Ryan’s surgery took a bit longer than anticipated, but went smoothly. I wish I could say the same for the hours immediately following.
He was struggling to breath. It was clear he was in distress. Each time he inhaled he gasped. It progressed quickly to him pulling in air entirely too labored. He would gasp, hitch, and gasp again. He spent fours hours in recovery because they wanted him right next to the operating room.
The doctor overseeing Ryan’s recovery ordered a breathing tube (to intubate him) and for a ventilator. Hell, she was even considering doing a tracheotomy! The doctor must have felt that his airway was obstructed. I immediately denied her order and asked that she run labs to measure his level of carbon dioxide in the blood; called an Arterial Blood Gas (ABG). I’m thankful I did… and annoyed that it was me that had to think of it! Hell, I’m deeply saddened that I even know what it is.
Turns out, I was spot on. Ryan had an extremely high level of CO2 built up. He was hypo-ventilating.
Respiratory brought in a machine, called a Bi-PAP, which is a ventilator… minus the breathing tube. Instead, a mask is strapped securely to his face. It regulates his breathing and allows the CO2 to “blow off”.
Within ten minutes or so Ryan was clearly out of distress. Still, the only way to confirm he was heading in the right direction was to take another ABG after an hour or so. As we waited, the doctor kept pressing to have a breathing tube placed. We kept telling her “no”. She then asked for other doctors to weigh in and we held our ground.
It was scary, but I trusted my instincts.
Sue pulled out Ryan’s medical history showing that EVERY time Ryan was intubated he developed pneumonia. This convinced the Intensivist (ICU doctor) that we had compelling reason to object, but we just couldn’t get the Recovery doctor to relent. Then again, neither would we.
Meanwhile, as we anxiously waited for the next ABG to be drawn, Ryan’s blood pressure went off the charts! His systolic was well over 200! Chaos erupted… again.
Now, one thing I learned is never to put all your trust in the machines. This was a hard lesson learned from a time about a month after the attack (by Austin Vantrease and Jonathan May, both from Newark, Delaware). Ryan’s heart rate was all over the place, but occasionally plummeted. He was hooked-up to an external defibrillator to automatically intercede if it dropped too low. It was the first time I left his side and Sue was with him in the ICU. I literally just left him a few moments before to get a bite to eat. Sue called me in a panic. He was being defibrillated because his heart rate was showing below 20 beats per minute. I ran back to the room, took one look at him, and knew something was wrong… but not with him. Pissed, I simply asked, “has anyone assessed the patient?” to confirm the monitored reading. Long story short, Ryan was being shocked for absolutely no reason other than the machine was reading incorrectly.
So, back to the blood pressure… I looked at Ryan and didn’t see any signs that his blood pressure was high. Sue was doing the same. The nurse is telling the doctor that it’s the third time the machine has given this reading. Sue, quite calmly directs them to not rely on the machine and do it manually (i.e., assess the patient). In the meantime I walk over to his side and adjust the cuff and reposition the tubes. Can you guess the result? Yep, Ryan’s blood pressure was completely normal.
Obviously I lost all confidence in the doctor from recovery. I began running the show. I had them get a room ready for Ryan in the ICU and got agreement from the Intensivist to take him up if the follow-up ABG was improving. Even as we where waiting on transport to push him to the ICU we were still hearing (but not listening) to the doctor from recovery.
A third ABG was ordered for 11:00pm that night. Ryan was so much improved that he was taken off the Bi-PAP before the clock struck midnight.
For all that struggle, I take my hat off to the neurosurgeon. He did an amazing job! He was able to close the incision without staples, using only stitches (29 in total).