Ravi and I sat in on morning rounds when they came to Elanor’s room this morning. I had sat in yesterday (while Ravi slept in the parent room) and had found it really interesting and informative.
Basically what happens is that our primary Dr (Dr. Whalen) and a team of 5 or 7 other doctors come to the hallway outside her door. The other people are generally a mixture of fellows (doctors who have completed residency and are training in specialty areas), residents (doctors who have finished med school), and medical students. Picture all of them with laptops on rolling stands. Elanor’s nurse (each patient in the PICU has their own nurse 24/7) also joins the conversation. Then we stand in the circle, but kind of off to the side.
Of the two times I’ve seen rounds, the first time Dr. Whalen came in and did Elanor’s exam during rounds while the others watched and he demoed some stuff. Today he just came in and did his physical of her prior to them all coming around on the rounds.
One of the doctors (I assume a resident or fellow) gives the update on Elanor…all the numbers and stats. Dr. Whalen will ask questions (why do you think that happens, what do you think that symptom means) and then clarify answers or expand on them. While most of the medicalese goes over our heads, we are picking up the relevant terms very quickly. Then Dr. Whalen will go over what they all just said with us (while I assume the others take notes on how to handle anxious parents or something) and answer questions. It’s a reassuring experience and a good way to get the big picture.
Rounds today did not include much in the way of news. When I asked about death rates, we weren’t told that while there are never promises, Dr. Whalen said we should feel comfortable talking about Christmas and First Birthdays and such. Which is great news.
Right now there are two major concerns
1-The infection. She is on 5 antibiotics and they would like to get her off a few. However, the bacteria cultures are still negative, so they still don’t know what it is she has, only that she’s responding to antibiotics. They think she’s stable enough for a spinal tap today, so if that’s true, they can do it and either it is or it isn’t meningitis, which would allow them to discontinue one of the antibiotics (assuming it’s not, which it doesn’t behave like). Infectious diseases is working with Dr. Whalen’s team to try and figure things out. However, the truth is that we may never know what made her so sick. When she first came into the ER, one of the big goals was to get antibiotics into her STAT, so by the time they drew the blood cultures, the antibiotics were already in her system, which makes the test results unreliable (or in her case, non-existant). As they know this, they’re not relying on the tests to show a specific disease. It’s hard because we want to know WHY and HOW our baby got so sick and we may never find out.
2-The bleed. Like we noted, the second CT scan showed no change, which is the best we could hope for. Now we wait for the MRI and hold our breaths. Dr. Whalen has said he’s seen kids with this sort of bleed turn out totally normal…but it’s equally likely that there has been some damage. Some of her prognosis will be determined by today’s MRI, but the rest on some level will just mean charting her milestones and seeing how things go.
There have been other issues along the way, but none of them are pressing or seem like they will be long term issues. Her blood pressure does need some regulation right now, but that seems like it will fix itself. Her kidneys are having a little trouble but again, seem to be returning to normal.
Keep your fingers crossed for us…the MRI is a pretty scary proscpect. We want the information, but at the same time it’s hard not to sit here and worry about what it will show.