Ethan's T&A Surgery Day

Ethan's tonsil and adenoid removal surgery was scheduled for Friday September 16, 2011. Check in time was 6:45 am! It was early, but we preferred it to be that way so Ethan wouldn't be too upset about not being able to eat all day. I took him to the hospital while Bob stayed with Jonathan until my mom could come pick him up. When we got to Children's, I parked in the Giraffe parking lot where parents usually park when their child is staying at the hospital and there were a lot of spots that early in the morning. The lot usually gets full by lunchtime and then you're forced to park in the Whale lot on the opposite side of the hospital where the clinics are. I didn't feel like trying to move the car while Ethan was in surgery.

There was no crying when we walked in the doors and checked into the hospital. I don't know if this was because he was just in a good mood or the fact that we entered through the Giraffe entrance instead of the Whale entrance and he just didn't realize where we were. He stayed in a good mood though as we walked through the train section and over to whale where the surgery center is located. We waited less than 15 minutes before we were brought back to the pre-op area. We spent that time looking at the fish tank. Once we were in a pre-op room, Ethan started to fuss when I put him down and tried to take his coat off. He finally let me take it off and then I was able to strip him down and put his gown on without any problems after I asked his permission. I sat him in the chair with his penguin, bottle, and 5 trains.

He's all ready for surgery.

Luckily, we didn't have to wait too long in pre-op either. The pre-op nurse warned me that people might see him with the bottle and freak out thinking that he was drinking something before the surgery and I would have to let them know it was his pacifier comfort thing and it had been empty all morning. Shortly after he was all ready to go, the anesthesiologist came in with his resident to go over all the necessary pre-op stuff. The resident actually was doing all the talking, but the mentor anesthesiologist was standing right there listening to everything. I actually heard him going over Ethan's chart with the resident before they came in. They gotta learn how to interact with families somehow and Seattle Children's is a teaching hospital. I felt comfortable with all that stuff and then Dr. Sie and Dr. Hopper came in to talk about their portions. I asked Dr. Hopper if he could do anything for the scar on Ethan's stomach from the g tube closure, which had grown a keloid and was itchy. Dr. Hopper said he could give him a shot of a steroid, cortisone in there as well as inside his mouth behind his macrostomia scar, which was extremely thick and resting against his teeth where he could bite it easily. Pretty quickly after that, we were off to the OR. I was able to go back with him this time as well. I carried Ethan and he was carrying his penguin, bottle, and my phone and then the nurse asked if he would feel more comfortable if he had his trains and I said yes, so she grabbed all of them. I was surprised because the paperwork for surgeries says they can bring one item with them.

Just after he was placed on the OR table.

When we got into the OR, Ethan was so brave. I tried to grab my phone away and as you can see, he wasn't very happy with me. I gave it back to him and turned the camera on because he likes to look at himself and the nurse pushed the button on my iPhone which allows you to take pictures through the screen side of your phone so as he was looking at himself, I took a picture of him. I am so used to him crying while he is going under that he really breathes in the gas a lot and is out pretty quickly. This time, it took him a couple minutes because he wasn't crying. Eventually he realized that something was happening and he was able to kind of knock himself out of the sleepiness, but then he started getting upset and was totally out within seconds. I saw the nurse, Dr. Pittaway the anesthesiologist, and Dr. Sie all standing there ready to go, so I knew he was in good hands. This was the 5th time going through this. I was so proud of my little tough guy for being so brave!

Once I left the OR, I went to check in at the ICU desk since he was scheduled to go into the ICU after the surgery. I went to visit Carol Parry and Jenny Calhoun who are the two ladies that contact me to come and do parent advisory stuff. I also went to the Starbucks on Giraffe 1 and got breakfast. I also checked out their chapel. It overlooked the construction site, but was very relaxing. I only waited about an hour and a half before I got paged. I waited for Dr. Sie in the ICU family conference area for a short time before she came over to talk with me.

Overall the surgery went well. Dr. Sie said his tonsils were pretty large under the gum line, so she thought it was good that we took them out. She also took the top 2/3 of his adenoids, but wasn't able to take everything out. She was not able to perform the bronchostomy because she discovered that Ethan's airway is curved instead of going straight down and she didn't want to irritate his throat even more by trying to jam her straight instrument down there to look. This can be done later on in clinic if need be with a bendable instrument. She confirmed that his palate was high but intact. Dr. Sie also mentioned that she found some Parapharyngeal Banding on both sides of this throat which indicates that he has allergies. She wasn't surprised that he has a peanut allergy and she wondered if a lot of the times we thought Ethan had a cold but his only symptom was a runny nose were actually allergies. She seemed pretty concerned about this and wants us to put him on Zyrtec a month before his sleep study to allow Ethan his optimal performance while he is sleeping. The steroid injections went fine too. I also learned that Dr. Sie did the intubation since she was going down there anyways, but was supervised by Dr. Pittaway the anesthesiologist. She said it was difficult, but she was able to get it in a couple of tries.

