Thursday, November 10

More Grey Hairs

There has been a pause in any posting due to my little troublemaker deciding it is once again time to visit, as Grandma calls it, the H Place.
At the very end of September, Wriggles had a very minor sniff but nothing out of the ordinary. Our physio came out on Friday 30th and at the end of a session listened to her chest and was perfectly happy. She was a bit of a grump at bedtime but nothing more. However, as the night progressed things went very downhill, very fast. She could not settle and quickly developed a hacking cough. Calpol and inhalers and saline drops did nothing and the poor mite could not even take water if she wanted as would just cough, choke and vomit. All through the night I held her upright, rubbing her back. As the hours wore on, she grew palers, clammier and her breathing gew decidedly more laboured. She was vomiting consistently (delightful) due to the cough. In the early hours I had had enough. After beginning to bring up bile with fleck of blood, I rang NHS Direct in a panic who sent us along to a&e. Oh dear a&e! How I have er.....missed it. Since the weekend previous. Oh well. 
Mind you, it has been a while since a middle of the night dash. Unfortunately it was quite reminiscent of when we had the dash that culminated in the infamous PICU stay; whereby I bundled us into a taxi who was a driven by a chap called Maxell Onions (you can't make these things up) who drove the wrongway down a slip road onto a major A road and would go right every time his sat nav said left.......
Once there this time, a nurse eyed the invalid warily muttering "She looks quite short of breath". She effeciently whisked us around to the room that brings a chill to my spine: the snappily named 'resus'. Bays of resusitaires, with monitors, ventilators, emergency equipment for life-threatening occasions and such like. Wriggles, who was slightly less wriggly than normal, laid on a adult bed which of course dwarfed her ridiculously. She was quickly hooked up with ECG leads and an oxygen pulse monitor. As suspected, her sats were low and her heart rate was looking a bit silly. Bucket-loads of oxgen with nebulisers were administered whilst different medical staff ran around waving themometres, trying to take blood tests and piece together medical histories (that was the easy bit. One doctor walked in "Oh hello!! It's you two again...what are you doing here? Oh dear...." and was able to bring everyone else up to date). As the shifts changed over and breakfast dawned round, Wriggles was more normal-coloured and trying to eat the oxygen mask and was showing far more acceptable numbers on the monitor. Whilst they tried to work out whether to send us home or keep us in for observations, we got ready to go round to the Day Unit rather than take up space in a&e. 
Off we went, pushing the big bed along with an emergency oxygen cylinder Just In Case. We got through the first set of doors from a&e and suddenly the newly-stabilised patient deteriorated infront of our eyes. Within seconds she was labouring breaths again, recessing so much you could see all her ribcage and muscles and her heartrate shot through the roof. Casualty-style, we quickly all jogged into the second Resus room of the day. More oxygen, more nebulisers.............. This time, it took hours and hours for her to reach anything nearer stable. A blood-gas had them debating whether to send her up to High Dependancy straight away or to give her the benefit of the doubt.
At least that made the former decision easy: we were definitely staying in.

In total, we ended up in hospital for just under 3 weeks. As no definitive infection seemed present, the likelihood is that Wriggles aspirated something. There has always been a slight infection in her right lung on X-rays, but normally this is not the root of problems. After the initial weekend, where she was on oxygen and IV fluids, she was weaned off both. A team of paediatricians decided that the likely explanation was that due to her cardiac arrest whilst being ventilated for pneumonia aged 6 and a bit months, her swallow coordination is sometimes defective resulting in infrequent aspiration. Due to the fact she already has Chronic Lung Disease (Broncho Pulmonary Dysplasia) and a history of respiratory tract infections, they decided that this combined with her notorious solids aversion and reflux were all grounds to be fed nasogasterically for the forseeable future to allow her tissues to renew and her brain to mature. We were referred to speech and language who observed a one-off oral feed and agreed that this was a good idea. Just to be sure, they booked a fluroscopy (moving X-Ray, like a barium swallow) for the following week. In between this, Wriggles did catch a gasteric virus which put us in isolation. 
Once recovered, we went for the fluroscopy which confused everyone. There appeared to be no swallow problem. She did have a peculiar reaction to a puree but not one that showed any obstruction, aspiration or allergic reaction. The doctors shiftily withdrew to decide on a New Plan. No one quite knew what to do. The respiratory team had been so confident that they had discharged us from their care and handed us onto SALT, SALT now wanted to hand us onto someone else... They had just spent two weeks training me in nasogasteric feeds and setting up a community support plan with the view of ng feeding for the next twelve months minimum and not ruling out longterm PEG feeds. The respiratory team, neurological doctors, developmental paediatricians, physios, SALT had been sure of aspiration being the cause. Over the next few days we saw an array of paeds all with their own take on things. The inconclusive evidence looked shockingly to was all a result of prematurity complicated by pneumonia which was a most likely a complication of prematurity! Excellent. I could have guessed that myself without spending weeks in hospital undergoing a barrage of tests.
Oh, and she might have a milk intolerance. Or she might not. It could be the reflux.
So with that, we were released into the outside world again. Over the weeks, the seasosn had changed from people in shorts to people in coats, mittens and umbrellas. The air was chilled and afternoons suddenly grew dark.

So now we are back at home as normal. The ng tube, for the moment, is out. We are on high-calorie soya-milk and an continous antibiotics Just In Case. During hospital, Wriggles has perfected sitting unaided (what else can you do in a very small room you cannot leave in case you contaminate people?) and has developed a love of shredding important bits of paper and newspapers I have not yet read, and also discovered the joy of banging on cardboard boxes. I have returned to work and am trying to remember exactly how many marbles I had a few weeks ago because I seem to have less now... Almost a year ago in Special Care I believed, naively, that leaving dear old Ward 35 was the end of the premature experience. The birth and NICU/SCBU had left me in deep shock and for me, discharge symbolised a new beginning. Hope. A light. A world free of clinical procedures, antibacterial gel and feeding charts. A world where I stopped being a rabbit in the headlights and became A Real Mum. Wriggles would have soon reached term and no longer be 'a premature baby'. This began  to wobble when a week to discharge they decided she would leave on oxygen. But I still clung to this ideal of it being the fairytale end. 
Of course it isn't. I'm sure some parents do leave and leave it all behind in the hospital reception with the overpriced crisps and tacky cards. But it often feels as though we never escaped the world of prematurity. To look at, you would never guess she was a premature baby, far less a 27 weeker. But the oxygen followed by frequent admissions from respiratory "incidents" have been a haunting reminder of prematurity. Each seems to invoke the trauma of the previous. This last admission has particularly triggered the memories of PICU: the weeks in a different world, roaming hospital corridoors at night, the eerie quiet of the 24 hour Costa Coffee at midnight. If I think too much, I hear the hospital machines with perfect clarity. Of course, if the alternative was to not have my darling Wriggles, I would go through it all again with hesitation. Yes it has been traumatic. It has shook my faith in the world and a sense of right and changed my outlook of life. But equally, my darling daughter has shown me a kind of love and joy that I don't believe can be equalled. She is better than the tastiest biscuit and more fun that running down a beach in the sun. When she smiles at me, I can forget the things I've seen and hours at a bedside. At the end of the day, miraculously, she seems free of any condition and utterly perfect. I know time is a great healer; it will heal my memories and will renew the cells in her lungs and rest of body and build up her immune system to make her stronger. Time will ensure she grows up and grows strong, away from being a fragile, premature baby. A year ago, I could have put her in my pocket. Now at 14 months old, we are not quite out of the woods of the whole experience but I am dreaming of hope again.