An Aspiration Operation

What started as a great day that Friday quickly turned into a nightmare, and it all started with a peanut.  It wasn’t even a whole peanut, but half of one, broken into two pieces.  Those two chunks of peanut nearly caused us to lose our baby.

Friday, September 8th was Doodle’s 4th birthday.  We woke up to a happy boy, watched him open gifts, and then spend the remainder of the day playing with his big brothers and sister and his baby brother.  He was busy playing, so I took the time to work on cutting up apples for applesauce.  We had some visitors come to wish him a happy birthday, and after they left, I headed back into the kitchen to finish the applesauce.  I hadn’t been out of the living room where the kids were playing for more than two minutes when I heard E gagging.  I ran into the living room, and he started coughing (a great sign right?), but something was obviously not right.  He was wheezing, his breathing was shallow and rapid, and he was greatly distressed.

On the floor in front of E, there was a peanut, broken up and wet.  I didn’t take time to assess whether or not the whole thing was there or not.  I tried patting him on the back, then giving him something to drink, and when neither of those things worked, I raced out of the house to take him to the ER.  I had him sit up front in the van, which is not normal for him, but I was worried something would happen if I couldn’t keep him awake, and I couldn’t reach him if he sat in the back.  (I think my rationale for driving him instead of calling the ambulance was that I could have him to the hospital in close to the time they would have first gotten to our house.  Whether that was acurate or not, I have no idea.)  The whole way to the hospital, my hand was on his cheek, gently shaking him awake, talking to him…

I didn’t know what to think.  Something was very wrong, but then again, he was still breathing.  Was this an allergic reaction?  He’d had peanut butter before, but never a whole peanut (I didn’t actually feed it to him, he found it on the floor).  Was it more like an asthma attack?  Maybe he aspirated some of the peanut?  I did know.  Why didn’t I check to see if that whole peanut was there or not???  When we got to the hospital, they brought us in promptly, first to a “standard” room for those who are just sick (among other things), and then to the ICU rooms where they have all of the stuff they need to do true emergency care.  So many people came into the room.

There were doctors and nurses and respiratory therapists… it didn’t help that there was a shift change not long after we arrived, making it more difficult to keep track of how many people actually needed to be working on our situation.  We did oxygen masks, watched his numbers, x-rays… nothing was helping.  The x-rays showed nothing.  My sweet, friendly baby who loves everybody was suddenly terrified every time somebody new came up to him to help.  I was just waiting for some kind of answer so I could tell Scott what was happening.  After all, I had left who-knows how many hours before, and he was still waiting to find out if E was alive or not.

At first, I thought this would be a quick fix, or at least I hoped it would be.  I was expecting to get home in time for a late dinner with Doodles on his birthday.  And then the doctor came into the room to tell me that we were going to be transferred to Children’s in Milwaukee and that an ambulance had been ordered to transport us. They needed to do a full bronchoscopy to see inside of his lungs, but they didn’t have the right equipment to do one on somebody so little.  I called Scott to let him know.

The ambulance and staff came, but they said he needed a breathing tube and could not be transported until one was placed. They couldn’t place a tube until they were sure there was nothing stuck in his windpipe.  Even though they had done a neck x-ray and saw nothing, they knew that a peanut may not show up on the x-ray, so it was off to the OR.  The nurse took me to the waiting room, me traumatized by leaving my very upset baby alone with strangers.  You would have thought I was torturing him by the look on his face when I left the room.  No news on how long this was going to take.

I waited anxiously, pacing, shaking, crying, and praying over and over again.  I called Scott to tell him what was happening.  I cried some more and felt sick to my stomach.  Finally, after close to two hours of waiting, the doctor came out.  He said that “he’s okay…” meaning he’s not dead, but he’s in really bad shape.  Then he told me that they didn’t find anything with the procedure they performed (they could only do a bronchoscope for the upper respiratory tract, up to the vocal cords) but there was likely something in his lungs, they were able to place the breathing tube, and the medi-flight from Milwaukee was coming up to transport him because the ambulance wasn’t going to be fast enough.  He told me we could be there for days to wait for recovery.  My stomach dropped and I started crying.

I called Scott to tell him the latest, and this time asked him to come to the hospital.  I was worried he’d never get to see E alive again.  Scott made it to the hospital before the helicopter, and once the helicopter arrived, they still did not leave right away.  He was not stable yet, and they needed him to be doing better before they could fly him out.  (I found out later that his lungs were bleeding during this time.)  Finally, he was brought out of the OR on the stretcher, tiny and looking nearly lifeless… discolored and too still.  His chest was still moving, the only sign of life.  Into the elevator they went, and we out to the car.

