I wrote this a couple of days ago, and just kept it in drafts.
OK, if you actually read this blog, you might want to know what happened. And wonder why I'm writing about chairs and IV's, but not about what got us here. I woke up wondering that myself, this morning. I just couldn't "go there," again.
And I still can't. But I will just say that I think what happened to Mallorie on Saturday (a week ago) was probably a laryngospasm. Probably nothing to do with whatever "else" she might have.
Years and years ago, I worked for an awesome oral surgeon, who made me laugh continuously, and filled me with information. Several times we discussed laryngospasms, and what to do if someone had one while he was performing surgery on them. He told me that almost anything getting into the larynx - even saliva, blood, anything - can trigger a spasm in the larynx which can completely block the airway. It's thought to be a self-protective mechanism on the part of the body, to prevent something from entering the lungs. You can read about it here or here. The laryngospasms he was talking about were anesthesia-related, but the mechanism would be the same. Once it happens, he told me, there's not a lot to do except try to get air in; I believe he told me that high-flow oxygen bagged into the airway can sometimes break the spasm. Otherwise, he said we'd use a paralytic drug to break the spasm, and he stressed the absolute need to continue breathing for the patient if we gave such a med. I only saw it happen only once, and bagging with 100% oxygen broke it almost instantly. A very dramatic day, and an easy lesson to remember.
Mallorie had finished a feeding, and for about a half-hour had been sitting on my lap in bed, playing and smiling, when she suddenly began vomiting. Gagging/vomiting is something we're really used to, but it hasn't been much of a problem for a few months. In fact, while she was hospitalized in early December, we went ahead an did another trial of Prevacid (vs Zantac), and were pleased to noticed that Mallorie stopped even the occasional gagging.
The girls had just left to drop their dad off at work, but the boys were with me. Matthew was right in the bedroom, and when we realized it was going to be a "big" vomit, went to get the suction machine, while I put Mallorie on my shoulder to help her clear her airway. By the time we got the suction machine going, I realized that she wasn't breathing at all, and was blue. When I suctioned her a bit, and it became apparent she wasn't taking even a breath, I began mouth-to-mouth. I realized right away that no matter how I positioned her head, no air at all was going in. I've had to do mouth-to-mouth on her before .... almost 2 yrs ago, when she was first home from the NICU and we hadn't yet realized that her caffeine level was low. I knew how to do it, and except for the emotions that such an activity bring up, it's fairly easy to do. I repositioned her several times, and kept trying, but nothing, and she was completely limp. And deep blue. And staring blankly.
It crossed my mind that I had lost her, and that there was nothing else I could do, if I couldn't breathe for her. I had some crazy thoughts running through my head at the time. I was praying loud, and Matthew called 911. My 11 yr old son is a rock.
Eventually, Matthew found the ambu bag, and I started using that, with the same result: no air going in. I decided not to take the time to check for circulation, but just reasoned that if her oxygen level was low enough to make her blue, and no more air was getting in, then her heartrate was going to be dropping, too. A's and B's, as they said in the NICU. Apnea and bradycardia. So I did some random compressions, but mostly fixated on the task of bagging her, hoping something would get into her lungs. I carried her to the front of the house, in search of oxygen. We use oxygen all the time with her, and have oxygen tanks and a concentrator. In the stress of the moment, I couldn't find anything, ambu bag, oxygen tank, tubing, anything. I just put her on her sister's bed and continued mouth to mouth.
Matthew had already called 911, and I assume was still on the phone with them as he got me the ambu bag. He was a rock. Not the first time I've thought that when the rare emergency occurs, it's too hard to be alone. I was so grateful for just his presence, as well as his level head. I'm sure my communications with him were cries, begging him to find the ambu bag and oxygen, and a constant string of prayers to God. He'd tell me things the person on the phone was saying, like to turn her on her side because of the vomiting, and I think I told him she was crazy, that I needed to bag her and do compressions. She's not BREATHING! He just repeated to her whatever he thought she needed to hear, and listened to her. And he got me an oxygen tank, and tubing. Which I couldn't even figure out how to connect to the ambu bag, so he held the tubing near her face.
Before the emergency responders arrived, I had noticed a couple of times when Mallorie exhaled against the air I was trying to squeeze in, telling me something must have gotten in. And once she even took what looked like a spontaneous breath in, but nothing after that, so I continued bagging her, and doing random compressions. Forget the 1:15 or whatever the heck the current ratio is for CPR (Yeah, I have already forgotten it, 'cause I think it's 1:5 or something else.)... I just bagged till I thought I ought to get a couple compressions in, worried not at all about the "proper" placement of my hand or fingers or whatever else I was using for compressions, and then got back to breathing for her.
How long did this all take? I have no idea. I never was conscious of a moment when Mallorie stopped being blue, or limp. But I suppose she did, because I don't have a memory of her looking terribly blue when the EMT's got there. But I am not sure.
Fast forward ... trying to convince the the EMT to take the ambu bag with him and to keep bagging her as he carried her out of the house. Feeling so helpless to convince him even to pretend to hear me. Then convincing the fireman to follow him with the ambu bag, since the EMT said he had whatever he needed in "the rig," and carried her outside without breathing for her. Begging the fireman to make the EMT keep breathing for her as he did whatever else he was going to do for her. Because she's not breathing on her own. (Why didn't he seem to think that was as important as I did?)
Looking for pants to put on, as I wasn't fully dressed. Asking my daughter to ride to the ER in the ambulance, and I'd follow with the other kids, thinking I needed to shower. Trying to figure out if I really should shower and change; I had vomit and poop all over the front of my shirt. Deciding not to take the time. Trying to decide what to pack. Meds? Her pulse ox, which had been left behind? A blanket? Diapers? Ultimately, walking out of the house empty-handed, except for an unstocked diaper bag, covered in vomit and poop, and without my purse. Hair wild. And able to ride in the ambulance.
OK, so that's the part I felt I couldn't share. The actual experience probably was 5 or 10 minutes until the EMS arrived, and maybe 15-20 minutes before they had her intubated, with an IV, and headed to the ER.
It felt like hours. And I must have aged a dozen years.
This Try-somy Girl
6 days ago