No cath, for now

It's hard to give an update because we're still very much in the dark. Here's what we know. After a fretful 2 hours of waiting while we were kicked out of the ICU for another procedure, the tests are in. That oh-so-important BUN test that everyone was waiting on came back and there was no change. Bad news right? But the doctors said "oh, we don't care so much about that, everything else still looks good." Apparently because the BUN and creatinine levels did not get worse we're not heading to the cath lab at this point. Aarghh. They're going to reduce his volume intake again (to 25% of Tenkoff output) and wait and see how he handles that. His Tenkoff drainage has also declined over the past three hours. If his blood pressure stays constant amidst the lower volume, that's a positive sign.

It's been a frustrating day for all of us psychologically. One doctor will tell us something is a sign of things going downhill and another will come along five minutes later to say he doesn't care about it. The holy trinity of caretakers - the intensivists, the CT surgeons and the cardiologists - rarely agree and frequently contradict one another. If one thing's clear, it's that nobody really knows what will happen and nobody can make a prediction. If Riley doesn't continue to show signs of improvement we're heading to the OR for either a fenestration or a complete takedown. And there's another point of disagreement. The cardiologists (including Riley's regular cardiologist) and the intensivists keep mentioning fenestration as a possible option should things go south. That's obviously preferable to a takedown. But the surgeon continues to maintain that fenestration is not an option for Riley due to his anatomy. We asked for clarification and they paged Dr. Karl who was on his way somewhere and promised to explain it to us tomorrow. We'll try to get it sorted out.

To summarize where things stand: they are keeping a close eye on Riley's oxygen saturation, blood pressure, fluid output, kidney/liver functions and rhythms. We want to see continued improvement across the board. If any of these metrics take a turn for the worse, it's probable that Riley will return to surgery for either a complete Fontan takedown or a fenestration (although the latter might not be an option as I've explained).

Riley is in and out of consciousness and not being sedated at this time. He has opened his eyes on occasion and is moving his arms and legs. They have removed one of his arterial lines and are about to change out the second to accommodate a larger input. The ICU attending is hoping to remove the respirator tomorrow.

We're still trying to take it hour-by-hour and day-by-day.