This was not while E was in the helicopter. One of the days we were in the hospital, I hear the helicopter come and leave 3 times.

Flight-for-Life landing on a Milwaukee hospital rooftop.

The landing pad at night. Again, not the day he arrived at the hospital, but this is what it would have looked like as the helicopter approached.

In a way, we wanted to watch the helicopter take off, but we already knew that the helicopter would get to the hospital long before us, so we left right away to get a head start.  Watching the helicopter fly overhead was unnerving.  My baby was “alone” up in the sky.  Scott reminded me that he was not really alone and that he had a great medical staff with him, exactly who he needed to keep him safe.  Still, I couldn’t help feeling sad and anxious the whole way there.  An hour and fifteen minutes later, we were at the new hospital… 10 minutes later we were finally in the room with him.  Thank the Lord, it only took the helicopter 21 minutes to get to the hospital.  What is normally a 30-minute flight was sped up significantly by a good tailwind.

We only got a minute with him before they ushered us back out of the room.  They needed to finish placing lines for drawing blood and for IV’s.  They had done an x-ray and found that his right lung was partially collapsed.  There was fluid buildup and inflammation.  His condition was bad and worsening.  They told us that it might get worse before it got better, and they were right.  His heart rate was 185, he was barely getting any oxygen on his own, and his fever kept getting higher, getting over 103F.

All of Friday night and into the wee hours of Saturday morning, we waited for his condition to stabilize.  Finally, he was showing stability, and even the tiniest bit of improvement.  The ear, nose and throat team came in to see him, and they performed a bronchoscopy to check for foreign bodies.  Almost immediately, the doctor found a piece of peanut in the right lung.  Suddenly the tension that had been building in the room turned to a wave of relief.  They took the camera out and started to prepare the OR for the procedure to remove the nut.  I cried tears of joy as Scott held me.

While we waited, a chaplain came into the room to say a prayer with us.  It was a beautiful prayer, and just what Scott and I needed in that moment.  We kissed E goodbye as they wheeled his bed out of the room, and then we waited anxiously for the next 30 minutes.

The doctor came back into the room looking excited.  He showed me a specimen container with two chunks of peanut in it.  He said that E had aspirated one chunk into each lung, and that was why he had been doing so poorly.  A peanut is one of the worst foods a person could aspirate because of the fat content in the nut… the lungs secrete fluids to expel foreign bodies, but a peanut was too heavy to be easily expelled, and the fat mixes with the fluid in a way that causes extra inflammation.  E was already doing better, and he was going to be okay, but he’d still need a lot of help for the next couple of days.

“We got it out!” There was a piece of peanut in each lung.

Who knew something so small could cause so much trouble?

Saturday was an odd day.  It was filled with relief, but as the night wore on, my tension grew.  He was improving, but not as fast as we had hoped.  He had been on paralytics since leaving the other hospital, and after the surgery, they moved him to sedatives.  He was still unconscious, but now he was starting to move and trying to wake up.  We needed him to stay asleep so that the breathing tube would stay in place.  His little arms were tethered so that if he would wake enough, he wouldn’t pull the tube out, and so that he wouldn’t move around enough to knock the tube out.

So many tubes and machines were hooked up to this little guy for over 2 days.

Brain oxygen monitor on forehead, feeding tube through nose, breathing tubes in mouth.

When he wasn’t holding one of our hands, he was holding onto one of these bears that a nurse gave him.

All day Sunday, we took turns holding him down.  Despite being unconscious, he was moving a lot.  We found out during this time that red-heads require on average 20% more anesthesia and pain medications than their counterparts of similar stature.  (This statistic is one I am glad to now know since 5 of the 7 people in our family are red-heads.)  They struggled to find the right balance for him, and as Sunday wore on he became more and more restless. He was the most “active” when I would be away from the bed.  If I stepped away to grab a drink of water or go to the bathroom, he would start thrashing.  The hardest part was the silent crying.  Turns out you don’t make any noise when you have a breathing tube in place.

Our room through the night

A glowing toe was the result of a heart rate and blood oxygen monitor… He hated having something taped to his toe!

