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Update for 11/7/03 (see below for this morning's happenings): Jessica is now somewhat stable on the heart-lung machine. The area on the brain that we were concerned about doesn't appear to be bleeding (good news). From what they can tell, it is an area that had low blood flow and is damaged. What this all means will become clearer within the next couple of days. If it is an isolated area, then it has a potential for a positive outcome. If there are multiple areas of damage, then it is a bleaker picture. She has decreased brain function overall, but that may be due to toxins built up from the liver not being able to eliminate them. If that is the case, then this will resolve as her liver gets better. That's all we know for now. I'll update again in the morning. Everyone have a nice weekend.
******************************* From 11/7/03 AM::
Bottom line: Jessica became unstable overnight. She has been put on a heart-lung machine. The main concerns are her lungs and a suspicious area on her brain. Read on for more details...
Well, it's been another rough morning. The hospital was nice enough to let us stay in one of their parent rooms (although it's not so comfotable having two people in a single bed). Gene woke up at 3AM thinking his phone was vibrating (ringing). It was on the off position. An hour later, the ward clerk was knocking on our door. We went down to meet the doctor in her room (the same doctor that was there from 6AM to at least 10PM the previous day). He said that Jessica was very stable until 3AM when her blood pressure began to drop dramatically.
They started chest compressions and gave her medications to help her heart start beating, but both of these measures weren't working. Her heart wasn't responding and didn't beat for about 1-2 minutes. They were able to start the heart again by pacing her heart (they had wires connected to her heart after surgery just for this purpose). They sent electric pulses through, and her heart responded to them.
The doctor's impression from this episode was that her body was telling us that her heart cannot handle all of this work (caused by a number of factors). He made the decision, in conjunction with the surgeon, to put her on the heart-lung machine (ECMO).
The doctors came out and spoke with us. Their impression is as follows...
She will probably need to be on the heart-lung machine for a minimum of 4-5 days. She will need to remain with the tube in her throat (intubated) AT LEAST 7 days after she gets off the machine.
He went over the concerns by organ:
Lungs: Her lungs are causing the most concern right now. They are filled with fluid (due to both heart dysfunction and liver dysfunction). They are trying to take some of the fluid off with special gadgets they can hook up to the ECMO. The lung status hasn't yet stablized, and this is what concerns them. They will feel more comfortable once they start to see a turn around for the better. With the ECMO machine in place, her lungs, along with her heart, will get to rest and recover.
Brain: The ECMO machine requires that they thin the blood in order to use it. This will prevent clotting since it is running through plastic tubes. This blood thinning increases the risk for bleeding in different places. They did a screening ultrasound of her head to make sure there isn't any exsisting bleeding before they start. They found a spot that concerns them. The neurologists overnight weren't able to tell what it was. They are calling the best technicians and neurologists to reperform the ultrasound this morning and come to a conclusion. The doctors are worried it might be bleeding. The thinned out blood might increase this bleeding and cause brain damage. We will just have to wait to find out what they see.
Liver: This was the organ of concern yesterday. They have seen that the liver function has stablized, and they believe that it will only improve from here. The liver dysfunction can play a hindering role in the operation of the ECMO machine. The clotting factors in the blood come from the liver. There will be a delicate balance between keeping the blood thinned, but not to the extent where there is bleeding. This will be the toughest part of keeping her stable on this machine.
Heart: Her heart is actually doing pretty well. Being on the ECMO will give it a chance to rest for a while, but they believe that it will recover completely from this as long as they can get all of the other organs to co-operate.
Kidneys: The kidneys are doing their job and don't seem to be much of a concern.
The doctor state that this is a critical situation, but it is not impossible that she will come out of this without any permanent damage.
Please keep Jessica and our family in your prayers. This will be a very long road to recovery, but the more that she comes out of, the more that God can be glorified through this.