Sunday Evening, 8/5/07

Yesterday morning started great. Both kids woke up (Alyssa - 5, Nathan - 2) woke up and were in great moods. They both had breakfast, played around, watched TV, and had lunch around 11:30. Around noon, we all headed out for a few errands and shopping. As we pulled up to bank, Nathan started crying and screaming. He expressed that his stomach hurt, but didn't want anyone touching it. Christa held him while I went into the bank and noticed that he was sweating quite a bit but didn't have a fever. When I came out, he was no better and really didn't seem ok to continue with the activities so we headed home.

Over the next two hours, he became very pale. He was cold to the touch and clammy, but showed no signs of fever or vomiting. He tried to sleep but was unable to get comfortable, moving every few minutes. He drank a couple sippy cups of apple juice or water, but did not pass anything through his system. Around 3:30 we noticed his stomach was very pronounced. We thought it might be a gas bubble or possibly even appendicitis (unlikely without fever/vomiting), but I paged his pediatrician because of how large his stomach had become. After hearing his symptoms, he instructed us to take him to the ER.

We drove him to Carroll County Hospital around 4:30. His lips were very blue at this point, and he seemed to be going in and out of consciousness. He was immediately admitted and taken to the ER for tests. They inserted a tube into his stomach; over the course of an hour, 600mL of liquid was drained from his system. He began to regain some color, and they were able to stabilize his vitals, but it was obvious something else was going on. The immediate focus was on diabetes (no family history) or appendicitis, although they were covering all bases. They arranged for him to be transported via helicopter to the University of Maryland Medical Center (UMMC) in Baltimore where they have an experienced pediatric surgery unit. By 6:15pm the helicopter had arrived and the EMTs and UMMC nurse began preparing him for transport. He took off around 6:30pm with an estimated flight time of 12 minutes to UMMC.

[ Side note: our babysitter was able to come to the hospital and pick up Alyssa, and take her home for the evening. She's doing great. ]

We arrived at UMMC around 7:45pm. After making our way to the Pediatric ER, they informed us of the gruesome news. Xrays revealed something seriously wrong with Nathan's abdomen. There appeared to be some sort of blockage or damage to his intestines. The only thing they could do was take him into surgery immediately. We signed off the process and followed him to the pre-op OR area. His surgeon had already arrived, but they had to page the on-call anesthesiologist. She finally made it in around 9:20pm and they briefed us on the procedure. They expected it would take at least a couple hours, possibly more. At this point we weren't sure if we'd ever see him alive again, so it was very difficult for us. We made our way into the waiting area in the atrium while he proceeded into surgery.

[ Side note: this is a really beautiful hospital. It's incredible what they've done by wrapping an old hospital with new architecture. If you haven't seen it already, you should check it out. ]

The surgeon and an attending finally came out around 12:30am. It's a good thing I was asleep on a bench or I probably would have freaked at the sight of the 2nd person accompanying the surgeon. He explained to us that Nathan has a condition called Volvulus (http:// en.wikipedia.org/wiki/Volvulus). They had to remove 1/3 of his large intestine and a portion of his small intestine. There was a length of small intestine that was not healthy, but was also not dead. In these cases, they err on the side of caution, choosing to save the unhealthy portion, hoping it will resume blood flow and heal on its own. If it does not heal properly, he will not have enough digestive tract to digest his food properly. The intestine was detached from his bowel and terminated in a colostomy outside his stomach. This gives him a "window" into his healing process. By 2pm we both resigned to the waiting area and tried to get some rest.

Surprisingly, I slept lightly until 8am. We went in to check on Nathan and were surprised to see him semi-coherent. I had expected him to be completely "out of it" for at least 24 hours, so this was a shock to me and really when I started to break down. Fortunately, the section of unhealthy small intestine is healing properly and has good blood flow, so the things that NEED to happen right now, ARE happening. If all goes well, he will still need another surgery to reattach the intestine and close everything up. In a perfect scenario, it will still be a few weeks before he is released from the hospital.

I'm not sure how rare/common Volvulus is for infants, but it's categorized as a birth defect. There's no way to diagnose this until it actually happens, and it's not hereditary or something you can develop. You either have it, or you don't. Obviously, it's imperative to get someone in this condition to the proper care as quickly as possible. We were fortunate and/or lucky that a) we called his pediatrician in time, b) his pediatrician had us go to ER in time, c) CCHS ER had him stabilized and transported to UMMC in time, and d) UMMC was able to perform surgery successfully in time. He's a very strong little boy and I can't begin to describe how proud I am of him for hanging in there. He hasn't cried once since we arrived at the hospital. He's still very sick, but so far everything has gone in his favor.