Things started to change at rounds, where Charlie's lack of urine output was causing concern. A plan was agreed and we went to lunch a bit earlier than normal.
On the way back to the room, we saw our team's fellow, Dr K, and she looked anxious. She told us she was on her way to our room. We soon learned that the concern was Charlie's blood pressure. We all have our blood pressure measured by a "cuff". On tiny boys like Charlie, this doesn't give a great reading and, when blood pressure is a concern, they like to get a direct reading from an arterial line. We all anticipated this and planned to put one in for Charlie's surgery. Unfortunately, on tiny boys like Charlie, this isn't easy. Two doctors tried and failed and we were left relying on the cuff reading, and it was dropping. Low blood pressure plus little to zero urine output equals big worries.
I have grown quite attached to the monitors on the boys and I was sad that we didn't have the arterial line blood pressure reading and I knew that Dr K was a kindred spirit on this. She felt she had nothing to lose and made a call to Interventional Radiology (IR) to see if they would send a team over to put an "A-line" in Charlie. In the meantime, the dopamine was increased, the cuff pressure reading made more frequent and the discussions about what was going wrong began.
Soon, whispers began that, not only were we getting support from IR, we were getting a visit from The Magician. Dr Marvelous had told us about The Magician before and we had met him briefly when he had put drains in Henry. On that occasion, Henry had to travel to The Tower. Was The Magician really coming to Charlie's bedside?
He did. It was universally agreed that if he couldn't get an A-line in, we weren't getting one. The first attempt (in his right arm) failed and I was now very stressed. Partly because of Charlie's blood pressure but also because I knew that without a true reading, the doctors were going to have to be more conservative in their treatment.
About an hour after he started, TM got it in, got us a reading and it was ok. Needed to be higher, was a lot lower than the cuff had said, but was ok.
My relief was very short lived. The reading started dropping. Scarily dropping. I began to wish for the days of the cuff reading when I could dismiss the reading as nonsense. Increase the dopamine. Order blood. I looked around and there was nobody to ask for. The team was all here, waiting for the dopamine to do its thing - get him stable so we can work out what the problem is. Aly was calm. She was by Charlie's side, telling him she loved him. I remember thinking that one of us was wrong because she wasn't as scared as I was.
Eventually, his blood pressure came back up. First to a not-scary level and then to a good level. Then, it stayed there. Everyone was now waiting for him to pee. Strange, I know, but I am writing this with a smile because Charlie peed.
I am still scared. He is on a lot of dopamine and we don't know what the problem is. But he is stable now and, if he keeps peeing, we can make a plan in the morning. I will make no predictions on how Wednesday will go. Who knows, maybe I will make it into the office.
Here's Charlie before lunch;
PS - Henry is "fine", in as much as being on full life support in intensive care can ever be "fine".
(D)
Little man Charlie you are so loved. On behalf of the new York fan club I would like to say our prayers go something like this: Give our little man a fucking break.
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