me like I’m some sort of freak, as I have a full bag of Bugles opened next to my coffee, and an undisclosed meal in a McDonald’s bag.
Little does she know that I will only eat a quarter of the Bugles, totally wolf the contents of the bag (hot cakes & sausage) and consume mass quantities of caffeine products to stay awake and alert until the doin’ is done.
This morning has all sorts of things going right for the ECMO patient.
The first being a continuation of excellent nursing care from a refreshed crew (Meghan from Duke, and Lisa as the ECMO tech).
The plan is to gently decrease ECMO support to the patient, by decreasing blood flow (cardiac output) from us, and allow the patient to regain control and assume more responsibility in terms of cardiac work load.
He seems to be handling it extremely well, not a blip, not a flinch, and as always I hold my breath and pray that it is all going to come together as it seems, with no unanticipated setbacks or “issues”.
No worries so far…
We are a Village…
There are qualities to the healing process that are immeasurable and impossible to quantify in terms of the positive effect that an outpouring of love and support from family and care givers can have, in assisting the patient’s will to live. How much that will impacts survival is unknown, but to witness it is to believe that there is a force within us all, that awaits to be woken when we need it the most.
In this case when you truly are at the edge of life’s continuation, the constant interaction that the parent’s and family of this young man rendered forward, were an amazing thing to not only witness, but to become a part of.
Sometimes there is an elegance to bluntness. And this boy’s father was totally blunt and unwavering in constantly telling his son how much he was loved, how he was going to get better, and how he was going to make it.
It is one thing to say things to people that you love when you know they can hear you. It takes away some of the powerlessness. It gives you a sense of some sort of impact, lays out a sliver of hope that your efforts might make a small difference. It allows you to believe that you can make a difference.
On the other hand, to do the same when you have no idea whether or not your son can hear you, knowing that most likely the answer is no, then to shout encouragement, and to never give up, is like waiting for your own voice to come back at you from the echos of the dessert canyons.
It is easily done the first 50-100 times, but after that amount of repetition, your own doubt or the feeling that you are talking into a mirror may cause you to waiver.
To go beyond 100- to perhaps 1,000 or more times, never knowing if your voice can be heard, is in my opinion heroic.
It boils down to never giving up… and so it seems that we may be getting a growing list of hero’s here, because nobody was willing to give up.
Wall Pictures and Students
Mom, Dad, and the Little Bro …
A family standing together…
So comes the moment when a family gathers to share their hopes and uncertainty.
This post is intense, but the whole day wasn’t totally like that.
Yeah it’s hard to deal with uncertainty, but the hardest thing today really, was to dare to accept faith and hope, and allow them to creep into the equation.
I’m a machine when it come’s to believing in myself and those around us. But sometimes I am afraid to hope. That’s what today was all about. Learning to not be afraid of the possibility that yeah we did it right !
So we’re weaning, and I keep going back and forth messing with my “bugle buddy”, razzing her, having to listen to her ask “are ya’ gonna eat that WHOLE bag ? ”
As if …
It was pretty funny really. I thought about it …
Ashley’s very cool. Played College level soccer on scholarship, and gave the scholarship up to be a nurse. Huh? Say it again?
Yep. She gave up her scholarship so she could spend days like this Saturday afternoon taking care of small babies that are so sick they need to be here. I don’t even have anything remotely noble enough to say what that says about her. Just grateful she is a friend- cuz you know you can definitely count on her.
1:00 pm – 4:00 pm
The Photo Shoot:
A moment to set aside things and let Hope have it’s way…
Meghan, Lisa, Dad, Little bro, and Mom… Photographer (me)
So we took a moment to take a picture. We actually took a few, but this one was the least blurry of the lot. Inside each of us is a small ray of hope and a bunch of very brave smiles.
Note: It’s a lot easier to take the picture than to be in it.
5:00 pm to 8:00 pm
Passing the Torch
During the last half of the last half of my shift, we weaned the patient down to 1.4 LPM, maintaining ACT’s @ 250 seconds or so. All the numbers looked great. PA’s, SVO2’s, ABG’s, were screaming to take this kid off bypass. The Intensivist was certainly ready, but unwilling to fully commit so late in the day, in case manpower was needed for something unexpected coming up in the middle of the night.
She charted a very prudent course in my opinion.
Fatigue doesn’t make cowards of any of us, but certainly at this juncture, keeping the eye on the prize (successful recovery) and not changing our strategy when the finish line was getting so close… That’s how we were going to close this out. There was no way we were going to fall down this close to home.
So to come full circle, my relief pitcher is Midge. Her first solo shift as an ECMO coordinator. She had earned it.
When I showed up at this program, I was a very seasoned perfusionist, but knew nothing about managing an ECMO (my experience to that point had been all adult perfusion programs). Midge broke me in on my first ever ECMO shift a few years back, and had amazed me with her confidence and just total commitment to the patient and the process.
I kept reminding her of how clueless I was, and she kept reminding me I was a pretty damn good perfusionist.
How odd that while she was the teacher on that day, in my role as the perfusionist / ECMO coordinator, I was still theoretically in charge of the management of the ECMO (the perfusion side of it).
It didn’t really matter though. It was never about who was doing what, or in what role or capacity. We worked together seamlessly as a team concerned about one thing only. A good outcome for the patient.
So now it was her turn. Coincidentally, we were starting to trial off as she began her shift. So I did a bit of dusting and cleaning and last minute STS data stuff, managed to hang out in front of a computer desk, and when all excuses were finally exhausted, peeked into the room as I was about to leave.
Midge never saw me, but she was totally in charge of what was going on (on the ECMO/perfusion end of it), completely focused on the patient, and had successfully navigated the patient off ECMO under the direction of a very gifted Intensivist. So I walked away. My throat was a little tight, that feeling you get when you are really proud and relieved at the same time. Yeah- there was 1 tear drop.
She did it- we did it- and Hope finally had it’s way with us.
On this one day, Hope had it’s way.
To Be Continued …
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