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the eric update - day 35: i want off this ride.

three hours. that's how quickly things can go to hell in a handbasket. we left at 11 p.m. last night, as confident as ever that we had escaped any problems which seemed to be lurking in the backbround all week long; by 2 a.m. several of eric's systems were failing all at once and by 4 a.m. there was serious concern that he might have a perforated bowel and they were getting ready to transport him to the other nicu in town for emergency surgery. at the time, apparently the only thing that kept eric from being transported was the fact that the surgeons said that they wouldn't do the surgery on him because he was too small to survive.

the following twelve hours were filled with as many, if not more, emotional ups-and-downs than the night eric was born. as the complications were delineated it became apparent that he had not one, not two but three calamitous events occuring, two of which were characterized as rare. the most acutely dangerous event was known as a strangulated hernia ( ironically, the determination that he did, in fact, have a hernia was considered so uneventful that i decided not to post such boring news right away ), which happens when fecal matter gets pushed into the herniated bowel and can quickly lead to a perforation. and the last thing you want with a micropreemie is a hole in the intestine, leaking fecal matter and air throughout the abdomen. it's quite uncommon to see a strangled hernia in a micropreemie; only one of the nurses could remember an occurance, 7 years ago, and couldn't remember having seen any prior incidences. somehow the neonatologist was able to unstrangulate his hernia by holding him upside down and pushing and poking at the hernia. in a very understated way, the neonatologist would later allude to just how lucky we were that her improvised unstrangulation technique worked, as i'm not sure what would have been done since it was already determined that they weren't going to perform surgery on him on account of him smallness.

why was fecal matter being so forcefully pushed through his hernia? because it didn't have any place to go as his bowels were shutting down and everything was stopped from moving along normally. in addition to creating a strangulated hernia, his backed up bowels quickly began pushing on his lungs, which stopped his breathing and necessitated eric being put back on the vent. and why were his bowels shutting down? a quick blood panel indicated that he was quickly getting an infection ( as evidenced by an increase in immature neutrophil cells or bands ), and his body began shunting blood away from his bowels and towards other areas in preparation for a battle royal. routing blood away from the intestines is likely a good strategy most of the time, as who has time for eating when you've got a bad infection, right? unfortunately when you've got 7 cc's an hour of breastmilk coming in and blood moving out, you're actually creating the best possible conditions for necrotizing enterocolitis.

as if a strangulated hernia, backed up bowels and a worsening general infection weren't enough to make for an exciting night, the nurses discovered that while they were trying to unstrangulate his hernia, his skin was sloughing off. yes, you read that word right, his skin was falling away. disintergrating. and creating a festering mess. for a little thought experiment, try to imagine having to absorb the word sloughing at 4 in the morning. at the time the disintegrating skin was perhaps the scariest news, because nobody had seen anything like it. nobody. in the morning nurse jan confessed that she hadn't seen it in 22 years of working in the nicu. even the infectious disease specialist hadn't seen anything like it.

oh, how we were wishing for good old days, when the worst we had to worry about was whether or not he'd be put back on the vent.

so the day was spent trying to come to grips with how quickly and how completely everything had fallen apart, as we tried to stay focused on how his clinical pictures was changing from moment to moment. an antibiotic regime was started to help fight the general infection and they decided to treat the mystery topical infection with pretty much everything they had as they were lacking any any definitive specific lab results ( no trace of yeast in the infection and no bugs are caught growing; the lack of any yeast was described and bizarre, since you'd expect to see some and as we learned in the past, it's not that surprising to not catch the bugs ), they decide to treat it as if could be anything, which i guess is just about the only thing you can do. as the day wore on, his blood counts began to slowly return to normal and by the evening almost all evidence of the skin sloughing had disappeared. it's hard to describe the feeling that you're left with as you realize that the wreakers of such rare havoc are going to fade away without you ever knowing their names.

it took quite some time for the neonatologist to rule out a bowel performation, as the regular x-rays kept showing large amounts of air in his bowels and it was difficult to know if the air was inside or outside the intestine; a specialized x-ray machine was hauled in which could more easily allow them to determine if the air was moving as he changed positions, which would mean that it was floating around his abdominal cavity. as luck would have it while the film was being processed, there were two more admits to the nicu, which meant that we had to sit around, wondering when they'd get a free second to review the results and release us from the purgatory of not knowing if he had a performation. eventually, the neonatologist rushed in and exclaimed that everything looked great and that we were out of immediate danger for now.

it's funny how quickly you can reset your personal expectations as to what constitutes good news. before we left for the night we watched eric resting comfortably on the vent, feeling a sense of relief to see him so peaceful while pondering the irony that today's good news would have been yesterday's catastrophe.

many, many thanks to all of eric's wonderful caregivers whose attentive observations and quick, accurate actions helped to avert what surely could have been a disaster. i've said it many times already, but i have no idea how you do what you do.

