Like one minute she was good and then...bam!
And naturally this would happen on a day that I was orienting with a new home nurse for her. The poor girl walked through our door at 7am expecting to get Tess up and ready to take to school for the day and instead got a crash course on how to help Tess manage her cough, fever, heart rate and respirations. It wasn't pretty.
We spent the whole day moving Tessie to try to get her to cough because I knew her left lung was filling up. We did many breathing treatments, cough assist airway clearance treatments, and a whole lot of suctioning.
But Tess continued to get worse. By the time Sheila came to help get Tess to bed for the night I had already called her pediatrician and pulmonologist for advice. Her pediatrician called in an antibiotic for her while warning me that it was most likely too late for it to work, and Sheila worked really hard to help Tess move that god awful junk in her lung. She and I did discuss taking Tess to the ER that evening but, and this makes me really angry, we knew that Tess just wasn't "sick enough" yet and we'd be sent right back home. What they don't understand is that by basically making Tess prove that she is sick enough to be admitted, she will have had just enough time for it to turn into pneumonia.
I was up a lot Monday night to try to help Tess breathe easier. I had hooked her up to oxygen and, by early Tuesday morning, was horrified to see her heart rate in the 150s, oxygen in the low 90s despite being on almost 4 liters of supplemental o2, and her respirations were between 70 and 80 breaths per minute. By 7am, when her nurse for the day got to the house, I had already given Tess her breathing treatments and knew we had to get her to the ER pronto. I quickly showered, packed up Tess's med bags, and called 911 while her nurse kept working on her. (If we had been on the island I honestly believe that they would have life flighted Tess off the island. She was in that much trouble).
Scarborough ambulance arrived within just a few minutes, packed Tess up, and loaded her into the ambulance and confirmed that I wanted to be taken to Maine Medical Center in Portland. I rode in the back with Tess.
The ER nurses, docs and respiratory therapists got busy and had drawn blood and done a chest xray before an hour was up. Her blood work showed an elevated white count and that it was bacterial while her xray showed a total white out of the left lung. She was immediately put on three strong antibiotics that covered everything from community acquired to aspiration pneumonia. During this time poor Tessie just felt miserable. She was also requiring deep suction using a nasal catheter and her oxygen dropped alarmingly at times. I was later told they suspected that her lung had at least partially collapsed.
By this point Charlie had gotten from the island to the hospital and helped soothe Tess while I excused myself to step out of her room for a minute for fear of bursting into tears in front of Tessie. I just couldn't handle seeing her struggle like that. It broke my heart.
After a consult with the pediatricians on call upstairs in the Barbara Bush Children's Hospital wing, it was determined that Tess should go to the PICU rather than the regular floor since she needed a lot more help and attention and basically a nurse ready to help at all times. They did tell me that they felt like, while yes, she was very sick, that she was being placed in PICU for the extra nursing help more than that they felt like was was in need of Intensive Care. Sort of like a mid-level of care. More than the regular floor could provide but not as intensive as the PICU made it sound.
During all of this, while still in the ER, they did an ultrasound of Tess's chest to be sure that she didn't have a pulmonary effusion on top of the pneumonia. They were very concerned at the fact there was literally no air movement in her left lung. Thankfully, no effusion was found.
Tess did okay her first few days in PICU. Tons of breathing treatments, meds and just top notch care but she was still sicker than I've seen her. In fact, I made a point to tell all of her doctors that very thing. They all kept saying that her xray looked very similar to her xrays from her past two admissions for pneumonia and I kept telling them that, no, this time was very different because the past couple of times Tess was admitted, she was not requiring oxygen, wasn't feverish much, and was just better all the way around symptomatically. This time I needed a freakin' ambulance just to get her safely to the hospital from house which was only a ten minute drive away. I needed them to hear me.
This time was different.
One of the pulmonologists came in to talk about possibly doing a bronchoscopy and bronchial wash to help move all of the mucus plugs out of her lung but was concerned that, since she would need to be intubated for this procedure, and she was so sick, that he may not be able to take her off of the breathing equipment when it was over and thus would weaken her overall condition and we would have to make the decision on possible end of life care. He recommended helping Tess fight this on her own first and if and when the time came that she needed to be placed on a breathing tube due to her not being able to keep fighting on her own, that we would revisit the bronchial wash at that time since we would have nothing to lose at that point.
On day three Tess spiked a fever and just generally looked like crap for a kid who had been on steroids and three antibiotics for three days. It was also the highest her fever had been throughout this whole illness. Not good.
More xrays were ordered asap as well as another chest ultrasound (neither showed any new problems thankfully) which didn't really help us answer why the sudden fever but also let us know that she wasn't physically getting worse. We discussed the possibility of switching to even stronger antibiotics but in the end decided to stay the course to see what Tess would do.
By Friday night she was well enough to be moved to the regular peds floor and by late Saturday was able to be weaned off the oxygen.
She was discharged late yesterday but here's the thing, she is still very sick. As in, I have never seen her discharged from the hospital this sick. Like, I would normally be taking her IN to be seen like this, not home after being treated and discharged.
As scary as it is to think about, this may be her/our new reality. Tess was diagnosed with neuromuscular respiratory failure several years ago and, as her pulmonologist said to me before she was discharged yesterday, Tess is at the age where the disease starts to take hold which could explain why this particular pneumonia hit her so hard and she isn't recovering the same way she has in the past. Last night was long and she needed some help managing her mucus and oxygen. She is acting scared at times because she can't catch her breath when coughing. Her oxygen and heart rate are still all over the place and she may need more oxygen at home now as part of her norm.
Frankly, it sucks. I'm hoping against hope that she just needs more time to heal up and will bounce back and be back to HER NORMAL baseline soon and that this is a temporary hurdle.
My gut has been saying otherwise. I don't think she's even close to being out of the woods with this pneumonia but god, I'm praying that I'm wrong. There are times she is looking so good and I'm like, Yes! She's kicking it! And then she's back down to low 02 stats and choking on her cough.
And if this does end up being the "new normal", all I can say about that is....
Reality bites.
But I'll leave you with this pic that her nurse took of her today when she looked so good because, dang, this kid is a freakin' Warrior!
