Month: August 2016

CaringBridge journal entry by Tonya Katcher – 8/7/2016

Hi everyone,

This is Tonya writing – I’m Stephanie’s niece and a pediatrician who trained in this very hospital not too many years ago. I’m so glad to be here with all of the family, surrounding Nancy and Steph in a web of love and support. Thank you to all who have commented so far.

I’m going to give a little more medical overview of what we know so far, hopefully translated into plain English (which docs are notoriously bad at doing!)

Nancy had a cardiac arrest on Friday morning, which means her heart stopped effectively pumping blood to her body. It seems that she had an arrhythmia called ventricular fibulation, or V-Fib for short. At this point we don’t know what caused this event to happen – most of the time it’s due to a blockage of the blood vessels that feed the heart muscle (aka a heart attack or myocardial infarction) but Nancy does not have any of this blockage, so that’s not the cause in this case. We’re going to investigate further as time goes on, but need to help Nancy get through the aftereffects of this event first. Luckily, Stephanie was with her, and called 911 right away, and started CPR right away – all of which are needed for good outcomes after an event like this. She had a second brief episode of V-Fib in the ICU and was resuscitated again on Friday afternoon with Steph and Dre and Cynthia bearing witness. At that point it looked like she might need to go on cardiac bypass to take over for her heart for a while, but her heart stabilized and that wasn’t necessary. She did have a balloon pump placed in her heart to support its pumping, and that has been in since Friday afternoon.

Things quieted down Friday afternoon and evening, once the pump was in, and all of the things supporting Nancy’s body were in place. She was awake some then as they worked to find a recipe for sedation that would keep her comfortably asleep. She’s been mostly sleeping since then, though opening her eyes at times and responding to directions from the nurses (like squeezing hands, coughing, etc). She’s had amazing, attentive, loving nursing care, and has been surrounded by family and support.

Nancy has needed a lot of support – to support her heart’s pumping, to keep her blood pressure up, the ventilator to breathe for her, oxygen to ease the work on her heart and brain. However, her body has been giving steady signals all along that it’s ready to do all of the things bodies do all on her own, so the process now is one of gradually reducing the supports and letting her body take over.

• Her heart function is normal, meaning it’s beating with a normal rhythm and is effectively pumping blood throughout her body. The doctors have turned off the balloon pump for brief episodes as a test and her rhythm and blood pressure were steady. They’re planning to take the pump out this morning, which is a bedside procedure. They’re also going to take the big fancy IV’s out of her groin/femoral arteries now, once they get another fancy IV placed in her wrist (that they’re using to monitor her blood pressure).
• She is on a ventilator to help her breathe, but the nurses are steadily turning down the amount of support she’s getting from the vent, and she’s tolerating that just fine. They’ve also been able to turn down the oxygen. All of which means her lungs are functioning well. She has had a fever off and on, and think she may have a little pneumonia – but she is on strong antibiotics and her lungs are not showing signs of distress, so I think this is not a big worry right now.
• She has been on medications to keep her blood pressure up, as it was too low right after the cardiac events on Friday. These “drips” have been regularly turned down, and now she’s getting minimal support – also a good sign that her heart and her vascular system is working properly.
• It took a while to find a good level of sedation to keep Nancy comfortable, but she’s been sleeping comfortably since Friday evening. All of the indicators of her neurologic function have been reassuring. She has been on a continuous EEG brain monitor, and hasn’t had any seizures. The doctor expects that she may have a little bit of injury to her brain due to the periods of cardiac arrest (when the brain isn’t getting as much blood flow as it really needs) but he expects that she will recover. She may have some short-term memory problems or coordination problems initially, but this will likely improve with time.

All in all, despite a terrifying acute cardiac event, all signs are pointing us to be hopeful. The doctors have been really clear that there is still possibility of setbacks and complications, and that this is going to be more of a marathon than a sprint. The immediate next steps are to take out the heart pump and the big IVs in her groin (after which she needs to rest for 6 hours before taking next steps). Then we hope to turn down the sedation so she can wake up a bit and get the breathing tube out. The doc thinks the breathing tube MAY come out tonight, or more likely tomorrow morning. Once those two things are out, the team wants to get an MRI of Nancy’s heart, and possibly a biopsy of her heart tissue, to further investigate the underlying cause of the initial event.

But that’s a day or a few days down the road at least. At the moment, we remain here at Nancy’s side, holding her in love and light. We are grateful for the skilled and kind care we have received, and for Nancy’s strong and beautiful spirit. We are celebrating the many small blessings and victories that have happened so far, and the many ways that Nancy’s body is responding and healing already.

Thank you for following along, for praying and sending woo, for reaching out and holding Nancy and Steph in your hearts. Many people have asked how they can help – we will definitely send out a call if we ned some material support (food, rides, etc). I will update again as I have more information, and am happy to respond to questions if folks want to post them in comments.

Much love,
Tonya

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