Emma's week

I don't know if words are ever going to be able to capture and accurately express the emotional roller coaster ride we have been on over the past 9 days. I had fully intended on first and foremost writing a post about Emma's birth before the details grew foggy but now I'm feeling the need to document all the thoughts that have been running through my head over the course of the last few days.

I am feeling so completely overwhelmed by the army of prayer warriors who have been lifting us and our sweet Emma Grace up before the Lord in prayer. I have not even attempted to count but know we have literally hundreds of people who have told either us directly or other family members that they are praying. And we can definitely feel it. On Tuesday, when things were looking pretty scary, both sets of grandparents were present to pray tearfully and fervently together with us as we faced the decision of whether or not to transfer Emma to Children's Hospital. Not more than a couple hours later, all of Emma's vitals turned around and began heading in the right direction! The power of prayer is amazing.

So for those of you who are wondering how this all came about, I'll fill you in with the details. I'll be posting eventually about the details of Emma's birth but for now all you need to know is that it went very smoothly but was quite fast. I was Group Beta Strep positive (GBS), which about 25% of healthy women are and basically all that means is that I needed to get IV antibiotics at least 4 hours prior to delivery to ensure that Emma got coverage she needed to protect her from getting an infection. Of course she decided to arrive after about only 2 1/2 hours on antibiotics so they kept us hospitalized 48 hours + after delivery to make sure Emma wasn't showing any sign of illness. She did great so we discharged home last Thursday, healthy, happy and tired.

All I can say is that I am so incredibly thankful that I work in the field that I do. I'm not sure I would have acted as quickly as I did had I not known from working in the NICU how quickly a baby's body can be overtaken by infection. Emma was acting totally normal on Sunday during the day, maybe just a little more sleepy in retrospect. We put her to bed about 10 PM and she didn't wake to eat on her own. At 2 AM, after way too long of a stretch of sleep, I tried to wake her. She'd started making some funny sounds in her sleep (Isla was known for doing this too so it would have been easy to think nothing of it) and when I touched her, she felt hot. We had her in a fleece swaddle since it was hot out and we were sleeping with the window open. I immediately pulled it off and took her temp. I can't remember what my initial reading was because I took it so many times but I know it was more than 100, maybe 100.4. I got on my pediatrician's webpage and read that increased temps are common in newborns due to overdressing them so I striped her down naked and waited to see if her temp normalized. At this point, shaking and with tears running down my cheeks, I woke Graham and told him I was pretty sure she had a fever. He told me to wait the 1/2 hour recommended on the website after striping her down and reassured me that it was probably environmental.

Thirty minutes later, her temperature was no better. I think the highest reading I got was 100.8. We called the after hours line at our peds office and meanwhile I got her to eat. A triage nurse from Children's called us back in 20 minutes and told to take her to the Evergreen Hospital's ER, as it was the closet to our home. I am so thankful my mom was still staying with us! It was around 3:45 AM by this time and so I ran to her room, told her Emma had a fever and that we were going to the ER and we were out the door in minutes.

When we arrived at the ER (after running a red light that just wouldn't turn green), I immediately began to question our decision to come to Evergreen. The triage nurse beckoned me back and asked "What's up?" I proceeded to tell her that I'd delivered 6 days prior and was GBS positive, inadequately treated with a precipitous delivery. She gave me this look like she had no idea what I was talking about and asked "What's GBS?" Now I realize that the average person would have no clue what the above sentence means had I rattled it off to them. But anyone in the medical field who works with babies should immediately know what I was talking about and begin to ACT as GBS sepsis can take a baby's life very quickly if not treated right away. This lady leisurely called me back, put Emma on the scale with her clothes and diaper on (totally inaccurate!) and proceed to get a rectal temp of 101.7. The taking of the temperature caused Emma to poop and we noticed her stool was completely watery. The nurse make a grossed out face and said something to the effect of "I'm ok with it if she poops on my hand, but definitely not on my face! She's all yours from here, Mama. I've changed enough babies raising three of my own." Wow. Not exactly what you want to hear in a moment like this.

