After a long day, Jude is resting and unconscious. He's under heavy sedation and paralysis from several different drugs, and he's still on a conventional ventilator. His surgeon wants him to remain generally immobile over the next few days as he begins to heal from the surgery, which is why a paralytic drug, vecuronium, is being given to him. Jude's hernia repair was done via thoracotomy, an incision in the chest that can be extremely painful, so his sedation has been notably increased to make him comfortable. A tube was also inserted where the chest incision was made, which is draining both air and fluid from the pleural space in his chest cavity.
Rose and I caught up with Dr. Hebra late this afternoon and had a really quick conversation with him. In short, Jude's surgery went as well as we all could have hoped. If my recollection is correct, Dr. Hebra confirmed that his bowel (small and large), stomach, spleen, and the left lobe of his liver were in his chest cavity. With so much stuff in his chest, it seems truly amazing to Rose and me that Jude wasn't in even more pain/discomfort than he seemed to experience. As with his first hernia repair surgery, Jude had a great team caring for him today: Three pediatric surgeons (Drs. Hebra, Streck, and Cina), a senior anesthesiologist, and other medical staff all contributed in some form to Jude's procedure. Rose and I are so thankful that God allowed so many skilled professionals to come together in order to care for our little boy, and we're particularly thankful today for Jude's nurse, Lesley, and his surgeon, Dr. Andre Hebra.
A few interesting things were recounted to us by Dr. Hebra and by the other staff who visited us periodically during Jude's surgery:
First, Jude's adhesions (bands of scar tissue) in his chest were not nearly as bad as we all thought they might be. Praise God for this blessing! While there was some scar tissue between the abdominal organs floating in Jude's chest cavity and his lungs, the amount was small enough that Dr. Hebra apparently didn't have considerable difficulty in separating the organs from the lungs and moving them back down into his abdominal cavity. That's awesome!
Second -- and this one is so exciting to me -- Dr. Hebra made a happy discovery once he had a look at Jude's insides: There was a small bit of scar tissue beneath his heart that was perfect for suturing the GORE-TEX patch on that side of his defect. This bit of tissue was not expected; rather, Dr. Hebra thought that he might have to stitch the GORE-TEX patch onto the pericardium, which is the membrane/sac on the outside of the heart. The fact that he didn't have to do that and that a stronger, more conveniently located tissue was present so that Dr. Hebra could secure Jude's patch on that side was amazing. No one saw this coming, but all we can do is praise God and thank Him for this unexpected mercy!
Third, Jude was rock solid throughout the surgery. His vital signs remained stable, his arterial blood gas analyses (tests that determine the pH, oxygen, and carbon dioxide levels in Jude's blood) were great, and he lost relatively little blood. Praise God for keeping our little boy steady through so much trauma!
The major challenge over the next few days, as we understand things, is to manage Jude's pain. As indicated above, Jude's chest was opened through an incision, and a lot of tissue had to be cut in order for Dr. Hebra to gain access to his chest, and that included cutting through muscle. Over the last 5 months, Jude has built up a bit of a tolerance to some of the drugs that he's presently receiving, and he's also grown to more than 15 pounds -- up more than 7 pounds from his birth weight; consequently, he will need quite a lot of sedation in order to remain comfortable and avoid distress. Please pray with us that the Lord would keep Jude's pain far from him and that he would remain stable and comfortable in the coming days.
Another area of Jude's care that will receive quite a bit of attention in the days to come is his respiratory status. Right now, because Jude is paralyzed and unconscious, he is being mechanically ventilated, i.e. a machine is breathing for him. So far, his arterial blood gas analyses post-op have been very good; however, per Jude's nurse for this evening, there's a possibility that he could be in the midst of a respiratory "honeymoon" period that some children experience after undergoing surgery. As things move forward, please pray with us that Jude's respiratory status will remain stable and that he will need very little or no additional breathing support.
The hour grows late, so I'll stop there for the night. I'll leave you with a few pictures of our little man. Again, thank you all for reading and for offering up prayers on behalf of baby Jude and our family.
Little boy looks up at mommy
Sneaking in a kiss
This little boy is long
See you in a little while -- last pre-op photo
Back in the NICU, post-op
Oh give thanks to the LORD; call upon his name;
make known his deeds among the peoples!
Sing to him, sing praises to him;
tell of all his wondrous works!
Glory in his holy name;
let the hearts of those who seek the LORD rejoice!
Seek the LORD and his strength;
seek his presence continually!
Remember the wondrous works that he has done,
his miracles, and the judgments he uttered,
O offspring of Abraham, his servant,
children of Jacob, his chosen ones!
(Psalm 105:1-6)
I will give thanks to the LORD with my whole heart;
I will recount all of your wonderful deeds.
I will be glad and exult in you;
I will sing praise to your name, O Most High.
(Psalm 9:1-2)
I will recount all of your wonderful deeds.
I will be glad and exult in you;
I will sing praise to your name, O Most High.
(Psalm 9:1-2)