Sunnier outlook

Today was a good day. Riley was extubated and is drinking juice, an arterial line came out and several medications were stopped (including dopamine). He is clearly doing better. His blood and common atrial pressures are normal. His BUN and creatinine levels have dropped. Tenkoff and chest tube drainage has slowed considerably. They were going to remove his chest tubes this afternoon but decided to wait until tomorrow since there was a bit of drainage from one (no point removing two today and sedating him again tomorrow to remove the other). What a difference a day makes.

Riley's doctors also gave us some much better news. Riley's cardiologist and the intensivist/cardiologist both feel he is making great improvements and surgery isn't going to be necessary. But we couldn't feel relief until we'd spoken to Riley's surgeon. He was in the OR all day and finally came by at 5:30pm. He said Riley is doing great and he doesn't think any surgery will be necessary. When asked if fenestration would or would not be an option with Riley's anatomy he basically said "it doesn't matter, he won't need it."

So what caused the Fontan to fail in those first harried 24 hours? The vote is 2-to-1 for arrhythmia. The surgeon and intensivist are pretty convinced. Dr. Karl, the surgeon, said "there is no doubt." The arrhythmia is common with asplenic patients and it was enough to push him over in the critical post-operative period. But what if it happens again? It shouldn't be a big problem in the real world. Arrhythmia can be managed with medication and won't have such dramatic effects when Riley is healthier. I liken it to pneumonia in a 20-year-old healthy person versus an 80-year old lung cancer patient. Riley will have follow-up EKGs shortly after we leave the hospital to monitor the condition, and we won't be allowed to leave until he's stable. We'll see the cardiologist regularly but at some point, he will only want to see Riley once a year (!).

What about that one vote against arrhythmia? That was from Riley's cardiologist who believes we won't ever really know what caused the meltdown on Friday. He saw some evidence on Friday that it wasn't arrhythmia but I didn't catch the technical description he gave to the other doctors. In any case, he thinks we're on the path to recovery and should be home from the hospital in another 2-3 weeks (fingers crossed). Riley's drainage will continue for at least another week.

It's hard to relax and feel like we're out of the woods, we certainly aren't. All of the regular surgical risks still apply - infection (especially for asplenic patients), drainage problems, chylothorax, clotting, irregular rhythms, etc. And the outlook might change again tomorrow. But for now we're feeling better and continuing to hope for a smooth recovery. Grampy is on night duty and Mom and Dad are sleeping at home for the first time in many days.