Saturday, May 7, 2011

Hit by a Van, Part 2

C lay very still on the gurney. One doctor commented that he hadn’t seen her move her right arm.

To our relief, she did move it shortly thereafter.  One nurse put a neck brace on her and strapped her head, torso and legs to a board to keep her immobile, leaving only her arms free. Other nurses and a lab technician worked to draw blood and start an IV, which proved difficult and took several tries.  A social worker covered her legs with a pink blanket from Project Linus. I started to read the little poem attached to the blanket but it drew tears to the surface again so I put it aside.

She was given 1.0 mg of morphine for the pain. They wheeled in a portable X-ray machine, and asked me to leave the room. I asked if I could have a lead apron and stay with her.

“Are you pregnant?” the technician asked.

“No,” I answered, grateful that although we started trying to conceive in the past month that God in his wisdom had not allowed us to be successful.

“They’re going to take pictures of your bones,” I explained to C. She had fallen asleep.

DH finally arrived. I buried my head in his chest and let some tears come. A social worker and a chaplain both came in to reassure us and pray. The X-rays were inconclusive so they wanted to do a CT scan to check for other internal injuries. I held C' hand, still asleep, as they wheeled her through a maze of hallways.

“How are you doing, mom?” the chaplain asked as we walked.

Feeling guilty,” I admitted.

“Oh, no. No, no, no,” he said with a kind smile. He said other gentle words that I wish I could remember. All I know is that they felt like an absolution.

The CT scan took quite some time. My lead apron felt heavy and kept slipping off my shoulders. C woke up part way through, fear in her eyes though she did not cry or speak. The machine was very loud and moved her back and forth as it scanned her body. I tried to keep things light by playing peekaboo with her around the edge of the machine when it took her out of my reach.

As we walked back through the maze of hallways, the chaplain asked “How’s Grandpa doing?”

For the first time I noticed that Pake was not with us. Beppe said he was in the waiting room, said it would be too hard on him to see her. I remembered the tears streaming down his face as we loaded C into the van, and the panic in his voice as we drove to the hospital. I wished for him to receive the same comfort I had.

A doctor came and told us that the CT scan showed bilateral pulmonary contusions, and a fractured pelvis with a hematoma which may or may not have been pressing on her bladder.

“She’s very lucky,” he said. “It could have been much worse.”

Because they didn’t know if the hematoma was actively bleeding, which would require surgery, they arranged for her to be transferred to a hospital with a Level 1 trauma center in Fresno, about 45 miles away.

The chaplain and social worker came back and asked if they could pray with us for C. Then the chaplain asked if Pake had seen C yet. No. The chaplain went to the waiting room and urged Pake to come in and see her before we left for Fresno. Pake did finally come in, looking stricken.

One of the EMTs, Johnny, was very kind. He explained everything that would happen during the ride to Fresno and what we could expect when we arrived.

They transferred her to a smaller gurney and we followed them as they wheeled her to the ambulance bay. As they loaded the gurney, I hugged DH, Pake and Beppe in turn.

“She’s going to be okay,” DH whispered.

Pake apologized. I said it wasn’t his fault.

Beppe prolonged our hug and said a quick prayer.

I climbed into the jump seat of the ambulance and put my hand on C’s head. She looked at me and signed water. I told her I was sorry but she had to wait to drink.

Fifteen minutes into our trip, the ambulance broke down.

We waited by the side of the road for more than 30 minutes waiting for a replacement ambulance to come pick us up. I nervously eyed the monitors that reported C's oxygen levels, breathing and heart rate. She remained stable. Hope grew when she tried to push away the oxygen and pull off her IV, and asked several more times for water.

DH had driven 100 miles an hour to the hospital, only to find that we weren’t there yet.

While he was driving, DH called our friends and family in Southern California. He had misunderstood and thought that C definitely required surgery. I later found out that the prayer request was passed on through phone calls and Facebook to thousands of people. As with any game of telephone, misinformation was added to the message. Some people heard that her legs were broken too, some people heard that her bladder was damaged.

The EMT in the second ambulance driver wasn’t quite so kind and reassuring as Johnny, and since the ambulance was larger, I couldn’t quite reach C from the jump seat. She went in and out of sleep during the remainder of the ride. We arrived and I held C’s hand again as we walked through the halls. DH finally found us.

At this point, I had been asked about what happened by every doctor and nurse we met, and even a CHP officer. I had told the story of what we were doing in the driveway and how I happened to turn my back on her so many times I lost count. Before my discussion with the chaplain I told it with an expectation of being found out. “Aha! So it was YOUR fault!” After his forgiving words, that fear diminished somewhat. As we kept vigil at C’s bedsde, I listened to my husband on the phone describing what happened. I felt his tender touches on my arms and back. It sank in that he didn’t blame me either.

