Thursday, February 22, 2007

A funny thing happened on the way to the hospital

I have been avoiding writing this post for a while, now. About two weeks. Everytime I come to the computer to check up on everyone else, I hear this nagging voice telling me that I need to write. So, here it is.

On the Monday evening that my husband and I took our daughter to the specialist to have her elbow looked at--the same evening that we were informed she would be needing surgery the following day--my blogging life took an interesting and unexpected turn. In my state of distress over my daughter's impending hospital visit, I logged on to the Internet and wrote the post explaining what we had just gone through. During the time that it took me to finish the post (no small feat, considering we have dial-up service, still), my daughter was hanging on me, getting into office supplies and generally adding to my distress. So I called out for some back-up (yo! husband!).

In the process, I got myself busted. Meaning that for the past six months I have been blogging without anyone from my "real" life knowing (except one friend), including my husband. But when he unexpectedly appeared to help me with the little one, I think I panicked and actually put my hand over the computer screen!! No, really, it wasn't quite that bad, but go ahead and imagine it that way if it makes you laugh. Because whatever my real reaction was, it must have been mighty awkward in that it provoked accusations of infidelity from him. (Understand that he still, at this point, didn't know that I actually write a blog.) Yes, my friends, my husband took my "caught-in-the-act" moves as indication that I am carrying on some sort of sordid Internet relationship with another man.

Now, there may be some association between having a blog that you don't tell your husband about and behaving unfaithfully, even if the blog in question is merely a therapeutic attempt to deal with one issue alone--recurrent miscarriage. But to me the very accusation was bruising. However, I made the painful decision that my privacy and peace of mind would have to be sacrificed in favor of full disclosure and marital harmony. My husband is a bit of a jerk for jumping to that conclusion (methinks he watches too much Dateline), but all things considered I believe that my marriage deserved my honesty at that moment, even if he was out of line. And there was just no way to keep my blog private and reassure him at the same time.

So when we finally crawled into bed at the end of the night, I handed him a print-out of the post I had been writing and somewhat tearfully confessed (everything that night, considering my daughter, was expressed somewhat tearfully) that for the better part of a year I had been keeping a secret from him. Not so much from him as to myself, but I'm not sure how much weight that argument had.

I'm sure he was a bit taken aback and maybe even a little angry. When I think about hiding something from him, I can understand those feelings. However, when I think about blogging as it manifests itself in my life, it seems much more on par with keeping a journal--albeit one others can read--which I have done for most of the time I've known him.

What bothers me most is that the dynamic of blogging has changed, irrevokably, for me. Now, much more than before, I feel I need to hide my time on the computer. While he always knew that I was reading other women's blogs, frequently regaling him with updates from some of the success stories out there, he never knew that I might be divulging my innermost musings to the world (wide web). Subsequently, when I am typing at the computer, he now says with a tone that may or may not suggest derision, "What are you up to, blogging?" Which is, in fact, one of the reasons I did not tell him in the first place. Whether real or imagined, I did not want my husband's views on my blogging to interfere with the healing I sought through it. And believe me, my interpretation of his views are very much that: mine. He has never said anything negative since that first discussion about it, when he was still digesting some very big and probably strange news.

Combined with other events in my life (growing business, growing belly, daughter on the injured reserve), it has become more and more clear to me that posting to this blog is falling woefully low on my list of priorities. While I am loathe to completely cut ties with the blogging world, I must admit that I just won't be posting as often. The hope and courage that I found here was not through my own writing, but through reading the stories of others. I would rather take my time to do that, still, than write. So, I will. And I will update about my own journey when I can find time, because I do know there is great healing in that for me.

In so many ways I feel (and know) that blogging and discovering blogs like Barefoot And... and Inhospitable (and many, many others) have pulled me through a very hard year. So it feels somewhat greedy to turn and run, now that my life is back on track and I am experiencing a success story of my own. I'm not ready to totally give it up for that reason as well. However, continuing to write when only out of a sense of duty and guilt...who wants to read that anyway?

So, if you don't see me as often, you'll know why. But, rest assured that I am still prowling around out there, reading your blogs and pulling for all of you. And when something--really anything--happens in my life, you can bet that I am formulating a post in my head about it, even if it never makes it to this site.

And if I haven't said it before, thank you all very, very much. I'm glad to read your stories and honored when you drop by to read mine.

Thursday, February 08, 2007

Closed reduction vs. open reduction

For those of you unfamiliar with orthopedic surgical lexicon, let me translate.

Closed reduction: externally manipulating the elbow to replace the radial head and align the bones of the arm.

