Grieving Uncle Rixie

While so much of our world has to do with what goes on in Room 5439 at Mattel UCLA Children’s Hospital, we are aware that life, with all its twists and turns, goes on around us.  The signficance of this became profoundly clear to us today as we learned that our dear Uncle Rixie passed away.  He made it to 100 in November and then even through Christmas (photo below) and New Years, but peacefully left us while napping this afternoon.

Just this week, I took a look at the calendar to see if there would be a way I could steal away from the Rudy routine and pay a quick visit to Uncle Rixie in the Bay Area.  I’m not wracked by feelings of guilt for not doing so, but just sadness over missing out on a chance to be with him (anyone who had the pleasure will know instantly what I’m talking about).  I have been fortunate to know many remarkable people, but I’m not sure how many could realistically be described as possessing true greatness.  I’m certain of at least one; who combined remarkable achievement, deep character and personal warmth over a lifetime to the benefit of thousands.

Over the last few years, Rixie maintained that he had lived long enough.  With his passing, there isn’t the pathos of one being robbed of years yet to be lived.  Yes, 100 years constitutes a “nice, full life”, but that doesn’t preclude us from longing for one day more.  I was so hoping for a chance for he and Rudy to meet.

I miss you “Big Pardner”!

Rixford Kinney Snyder 1908-2009
Rixford Kinney Snyder 1908-2009

1-07-2009: Happy 14-week Birthday!

Rudy turned 14 weeks old today!  I’m so proud of him…I’m proud of his will to fight…I’m proud of Wilson, Max and Olivia and their will to remain strong and keep up life’s routine in our prolonged hospital stay with Rudy.  I remember sitting with Rolf and the kids in a restaurant in August shortly after Rudy’s diagnosis talking about how it would take a commitment from us all working together to give Rudy a chance at life.  I’m not sure they really understood what that meant at the time…I’m not sure any of us really understood what that meant…we’ve already been stretched beyond what we imagined…Rudy’s endured more than we ever imagined…and yet, I’d say, our family is thriving in the midst of it all.  We are learning and growing and, in the long run, will be better for all that we are experiencing.  Rudy is learning and growing too…and although his journey so far has been one challenge after another, his opportunity at life is due in part to three siblings willing to accept “doing life” differently eventhough it’s really hard at times.  ‘Something I can’t wait for Rudy to understand when he’s older.

Today was much like yesterday.  Rudy continued at 10bpm on the ventilator and tolerated 3 one-hour sprints.  He did struggle with a high heart rate over 200 for a long stretch this afternoon but, thankfully, it did not compromise the progress he has made on the vent.  He also spiked a high fever again so he’s back on antibiotics until the cultures come back.  It’s hard to determine what is causing what…is he fussy and battling a high heart rate because of the high fever or is he spiking fevers  because he’s upset and fitful?  It could be infection, it could be withdrawal, it could be him being a normal baby or it could be the start of another “issue”…it’s simply hard to know with Rudy.  Although he is off most of  his heavy-duty drugs, he did need a couple of “rescue” doses of methadone today to get him to calm down and his heart rate back to a safe range.   His struggles yesterday and today are concerning but don’t feel like past setbacks which is good. 

The plan is to increase the sprints tomorrow to 90 minutes.  I hope to hold him as our time today got cut short because he couldn’t settle down.  The only thing that helped at all was the pacifier…he loved the pacifier again today.  He sucks so hard but can’t keep the pacifier in his mouth because the ET tube gets in the way.  Nurse Denise and I tried to solve the problem with tape as you can see in the ridiculous picture below but it didn’t work.  Poor thing…he puts up with alot in our trial and error attempts.  I realize I’m at a bit of a disadvantage not “knowing” my baby prior to his hospitalization.  His likes and dislikes, what works with him and what doesn’t is all a guessing game at this point.  There’s alot to learn now that he is starting to behave like a normal baby…I gladly confront that big learning curve!  🙂

a failed attempt at securing Rudy's pacifier
a failed attempt at securing Rudy's pacifier

1-06-09: Teething???

Call me and Nurse Denise crazy but we were convinced that Rudy was teething today.  Although it’s a bit early, he was showing the “typical” symptoms of a teething baby and the only thing that would calm him down was gnawing on my finger.  Denise and I were both amazed at how vigorous he “latched” on to the pacifier that Denise custom fit around his ventilator tube…he’s a strong sucker and I sure pray that what we saw today translates smoothly when it comes time to introduce nursing!!  Check out the powerhouse below:

Rudy had a good day in general.  He held steady at 10bpm for most of the day.   During the whole “teething?” episode, he did get himself worked up into a frenzy from which he couldn’t calm down and at that point they bumped the vent up to 24bpm for a couple of hours.  Before long, he was back down to 10bpm and even tolerated two one-hour sprints!!!  It’s 10pm and he just finished another sprint – his third one today.  He’s doing really well.  The plan is to continue with the sprints this week – increasing them gradually with the goal of possibly attempting extubation early next week!  Currently, Rudy is fluid- and infection-free so everyone feels we have a positive window of opportunity right now!

