I woke up in the afternoon having slept poorly after the bad dream. Schlepping my way into the kitchen, I made a cup of tea.
Simon dropped Maddie off from school, and then went back to coach practice. I helped Maddie with her homework while starting dinner.
During dinner Maddie chatted animatedly about what her friends at school are up to. Simon tells us about a new project he’s introduced to his students. He notices my distraction and asks, “Is everything okay, Nik?”
“Oh, yeah, I’m fine. I just didn’t sleep well today.”
Simon gives me a curious look, but makes no comment.
I kiss them good-bye before leaving for work.
Corey brings a ventilated baby with pneumonia to the PICU at change of shift. He turns his head away, but not before giving me a look so sharp I catch my breath.
Pointedly, Corey gives the report to Kathy. As he leaves the unit, he looks at me again. Silently, I mouth the words, “Can we talk?” but he puts his head down, rapidly disappearing down the corridor outside the PICU.
Kris is finishing her day shift charting at the nurses’ desk. I suddenly realize she’s seen all of this.
“Everything okay, Niki?”
“I’ve never seen Corey transfer a patient so fast when you’re here, that’s all.”
“Mind your own business, Kris.”
She raises an eyebrow at me, and returns to her charting.
Later in the shift, the pulse ox alarm in Kathy’s patient’s room sounds, and she gets up to check on it. Poking her head out the room’s door, she says, “Niki I need to suction him. Would you help?”
At the crib, I manage the ambu bag; manually giving the baby breaths of oxygen while Kathy suctions its breathing tube to remove secretions. Nothing comes up, so she places a few drops of normal saline down the tube before making another pass. A bit of yellow-green mucous comes up. She replaces the ventilator tubing, and silences the pulse ox alarm again when it continues to read 90%.
“That’s funny. His oxygen saturation should improve after suctioning,” she observes out loud.
“Maybe he’s due for a respiratory treatment,” I offer. “I’ll page Gerald.”
Gerald administers an aerosolized medication into the ventilator tubing, and then gently taps on the baby’s chest and back with a soft rubber percussor. Kathy suctions again, while Gerald bags. Still, no significant secretions. The baby’s oxygen saturation drops to 85%.
I listen to his chest with my stethoscope. There’s breath sounds on both sides. However, the little guy begins pulling hard with every breath. We watch as the tiny muscles between his ribs pull in with the work of breathing.
“He’s getting worse.”
Gerald takes him off of the ventilator, and starts hand bagging again. I suction without secretions, while Kathy pages Dr. Polk.
“He’s down in the ER, assisting with a pediatric trauma. He said to keep bagging. He’ll be up as soon as he can.”
“I’m not sure we can wait that long,” I said. Not only were the sats less than 80%, but now the baby’s heart rate was dropping.
“What’s wrong?” Kathy called out.
Insight flashed before me, “His breathing tube is blocked.”
“Are you sure? asked Kathy. “How do you know?”
“It has to be. His chest sounds are good. He’s moving air, but he’s not getting oxygen from either the vent or the bag. We’ve got to pull the tube out now!”
“Dr. Polk said to continue bagging until he arrives,” warns Kathy.
“The baby is going to code if we don’t pull the tube now,” I insisted.
“Yeah, and who’s going to take responsibility for that, Niki?” Gerald cautioned.
“I will,” I said. “I’m pulling the ET tube.”
I removed the tape from the baby’s face, allowing the tube to slide out easily. At its end was a glob of thick, white secretions half the diameter of a ping-pong ball. It resembled a wad of chewed up bubble gum. I laid the mucous-blocked tube on a paper towel, and placed it on the bedside table. The baby started to cry.
“Well lookee there,” said Gerald. Immediately the oxygenation returned to 100%, and his heart rate returned to normal.
The three of us remained at the baby’s crib, watching him breathe; Gerald helping him out with occasional bagged breaths until Dr. Polk arrived.
Flying into the room, Dr. Polk saw Gerald bagging his extubated patient.
“Who pulled out the goddamn ET tube?” he roared.
“I did, Dr. Polk.” I held up the gelatinous ET tube for him to see.
“Good job,” he said. “Everything looks okay.”