Open reduction: failing success during a closed reduction, surgically opening the elbow and pinning the bones back in place.

Both under general anesthesia (open taking place immediately during the same visit to the OR if closed reduction fails).

*****

It was a long day at the hospital. We had to get up at 6:00 am to call the Day Surgery desk and find out when to be at the hospital. As the doctors were not even in, yet, along with my daughter's case being an "add-on," we were told to sit tight until we were called. Which allowed two more precious hours of sleep. Sorely needed, as both my husband and I agreed that our dreams had been vivid and draining during those few moments when we did nod off during the night.

A little after nine we got the call to head on in to the hospital. Within an hour we were on the road. By eleven we had begun the admission process.

Perhaps hospitals have devised their pre-surgery admission routine to include as much paperwork, question and answer, and moving from waiting room to waiting room with a larger purpose in mind. In the middle of all the tedium and attention to minutiae, one hardly has time to contemplate the enormity of the situation.

I'm not sure when in the process we met with the doctor, but I know we did, because I know he explained in great detail what he was expecting to have happen. Go in, pop the bone back in place, x-ray it, cast it and on to recovery. He also explained what might happen. Sometimes in cases like these, you find that the dislocation is the result of a congenital defect and would require a different approach. However, my daughter did not give any indication (via x-ray) of having the markings of a congenital case. Also, he talked about an intermediate step between a closed reduction and an open reduction, where, failing to get the bone to snap back by itself, he would make a small incision in the elbow and run a k-wire down into the arm bones to hold them in place. A percutaneous pinning, it is called, and the doctor said it's not his favorite thing to do. (I didn't ask him what his favorite thing to do is.) He also explained that because children's bones are what they are, there is a possibility of causing an additional fracture during the mainuplation.

Right after that, a nurse practitioner took us to an exam room to get my daughter's vitals and history. Suddenly, two new concerns arose. First, exactly how much Motrin had we given her since the injury took place? Secondly, how long ago did she have a cold?

The Motrin is an issue because it thins the blood. In some cases, the three doses that we had given her in four days would have been enough to call off surgery, but because hers was not going to be a procedure, even in its extreme, which would result in a lot of blood loss, we got a pass on that one.

Next, the anesthesiologist and nurse anesthetist had a listen to my daughter's lungs for themselves and were put at ease about possible complications with anesthesia due to respiratory congestion. (Prolonged intubation, lungs seizing during administration of anesthesia, the list goes on.)

While I felt very comfortable with the assessment of both of these professionals, it is a bit of torture to add any additional worry to a day that already felt interminable.

Finally, we were taken to a holding room, where my daughter (now dressed in hospital p.j.'s, playing happily in the waiting room full of toys and breaking my heart for all of her innocent unawareness of the extraordinary nature of that vision) was given "giggle juice" (some form of sedative) along with a shot of apple juice to wash it down. As she had had nothing to eat since the night before, and nothing to drink for hours, the apple juice (all one tablespoon of it) made her quite happy.

And then the hardest part. Watching the surgical team wheel her stretcher away from the two of us, her beautiful brown eyes locked on to us the whole time. She was small and brave and no amount of kisses and hugs could have made that separation bearable.

Rather than detail the remaining minutes and hours, which turned into an overnight stay, let me just say that the surgery went fine, as far as we are told. The closed reduction did not work, in that her little bones are so flexible, they wanted to pop right out of place, even after being held there by the doctor for thirty minutes or more. (This is where, perhaps, the local ER failed us, by not catching the dislocation and suggesting that we wait four days before approaching the children's hospital.) While in the OR, the doctor phoned us in the family waiting room (unsettling, again) to tell us that he would be performing the percutaneous pinning. It is, I gather, less than ideal. However, it is better than settling for an unstable closed reduction, possibly necessitating another visit to the OR for an open reduction down the road.

My daughter did great in the OR. Her vitals were strong and her recovery uneventful, aside from the tremendous exhaustion she experienced. That is why we made the decision to stay overnight. She was just zonked, and at nine thirty at night, it was no time to rouse her for a cold car ride home. Of course, I stayed overnight with her. I'm just glad she slept well. :)

By 6:30 the next morning she had me walk her down the hall from her hospital room to play in the toy room. It was easy to see that she was back to herself, giving me specific instructions for playing with her and enjoying all of the different toys.