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8/09/2004 12:22:00 AM 11 comments


Hi, it's Stacy from just wanted to let you know that I'm following everyday praying for the little guy, you & your wife, and his nurses & doctors..

By Anonymous Anonymous, at 2:44 AM  

I am sending all the love and prayers that I can send today to Eric IV and you and Kris. Yesterday morning I was feeling so relieved that Eric IV appeared to be turning a corner. Then the roller coaster decided to take another turn. All a reminder of how precious and fragile life can be. I am trying to take comfort in the fact that so far Eric IV appears to be beating the odds. Every time they say he can't do something, he shows them otherwise. I think the picture with his fist raised in the air epitomizes his strength and resolve. Maybe it is to show us to have faith as well. That everything will be ok. I love you all. Monica

By Anonymous Anonymous, at 7:56 AM  

Remember when we were kids and wanted to stay out until 1:00 am for a concert, but we knew that would be a hard sell, so instead, we'd ask to stay out until 3:00 am, just so 1:00 didn't seem so outrageous? It's all about perspective I guess. I think that we'll all have new appreciation for the days when Eric's breathing is the only worry. Glad to see that things were quickly taken care of and that Eric won't need surgery for now. That is an amazing staff. And you guys are amazing parents - excellent rollercoaster passengers. :)

By Anonymous Anonymous, at 8:23 AM  

thanks for the supportive comments, we're doing our best to tighten our seatbelts as we try to prepare the upcoming twists and turns. i like the "fist raised" photo too. i'm thinking about doing something special with that photo.

as a side note - i know from server traffic patterns that more people than ever are visiting, but very, very few comment - in fact the traffic to comments ratio is very different than what one might expect. certainly people don't have to comment, but it's an interesting phenomenon that the most prolific commenters are parents of micropreems who have gone through similar experiences and close family.

perhaps every else is just sitting back in stunned silence not knowing what to say?

By Blogger e3, at 2:05 PM  

Good thoughts and prayers, Eric.


By Anonymous Anonymous, at 2:06 PM  

we are praying for you eric IV

By Anonymous Anonymous, at 3:01 PM  

eric, kris, and e4

i am guilty of only reading, and not writing i guess, but you do such a good job on your e4 news coverage. my potential questions and comments are answered as i read the daily news. which is amazing considering the emotional rollercoaster state that you guys are in. furthermore, i hate to reiterate what someone else has commented on. but i realize that is selfish, and that every post that you read helps you. so i will try to do better, and i hope others do too. just an idea about the "fist raised" picture. perhaps, the many reasons why your traffic volume is so high, is that you have found a way to educate everyone on the life of a preemie and that maybe somewhere out there, you are helping others cope with their own nicu situations. i feel that perhaps the fist in the air is a reminder that though incredibly small, the fight can be amazingly huge. perhaps you could put the picture on a t-shirt or something like that and possibly use proceeds to benefit other preems that have not been so fortunate as e4 or to aid parents that have a tremendous nicu bill.

uncle keith

By Anonymous Anonymous, at 5:04 PM  

I am not a writer...regardless I am so often moved beyond words when reading, watching, listening. At 45, with parents, friends, acquaintances, children of friends etc all engaged in winning and losing life-battles, I can only say that no one in my orbit appears to have more dignity, love or support than your son. allbest, nick (lurking-no-more).

By Anonymous Anonymous, at 5:25 PM  

Sending prayers your way... We know that battle, Kyle preforated due to a yeast infection from the anitbiotics he was on (I thought it so strange that they grew yeast from his bowel).

In any event, they where able to insert a drain by cutting a tiny slit in his side near the preforated area. Within a couple weeks he was doing so much better, but it was a setback. I'm just so glad to hear that this did not happen to E4!

It's great to see how quickly they where able to respond!

By Anonymous Anonymous, at 6:02 PM  

It's no wonder people lurk and dont write, you are so good at describing every detail of your little son's ordeal. What can people say. Just remember, it never hurts to get down on your knees and pray to God what you want for your son. I did for my son, and he is alive today. He was not a preemie, but other circumstances. I am now a gramma to his kids.
More postcards (from Ohio) are soon in the mail for Eric. I hope and pray for him to have much better days ahead.

By Anonymous Anonymous, at 6:23 PM  

aha! now i know who the really dedicated readers are since the comment about the comments was buried in the comments.

thanks everyone.

hopefully my intent was not miscontrued - somebody on the flickr site had mentioned that they were sometimes hesitant to comment on the pictures because it's often difficult to know how a comment will be taken when it's about such a sensitive topic. i was wondering if the same thing was going on here, since the people who are usually commenting either have first hand experience and likely know how we're feeling or close family who have a familiar obligation :-)

in any case, thanks for everyone for commenting on the lack of commenting.

By Blogger e3, at 8:10 PM  

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