The day before they extubated Shepherd, my dad, who is a doctor, wrote out what Shepherd’s body had been through using more medical terminology. It paints a much more detailed picture of what we were facing than I ever could. It was such a comfort to have my dad with us every step of the way. Ironically, Shepherd looks just like him, and they were both born early at 32 weeks. Poppa T was there when Shepherd fell in the pool, once I rushed Shepherd inside, I immediately handed our boy off to my dad for CPR. I knew he would perform it better than I. My dad hardly left our side the entire time we were in the hospital. He was there for every rounding, every question…he was a huge comfort to me. For those interested, here is Dr. T’s (Dad’s) medical version of Shepherd’s drowning:
At approximately 4:15 on Saturday, 21 June, Shepherd James fell into our pool. We will never know why our normally very cautious 3-year-old grandson wandered out of our house and into our back yard. We will also never know how long he was in the pool. We do know that it was long enough that by the time Shepherd made it to the Saint Francis Hospital emergency room, his pH was critically low and lactate level critically high indicating significant anoxia. These laboratory values were so abnormal that the PICU physician counseled our family that Shep had no more than a 20-30% survival chance.
His grandmother was the first to realize that Shepherd was not attended and was the one who found him and dragged him unresponsive out of the pool. CPR was begun immediately by his grandfather. An encouraging sign at the very beginning was a spontaneous cough after filling his lungs with air which removed a significant amount of pool water from his lungs. EMSA was also encouraged to find a pulse and spontaneous respiration when they took over CPR after no more than 5-8 minutes of the 911 call.
Shepherd was transferred by ambulance to Saint Francis Hospital on 100% oxygen. He was in the emergency room for less than 20 minutes before a CT scan was performed (this showed minimal cerebral edema) and he was transferred to the St. Francis Hospital pediatric intensivecare unit (PICU). Within 20 minutes of his transfer, his body was being cooled from the normal body temperature of 37°C down to 33.5°C (92°F). This process, called “therapeutichypothermia” protects the injured central nervous system during the acute phase of recovery. Insulin was also given to encourage release of insulin dependent growth factors which are also neuroprotective. Shepherd was intubated and placed on an oscillating ventilator that moved very small amounts of air in and out of his lungs at a rate of 200 breaths per minute. This expanded his soggy lungs and forced more fluid out thus increasing oxygenation.
It soon became clear that despite all of these maneuvers, Shepherd’s oxygen saturation, which was consistently less than 80%, was insufficient to assure proper healing of the brain. Within or 6 hours of admission a decision would have to be made whether to switch the pumping of Shepherd’s blood to a heart-lung machine (extracorporeal membrane oxygenation (ECMO)) orhoping that the rapid oscillator would do the job. By raising Shepherd’s temperature ever so slightly from 32.5°C to 33.5°C, a profound improvement in oxygenation occurred allowing the doctors to not have to use the more invasive ECMO process. By Sunday morning, Shepherd’s saturation’s were greater than 90% consistently. Signs of severe hypoxemia including shutdown of kidneys, bloody diarrhea, skin necrosis, and brain herniation did not develop. By Tuesday morning, Shepherd’s oxygenation had improved to the point that the doctors felt it was safe to switch him to a regular ventilator which dropped his respiratory rate from 200 down to 35. He tolerated this well for the 1st 24 hours or so.
We then were faced with a 2nd wave of pulmonary insufficiency related to injury to the lung because of the pool water (acute respiratory distress syndrome (ARDS)). Shepherd came perilously close to being forced back on the rapid oscillatorto maintain oxygenation. However, just as dramatically as the 1st wave of pulmonary improvement, he turned a corner and was able to avoid a therapeutic setback. By Friday and then on into Saturday his oxygen saturations continued to improve as the respirator settings were continuously “weaned”. At this point, his gastrointestinal tract ileus resolved and and Shepherd was able to begin progressively increased feedings through a nasogastric tube.
Although there were glimmers of purposeful movement early in the week, Shepherd spent several days in the middle of the week almost entirely motionless with exception of a strong cough when he was suctioned. This changed dramatically on Thursday as the sedation gradually began to have less and less effect on Shepherd. He began to respond more and more dramatically to our verbal stimuli. We were thrilled when he began to squeeze our fingers in response to our requests. A particularly poignant episode occurred Friday night when Erron and Allie were reading Shepherd a story named “How I Became a Pirate”. When Allie asked Shepherd if he wanted to be a pirate he vigorously shook his head back and forth! He nodded up and down when she followed up with “do you want to be a little boy”? On Saturday night he shook his head “no” while his grandpa read him one of his favorite stories (Jack and the beanstalk) when asked if Jack should go into the castle! Another thrilling episode was Allie asking Shep how old he was and seeing him extend his 3rd 4th and 5th fingers just the same way he would have done a week and a half ago.
We look forward to extubation within the next 24 hours and continue to pray for Shep’s healing.