Just a Hard Day

Yesterday afternoon one of my worst fears came true. 

Arden had gone down for his afternoon nap. He’d been a little extra sleepy, fussy, snuggly, and had lots of secretions. He’s teething, and for trach kids, the secretions are never ending during teething times. The poor guy has gotten four new teeth in the span of a week and a half. Talk about bad luck. He’s handled it like a champ but just like with any teething baby, he hasn’t quite been himself.

I had laid him down on the floor on his comfortable little lambskin that he loves. When Arden needs me, a floor nap is usually in order. He fussed and I laid next to him so that he could twirl my hair between his fingers as he drifted off to sleep. He loves to play with my hair. For some reason, it’s usually one of his greatest comforts. I daydreamed as he snoozed, and after a short while, he coughed and began to wake up. Coughing upon waking up is very normal for Arden. When he sleeps, all of his secretions pool, and as soon as he begins to stir, they mobilize. 

Arden usually requires quite a few suctions when he first wakes up. However, this time as I suctioned, it didn’t seem like I could get much. He had small coughs, and not much came up. As I turned to flush his suction catheter, I could see that his oximeter read 97% oxygen saturation, but Arden’s face read differently. His breath had caught, and his little face was turning blue. In an instant I knew that his oxygen saturation had plummeted, and I needed to act fast. During that split second thought, the oxygen saturation reading on his oximeter decreased to 60%. I did my best to remain calm as I said to Arden, “It’s okay baby, mom is going to bag you, as I RAN to his bedroom to grab his bagger and his oxygen tank.” 

When I returned, I cranked the oxygen tank on, waited momentarily for the bagger to begin inflating, pulled off his vent circuit, and began to bag him. As I gently rested my left hand on his chest to feel the breaths going in and out, I bagged oxygen into his lungs with my right hand. I knew that something must be causing his lack of oxygenation, so I grabbed a saline bullet (something we call a pinky) and squirted it down into his trach before readjusting the bagger and pushing a few more breaths. I suctioned him again, and was able to mobilize a few more secretions. This is something we call a bag-instill-suction. When secretions won’t mobilize on their own, it’s what we do in order to help the lungs push the secretions up, out, and into the trachea to be suctioned away. After doing this, his oxygen saturation returned to the high 90s and I was reassured. I placed his vent circuit back on, took a breath, and prepared for our scary moment to be over. 

Unfortunately, it wasn’t over yet. Arden quickly became distressed again, and his oxygen saturation dropped to 70%. I immediately pulled off his vent circuit and repeated the process of bagging him, instilling saline to mobilize secretions, and suctioning. After that, his oxygen saturation stabilized again, and we were in the clear. The whole ordeal probably occurred over a period of 3-5 minutes. But it felt like an hour. 

I held our little man close, hugging and kissing and appreciating him. I cannot believe his level of resilience. Directly after our terrifying moment, he was looking up at me, smiling and gazing into my eyes as if to say, “It’s okay mama, I’m alright. You did it.” He amazes me. For a boy who has been through so much, he is one of the most content babies I have ever seen. 

Although our little man recovered quickly, my heart has not been as quick to recuperate.This was the first time that I have experienced a respiratory emergency on my own. Don’t get me wrong, I had experienced this same situation many times when Arden was in the hospital. I learned how to deal with these situations as soon as Arden got his trach, and I had taken the lead to stabilize him many times before. But this was the first time that I had done it completely alone. Where before, I was surrounded by nurses and respiratory therapists and doctors who could step in if I wasn’t successful, this time it was just me. In our subconscious, Brodi and I always know that these situations are a possibility. We have trained for them and prepared emergency supplies for them. We’re ready. But that doesn’t take away the terror that is felt when YOU are the only factor that stands between your baby breathing and not breathing. 

There are times when we feel bored, or isolated at home. COVID-19 has made all of our lives a little quieter, and more isolated. Having a trach-vented baby just adds to that inability to get out and about. But I will never take the boring moments for granted. Boring is stable. Boring means that we are inside our peaceful little home. We’re happy and content, and Arden is doing well. This weekend, I’ll hold my little family even closer, and just like we always do, I’ll appreciate and be mindful of every single wonderful moment. 

XO, Rayel

Terminology:

*Bagging: using a manual resuscitator to ventilate a patient. Bagging is used in medical emergencies when the patient’s breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest).

*Instill: putting a few drops of normal saline into the trach in order to break up thick secretions directly before suctioning.