Day 39 Spinal Surgery: Complications

November 2, 2008

 

We’ve been on a roller coaster ride for days as we work hard to stabilize Katie in the ICU. On October 11, Katie was discharged from the children’s hospital and we thought that she was well on her way to recovery. However, eight days later, we found ourselves back in the ICU and praying like hell the problem was not her back – that Katie’s fever and reduced urine output was due to a bladder infection. Unfortunately, this was not the case. I was told Katie was in septic shock and that this was more than a bladder infection.

 

In the ED, it was discovered that the Band-Aid over the chest tube exit wound from her first surgery had pus on it. It was a small amount and no one seemed initially concerned this was the source of any problem or infection. The incision on her back looked clean and was healing nicely with no signs of infection. However, after a few days in ICU and no identified source of infection, the surgeon reluctantly sampled a small pocket of fluid near the incision site. I was told it was normal and, at first glance, it did look sterile to the naked eye. However, a day later, the results came back positive for a staph infection and possible meningitis resulting from the surgery. (Note: the meningitis is unconfirmed, as the surgeon did not do a spinal tap. During the wound debriding they found pus on the Baclofen pump catheter which was attached to the spinal cord. It’s assumed her spinal fluid was compromised.)  

 

She therefore had to be taken back to the operating room to have her spinal incision opened up to clean out the infection – not a good thing. When Katie returned from the operating room, she was attached to a device called a “wound vac”. This is a machine that pulls accumulating fluid/blood/pus from the open incision via two plastic tubes that are inserted through sponge like material packed into the wound and covered with a clear plastic film

 

Katie’s surgeon indicated that this infection was a deep one and she returned to the operating room three more times to have her wound washed and cleaned with a special antibiotic solution. I now wondered if the source of the infection came from the first surgery in which 4 discs were removed via her chest cavity.

 

After this, the “wound vac” sponge/dressing changes were done in Katie’s bed after pain mediation was administered. The first time I saw the bandage change at her bedside, I was overwhelmed and slowly knelt to the floor to quietly whisper to Katie that she was O.K. I wasn’t O.K. – but Katie was going to be. I knew it was going to be hard to watch but I also knew that I had to be trained to change this bandage when we got home. However, when I saw how deep her wound was and realized that I could actually see to her spine, I didn’t know if I could do this.

 

When I was 18, I took an EMT class that required me to work 48 hours in an LA hospital Emergency Department – it didn’t go well. At 18, I wasn’t prepared to see the things I did and I felt totally incompetent. Thank goodness that my job at our local ambulance company was a dispatcher in the office and I was not required to go out on calls. Twenty seven years later, I faced the same feelings of incompetence.

As a teenager, I knew that being a first responder was not a game or a way to feel important. This was serious business and I was afraid of making a mistake that would either hurt or even kill someone. Now, I look at my daughter and realize that there is no one else but me to do this because my home-care nurse is not allowed to change the bandage because she is not “certified” as a wound nurse.

 

Katie did quickly respond to the antibiotics and, once the point is reached where her blood pressure and fever are stabilized, we will be able to go home to continue her recovery. Of course, all of this is contingent on my learning how to care for a deep wound and administer IV antibiotics at home. I’m scared to be given so much responsibility – one mistake and I could jeopardize my daughter’s life.

 

I expressed my fears to Katie’s Pediatrician and to her orthopedic surgeon. They assured me that I’m not doing this alone, that I will have help and not to be afraid. The surgeon explained that it is overwhelming to see such a deep wound but, over time, I will get used to it and soon be moving the nurses out of the way to change the bandage myself. However, after the Pediatrician observed a dressing change, she realized that this would be too much for me. She therefore ordered a “certified wound nurse” to come to the house three days a week to change Katie’s bandage. She also ordered two of her office nurses to personally observe the changes as, in the event that the wound nurse would ever have to cancel, they will be my back up.  

 

At this point, there is nothing to do but roll up my sleeves and do what needs to be done.

 

Katie was discharged from the hospital on November 8, 2008