Extubation talk

Today the medical team in the ICU started preparing Samuel for extubation. The ventilator settings are at desirable levels and Samuel is responding well. A plan was made for sedation so that Samuel would be awake enough to breathe but not upset or uncomfortable. An NJ tube was put in so that feeds will go directly to his intestines, bypassing the stomach and reducing the risk that he could vomit and aspirate fluid into his lungs. Another antibiotic was added to cover the ventilator-associated infection (since he didn't listen to me when I told him no more infections!), even though he is not showing any outward signs of being sick at this point.

NG tube in one nostril, NJ tube in the other, ET tube down throat. What will these people think of next?!

Monday morning at rounds, the intensivist in charge will decide if Samuel is ready. If she gives the green light, Samuel will get to try life without a breathing tube for the first time. He will still be on ventilator support with an air-tight mask over his nose and mouth. The RTs will be challenging him to work his lung muscles and show us what he can do. He could be reintubated in hours or days and then we will resume the tracheostomy talks. Or he could demonstrate that he is strong enough to manage with less invasive oxygenation strategies.

Last night I went to the store on my way home and bought Samuel sleepers and hats. He only had two that worked and he managed to pull a typical baby maneuver by barfing on one and pooping on the other all in one day. He'd outgrown the newborn sizes - yay! He needs ones that don't go over his head and that snap all the way from ankle to neck so that they can work around the various lines. It was one of the most delightful shopping trips I have ever had, getting to outfit my baby who I didn't expect to be here.

Today we bathed and dressed him and then his brothers came for a visit. Getting a family photo was a bit challenging given that both Chris and I have a propensity to appear severely deranged in photos. Below is the best of the lot, the first of our family all together. Does anyone know how to photoshop Chris' eyes open?!

As Zachary says, "We are a SIX FAMILY now." Here's proof.

Daniel and Zachary have shown a real interest in Samuel and they spent a long time interacting with him today. They all held hands with him and showed him toys when he opened his eyes. They also set about trying to give their father an anxiety attack by constantly tripping over Samuel's lines and almost knocking over the IV pole. The ICU is no place for a crew of healthy boys. Jakey got his popsicle and went to the waiting room with Chris. Daniel stayed the longest, stroking Samuel's head, talking sweetly to him, and asking me lots and lots of questions.

It was a very sweet time for me to realize that my big boys really do love their baby brother. (Okay, I am not so sure about Jakey. I would not be surprised if he was plotting a superhero ambush of Samuel as soon as he can get him alone.) Zachary talks all the time about Samuel and how he feels happy that he is alive but sad that he is sick. He draws him pictures and writes him notes. Daniel is quieter about it but says he is sad that Samuel is having to go through so much and that he wishes he could hold him. Jakey cuddles up to me and asks if he can still be my baby for a while until Samuel comes home. One night he told me that he wasn't feeling well and his primary symptom was, "I feel like I have a tube down my throat." Come on, buddy. Mommy is a psychologist. At least make me work for the meaning here.

I think we are doing okay as a family considering that the juggling is just plain hard and we are into our third month of hospital life on the heels of some rough months before Samuel's birth. We take it day-by-day as much as possible. And it seems certain that one of the days this week will include that 'extubation' milestone. We pray for Samuel's strength to negotiate this step.

Jakey's popsicle face. Hannah help me, this child is, um, "full of life."

Zachary.

Daniel gets some time to sit quietly and hang with Samuel.

Our four boys.