I hoped again that Pake felt the same balm of forgiveness. Everyone we met asked how Grandpa was doing. He had stayed in the waiting room again.

Beppe came back to join us, technically exceeding the visitor limit. DH's youth pastor who happened to be driving through the area on his way back from the coast stopped by to comfort and pray with us.

C’s blood glucose spiked to over 200, but we were told that was an expected reaction to trauma. Her oxygen levels remained good as long as she had the mask on or near her face. They decided to take her off the immobilization board, but keep on the neck brace.

She was in and out of sleep. Suddenly I noticed her choking. I helped her turn over, and she vomited a small amount of reddish brown fluid. I shook uncontrollably with adrenaline and fear. Was this a sign she was getting worse?

One doctor said it was nothing to worry about and that he was surprised it hadn’t already happened, but others were concerned that it could signal an underlying brain injury. She was so sleepy and relatively non-responsive because of the morphine, so it was hard to see if she was exhibiting any other symptoms.

C had had a BM after the accident, but hadn’t urinated. They didn’t know if it was just because she hadn’t had anything other than a little bit of breastmilk to eat or drink since breakfast, or if the hematoma was putting pressure on her plumbing and keeping her from going. They put an adhesive bag on her to see if they could monitor her output without using a catheter. After almost three hours, there was only a dribble in the bag, so they had to go ahead and put in a catheter. The bag filled rapidly once the catheter was in.

After they took more x-rays and evaluated the CT scan from Kaweah, the attending doctor came and spoke to us. He explained said they had decided to admit her for observation at least overnight. He was very reassuring that it was just a precaution.

“Babies are resilient,” he said. “She’ll make a full recovery.”

One sign that her brain was working was that C continued to sign for water. I asked a nurse if it was possible to give her some.

No, because they still didn’t know if she would need surgery. The nurse glanced down and saw on the chart that C had been breastfeeding when we arrived at Kaweah. She told me that I probably wouldn’t be able to nurse her again for at least 24 hours. Did I have a pump? No. The nurse made arrangements to get one from Labor & Delivery.

When they finally found a room for us it was after 4:00 p.m. We followed C as she was wheeled upstairs. It took extra time because they found a private room for us, and even arranged for a private waiting room nearby where DH could sleep. The room was in the Burn Center section of the ICU.

As we were getting settled in, we asked how long to expect to be there, and what they were looking for in terms of readiness to go home. The lead doctor in the Burn Center was a little less reassuring than the ER doctor as he described all the worst case scenarios. There may be internal bleeding we missed and her pelvis could fill with blood, requiring surgery. The fractures may be in her growth plates and might cause deformities. They still wanted to be sure that there weren’t any brain injuries they had missed.

The nurse said that most often with this type of trauma, the child needed an MRI to rule out hidden spinal cord injuries before they would remove the neck brace. I was concerned about another test, this one where I wouldn’t be able to be right with her. Worry was for nothing, because not an hour later, one of the ER doctors came up and took off the neck brace, explaining that they were confident her upper body wasn’t involved in the accident at all.

Pake and Beppe headed home with a list of items to bring back to us the next morning.

C slept for a few hours, and DH and I sat next to her bed and talked about what had happened. We looked at all the text messages we received from people praying for us and praising God along with us. I let myself cry again, releasing more fear and guilt, and absorbing more acceptance and understanding from my spouse.

At midnight, I pumped for the first time since the accident. We set up the pull out chair next to C’s crib. DH headed to the private waiting room. Not long after he left, C became extremely uncomfortable, waking every 30 minutes or so crying out in pain. Earlier that afternoon, they had reduced her morphine to 0.5 mg per dose so that she would be more alert and responsive to assessments for brain injury.

She also continued to urgently request water, even pointing frantically to the clear liquid in the IV bag. It was so heartbreaking to have to say no to such a simple human need.

Around 1:00 a.m., the night shift nurse said it was okay if I held C. I cradled her in my arms for the next two hours or so. She only asked to nurse once, the first time since we arrived at the hospital. I was relieved not to have to refuse her more often, and yet sad that she didn’t want to. Finally the nurse suggested we up her morphine to 1.0 mg again. I agreed, and C slept in the crib for the next few hours while I rested fitfully beside her.

That morning I was very grateful for the thoughtfulness of the nurse who had arranged for me to have a breast pump.

By mid-morning, Pake and Beppe returned with our requested items. C clung to the baby doll and requested to watch her favorite DVD whenever she was awake. DH and I took turns eating and getting cleaned up.

