Thursday, August 20, 2009

My son's story -- Part 3

Continuing from above:

I arrived at the hospital about 3-4 minutes before the is amazing how fast you can drive when you just don't care if you get a ticket. I met his mom at the entrance to the ER and waited. The ambulance pulled in and they unloaded my son, still bagging him. The parent/doctor had ridden in the ambulance and he had already called the hospital to alert the cardiologists and the trauma team (they didn't really know if he had also received a brain injury when he fell down the ravine).

They packed him with ice to lower his body temp to help protect the brain function and reduce the damage from the heart attack and put him on a ventilator to allow them to stop bagging him
They took him to the Cath Lab to take a look at his heart and determine what might have caused the attack - his arteries were wide open so it wasn't from a blockage in an artery.

They took him to Radiology to get a CT scan of his head to see if there was any swelling or trauma from the fall - luckily there was no evidence of trauma, but he was still unconscious
They then rushed him to ICU where the cardiologists and Critical Care Team tried to get him stabilized, assessed, and cleaned up.

Finally we were allowed back to see him in ICU after about an hour.....he was connected to all kinds of machines, pumps, and IVs....and he was completely non responsive. The cardiologist walked us out and told us what was going to happen next - they were going to do an EKG and an Echo-cardiogram to figure out what his heart function was and to assess the damage to the heart muscle. She told us he was "very sick" (a term she used with us over the next 36 hours) but that they were going to do all they could to fix him. I signed a bunch of non-specific releases and went back to the waiting area to, well, wait.

Four hours later she came back out with a cardiac surgeon....and with the parent/doctor who had been with my son since the event. They pulled us aside and told us his heart function was drastically reduced (an ejection fraction of 20%), his lungs were filling up with fluid despite the diuretics they had him on, and his vital signs were dropping....they wanted to discuss options with us....they also told us they had put him on a unique cooling machine called Arctic Sun (which sounded like a juice box flavor) that would keep him at a constant lowered temperature for the next 20 hours and that they had called in an interventional cardiologist in on his off day to help them decide what kinds of things they could do to prevent him from failing completely. I signed a few more release forms and we went back to wait.

By now the waiting room at the hospital had about 60 people in it all for my son....teammates, classmates, teachers, coaches, family, friends, neighbors, random people, etc. I was on point to come out and give the crowd updates as we had them....

A few hours after the last conversation with the trio of doctors, the cardiologist came back out and told us that they were going to have to do an aggressive and fairly unique combination of interventions - a TandemHeart centrifugal pump to take the load off of his laboring heart and ECMO to essentially provide a lung/heart bypass to take the load off of his lungs and to oxygenate his blood for him. It was the only hope to keep him alive long enough to give his heart and lungs a chance to recover. The major complication from the intervention was the likelihood he would lose blood flow to his right leg as they were bypassing his circulatory system via a large catheter in his femoral artery. They would try a percutaneous bypass from his left leg to his right leg to give it some blood flow but clots could still form in his right leg that would require a vascular surgeon to they had called in the top vascular surgeon in the area to come in on his off day to be at the ready – he gladly agreed to help as was the father of a former classmate of one of my other sons.

They performed the emergency interventions at his bedside in ICU and we waited... a few hours later we were told that the pump and the ECMO were doing their jobs and the leg bypass was giving his leg some blood, but it had become apparent his lower leg was getting no circulation....a clot or clots had formed but he was too unstable to move from ICU to the 2am, the interventional cardiologist told us he was most likely going to lose his leg but he wouldn't survive the amputation even if they could get him to the OR, so we just had to wait and see through the night.

The next morning the crowd grew as more and more people heard the news....I gave the room the latest discouraging update and we all settled in to wait for the next communication from the clinical team. Sometime that morning the cardiac surgeon and the vascular surgeon came out and told me they thought his heart and lungs were sufficiently strong enough now to do the frantic sprint to the OR to perform a fasciotomy to remove the clots and try and save as much of his leg as they could. Seven hours later, the vascular surgeon came out to tell us he had opened up his leg and cleaned out dozens of clots, large and small, and the blood flow had returned to his leg to about looked like his leg would not be lost, but that he would most likely lose the forefoot. They had also started to warm him up and to take him off of the drugs that had kept him in an induced coma....we would be finding out soon enough whether or not he had any brain function impact from being without oxygen on the trail.

He stayed in ICU that night and the next morning we were told his heart function was stable and his lungs greatly improved, so they were going to take him off the pump and the ECMO and the ventilator to see if he could do it all by himself...he did....later that day, the parent/doctor came back to tell us, with tears in his eyes, that my son had responded to some yes/no questions he had posed with a squeeze of his hand! We waited and watched him the rest of that day but he was still mostly unconscious.

Early the next morning, the cardiologist came out and told us to follow her into the ICU....she walked up to his bed and told him to open his eyes....he did....she asked him his name and he responded with a coarse whisper and then asked what had happened. The cardiologist started crying at this point. We were able to bring more and more people back to see him in the ICU and he started joking with his brothers and friends and talking more and more.

Continued below.

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