4 Letters to Avoid: PICU

Being in the hospital for more than a week, you begin to pick up on things. Being in the hospital for over a month, you feel qualified to manage a department - or at least administer basic vitals like blood pressure and temperature readings (which I do). But I've also noticed in hospitals, just like any business, they tend to use a ton of acronyms. One of my least favorite acronyms so far is PICU. Pediatric Intensive Care Unit. It's nothing personal against the department or the amazing staff of doctors, nurses, and respiratory therapists, but it's an acronym you should hope to avoid. 

On Saturday, July 29th, after 7 days of chemotherapy, Viv went into septic shock. Chemotherapy drugs that are designed to help cure AML are very dumb drugs. Their job is to kill every living cell in the blood. Good and bad. Clearly the goal in chemo is to kill off the blasts (cancer cells), but it also kills off the important cells, like white blood cells (WBCs - just another acronym to throw at you). The process of chemo is simple: kill off as many of the bad cells as you can, and while the "system" is down, maintain a sterile and clean environment for the patient to avoid infectious diseases or viruses. Chemo is also very hard on the digestive track, liver and kidneys. As chemo enters the body through IV (delivered through a central line), it's ultimately absorbed into the kidneys, liver and the gut in order to process and flush it out (pee and poop). As a result, chemicals are coursing through the kidneys, liver and gut and this can take a toll on the patient. In Viv's case, it really made her sick. 

For 48 hours Viv was in a state of septic shock. She had an elevated heart rate of 230 bpm (beats per minute). Her blood pressure was dangerously low. She required multiple blood transfusions. And her ANC (Absolute Neutrophil Count) was racing to rock bottom. ANC is a measure of neutrophils present in the blood. Neutrophils are a type of white blood cell that prevents an infection. It was determined that she had a small bowel obstruction. Without any neutrophils to fix the problem, Viv relied on an amazing team of medical professionals to aid in her recovery. She was intubated for nearly two weeks. Sedated and strapped to a bed for nearly 3 weeks. Had a chest tube to drain fluid from the cavity between her lungs and ribs. Had an NG (nasogastric) and an OG (orogastric) tube to pump fluid from her stomach. Another tube from her stomach to pull fluid residing outside her bowels. She had an arterial line monitoring her blood pressure and allowing medication to be received. Leads monitoring her respiratory rate. A pulsox monitoring her oxygen saturation and heart rate. A foley catheter collecting her urine. A femoral line and a subclavian line for receiving additional IV treatments, medications, and ultimately her nutrients. It took all of this and a dedicated team to keep her body in a stable condition. 

On August 13th, two weeks after being admitted into the PICU, Viv received surgery. The surgeon, who had been following her progress for over a week, determined it was the right time. After cutting open her stomach, he removed some lesions from her small intestine and put her back together. She made a decent recovery and we were able to leave the PICU several days later.

It was a weird feeling leaving the PICU. We spent almost 3 weeks watching our child fighting for her life - but we felt very reassured knowing type-A personalities and an amazing staff monitoring all her vitals were keeping her healthy. It was also a uniquely weird distraction from the war on cancer. In the grand scheme of things, this was a small battle.

One week later, on August 20th, Annie and I welcomed our 3rd daughter to the world. We named her Quinn Everette. I'll keep this brief: Quinn is a happy and healthy baby and we couldn't be more fortunate. There will be plenty of time to post more photos and share more stories about Quinn. But this blog is dedicated to Viv's journey. It was an unusual commute to L&D (Labor and Delivery). We're stationed on the 6th floor, and L&D is on the 2nd. After Annie and Quinn were discharged the nurse pushed the down arrow on the elevator; presumably to take us to the ground level and leave the hospital. Odds are we're probably the first family discharged to take the elevator up to the 6th floor. Annie and Quinn were wheeled into our "deluxe" suite at the end of the hall. We're now a family of 5, and 4 of us live in a hospital.

Less than a week later, on August 26th, Viv wasn't feeling well. More fevers and more pain. Within a few short hours after a physical assessment, we were sent back to the PICU. I laid in bed with Viv that night but neither of us got any sleep. She was in constant discomfort and pain, and no medication could calm her. The following afternoon, she went in for a second surgery on her stomach. It was discovered that there was still a small bowel obstruction and before she could resume chemotherapy, this needed to be addressed. People seem to think that surgeries are a routine thing, and maybe they are. But as a parent it's an overhwhelmingly emotional experience that leaves you counting the seconds until your child is back in your arms. Viv's second surgery required the removal of 20cm from her small intestine. She had a jejunostomy, which is a surgical opening through the skin, creating a stoma. Basically, instead of being able to reconnect her small intestine, it is positioned on the outside of her body and empties contents into a bag. This is a reversible surgery, but it will likely be awhile before it can be reconnected. 

Within a few days post-surgery, we were released from the PICU... again. Back to the 6th floor to fight cancer. This time, though, Viv was recovering faster and stronger than before. She was her "usual" self. Walking, climbing, getting into things, and squeezing her new little sister every chance she could get. Her stomach looked noticeably better and despite everything she had been through, she was happy. 

Today is September 18th. Viv is approaching the final day of her 2nd round of chemotherapy. As of writing this blog, she's still kicking ass and overcoming adversity like a champ. The next few weeks will be rough as her counts (WBCs, ANC, etc.) begin to drop and she becomes neutropenic. But she has an army of dedicated supporters in her corner to help her get through this round. 

I love you Viv. Stay VIVSTRONG.