Unexpected valentine's "date"

Jason and I had a pretty uneventful Valentine's DAY. We did not plan anything. I did order lunch take out so that I would not have to cook for the day, and Jason managed to make sure I got flowers.

---I love flowers. He used to pick me up flowers with every grocery store shopping trip and there never had to be a event for flowers. He got his mom involved to make sure I got a delivery <3---

Our uneventful DAY changed at 9pm when we did the cough assist machine. It has been a while since I've explained this machine, as we have been using since December 2016, so I'll give a little review!

The cough assist helps clear secretions from the lungs. The machine works by helping the lungs expand when the machine gives air (inspiration). It gives Jason a huge breath when the machine makes him breathe in. The machine then creates a sucking force (expiration) that pulls air and secretions out of the lungs. Although it isn't something we have to think about, this mimics what the body would normally do to creates a cough. We dispose of the secretions. In the past, we have described junky looking mucous during trach change appointments-these are the those secretions.

Jason needed a "cough," and we used the machine as we always do. This time, unlike any time we have ever used it before, the machine brought up blood and a quarter-sized clot. It wasn't just one link of the blue tubing (above), there were several with frank blood. Jason felt fine. Both of us were as surprised, worried, unsure of what to do. The blood had to come from the lungs because there is no where else it could have come from. Although Jason felt fine, we just could not ignore it. I could not in any way go to bed that night without answers. We had to go to the emergency room. I called Jason's mom to let her know the situation and show her the tubing, cried a little because I was scared!, let Jackson out for the night, we packed a few items and headed that way. The hospital is approximately 7 miles away-Emory John's Creek.

On the way, I arranged for a neighbor to take care of Jackson in the morning. As soon as we arrived in the ER, with all those masked coughing sickly patients in the waiting room, I felt doomed to get the flu. BUT as soon as you mention lungs and blood, then add trach to it-we spend less than 10 minutes total in the waiting room. Within 5 miles, we were taken back for lab work and vital signs. His heart rate and blood pressure were slightly higher than "normal," but we did go very quickly to an emergency room! That would raise anyone's blood pressure. They did not take mine (HA) We went to the waiting room again and spent less than 5 minutes there while a room in the ER was prepped for us and a nurse was assigned.

Lab results showed slightly elevated white blood count (WBC, immune system cells that are elevated when there is an infection in the body), but remember that Jason is always expected to have a "touch of pneumonia," which explains away the elevated WBC. Red blood cells that carry oxygen (important with active bleeding-if they drop, then he is loosing blood from the blood stream internally that we cannot see) were normal. Platelets (which blot blood) were normal. Heart enzymes (enzymes that can alert the doctors to a heart attack) and blood clotting factors were normal. They did a chest xray in the room that showed "a touch of pneumonia" and Jason felt fine throughout all of this. We watched the Olympics and waited. The doctor did see us an explain all of this. He gave us the option of admission to the hospital for further testing or said that we could go home and see our lung doctor, Dr. Berkowitz, the next day. At 12:30am, we did the cough machine again and there was still frank blood in the tubing. We decided at that time to be admitted because it was the safest option. They did start some IV fluids and 2 antibiotics in the ER because of the xray results. We let my Mama in NC know what was going on via text, that she would get in the morning.

We were admitted to the ICU (required because of the trach and ventilator, no matter the reason for admission) around 2:45am. With admission comes questions, doctors, and paperwork, so we didn't get settled until around 5. The doctors did call and speak with Dr. Berkowitz first thing in the morning prior to rounding. (Dr. Berkowitz goes to several Emory hospitals, but unfortunately not John's Creek, which is the closest one to our house) His thoughts is that some type of irritation happened, maybe a rubbing or something right there at the end of the trach in his neck. He thinks that the cough machine irritated the area and brought up a clot causing the active bleeding. The doctors round to each of the rooms starting at 10am on this particular unit (we were in room 7, so it was more like 10:45). The plan at this time was to continue on one antibiotic called cefepime based on cultures from the broncoscopy done on February 1 (trach change appointment), while waiting for cultures from a sample sent since admission. The blood seemed to be clearing up a little, still reddish in color, but not frank blood. Jason still felt fine throughout. We would be monitored throughout the day and when the hospital lung doctor came by, we would discuss doing another broncoscopy to see with a camera what the bleeding source was.

When the lung doctor came by around 2:30pm, Jason was still feeling "fine." We discussed our options with him and he completely supported our decision to come to the emergency room and everything that Dr. Berkowitz said. He thinks that some trauma occurred, which sounds terrible, so I'll go into more detail. The end of the trach tube in the neck is sturdy plastic. We move often during the day and that end does have the ability to scrape the mucousa in the neck. It could have also scraped during trach change out 2 weeks prior, clotted, and the cough assist dislodged the clot. We were given several options. We could go ahead and do the broncoscopy, which he said may or may not show the source of bleeding. We definitely could stay overnight or a few nights for antibiotics and monitoring. Or, we could go home. We felt safe with the monitoring that we got, labs results, that Jason felt fine throughout, and the doctor's explanation. We decided to go home and made it home around 5:30.

WHAT A WHIRLWIRD! Amazing that approximately 20 hours can seem like such a long period of time. We were both tired. Jason may have gotten 2 hours or so, I think I got closer to 1 hour. Trying to stay strong, send updates, stay the support and keep my cool adds to the fatigue. AND, how scary!

My mama decided to come to Georgia and got here a little after 6pm. Sometimes the heart wants what it wants and she needed to see us to make sure we were OK! Jason's parents are flying in next Tuesday (2/20)-it was such a scary situation that they were already in the planning stages of changing flights to come earlier too, so I am sure they felt better with my Mama making the drive. We ordered supper, and had all day Friday to catch up and spend together. She did a little grocery shopping for us while we napped. We put together the hutch on top of the dresser and started decorating baby girl's room. February 19 makes 25 weeks along. It was planned to do these things next time they visit in March, but we got it a month early. So, to leave all of you faithful readers on a happy note and looking at the positives, I got to see my Mama. She got to feel the baby kick (Jason has been able to feel her nearly everyday since February 2nd), and we got to give that room a little TLC! Aren't these paper 3D flowers just beautiful? My Mama is so talented.

We put together the hutch

flowers above the crib

Jason and I watched Mama

Posing with the flowers