The team has decided to continue to hold off on his feeds until after he is extubated.  In the past, feeds to his gut seemed to add to the fluid issue.  Although Dr. Robert said everyone is anxious get going on the feeds again, the consensus is to focus on extubation and give the lymphatic system a little more time to heal and strengthen.  As of this morning’s xray, Rudy’s left side was completely clear of fluid and the right side had just a small pocket of fluid that was unchanged from previous xrays.  This is encouraging news and I’m praying in advance that when feeds do start back up again, Rudy’s lymphatic AND digestive systems will work GREAT!!!

What strikes me about today is the “normal” baby things that happened for Rudy…time sucking on a pacifier, sleeping in mommy’s arms for almost FIVE hours, crying and being fussy while maintaining good sats and blood pressure…  While the unit was packed and buzzing with activity today,  Rudy and I relished the moments of normalcy that we’ve not experienced yet.  Simple moments I hope never to take for granted!!!!

Mommy and Rudy 1-6-09
Mommy and Rudy 1-6-09

 

 

Daddy and Rudy 1-3-09
Daddy and Rudy 1-3-09

Down to Ten!

Trish and I have both been in Santa Barbara today to be with Grandma and Grandpa and get the kids back off to school. Had lunch out on the pier and enjoyed that “only in Santa Barbara” view.  We’ve been checking in down at UCLA by phone and are very encouraged by Rudy’s steady progress.  Two more steps down on his ventilator rate mean he just came down to 10 breaths per minute this evening and seems to be tolerating things well.  The team will likely continue to step down the rate, but will also start to turn down the pressure with which each breath comes from the ventilator.  In my check-in with Dr. Lee this evening, he mentioned that Rudy’s prealbumin, which is an indicator of nutrition, is now at 29!  The last time they tried to extubate him, it was less than 10.  With good nourishment, they hoped to maintain a level of 20 so it’s great to have Rudy well above that.  The prayers for nutrition are clearly being answered and he now has lots of energy for breathing.  Go, Rudy, Go!!

Trish will be heading back to UCLA tomorrow and we’re excited that one of us can be with Rudy during this encouraging swing.  While the team is keeping an eye on some very small fluid pockets on his lungs, these haven’t grown significantly over the last week so we can continue to hold him–and something tells me that’s what Trish will be doing most of the next few days.

In addition to your prayers, we also have a minor logistical request for those who are so inclined.  A few people who called Trish today might have wondered if it sounded like she was whitewater rafting.  Actually, in a fit of efficiency this weekend, Trish laundered her cell phone–she might just be taking the whole hygiene around Rudy thing a bit too far.  It’s now downy fresh and static-free but doesn’t actually send and receive calls.  We did set her up with a new one (Dante overlooked a 10th circle of Hell–the cell phone store).  Unfortunately her contacts didn’t transfer so if you speak with Trish regularly by cell phone, she would appreciate you calling hers sometime in the next few days so she can capture your number–or send it to her by e-mail.  Pat me on the back for restraining myself…there are just too many jokes to make here.

A number we like to see dropping…

I just have time for a quick post as I had a hard time putting Rudy back in the bed so I can make the drive home. At nine this morning, we broke through the “20 barrier” as the ventilator rate was turned down to 18. He’s been handling it well–alert for long stretches, sleeping peacefully while breathing comfotably and maintaining a good level of oxygen saturation. As many have told us they pray for Rudy every night after they get the blog e-mail around 9pm, you might remember that this is also when a vent step comes so you can pray specifically for Rudy to continue the good progress he’s making.

As hard as it is to leave Rudy when I just want to keep on cheering him on, I’m going to go get Wilson the two dozen Diddy Reese cookies I promised him and then make it home in time for some basketball with Max before dark. It’s back to school tomorrow. Not sure how much this will be celebrated at our house tonight.

Rudy’s World In Pictures

I was looking over past entries this weekend as I sat here with Rudy and enjoyed looking through Greg Lawler’s pictures again. Seems like a lifetime ago, but if you’ve joined us on the journey more recently, I’ve put a thumbnail on the right column that can take you to them. They’re too special to get buried in the archives. Thanks again, Greg!

