Monday, June 21st was a very eventful day in hospital land...
Niki woke up at about 4am with a full on bloody nose. Her nasal discharge was ever so slightly pink the night before and it turned into a full on bleed by morning. We let Niki's very sweet nurse know about the bleed and she asked us what she should do. And, I thought that was wonderful. Not too many health professionals are keen on relying on good old parental expertise. I'm starting to realize that Pediatric professionals are better at trusting the parent's opinion. After all....we know our children best, don't we? Thankfully, it wasn't a bad bleed and it was a factor day so John and I weren't too worried about it. Niki got her regular factor dose at her scheduled time and all was well with the world again.
A few hours later, Dr. Cool came in to let us know the final results of Niki's x-ray and blood culture.
The good news was that the density in the chest x-ray was deemed to be a non-issue. Dr. Cool highly believed that the Radiologist was just being super cautious with his/her interpretation of the films. And, Niki's lungs were now completely clear (no noise!) so there was no need to explore the lung issue any further.
The bad news was Niki had a very odd bacteria that grew in her culture -- Serratia. This bacteria is not part of the normal flora that you or I have in our bodies. Most central line infections occur when normal flora moves and overpopulates in an area (like near catheter for example) where it wouldn't normally be. Serratia is environmental (a water-borne bacteria) so it was odd that this "bug" grew in my lady.
John and I are absolute freaks about maintaining sterility whenever we access her line. We wash our hands, glove up, and "scrub the hub" religiously every time we access her line. Actually, I felt really guilty when I found out that it wasn't normal flora that caused her infection. I felt like it was something that we did wrong. However, Dr. Cool reassured me that it is impossible to know how the bacteria got there. And she strongly advised John and I to not blame ourselves. All it takes is one single bacterium to start the colony. One single microscopic bug to make the shit hiteth the fan. ;-) . So, it really wasn't our fault.
The good news was Niki was already on a combination of two antibiotics that work to fight Serratia. Dr. Cool took Niki off Vancomycin (which is ineffective on Serratia), but still kept her on Zosyn at 4x a day and Tobramycin at every 24 hours. And she was still going to be attached to her 24 hour IV fluids until she was discharged. Dr. Cool was anticipating that Niki would be discharged by 6/23 as long as Niki's blood cultures from 6/20 and 6/21 remained negative for bacterial growth. (Obviously, Niki's first blood culture on 6/19 was positive otherwise she wouldn't have been admitted in the first place.) So far, her culture from 6/20 was negative. Dr. Cool urged us to consider pushing up Niki's port surgery sooner than later because the internal microscopic structure of the tubing is permanently altered once bacteria colonizes in the line. Thus, Niki would be more prone to infection now that she has had one.
John and I found out the news a little after 9am so I ended up spending the rest of the morning playing "Dr. Google" by researching Serratia online. Thank God the hospital has Wi-Fi! I also called my sister to pick her brain about Serratia and her theory on how Niki got infected. Apparently, Serratia is found in various water sources. So, because Niki is immunocompromised thanks to her Broviac, she is more prone to being sensitive to environmental bacterias like Serratia. Make sense? When my sister worked for a Public Health Lab for the one of the counties here in the Bay, they did tests on local water sources and found Serratia in the filtered water dispensers you see at the supermarket. Serratia can be found in almost every bathroom (no matter how clean it is) and even pump soaps if the spout is contaminated with the bacteria. However, people with normal immune systems tolerate the bacteria without any problems. The more I learned about Serratia, the more my initial guilt dissipated 'cause really --- that shit is everywhere.
It just so happened those opportunistic bastards got lucky and infected my baby's central line.
Monday was a little lonely. John unexpectedly had to go to work so Niki and I spent a lot of time alone. It was nice cuddling in bed with my little lady, but it was also very tough when she got into her "cranky mood". I think the both of us were craving for fresh air since neither one of us set foot out of the Pediatrics wing. After what seemed like ages, John finally came back from work. Niki's Ninang M came by bearing gifts too - delicious adobo burritos from the famous Paplote Mexican Grill in SF. Yes, the Papalote from Bobby Flay's Throwdown! I've been meaning the check that place out. Ningang M is good friends with one of the owners so the burritos were on the house. One of the best gifts you can give a starving pregnant person in the hospital isn't flowers or trinkets from the gift shop -- it's FOOD. :)
More visitors = more playing! :)
Niki was having a blast. Ninang M stayed for a while and Niki's Cousin-Ninang D came by with her boyfriend to visit too. They also came bearing goodies -- Peachie-Os and BBQ chips for yours truly. Niki preferred the burrito and Peachie-os over her hospital food, but that night she FINALLY opted to pig out on yogurt. We had been trying to get her to eat yogurt since she got admitted, but she never showed any interest. I knew that probiotics would work wonders on her diarrhea (a side effect of her antibiotic regimen) so I was happy to see her making a mess of herself. Her diaper area was irritated from the countless bowel movements she had throughout the day. In closing, if you ever have the squirts from antibiotics - get yogurt. ;-)
Niki had another very good night in the hospital after all her guests left. Things were really starting to look up with just a few more days before Niki could go home! And although I was still worried about Niki, I was worried about my boys too. John would go home to see them, but I missed my boys desperately. I hoped that my absence wasn't affecting them in any way.
A mother can only hope that her children will understand.