It seems that Hannah has failed the external drain test. As they lowered Hannah's bed, and tried to decrease the work of the external drain to see if her brain would absorb the fluid normally, she started having headaches, very painful headaches. There are two options now, an internal shunt or a ventriculostomy.
A shunt is a mechanical device that is inserted in the brain, and runs down into the stomach. It would be something that Hannah would have to be aware of for the rest of her life. She couldn't do any contact sports, and there is always a chance of malfunction of the shunt (which happens quite a bit).
The ventriculostomy is a relatively new procedure that not many neurosurgeons are performing. It is a brain surgery where the doctor drills a hole through the bone into the third ventricle. This hole will allow the fluid to drain, and find a new pathway. If it's successful, it eliminates the need for a shunt. Hopefully it would be permanent, but there is no guarantee that it wouldn't close up in the future. Something we will have to monitor forever.
The doctor thinks she is a good candidate for the 3rd ventric, so today he performed the surgery. Everything went well until we were in the surgery recovery room. The incision for the surgery is at the top of the head, in the front. Hannah's head was wrapped like a car accident victim, around her whole head with gauze. She was very agitated and in obvious pain. They determined she was stable, she was coherent, so Dave left to go back to the office. She really seemed to be thrashing and uncomfortable. We were just waiting for the ok to go back up to her room in the Peds ICU. I walked around to the other side of her bed and noticed quite a bit of blood on the bandage on her head. It had soaked the bandage and was running down the side of her head. I called the nurse over to take a look. She said calmly "there is a bit more blood there than should be."
Then, things started happening very quickly. All of sudden there were several people around her bed, doctors and nurses. They were paging the neurosurgeon and his assistant. He didn't come right away, so next they paged him STAT. Pretty soon the recovery room doctor in charge was at her beside. A nurse brought the phone to me to ask if I wanted to call my husband back. I called him to tell him "Come now, there's a problem." As I was on the phone, the neurosurgery fellow, came running in. He started to remove the bloody bandage from Hannah's head when all of a sudden the blood started shooting out. Not just running out, SHOOTING across the bed from her head.
I was petrified. I thought she was dying. This was the scariest point by far in all of this. Seeing blood shoot out of your daughter's head from the incision is pretty shocking. The doctors applied pressure to her incision to attempt to stop the flow of blood. They paged the Dr. Egnor, the neurosurgeon, and asked him if they should rush her back to surgery or do something in the recovery room. What had happened was that when they closed her incision in surgery, there was an artery that was left exposed. When closing up the wound, they pinch the skin together, because when it heals, it will constrict, and flatten out. So, even though it looks like a big lump and a lot of extra skin, it flattens out and lowers over time. When pinching the skin together, they accidentally included an open artery. The artery continued to leak blood, so when the bandage was removed, it was pumping blood out through the open artery.
The team decided that they would put staples on the incision to close it in the recovery room. They explained to me that they could give Hannah a numbing shot, but that would be as painful as the staples. So, I told them to just do it. Next thing I knew, the doctor had a staple gun (it looked just like a regular big staple gun) and was on top of Hannah's bed, with the gun on her head. They put two staples in Hannah's head while she was conscious and aware. I don't think she remembers many of the details, but she does remember them putting staples in her head. She didn't even flinch when they did it, she was already whimpering from the pain.
To top it all off, the iv in Hannah's arm wasn't inserted properly. I asked them why Hannah's bed was all wet. There was a leak when they connected the line to the iv, and all of her pain medicine was draining onto the bed, instead of into Hannah's body. Why? I don't know why.
What a day. The ventriculostomy seems to be doing it's job. Let's pray it holds.
XOXO,
Kim and Dave
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