Wednesday, January 21

Today was a very eventful day in terms of communication regarding Caden. We got to the hospital a little before noon and upon arriving, one of the cardiac surgeon fellows came by and said they were going to talk to pediatric surgery regarding how to do Caden's surgery. Shortly after that, the neonatal nurse practitioner came by and started giving us an update regarding conversations between neonatology and cardiac surgery. At that point, she said it sounded like cardiac surgery and pediatric surgery were going to coordinate to do the surgery together, but the timing would be driven based on Dr. Reddy and availability of a bed in cardiovascular ICU (CVICU).

The neonatology attending and our social worker came in and joined in the conversation as well. The neonatologist said he had talked with pediatric surgery and they were planning on joining in the surgery after Dr. Reddy had finished with the coarc repair. They would take over and repair the diaphragm and close up. It was nice to know there was finally some communication going on, but it still sounded like Dr. Reddy hadn't made a final determination.

In the meantime, our nurse had told us they needed to take out Caden's central line from his belly button because it wasn't going to last much longer. And, they were going to put a PIC line in to take it's place. She said we would need to sign a consent in order for them to do the procedure. The transport nurse assigned to do the PIC line came by and explained everything to us and we signed the consent. We didn't want to see her put it in, so we decided to go back to RMH to eat. No sooner had we gotten back there and were eating, than Caden's nurse called me and said that Dr. Reddy was coming to NICU to talk to us about Caden's surgery. This was a pleasant surprise since we had been wanting to speak with Dr. Reddy, but had given up on the idea because it did not appear to be a possibility. We did not waste any time heading back to the hospital.

We ended up being there almost an hour waiting for Dr. Reddy to show up, but at least we were there when he arrived. He said it was up to us whether we wanted the surgeries done separately or together. He said if they were done separately, that pediatric surgery would need to repair the diaphragm first because they would need to relieve the pressure on the right lung. Then, Caden would spend a few days recovering from that surgery before Dr. Reddy would go in from the left side and repair the coarc. He said he wouldn't do the coarc before the diaphragm if the surgeries were done separately because in order to go in from the left side, they have to partially collapse the left lung. And, if the right lung was already compromised, they wouldn't want to compromise the left lung at the same time.

He also said if he went in through the chest and did the coarc from there, he could very easily take care of the diaphragm at the same time. He said he would be willing to talk to pediatric surgery to see if they wanted to scrub in and participate, but he wouldn't leave Caden in the middle of the operation. He said he would remain through the whole thing and would be the one to open and close. But, he said he had not personally spoken with anyone from pediatric surgery, so the cardiac surgeon fellow that was with him, paged peds surgery and they called him right back. So, while we waited, Dr. Reddy talked with one of the peds surgeons and they agreed that Dr. Reddy would do the surgery by going in from the front and would repair the coarc first. Then, someone from peds surgery would come in and they would work together to repair the diaphragm. Then, Dr. Reddy would complete the surgery and close Caden up. One of the main things Dr. Reddy was concerned about with simply handing Caden over to peds sugery in the middle of the operation is that they are not used to doing surgery from the midline and cardiac surgery is used to doing repairs from that vantage point. This is the approach we are most comfortable with so we are glad to have had the conversation. Caden will only have one surgery and Dr. Reddy will remain through the whole thing. But in order to ensure the diaphragm is repaired well, peds surgery would scrub in and assist in that piece.

Once we had sorted out the surgical plan, we discussed the dilemma of timing. Dr. Reddy said that Caden is scheduled for surgery on Friday morning at 7:30 am. He is the first patient on their schedule that day. Dr. Reddy reminded us that there is always the potential for that to change if another patient who is worse off needs surgery, but for now, this is where we're at.

As Greg was leaving the hospital after our conversation with Dr. Reddy, he ran into the neonatology attending doctor and told him about what Dr. Reddy had said. The neonatologist expressed some concern about the arrangement, but he said he was going to close the loop and contact peds surgery and see what they told him. He wanted to make sure everyone involved was okay with the arrangement before we proceed. We are okay with that because we want what is done to be in the best interest of Caden. So, hopefully he will get back to us today with what he finds out.

I can't express how relieved I am that we now have a direction. I feel like my stress level has decreased immensely today simply because there is a plan in place. Even if Caden's surgery gets bumped for another baby who is more critical, I at least know there is a plan and that he's not being ignored. We just want to make forward progress. So, I don't know if we'll get any more news in the next day that is different than what we were told today, but if so, we'll keep you all posted.

In the meantime, we would appreciate your prayers specifically for Caden's surgeons and that everything will go smoothly in the operating room. And, prayers for us as we wait for him to come out and start his recovery. That will have it's own set of stresses, but we are really happy to be moving forward. It means we'll be one step closer to bringing our baby home! We appreciate all those who have been praying in earnest and we are reminded that when we work we work, but when we pray God works!