I apologize for the crappy format of this entry, but I didn't want to fool with adjusting the tables in my normal template, so I'm just throwing this up here as is. It was written by Keith, not me. He wrote it to put up on our private family website, but I thought I'd copy it here as well, because I'm in no mood to compose a journal entry myself right now.

Zeke is in the infant ICU at Children's Hospital with RSV - Respiratory Something-or-other Virus. He's been on a ventilator since he got there Saturday night. He's in stable condition and starting to get better. He weighs more than ever, he's pinker and less jaundiced, he's able to rest but has some energy and is responsive to our voices and touch. He's digesting and breathing for himself a little. He may not come home for a week or two or more, he may have some setbacks along the way, but there's no indication that he won't come out of this perfectly fine.

We've all had colds since early last week. On Wednesday we took him to the pediatrician, who said he would get worse before he got better, told us the warning signs we need to watch for and call to tell her about, and said otherwise don't worry. On Saturday night he was looking dehydrated, his fever had briefly spiked above 100 a couple times, and he was grunting every time he exhaled. Jan became concerned, and asked me if I thought we should call our pediatricians's office. I didn't personally, but I said that was what they were there for and it was better to call than to fret over whether we were right not to. The nurse (somehow our call routed itself to Harborview) listened to his breathing over the phone and told us he had to go to the ER at Children's. Then she asked if we had a cell phone. We said yes, and she said good, then you can drive him there yourself and if his breathing gets worse or stops or if his lips turn blue, pull over and call 911, because help can get to you faster than you can get to it.

So now I was concerned too.

In the ER they said, you parents both have colds, he probably has the same cold you do, but his air passages are so tiny that it doesn't take much congestion to seriously restrict them or even block them completely. They tried giving him some inhalants - one that's a common asthma medicine and one, ephedrine or something like that, that they said was basically synthetic adrenalin. That one jacked his heart rate up to about 180 (babies' little hearts ordinarily beat faster than adults', 140 is a perfectly normal heart rate, 180 made us nervous but we figured with all the monitors he was already wired up to, an alarm would certainly go off before his pulse got dangerously high) but neither one eased his breathing any.

So they said they'd need to admit him to one of the floors, and a doctor from the floor would come down and look at him first, but it might be an hour or so because they're getting a lot of RSV cases and the whole hospital is unusually busy. Jan and I talked about having me drive home and get some clothes and toiletries and stuff for a protracted stay before I got any tireder; and while we were discussing that, two doctors from the floor came and examined him. After a while the ER resident came back and they talked together about how the inhalants hadn't seemed to help, "in fact, he's a bit worse," which was news to us. And suddenly the ER attending comes in with a doctor from the infant ICU, which they now say they want to admit him to.

I think it was less the idea of the ICU than realizing that on this unusually busy late Saturday night we now have five doctors and two nurses crammed into Zeke's tiny examining room, but this is where we really got scared.

They took a chest X-ray, which showed that the upper lobe of his right lung was collapsed (thanks to a gift of some of those Worst Case Survival Guides last Christmas, I already knew that this is a temporary condition you can fully recover from). They drew some blood for various tests, particularly his blood gasses (O₂ and CO₂) and started him on CPAP, which is a nose plug that supplies pressurized, oxygen-enriched air. So he still has to do the work of inhaling and exhaling, but it makes the inhaling part easier.

They kept him on that while they started an IV to get him rehydrated. The bitter irony is that people, babies especially, are often dehydrated by the time they need the IV, and dehydration makes it hard to get the iV into the vein properly, especially in babies. They were at it for a while.

They also took samples of his throat mucous and urine to grow cultures from, and a red blood cell count, which was alarmingly low. They started him on a couple broad-spectrum antibiotics, and then they took blood gasses again. His oxygenation was better (they already knew that, they continuously monitor it, see below) but CPAP doesn't help you exhale CO₂ at all and his blood had become more acid. So they decided to intubate him and put him on a ventilator. Which meant they had to start him on morphine.

By now it was 4 am; I had only gotten about three hours of sleep since Friday evening and Jan wasn't much better, we'd both been at his side all night, and Jan hadn't pumped her milk in over 5 hours. They showed her the ICU's excellent mother pumping and storage facilities and she made the first of many deposits. Then, figuring that since Zeke was going on morphine he wouldn't miss us too much, we went to our room, curled up together on our cot and got about 4 hours of sleep.

The next day the ER attending doctor tried to tell us the results of his cultures; she kept contradicting herself and apologizing and saying she'd only had an hour of sleep. The gist we got was that he was positive for RSV - no surprise; his urine culture was growing group B strep, which wasn't an immediate problem and the antibiotics would take care of; and his throat culture was growing MRSA, methocyllin resistant Staph A. This was peculiar - they said they would only expect someone to come down with that in a hospital environemnt, and he just hadn't been there that long. We couldn't offer nay illumination, but they changed one of his antibiotics from ampicillin to something non-penicillin based, and started another throat culture just in case the first one was contaminated by the lab. (It takes two days for the cultures to grow enough to get a definitive analysis, so the thought that the lab might have done that is fairly distressing.) We've gotten the second cultures back by now, and they're both negative, which is unsurprising given the antibiotics he's on, and we all agree that we'd rather have him be free of infection now than know exactly what was going on with that MRSA result. However, every time he goes into the hospital in the future, we're going to have to say he has a history of penicillin-reistant bacterial infection, so he'll always be in isolation.

