We left off on Friday afternoon, February 13. Bradley was doing very well. He was able to get up and walk two laps around the hospital. All of the nurses were shocked and surprised at how well he was doing so quickly. Bradley does like to impress the ladies! His pain was controlled, and he was also diligently using the breathing thing they give you to prevent pneumonia. That night a “candy cart” came around for all of the children and their families. It had full size candy in every assortment you could imagine. Our nurse told us to stock up for the week and we gladly obeyed. Just another perk to being on the pediatric floor.
Saturday, February 14, seemed as though it was going to be another great day for Bradley. The tube in his nose used to suck out his stomach acid was removed. It was done very quickly and was very uncomfortable for Bradley and caused a nosebleed. Later in the day his chest tube was removed. Thankfully the removal of this did not hurt, as it was painful having it in and it was also leaking. Unfortunately after this things started to go downhill fast.
Bradley had not needed blood during his operation or on Friday. However, on Saturday his hemoglobin had dropped to 7.6. At Memorial Sloan Kettering they transfuse at 8 or less. So Bradley was given 2 units of blood. Near the end of the second unit Bradley had a mild fever. I did not think much of this as this has happened in the past. The resident assured us it was normal to run a mild fever for up to 4 days post op. Bradley was also producing an “ok” amount of urine, but the resident wanted to jump start the body’s natural process by giving him more fluid to help push it out. I think this was the start of our troubles. Bradley’s oxygen level fell to around 70. The normal amount is supposed to be 95 or higher. It was just by chance that they did his vitals at that moment as Bradley was not feeling short of breath. This seemed to alarm everyone as suddenly a rush of 3 residents and 2 nurses came in trying to fit him with an oxygen mask. This was one of the downsides to being on a pediatric floor. They had to raise his oxygen level using the highest amount of oxygen they are comfortable giving. Also at this time Bradley began experiencing intense pain in his incision. He felt as if his stomach was swelling with fluid causing his incision to stretch apart. We also learned the blood he had been given did not raise his hemoglobin as it should have.
So within a matter of hours Bradley developed a fever, low oxygen levels, intense pain and still low hemoglobin levels. I was worried of course and the fact that the residents seemed worried made me worry more. They drew blood to culture for infection as well as to send off to see if Bradley experienced a reaction to the blood transfusion. They said it would typically have happened early on, but since he had so much chemo his body may have had a delayed reaction. Another theory was he may have had too much fluid causing there to be fluid in his lungs. The scary part was these were all theories and none of them seemed to really know. He was sent for multiple chest x-rays, no easy task switching beds when you are in an extreme amount of pain. The x-rays came back looking pretty normal. Lasix was ordered (a diuretic) to help flush fluid. Bradley was hoping this would help with his pain and abdominal swelling. We went to bed with Bradley on high oxygen and no real answers or relief to pain.
Sunday, February 15, did not start out any better. Bradley had a long night due to his pain. His oxygen level had not improved, nor his pain, but his fever was gone. More chest x-rays were ordered as well as an abdominal x-ray. According to the resident it showed a small amount of fluid in Bradley’s lungs. She seemed quite concerned and said she would feel more comfortable transferring Bradley to the step down ICU unit. I thought this was one of the better decisions they had made so Bradley would receive more individualized care.
When Bradley entered the step down ICU unit the nurses and a nurse practitioner immediately came in to evaluate him. The nurse practitioner immediately addressed his pain. Bradley and I had asked his nurse in the old room several times to check his epidural. Bradley thought that being transferred from bed to bed for his x-rays knocked the epidural catheter out. I also asked the nurse when he was getting an x-ray about a puddle on the bed. Bradley and I put 2 and 2 together and realized his epidural was out and this was causing his pain. In ICU the nurse practitioner confirmed our suspicions and removed the epidural. It was a great idea to help with pain, too bad it did not serve its purpose. I was however relieved that this was what was causing his extreme pain. I felt horrible that Bradley had been receiving next to nothing in terms of pain medicine. The NP immediately adjusted his pain medicine and also said that his dose was not effective for his weight. Within 20 minutes Bradley was getting relief from his pain. She also reviewed his chest x-ray and said there was definitely fluid on his lungs as well as a partially collapsed lung. Thus, causing Bradley’s decreased oxygen level. They started him on lasix and by the end of the day he had lost 2 liters of fluid. His pain was controlled and the oxygen they were giving him was reduced, and he was doing fine maintaining the normal oxygen level. They also had him up walking, sitting up, and using his breathing thing. They said this would help greatly in getting rid of all the excess fluid. The resident had told him not to sit up or walk because it would further hinder his breathing and oxygen level. Bradley had not walked for a full day and this set him back some.
By the end of yesterday, Sunday, Bradley was walking and on clear fluids and looking overall 100% better. I felt much better about everything since we knew why everything was happening and they were working to correct the problems. I was not very happy that 3 residents each told us different theories, and that they did not bother to up his pain medicine or check his epidural until we went to ICU. I was just thankful though that while in ICU the nurse practitioner addressed all of his problems and corrected them shortly thereafter.
That leads us to today, Monday, February 16. Bradley has been walking, sitting up, and beginning to eat soups and such. His pain has subsided some and he is not using his “pain button” nearly as much. He is maintaining 95 for his oxygen level on his own. He is continuing to receive lasix and that in combination with moving around will help to flush out any remaining fluid in his lungs, etc. He received 2 units of blood taking his hemoglobin from 7.7 to over 10, and he did not experience a fever this time. His other drain was removed as well as the bandages over his incision. He will stay in ICU until his room there is needed. I am glad to have him there as long as possible. His care there is wonderful.
He is getting stronger and getting himself out of bed, each time he says it becomes easier. We are hoping tomorrow is an even better day yet and that there are no more setbacks to Bradley’s recovery.