The night before last I was awaken in the middle of the night by the resident, for a split second I had no idea where I was or who she was. Lucy's oxygen saturations were falling into the 80's and they were asking me if this was normal for her. Normal for Lucy, there is no such thing. Luc was in need of a little more support so we cranked up her O2 and watched as the monitor brought her numbers back up to 100 percent, but not before first repositioning her nasal cannula. It's always good to check to make sure that it is on. It would have saved the mama, the nurse, and the resident from having a mini heart attract as we continued to crank her up O2 up to five liters with no rebound in her numbers. Once her cannula was positioned correctly we set her O2 at 2.5 liters, watched her numbers climb back up into the nineties, and all took a deep breath ourselves. Her breathing is more shallow than usual, increasing the O2 has helped to increase her respirations as well.
Our palliative care team stopped by to see us yesterday. We are taking things one day at a time, but we talked about switching Lucy over to a fentanyl patch sometime in the very near future . There is a very real concern that Lucy could develop hyperalgesia, a condition in which her body would respond with increased pain as a result of a paradoxical reaction to opiate pain meds. Apparently this is what happen to Lucy when we tried to sedate her with Ketamine in the spring of 2011, as we increased the dose of ketamine her pain continued to worsen. In Dr. R's words, "this is a very real reality and would be horrific if it happened". I am processing all of this, it is not easy, but comfort is our ultimate goal for our girl and we will do what we need to do to keep her comfortable. I was told that hyperalgesia is not a concern with fentanyl.
The plan for the weekend is to keep her stable until Monday when our main doc is back, I can't wait to pick his brain about a few things. Cultures are still negative, and her labs are not very telling. Clinically she looks awful, but if you asked Lucy she would say she is good, she is always good and never tired for those who ever ask her :).
Our little fighter, she tried to smile, and then immediately feel back asleep.
Thank you for your continued thoughts and prayers, love and support.