As a side note, while we were talking in the family conference area, some lady came out of the ICU, sat down across from us, and talked really loud on her cell phone. Maybe she was oblivious, but I thought it was pretty rude of her. I would think it obvious that a parent and surgeon were having a discussion since Dr. Sie was still wearing her OR stuff, but the conference area is also not marked well and the opening faces the ICU entrance. Dr. Sie asked me if I wanted to move and she moved us to a private room down the hall to finish our discussion.

When I was done with Dr. Sie, I walked back to the ICU desk because they paged me twice while I was with Dr. Sie and realized that they were paging me because Bob's parents had showed up to check in on their way back to Vancouver, B.C. Before I left the area, I was told that Ethan was not coming to the ICU and just going to the surgical floor so I checked back in with the surgery center where I got another pager so I could find out his room assignment when it was ready. I had the pager not even 30 seconds when I got paged and was told I was needed in the PACU.

In the PACU (Post Anesthesia Care Unit or Recovery Room)

Since Bob was on his way by now, I had my inlaws sit in the waiting area and texted Bob where to find them. I then went back to the surgery area where someone brought me back to the PACU. Once there, someone pointed me to a curtain where I could hear Ethan crying, though his cry was very hoarse sounding. As I walked around and spotted the nurse, she looked at Ethan and asked if he wanted to see momma. Ethan turned around, made eye contact with me, pointed, and said "momma" in that sad, hoarse voice that he had. It melted my heart. The nurse said that Ethan was ok, but she mainly needed me for pain management. I was set up in a chair next to the bed and I held him. As I held him, the nurse noticed that he was having oxygen saturation level problems and I noticed that his whole body was moving as he breathed. It was very unsettling to see how hard he was working to breathe. The nurse mentioned that he was doing well when he first got to the PACU; he had a lot of adrenaline and was moving around crying. She theorized that as I held him, the adrenaline wore off and he relaxed, causing his airway to relax as well which is when we began having problems with his breathing. Dr. Sie was called and came to check on Ethan. She wanted him to be watched for another half hour to see how things went. Ethan was allowed to have some juice so a nurse put straight juice in his bottle. He usually gets diluted juice, but I thought full strength juice would encourage him to drink, but it didn't. Dr. Sie checked in from time to time and eventually the anesthesiologist came in as well. Dr. Sie and Dr. Pittaway along with the nurse discussed the situation and agreed that he should actually go to the PICU (Pediatric Intensive Care Unit), so the nurse had to call and get his bed back since it had been cancelled. Dr. Sie talked to me about what was going on with Ethan and why she thought he was doing what he was doing as well as reassuring me. She gave me the plan for what was next. Overall, we spent about 2 hours in the PACU.

Once Ethan's bed was ready in the PICU, Ethan was put back into the bed and pushed to the unit. I followed behind. He was put in the bigger side of the room with a nice view of the construction site. Once we were in the room, Ethan actually started to do a little better, which we were told usually happens. I told the PACU nurse that we should have come up to the PICU right after his surgery so maybe he would have done better faster! Once there, Ethan wanted me to hold him, so I sat with him in a chair for about 7 hours. I texted Bob before we left the PACU to tell him that we were on our way up to the PICU and he met us in the room shortly after we got there. He brought his laptop, which turned out to be great because we were told all of the beds had a DVD player except the one Ethan was in and he was so unhappy that we wanted him to be able to watch a movie that we had bought him specifically for the hospital stay "Misty Island Rescue", which has Bash and Ferdinand who he is obsessed with right now. Our roommate was a baby who had surgery and was getting teaching on how to take care of a child with diabetes. I think the baby lost it's kidney or something. So sad and since Ethan was crying to much, I felt really bad.

Ethan and I in the PICU.

The construction area outside Ethan's PICU window. Bob and I played with "Where's Waldo" game that Sellen Construction does for the kids on a daily basis. It's hard to see him in this picture, but he is in the far right on the blue wall.

This is the newest building going up at Children's. I heard that the SCCA, Emergency Department and the ICU are moving into the building, but I don't know for sure. Notice that there are names on the beams. Parents can write their child's name on a piece of paper and put it in the window where steel workers will put the names on the beams.

