Boston Day 9 continued (spoke too soon)

So we've been watching Nate's ICP (intracranial pressure) all evening, and it's not alarming, but it's not great either. Then all of a sudden it starts spiking into the 30s. I figure there's something wrong with the monitor, but I go over and look, and I see that Nate's hair is wet next to his drain. Crud. Called the nurse to tell them his EVD is leaking spinal fluid. She comes rushing in, and if I didn't already know this was a very big deal, her reaction would have clued me in. You see, if spinal fluid is leaking out, that means that infection can get in, and a brain infection is a very, very big deal.

So the resident neuro came in to take a look, and he called Dr. Warf. They decided to put a couple of stitches around the EVD to seal it up better, and they opened the EVD, which had just been clamped this morning. The plan was to take Nate to the procedure room on the floor here. At first I was thinking that is just a bit more sterile place to do procedures, but now I'm thinking that's where they take the kids who are going to scream really good and loud so it scares the other children less.

They wanted to give him adivan (to chill him out) and morphine (to knock him out), but lucky us, his IV had gone bad. Nate is very hard to get an IV in, so our nurse called the best nurse on the floor to check him out, and after checking him out, she called IV therapy. After a few minutes, they got the IV in, with much screaming from poor Nate. They gave him all the meds, and the nurse was shocked he didn't go to sleep. Took him to the procedure room (remember, he has to be laying flat this whole time), and he started flipping out before the doctor even touched him because the nurse was holding his head tightly, and another nurse and I were holding his hands down. Then when the stitches started ... well, I'd rather not ever think about that again.

We got Nate back to his bed, and he was itching big time because of the morphine. So here he is, wiggling around his bed trying to scratch his back. The same back that has a healing incision down the middle of it, and in his itching he is rubbing all of the dermabond off. I tried my best to stop him any way I could, mostly by rubbing his back for him. The doctor gave him some benedryl through the IV for the itching, and would you believe after adivan, morphine, and benedryl, this kid is STILL not asleep. One thing I learned is that, yes, Nate really does react to morphine. After two of his last 3 surgeries, he's had morphine for pain, and he's been itchy, but I have attributed it to the anesthesia. But this time it was very clear what caused all the itching. And this time, he was seeing hallucinations! He has been grabbing at things in the air and pointing to invisible floating things that disappear. He also sees animals and a flying racecar!

So, what does this mean. I guess it means he wasn't ready for the EVD to be clamped today. I think the idea is that as he had CSF draining so much for several days, his body started making more to compensate. Then they raised the drain a couple times, and the body tried to adjust by making a little less fluid each time. But maybe it needs more time. I'm going to ask in the morning if it would help to raise the drain a little more before we clamp it again.

I guess the bright side is it didn't leak out of the back. But tonight was no fun.