The good news was that he had started to improve a lot.  They gave him some breathing treatments that are used on cystic fibrosis patients to help clear the lungs (it involves shaking the torso to loosen phlegm), and gradually, the lowered his help form the machines.  His early morning x-ray showed some improvement in the lungs, and shortly after that, the breathing tube was out.  Typically, they wean patients off of the medications, but he had been fighting them so hard and they did so little for him that they cut him off shortly after the tubes were out.  He didn’t seem to mind and wasn’t in any pain, but he was shaky for the next two days.

We spent the rest of the day Monday in the ICU snuggling for the first time since Friday.  His first reactions were a smile for Dad and the word “Mama” over and over and over for me.  I still couldn’t’ leave his side without him getting upset.  That evening, we were transferred to acute care where he was monitored for the remainder of our stay.  He received a few more breathing treatments, but our biggest concern was to get him eating.

Smiles for Dad.

Snuggles from Mom.

He took a lot of naps that day… an hour here and there

Awake and happy would suddenly become…

exhausted and passed out. All he wanted to do while he was unconscious was to sleep on his tummy.

I slept in bed with him that night, and by Tuesday morning, though sad and tired, he was feeling so much better.  The doctors told me we would be released later in the day if all went well!  By mid-afternoon, our release papers were ready, and thankfully, Scott was already on his way to the hospital to come visit.  Now he could take us home instead.

Snuggling with his monkey from Daddy on Monday night.

Playing with a balloon from his great-aunt and uncle.

Life is good when you can eat a pancake as big as your head.

Especially when you can start in the center 🙂

Once the tube was out, he would not let me get far away from him at all… this was us for two days. I’m not going to lie. It felt, really good!

E still had to take medications for a few days afterward.  He was given a steroid to help with the inflammation in his lungs, and an antibiotic to fight the aspiration pneumonia that he developed.  There was a follow-up appointment at the pediatrician’ s office that Thursday after everything that happened, and he was doing great.  I, on the other hand, was a little worse for the wear.

The pediatrician’s office is right next to the hospital, and I had flashbacks of the helicopter and my little baby on a stretcher as we drove past the helicopter landing pad.  The rest of the day, I could not shake the anxiety I felt from those flashbacks, but since then, I’ve been doing alright.  It helps to have things “back to normal” around the house.  My sleep may not be back on track yet, but I’ll get there.

E spent his first week back at home happier than normal.  He’s back to a normal level of friendly, happy baby and stubborn independent toddler.  Right now, he’s just struggling to get his sleep on track after a series of field trips and outings from last week.  I think Scott and I will feel extra nervous for a while every time he eats or we hear the big kids coughing.  The big kids were worried about their baby brother, and they have been a little bit better about cleaning up after themselves.

Back at home a few days later…. happy to be with Miss Lady and Peanut again.

I don’t know what I would have done without those big blue eyes in my life!

Hanging out at home with his new monkey friend, milk in hand… life is good!

We are so grateful for all of the prayers we received while in the hospital (and after), for the visitors, the gifts, the help with the kids, the help with the house after we got back, and the meals and other things people gave to us in support.  With 5 children and as many nieces and nephews as we have, you kind of know something bad is bound to happen sooner or later, though you hope and pray it never does.  I’m just so thankful that ours has a happy ending.  I am thankful for the medical team that did amazing things for us and who have a really difficult job, and as much as I know he is still here because of them, he would NOT be here if it were not for God’s grace.  When he was so close to slipping through our fingers, I could see that the most knowledgeable staff with the best equipment would not succeed if it was not in God’s plan for E or our family.

We could blame the whole thing on a peanut being left on the floor… and really, that is what caused all of this, but the truth of the matter is that E could have choked on anything, even food that we fed him in the high chair.  At 16 months old, I never would have considered feeding him a peanut, but he has older siblings who are oftentimes messy, despite our nagging.  He had only recently gotten his molars, and we were still experimenting with more “difficult” foods than purees or mushy or dissolvable foods, and certainly weren’t ready to move on to foods like peanuts.  The doctors told us the obvious, that hot dogs cut in circular slices are one of the worst foods you could feed a child, that grapes should never be fed without cutting them up, but the one that surprised me was popcorn.  One doctor told me that popcorn is about the worst food you could feed a child because it doesn’t dissolve, it expands.

I hope our story reminds you to hug your children a little tighter and tell them often that you love them.  And don’t just do it with your kids.  Do it with your siblings, parents, spouse, and friends.  I kid you not, a friend of a friend died that very same Friday (a full-grown adult) from choking on a piece of steak. Life is fragile and fleeting.  Enjoy the time you have, know that you are not invincible, and take comfort in the grace and mercy and wisdom of the Lord.

Love~ Danielle