Poor Guy. So tired, but not sleeping.

During the day, we were visited by the PICU attending physician and Dr. Sie and her team. The two doctors discussed Ethan's situation and plan for his care going forward. We also had requested to see the respiratory therapist who showed us the options for a CPAP machine if we ended up having to go that route. Auntie Erin also showed up just as the team of doctors walked in. She brought Ethan a little giraffe. So sweet.

I eventually had to eat something. Ethan was brought some dinner, but it was mashed potatoes and chicken nuggets. He really wanted to eat something, but the chicken nuggets really hurt when he swallowed along with everything else. I felt so bad for him. He also wanted a graham cracker, which we knew wasn't really good for him, but we let him try it and he took a bite and cried when he tried to swallow. He was persistant though and kept trying. He eventually gave up. The nurse also wanted us to try and give him a popsicle. He did take two licks off of that, but turned it away after he tried to swallow. I didn't want to eat his food, so after Bob came back from eating his dinner, he took Ethan and I went to the cafe before it closed. Patients are allowed to eat in the PICU, but parents are not for infection control reasons. It is also for reasons of infection that parents cannot use the bathroom in the room. I also kept sending Bob out to the waiting area to call people since you can't use your cell phones in the room. As I was leaving, I couldn't figure out how to get out of the unit since I got there a back way.

While I was in the cafe eating, my dad arrived and saw Ethan for a bit before finding me in the cafe. My friend Kathy also showed up and found me in the cafe. It was a nice change of scenery to see them and I was able to just talk to them about how the day went. Visiting hours go from 10am to 8pm for everyone except parents and by now it was past 8pm. My dad and I finished visiting and then Kathy and I walked back to the ICU check in desk. You always have to stop at the desk. The lady at the desk knew Kathy who is a charge nurse in another unit, but they let Kathy back to visit for a few minutes. She was so sweet because she not only came to visit on her day off, but she bought Bob and I coffee. Kathy came up to visit us for a few minutes and while she was there, another doctor from Otolaryngology came up to check on us. Apparently while I was away, the attending unit doctor came and told Bob that Ethan might be moving out of the unit. I also had trouble finding my way back to the room. The person at the desk told me how to get there, but apparently I don't follow directions well or wasn't listening because I almost walked into the wrong room and ended up in the CICU (Cardiac Intensive Care Unit) and as I backtracked, I ran into the NICU (Neonatal Intensive Care Unit). All three units are circular in shape and are all attached to each other to make one big ICU divided into 3 sections.

Before Bob left, we were told that Ethan would indeed be transferred to the surgical unit because the PICU had plenty of rooms but not enough nurses and a couple of kids in other units needed to transfer into the PICU and needed the nurse. Bob left around 9:00pm to go pick up Jonathan from my mom's house.

Ethan did a lot of sleeping sitting up. His poor hand was placed on a board and wrapped in coban tape to secure the IV.

By 10pm, Ethan was moved to the surgical floor on Giraffe 3. The cool thing was that he actually got his own room. This was the first time he got to be in his own room. These are called isolation rooms usually used for kids with something contagious or for the more serious kids like the ones who come from the ICU. I was happy because this was less stress for me and hopefully quieter for Ethan. Whenever we share a room, I always feel bad when Ethan cries, especially in the middle of the night because I don't want him to disturb the other patient. We also wake up when the other kid is crying. When we got to the room, Arnie the charge nurse was there waiting for us as well as our nurse Julie. Arnie spent at least 15 minutes talking to me about the floor, getting to know us, and assuring us that we were being well taken care of. He was a really nice guy and we saw him 2 other nights, one was our last night and he brought Ethan a stuffed Goofy and told us how great it was to see how well Ethan was doing since they hardly get to see a patient from arrival to discharge. We also got to have Julie as our night nurse for Ethan's first 3 nights in the hospital, which was great for consistency reasons and she was really nice too.

Arnie the charge nurse upon arrival in the surgical unit in Giraffe

Julie our night nurse for 3 nights in a row.

That first night was pretty difficult. Ethan did not sleep well. He kept waking up throughout the night looking for me and calling "momma". Of course I had to get up and go be with him until he fell asleep. This continued throughout the night. At one point, I put my arm out and he grabbed it, pulling himself towards me. Then he laid his head on my arm and fell asleep. I actually debated standing there all night for a brief few minutes. I think I finally got about 3.5 to 4 hours of good deep sleep. The nurse also put a red sock over Ethan's IV so it would be less tempting to pull and thought about getting a respiratory therapist to evaluate Ethan, but respiratory team didn't think it was necessary to evaluate him at this point.

-Dina