Over the last couple of days, the PCICU team has worked to determine the cause of Becky’s rapid breathing and continued poor x-rays. They have made their diagnosis and a game plan.
Becky will have a second open heart surgery on Friday.
After admission to the PCICU, Sunday was a quiet day. We were in a holding pattern, waiting for the ENT and echo teams on Monday. With Becky back in the hospital, we rearranged Josephine’s birthday celebration. Sam brought the kids down and we celebrated at a local Italian restaurant. I was excited to see everyone and relished the opportunity to be together. Johnny was inappropriately dressed in shorts and a t-shirt, refusing to accept that Punxsutawney Phil had predicted six more weeks of winter. Luckily, Michael had an extra sweatshirt to drape over his frigid body. Veronica argued that this was a great time to buy a puppy and Josephine asked if she could get her ears double pierced. What’s that line about never letting a crisis go to waste?
Monday was a whirlwind day. Since the daily census announced Becky’s return, many staff members visited to admire the pudgy rolls now cascading down her arms and legs. Becky especially responded to Nurse Kathleen, the super hero who accompanied Becky to surgery and took meticulous care of her during those first post-op hours. Nurse Kathleen also brought Becky lots of headbands. As Becky held court in the PCICU, I tried to understand her worsening medical condition.
Becky had several tests done throughout the day. For the upper GI series, she enjoyed yet another wagon ride through the hospital. The results of this test were encouraging, showing no significant reflux issues and revealing nothing anatomically problematic. Finally, something works properly on her body.
Shortly after Becky returned from this test, Dr. R., her cardiologist, walked into the room. He had just finished reading Becky’s latest echo. He didn’t sugar coat things. There are significant concerns regarding the leakiness of her tricuspid valve as well as a residual VSD. He doesn’t think there is anything more to be gained from medical treatment. Bottom line: it’s time for another surgical intervention.
Becky’s first operation was to repair an ASD and a VSD. The operation was significantly more complex than the surgeons expected. She recovered well and the Pulmonary Hypertension Team worked to control high pulmonary pressures with medications. During one echo, a residual VSD (small hole) was observed. However, the PCICU team felt this area was located between two sutures and would not cause problems. Unfortunately, that’s not the case.
Blood is now flowing from the left ventricle into both the right ventricle and the right atrium. Blood should flow one-way through the heart but Becky’s heart has essentially sprung a leak. Becky’s high pulmonary pressures acted as a barrier to this shunting for a time. But now that her pressures are down, and since liquid travels the path of least resistance, blood is rushing through this hole. There is a second issue with the tricuspid valve. While it is difficult to see exactly what is going on here, the valve is not closing properly. Once the VSD is closed, the surgeons will better determine the situation with the valve.
Those are the two goals of her surgery: close the residual VSD and fix the tricuspid valve. So six weeks after her first cardiac surgery, Becky will return for a second major operation. And she was just beginning to enjoy some new bunny-themed clothing at home.
Dr. V is currently operating in Rome but was immediately contacted regarding Becky’s situation. While serious it’s not an emergency, so they’ll wait for Dr. V’s scheduled return on Thursday. Here’s hoping for safe travels, an on-time arrival, and limited jet lag. Dr. V and Dr. E will operate together on Friday morning. This operation is essentially an adjustment to the previous operation. It should take 3-4 hours, with 1-2 hours on by-pass. Dr. R is hopeful that the pulmonary hypertension will resolve itself quickly after the operation. Becky’s x-rays will most likely clear up once there isn’t as much overload on the right side of her heart.
We will go back to square 1 in terms of her recovery. But at least I know that square well. Despite the bad news, I appreciate the team’s confidence in the diagnosis. Dr. R is known as the echo guru and his expertise contributed to the avoidance of a cardiac catheterization. Obviously we’re disappointed in the news but grateful that Becky has access to such fantastic medical care.
All of this developed on Monday afternoon. After the revolving door at Grand Central Becky, I realized it was 5:00pm and I hadn’t eaten lunch. The heavy news had been delivered and I began processing what the next days and weeks might contain. It was a bit overwhelming and I needed a break. So I did what any normal person would do under similar circumstances.
I went to Target.
As I walked around the store, I talked with my sister. At one point, I stopped my squeaky red shopping cart in the middle of the shoe aisle and asked Karen why I was there. I literally could not remember my shopping list. But I knew I needed something. She told me to go buy coffee pods, tea bags, Greek yogurt, and some waterproof mascara. Good thing I had mentioned these items earlier in the conversation.
Nothing much will happen the rest of the week. Becky is resting and continues to receive supportive oxygen therapies. She’s a happy baby, generous with her babble talk and smiles. Karen arrives tomorrow night with Greta and Angela. She will be with me in the PCICU during Becky’s surgery. The Ronald McDonald House has re-opened to the siblings of patients. I look forward to seeing the girls and having at least a few days with them. Josephine will join me some days and commute to school in the city from here.
Yesterday, Fr. Casimir came and administered the Anointing of the Sick to Becky. The PCICU chaplain made the arrangements quickly. Mom and Dad Rauch, Sam, Michael, and Josephine prayed with us over the phone as the chaplain stood nearby. She bowed her head and respectfully watched as we prayed together in our tradition. I was grateful for her presence.
During this simple but beautiful sacrament, Fr. Casimir anointed Becky’s head and her hands. I love the prayer that he said: “And now we pray that God will do what God does, and extend His healing hand over Becky.” What a lovely image. We prayed the Our Father and the Hail Mary. I received the Eucharist and he left, assuring me of his prayers for a successful operation. Becky immediately responded by licking the oil off her hand.
Hopefully that blessing travels down to her heart.