Beppe said my mom had called and told her about some of the times I was hospitalized or treated in the ER as a baby and toddler. I had an eventful babyhood, with suspected spinal meningitis, a bout of pneumonia, and a dog attack. I’d heard all those stories before, but now had a renewed appreciation for my mom’s tender care of me through that trauma as I experienced the other side myself.

As the morning went on, we noticed that C’s face looked increasingly red and she scratched it continually, rubbing the skin raw. A side effect of the morphine, we were told. Sometimes she would use the back of her hand with the IV, and as a result had two deep scratches on her nose. I asked a nurse if we could put something softer over the IV tubing and tape to prevent further injury to her face, and she found some cotton mesh to wrap it.

Late Sunday afternoon, C was cleared to eat and drink. I asked her if she wanted to nurse. It was such a joy and relief for both of us to be connected again in that way. Then they brought in a hamburger, jello and applesauce for her to eat. She lit up at the sight of the food. For the first time since the accident, she became animated and chattering.

I tore the hamburger patty into bite-sized pieces and offered to feed her. She pushed my hand away and reached with her right hand (the one with the IV) to try to pick them up. I told her she could either eat with her left hand or let mama feed her. She stopped, looked at me for a moment, then picked her left hand out of her lap and started to feed herself!

Then she pointed to the cotton wrapped around her IV. “Sock,” she said, and giggled at her joke.

“Oh my! What is a sock doing on your hand?” I asked. She pointed and giggled again.

Immediately after she finished eating, she fell asleep in my arms, exhausted.

While I held her through her nap, a cleaning lady came in. She asked what happened. I told the story once again, but this time the similarity of our story to the tragedy Steven Curtis Chapman and his family experienced recently struck me. The lyrics to his song “Cinderella,” played in my head, and I began to cry again at how we almost lost her and the miracle that she was still in my arms.

The nurse said they were reducing her number of blood draws from every 6 hours to every 12 hours, and that we likely would be able to go home on Monday assuming she continued to eat and drink well.

When C was cleared to eat on Sunday, they had switched her pain management from morphine to Tylenol with codeine (T3). She took it with her lunch and seemed to tolerate it well. We gave it to her again at bedtime, and she slept well, even getting a long unbroken stretch from 10:30 p.m. to 5:30 a.m., when she was awakened by another challenging blood draw. After 45 minutes of trying to get blood to come through her IV, they gave up and took it from her arm instead.

Afterwards I nursed C, and they removed the IV since she had been eating and drinking so well, and since the line seemed to be blocked anyway. She started acting uncomfortable so we administered more T3. Shortly after that she asked for water. I held up a cup and put the straw in her mouth. She appeared to choke on the water and spit it back out. She made the same choking/gagging motion she had the day before, and I realized she was vomiting. I helped her sit up and it turned into projectile. For the rest of the morning, she couldn’t keep anything down, and there was renewed talk of brain injury and of finding a new place to restart IV fluids.

Meanwhile, her catheter had stopped working, but she appeared to be peeing around it. The doctors ordered it to be removed.

They gave her an injection of Zofran in her thigh, which helped. We decided that the T3 on an empty stomach was the culprit. She was obviously in pain, so we gave her another dose of codeine with her lunch. Whether it was the Zofran or having the T3 with food, her stomach stayed calm the rest of the day and we remained on the course toward discharge.

After the doctors held their rounds for the day, they gave us the official word that we were going to take her home that afternoon. A social worker helped us arrange follow up care for her in Orange County.

When she was discharged, they had me sit in an oversized wheelchair with C on my lap and wheeled us down to the car. C is normally ambivalent toward her car seat. Some days she fights getting into it and others she is indifferent. But that day she seemed delighted to be in her seat, in our car, driving away from the hospital. She renewed the animated chatter, pointing at all the sights for the first few miles. Then she fell asleep.

I couldn’t take my eyes off her. I couldn’t stop smiling through tears at my precious miracle baby.

On Wednesday's follow up appointment with her pediatrician, we found out that her lungs are healing well. At Friday's appointment with an orthopedic specialist, we were given permission to let her bear weight on her legs. On Saturday she walked for the first time after the accident, slowly with a limp, holding our hands for balance. Sunday, she took many steps unassisted and her limp was noticeably less. We see a pediatric orthopedist tomorrow morning.

Please join me in praising God for his merciful protection, the blessing of rapid healing, and for His amazing grace on us all.

The end!

1 comment:

  1. (((HUGS))) I have read through both of these with blurry, tear-filled eyes. I am so thankful that she is OK!


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