The Stockdale Paradox

With the dawn of the New Year, it’s fitting to take stock of our situation and do some assessment.  So much has happened with each week; and sometimes each day has such unexpected twists and turns that, as I drove down the coast today, I tried to assess things on a larger perspective.  Trish and I often find ourselves trying to give answers to general questions people naturally ask about Rudy’s condition.  As natural as these questions might be, they are difficult to answer in Rudy’s case.  We’re encouraged because he’s making progress so we can’t say he’s doing poorly; but is it accurate to say he’s doing “well” when he remains in an ICU facility reserved for seriously ill children.

 

This week, I realized the relevance of the Stockdale Paradox (Collins, Good to Great) to our situation.  Admiral James Stockdale survived an extended POW ordeal while many around him perished or went insane with waiting.  He credits his ability to maintain a dual mindset.  First, he stoically confronted the brutal facts of his reality.  Second, he held an unwavering faith that he would prevail despite the difficulties.  For Stockdale, the brutal fact was that he was inhumanely imprisoned in an inescapable remote location without any assurance that his comrades even knew he was still alive.  Yet, never losing site of this, he lived life with a mindset that he would one day be free.  He speaks of the many who weren’t able to do this—who mistakenly thought they’d be able to escape the guards and then flee into an unknown jungle with no strength, gear or idea of which way to run; or who held forth arbitrary deadlines for release (“we’ll be home by Christmas”) only to get more demoralized as they passed with no change.

 

I’ve found it helpful to apply Stockdale’s mindset to our own situation.  In confronting the brutal facts of our situation I don’t start with a scenario as grim as his, but we constantly keep in view the fact that Rudy is facing some very serious circumstances—just this week, HLHS claimed the life of another child here (even though he had passed through several of the milestones we haven’t even gotten to yet).  It would be delusional for us to get complacent or lulled into believing that this is going to be easy:  Rudy is facing something that should never be underestimated—it kills kids.

 

Yet, we are kept going by a sense that we will prevail over this.  Everything I see the team doing is done with this in mind.  There’s no trivializing what we’re up against, but every step is done because of a belief that we can prevail in the endgame—he will come off of all these machines, breathe and eat on his own and leave this hospital.  We don’t know when (but do we ever wish we did!), so having had a major holiday milestone pass with us still at UCLA, we’re not going to arbitrarily hold out another.  So we’ll try to keep moving forward holding an appropriate balance of realism and hope without approaching the poles of delusion or despair.

 

This has involved our letting go of any of our own timelines, and once we’re able to do that, we can see that Rudy has made steady progress on one of his own.  Today was a great day, where I held him for two stretches of over two hours (loving those NFL playoffs).  The team removed his arterial line and the Foley catheter so he only has two lines going into him (compared to something like six at one point).  The team has been very slowly weaning the ventilator rate down (12 hr steps at a minimum) to where it’s currently at 20 bpm and he’s managing well.  They’ve decreased his pain meds to a very small dosage, more to ease his withdrawal from them than to manage any discomfort, so he’s alert and twitching around just like a baby should.  The chest Xrays are clear of fluid (we’ll see how that holds once they start feeds again).  This week he weighed in at over 11lbs, which means the nutrition is doing some good—the bigger he is, the better chance he has of getting past some of these milestones.

 

Does this progress mean he’s clear of danger?  No, but it does bring realistic hope.  We’ll take it and thank God for it.

Grandma Jo and Oma Will Be Jealous!

Rudy’s first day of 2009 included family and football!  Rolf, Max, Olivia and Grandpa Dick arrived close to noon.  Wilson wanted a quiet day at home in SB so Grandma Jo was kind enough to stay home with him.  The rest of us enjoyed lunch together before we settled down in Rudy’s room for the Rose Bowl.  Rudy had a good day today with only a small fever in the morning and then the periodic lowering of his oxygen sats.  This morning’s chest xray looked good and he continued to tolerate the ventilator rate at 24bpm all day!  It was a day to sit back and stabilize. 

Grandpa Dick had an opportunity to hold Rudy for a bit before his numbers went a little wacko but it was special nonetheless.  Rudy’s numbers were great when he was relaxed and asleep but as soon as he woke up, it was hard to control his breath rate and oxygen saturation.  He’s getting another blood transfusion tonight and resting comfortably.  Rolf et al left for SB at dinnertime.  I’ll head home tomorrow (Friday) afternoon, Rolf will return to UCLA Saturday and Sunday and then it will be my turn again Monday-Friday of next week.  It will be interesting to see what next week brings if the chest fluid issue is truly behind us!!  Baby steps…baby steps…dad-and-rudy

                                                                                                        grandpa's arms

 

A picture says a thousand words...
A picture says a thousand words...