Now we have three weeks with an ERNOMOUS pink cast, which is about three times thicker at the elbow than a normal cast. She is in great spirits and only took one dose of Tylenol last night around seven. Today was the first day since it happened that she said her elbow doesn't hurt. Hurray! In three weeks the doctor will x-ray and if all looks good, he will remove the k-wire under conscious sedation and replace the cast with a removable splint. That part (sedation) worries me, but at the children's hospital, the protocol seems to place the patients' comfort at the forefront of care. Hopefully there won't be much drama during that visit.

Not out of the woods, but glad to be where we are and no longer where we were.

Monday, February 05, 2007

Update

Diagnosis: Dislocated elbow.

First solution: In-office manual manipulation followed by immediate casting while daughter cries her eyes out. (I promise you, it was 90% fear because the doctor was a prick. There was some pain, I know, but the screaming was provoked by his lack of bedside manner.)

This attempt did not yield positive results, so we are now scheduled for the OR at the nearby children's hospital for tomorrow sometime. Doesn't mean that there will be surgery--although there very well could be--it simply means that they will administer anesthesia and then try another external manipulation to get the arm bones aligned. If that effort fails, they will have to open her arm and use pins to secure it. God help me. Even if it doesn't come to that, the general anesthesia part is enough to make me lose it already a few times tonight.

I have a friend who is a nurse anesthetist at this children's hospital and she is doing everything she can to line up a great team for my daughter. She has already called in her favorite RNA to handle the case because she, herself, can't be there. She has given us names of doctors (only one actually) from whom we should run if slated to work on our daughter. And she has familiarized me somewhat with what to expect.

Still, I am frightened. General anesthesia. The risk. My baby. Sigh.

Charlie is Broken*

The title of my post comes from a lovely children's show called "Charlie and Lola," which is one of the few shows my daughter enjoys that I can tolerate watching. It is set in England, so perhaps it's the quirky accents and dry wit.

In any event, I am tempted to post a long-winded story about napping and how I am on the fence about discontinuing my 3 1/2 year-old's nap regimen. Actually, I am not on the fence about it. I am very much for continuing it. And, each day she takes a nap that usually lasts around two hours. However, sometimes I become overly frustrated begging her to fall asleep ("Stop kicking me. No picking your nose. When you shake the bed you wake me up!"...oh, did I mention that I sleep with her, which is why, most likely, I'm still for it?) Add to this the fact that a nap seems to keep her up until at least eleven each night--which can become a bit draining--along with some opinionated neighbors who pester me to end it for once and for all, and, well, I wonder if the nap's days are numbered.

So, last Friday (why, yes, Groundhog Day), the neighborhood kids who go to public school had a half day, so I decided it would be a good day to forgo the nap and hang with the local mommies while my girl wore herself out digging in dirt piles so I could put her to bed early (which, as you can see, is anything before ten). The plan worked beautifully, dovetailing into a playdate with a little friend her age who was also digging in dirt piles , who then came to our house to continue the merriment.

Which lasted just until my daughter fell off her bed whilst dancing, breaking her arm in the process.

We think.

Of course, I rushed her to the local ER, where x-rays were ordered, but I couldn't go in with her because, well, I'd like my unborn child to have only two eyes.

"No problem," said the admitting nurse. "The tech will take her in and you can wait outside."

Um. No. We shall wait until her father gets here. (I was channeling my sister at this point, who is a tiger for her children when in these--or any--situations. Yes, the same sister I maligned so easily days ago.)

My husband called me on his way to the ER and I could hear sirens in the background. "Oh, thank goodness," I thought. "He's already at the hospital."

Um. No. That was the sound of three police cars cruising by him on the highway, which was now closed due to an accident caused by the severe weather.

And still we waited for him. I mean, seriously people. You know when you decide to go to the ER that you have just signed away at least four hours of your life. So what's a little more waiting so that my frightened, hurt baby didn't have to be manhandled without a familiar face to comfort her.

The x-rays were somewhat inconclusive in that there might be a break in the growth plate, which is hard to x-ray because it is soft tissue. She was fitted with a splint (which caused many tears prior to application because my daughter thought they were going to give her a splinter.) at which point she started to become more herself. Chatty and wide-eyed, as opposed to weepy and morose.

This afternoon we are going as a threesome to see a pediatric orthopedic surgeon (which was the plan implemented by the attending MD at the ER). We will know more once he sees the film of her elbow.

So that is my drama for now. I'm tempted to become heartsick at the thought of my baby having a broken bone, but she is really doing so well (slept about ten hours last night with only one awakening for water) and seems so happy that I guess even if it is broken, she will heal. I just pray we avoid surgery. That will really distress me.

*As you can guess, in the episode "Charlie is Broken," Charlie breaks his arm playing football with his friends, and his little sister Lola is beside herself trying to find some way to comfort him.