Wednesday, May 2nd

With the new NG tube placed last night, Dallas experienced some coughing, as the tube was now inserted through the other nostril and the placement felt different. The tube was also set to mild intermittent suction to help remove any excess stomach contents. She appeared increasingly uncomfortable and occasionally let out moans or sighs. Tylenol was administered via IV in hopes of providing her some relief.

The CT scan occurred around 11pm and after midnight, we learned that her IV central line appeared to now be in wall of her heart. A pediatric rapid response was called – the same ones that you constantly hear on the overhead intercom system and cringe when you’re not in the the room – with it came an entire calvary from the PICU. Our attending evening physician, though I’m being told may have actually been a resident/fellow, made the case that in light of the central line findings, she wanted Dallas moved to the PICU for closer monitoring. The team agreed, and within minutes we were on the way down to an open bed.

Dr. Cotton, an on call cardiologist, was brought in and preformed some bedside ultrasounds. He found the presence of fluid around the heart – which could be related to the central line or not – and had the nurse push a small amount of saline through the line while watching on the ultrasound.  While her heart function was good, it was clear on the screen that the fluid was going around the heart, not in it. The belief now was that her central IV line has eroded into the pericardium, a double-walled fluid-filled sac that surrounds the heart. The plan would be to wait until morning for surgery, when the docs round to discuss plan – after all, her vitals looked good and there would be more resources/docs/staff on in the AM.

We met with Dr. Ungerleider, a pediatric cardiovascular surgeon, who exuded confidence and had a calming demeanor – exactly the type of doc you want doing a surgery such as this. His plan was to take her central line out, which has eroded/penetrated the pericardium (fluid layer surrounding the heart) and once removed, stitch the hole in the lining of the heart. Dallas was off to surgery and we anxiously awaited an update, which was slated to come in about an hour.

The call finally came in that surgery was a success and had no complications. Phew, what a relief! Dr. Ungerleider came down to our waiting area and revealed that her central line had actually pierced through her heart – WAY more frightening to us than originally planned. He showed a picture from surgery (showed the same), but his experience had him well-prepared for anything he’d find once “in“. The surgery procedure goal remained the same, though he stitched up a hole in the heart instead of just the pericardium.

Our minds were flooded with concerns and questions about how this could have even happened. While we may never have the answers, Dr. Ungerleider put us at ease that the biggest challenge will be managing her discomfort over the next week to week and a half. Speaking in regard to the heart problem for which we did surgery, he said, “it was now 100% fixed!” – and we fully trust him. Dr. Cotton – the cardiologist from last night – also stopped in after surgery and said he and Dr. Ungerleider will be checking in periodically over the next few days.

We still have the pneumatosis (the gas within the wall of the intestine) to deal with, but it’s thought to be benign and expected to subside over time. She had a BM this morning, so we’re thinking things are moving in the right direction, so to speak.

The remainder of the day has been spent in the PICU where Dallas is resting and recovering peacefully. PopPop has tagged in and swapped with Papa to help with getting us out of there for a little bit to catch some sleep – we only an hour or so last night. Dallas is on a bit of meds to help manage her pain/discomfort, but we are so thankful the surgery was a success, and that we had the hands of such a skilled and experienced surgeon, and team, working on her.

It’s believed that we’ll spend only a day/two in the PICU and then head back to the floor to focus on continued recovery. We asked via Facebook for some extra thoughts and prayers this morning and you all certainly delivered – we’re truly grateful!

“Alone, we can do so little; together, we can do so much.” — Helen Keller

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