We were moved from triage to a room in the ER and a new nurse appeared. She got a little background and then the doctor arrived. Thankfully, he understood my GBS mumbo jumbo (and the fact that I was likely in the medical field given how it rolled easily off my tongue) and began to take action. He was probably the only professional presence we encountered in the ER. He ordered a blood culture, urine culture, lumbar puncture (spinal tap), IV antibiotics and a blood count and told us he was going to need to admit Emma given my history and her presentation (by now she was breathing really fast and continuing to grunt). The nurse got to work trying to implement these orders, all the while making really reassuring comments like "Hmmm, not sure how we do that here" and "I'm a traveler so I'll need to check on that" and "Wow, I've never had a patient this small before!" When she was trying to get the IV started, you could tell she was second guessing herself as she asked Graham if he wanted to take a look and see if he could "see a vein there." Throughout all the poking, Emma just laid there on the table, not even attempting to fight it.

Graham was pacing and I was crying and completely regretting that we didn't make the slightly longer drive south to Overlake where they had Emma's records and where I knew the staff. I began praying that we'd made the right decision, telling myself that the Children's nurse would not have sent us here if it wasn't where we needed to be.

We should have asked right then and there that they send a pediatric or NICU nurse to start the IV but our heads were swimming. Graham kept telling me it would be ok and that we did what the Children's nurse told us to do. He hugged me and thanked me for being persistent and going with my gut even when he told me the temp was probably just due to overheating in the swaddle.

After one failed IV start and a catheter attempt that Emma basically peed completely around, they told us they were sending us up to the peds floor where a NICU nurse would start the IV. Phew. The NICU charge nurse met us upstairs and immediately got to work, verbalizing the importance of getting the antibiotics going immediately which made me feel better. Finally someone who knew what they were doing! She went to working poking and prodding in Emma's little hands, unable to find a good vein. She explained that in sepsis, blood flow slows to the extremities, making it quite challenging to get a vein. I knew Emma was a "hard stick" when she started praying over her as she poked. Finally she got one in and relief washed over me along with a pool of tears. 

By now, we'd been at the hospital for about 2 hours and it was 6 AM. The events of the rest of the day are already a blur but numerous labs and cultures were drawn and sent and the doctor came by to assess Emma. Little did I know, the same doctors who work on my peds floor in Everett also work down here so I was pleased to see familiar names/faces. Emma was started on oxygen to help relieve her work of breathing and the nurses took her temperature almost hourly and it only seemed to be climbing. The doctor came by about 5 or 6 times during a 24 hour period and spent more time with us than I've ever witnessed from a doctor. He was obviously quite worried. Our care from the moment we arrived on peds was 110% better and I felt very confident and reassured that this was where we needed to be.

Things began looking grim after 24 and then 36 hours of fever that could not be relieved, even with Tylenol. Emma's heart rate was inching toward 220 beats per minute, far too high for my comfort level. We began to talk about the possible need to transfer her to Children's where she would have access to a higher level of care should the sepsis overwhelm her body and she start to deteriorate. Meanwhile, the doctors here consulted with the infectious disease doctors at Children's, trying to piece together her puzzling presentation. Apparently she had a lot of people stumped since her cultures were all coming back negative and she remained febrile for such a long period. The poor girl barely opened her eyes and wanted to be held constantly but not messed with. She continued to grunt and moan and was obviously in a lot of pain. The doctors began talking about looking for other potential sources of infection such as endocarditis (infection of the heart) or internal abscesses on various organs or in her joints.

On Tuesday morning, the doctor basically said that if things weren't improving by late afternoon, we'd discuss shipping her to Children's. I felt totally overwhelmed and panicked by the gravity of the decision, not wanting to be held responsible if we chose to stay here and then things fell apart and also not wanting to head across the water to a unit where we'd be unable to room in and spend 24 hours a day at Emma's bedside. An echocardiagram (heart ultrasound) was performed that afternoon and there was talk of doing a more detailed ultrasound of her body to look for these possible abscesses.

You can work with ill patients every day and somehow not let it phase you, but when it's your daughter's well-being that's in jeopardy, it's a whole different ballgame. Thankfully, by the GRACE of God, Emma's condition turned around literally a couple hours before we were to have to make the decision. It was made for us and I couldn't have been more relieved. Emma's temperature began to go down, her heart rate dropped below 200 and she began to perk up a little bit. She spiked one more temperature that night but then has not had another one since!

And here I sit, having barely left Emma's bedside since the wee hours of Monday morning. I am thankful to say she is on the mend and we may get to go home tomorrow if the last couple pending tests come back negative. Initially we all thought Emma had a late onset GBS infection but with all the negative cultures and tests, it is looking more and more like some unknown and never-to-be-known virus that brought this all about.

Thank you EVERYONE for all the prayers, texts, calls, food and Isla care you've provided over the past week. We feel so loved and cared for.

Someone's looking mighty fine this morning, don't you think?