Which at least means the insurance companies can't balk about him getting a private room.

• The ventilator tube is taped to his mouth, which gives him fish lips, and they have to have him on a morphine drip to keep him from, I forget exactly, reflexively trying to swallow or chew or suck on the tube - besides which it isn't comfortable. It gives him air enriched with oxygen and, if he doesn't breathe on his own for a set interval of time (so far between 2 and 3 seconds, a respiratory therapist tends to tweak it every few hours) it gives him a breath. They try to set it so that it gives him almost enough air, because if he draws a breath on his own the machine senses that and waits another two-seconds-and-change before it gives him one. Sometimes he'll take four or five breaths in a row by himself, though they aren't as deep and full as the ones the ventilator gives him. The tube with rainbow striping attached to the mouthpiece is a suction hose; periodically a respiratory therapist will massage his chest to loosen the phlegm in his lungs, then slide the tube until the purple stripe reaches - I'm not sure, a certain point - and then the tip of the tube in his lungs is at just the right the perfect depth to suck out the loosened mucus. Then they retract the hose until next time, to give him more room to breathe.
• The thin tube in his nose goes into his stomach. They use this to give him three CCs - the better part of a teaspoon - of Jan's milk every three hours, just to stimulate his digestive tract. He gets most of his nourishment - water, glucose, minerals and electrolytes, even some protein and fat - through his IV's. While we were still in the emergency room they told us not to feed him, since they knew he was going to go on an IV and they were afraid he might vomit and then inhale milk and bile into his lungs, which were already clogged enough. I gather he'll have to get off the ventilator before he can have substantial amounts of milk again.
• The green circles taped to his chest are EKG probes, for measuring his heartbeat, which has been fine all along.
• I believe the white cuff around his right arm measures blood pressure, although you musn't think of the kind of blood pressure cuffs that inflate and deflate; this one is never tight. The blue band on his right hand is a sort of Ace banadage holding an oxygenation sensor in place on his finger. This shines a red light right through his finger (or big toe; the Ace wrap is tight, so they move it around several times a day) and measures the light coming out the other side. It has something to do with the fact that blood cells are red when oxygenated, blue when not, so the color, or something, of the light that gets through varies with the proportion of oxygentaed blood cells.
• He has an IV in his left hand, another in his scalp, and a third in his foot. One - the one in his foot, I think - taps off an artery, and they use this one to draw blood several times a day, mostly to check the amount of carbon dioxide in it. (When too much CO₂ builds up in the blood it begins to turn into an acid, and on Saturday night he was having just as much difficulty exhaling CO₂ as he was getting fresh oxygen, so his blood pH began to drop. Or is it rise? I know 7.0 is neutral but I can never remember which way is which.) The other two IV's go into veins. He only needed two of these because, between being sick and the fact that they gave him enough IV fluids to increase his weight from 8 pounds 4 ounces to 10 pounds and change, his red blood cell count dropped to about two-thirds what it should be. So he needed a transfusion, and apparently when they give blood they don't mix it with anything else in the line in. (His other venous IV has about 4 y-connections coming together into it: antibiotic drip, morphine drip, lipids, and his maintenance fluid, which looks and probably tastes like Gatorade.) They gave him 100 CCs of blood yesterday (he only has about 400 CCs total blood volume) and then they took the IV out of his hand.
• He also has a catheter into his bladder, and they hook up various other implements to him from time to time. For instance, even though he's too young to be able to breathe through his mouth, he ends up swallowing a bit of the pressurized air the ventilator gives him. So they occasionally use his feeding tube to suck any accumulated air out of his stomach.
• You may also notice that his eyes are puffy. He didn't seem to open them at all from mid-Monday to late Tuesday, and we worried that it was the morphine, but one of the nurses suggested maybe they were just swollen shut, and he'd start to open them a little once he stopped retaining so much fluid, and indeed he did.

This is a close-up of the IV going into the vein in his scalp. Jan told me she heard somewhere (from one of the nurses? on a messageboard?) that some parents take one look at it and can't deal with, and make them take it out. But infants don't have that many suitable veins, and besides, he's already holding his head still - he can't move it that much yet and between the ventilator and the morphine he can't (or doesn't want to?) move it at all. For more than a day he had stuff attached to both arms and both feet, with an arm and a leg strapped to splints. I'm glad he has more freedom of movement now, and he's using it.

He's in isolation, so we're asking you not to visit (except Zeke's aunts, uncles and grandparents.) We had a parent sleeping room at Children's for the first three nights, but what with cold and flu season the hospital is full so we gave up our room to somebody who lives more than 10 minutes away. So we're at home, and we're probably going to be keeping fairly normal hours - staying with Zeke at the hospital during most of the day, and sleeping at home at night - maybe he'll start learning the difference between day and night, he's about the right age. We're keeping the phone turned up in case the hospital calls us at home, so feel free to call us at home but not between 11 and 9.

Thanks for keeping us all in your thoughts and prayers.