Monday, Monday

Dear Eliza,


Just because we talked about how great you were doing and bragged on you all weekend does not mean we think what you are doing is easy. You really don't have to demonstrate how hard you have it by having a truly terrible Monday. Getting a little less attention from the professionals because you are doing better really is a good thing (more food, less poking!), I promise.


All my love,
Mom

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Eliza had quite a day on Monday. Basically she was running low on blood (all those heel sticks for lab work really add up) and really needed a transfusion. The nurses didn't clue in because she wasn't showing any of the typical signs of this (brady's and desats). This seems to be just how she is - even when she's been really sick before, she hasn't had too much of either of those. I knew something was wrong though because she had been very still all morning which is unusual for her since she is a feisty baby. Her color was also a little off and by the time her lunchtime assessment rolled around she was looking really bad to me. She was slack jaw and a nice shade of grey. I pointed this out to the nurse who agreed. Thankfully everyone jumped to action since when she starts to get sick she can progress to REALLY sick very fast. Her BP was plummeting so they had to almost max her out on dopamine (hypotension medication) to stabilize her until the blood arrived and the transfusion started to work.

Once the transfusion kicked in, they were able to start weaning her off the dopamine pretty quickly, and she was back off dopamine by 9:30 that evening. But she had to be NPO (no food!) for as long as she was on the dopamine, and for four hours after the transfusion too. When they checked again, her hematocrit (level of blood in her system) was still not real high so they gave her a second transfusion.

She finally started to look better Tuesday and much to Eliza's happiness they started her food back Tuesday night and will be ramping up to her previous amount over 24 hours.

This time I think Eliza made her point very clear and a few things have hopefully been learned by all:

1. Girl likes her blood. Normally they only transfuse when the hematocrit gets below 30, but her last reading a few days ago was 31(but had dropped to 26 by the time they started the transfusion). So the new rule is when she gets below 35, she gets a transfusion. Maybe she gets to be a vampire for halloween ;-)
2. Bradys and desats are her last resort to show that she's not feeling well. To catch things earlier, attention needs to be paid to activity level, color, and general appearance.