day 4

Another long day at the hospital. It feels a little sad when the hospital almost becomes a "home". I remember feeling that way when Carter was born and the motony of everything, waiting, eating...everything there at the hospital. It feels like a prison...yet you don't want to leave. Just being there feels like you are doing something...if anything. The hours tick by...sometimes slow and sometimes fast. We all have come and gone. Jimi is there first thing in the morning and leaves last at night. Could Sarah have a better husband? We don't think so. We love you Jimi! You are the best!

Again here's the 24 hour recap:

Sarah had fairly decent night. She was able to rest better being ventilated, but still was having a hard time with any movement. She gets a chest x-ray every morning and to even help her lean forward to put the x-ray plate behind her back caused her sats to plummet. She also was requiring about the same % of oxygen...between 80-100%. She still continued to cough and was somewhat restless. Another thing that was concerning was her ventilator settings. She was requiring a lot of PEEP (positive end expiratory pressure) to keep her lungs from collapsing..it keeps those little alveoli in the lungs open. PEEP is like blowing up a balloon and not letting it completely deflate before blowing it up again. One of our RT's told us that when you get the wind knocked out of you...it's really getting the PEEP knocked out of you.

Jimi and I were there for morning rounds. Can I just tell you how much I love the staff at McKay? Jimi and I were able to be there with the whole multi-diciplinary team (the dietician, pharmacist, RT, case manager, intensivist, and Sarah's RN) and hear the whole picture. They talked about the medications she is on. They have her on an anti-viral called Tamivar. If this doesn't work, they can try another drug but will have to get the clear from the CDC to use it since it is so new. They have her on some big gun antibiotics to cover any bacterial infection. She is getting medicine to prevent blood clots. Basically...they are on top of every problem and also trying to prevent other from happening.

Dr. Hoffman showed us Sarah's chest x-ray from this morning. Compared to the one from last night, this one looked slightly better....nothing substantial...but it was a small step in the right direction. Every little victory is something we will gladly take.

We discussed the condition of her lungs. With requiring that much PEEP, they know that her lungs are very sick and getting stiff from all the crap in them. They talked about putting her on a different ventilator...called an oscillator. This delivers tiny rapid puffs into the lungs to keep the alveoli open while also vibrating super fast. That was a possibility, but as the day progressed, she has not had to go on that. They have it outside her room just in case...and if you are a nurse you know that having things right outside the room is the best thing you can do to ward off actually needing them!

They added a paralytic to her many infusions this morning. It is called Rocuronium (Craig said it sounds like a cool album title...yes I would agree!). The hope was that having Sarah completely unable to move would help her not resist the vent and also to better tolerate being moved. After being on it for an hour, they did start to see some improvement.

The goal for the day was to let her rest and see if the paralytic would work. It seems to have definetly helped. They were able to turn her and give her a bath tonight with much better results than the last 2 nights. She is tolerating movement more. She is still requiring a lot of PEEP and in fact tonight the intensivist ordered it to be bumped up a little more. He did this with the intent of hopefully being able to come down on her FiO2.

So...right now it's hurry up and wait--- which is so hard. Sarah is very, very sick. I don't want to scare everyone, but she is literally in the fight of her life right now. It breaks our hearts to see her this way. I think I have wiped out the ICU waiting room's stock of kleenex! We have been told that it could go either way...these sudden changes are typical for H1N1 patients.

Because this disease is so new, Sarah is one of the pioneers in the treatment for other patients to come. What is happening to her and others will help doctors see trends in the future and will help them better care for these patients based on what they have learned right now. Every patient is different...some are vented for a few days, other for a few weeks, and yes some have died. We know Sarah will make it. She is our feisty girl! We just don't know what the course will be...all bets are off. It's literally waiting for the smallest of improvements and then looking to the next.

Thank you, thank you, thank you. Your calls, emails, comments, flowers, and everything else mean so much. Thank you Ruth, Skyler, Bennett, Liz, Jimmy, and Craig for visiting. Sarah is one special girl to have so many people rallying for her.