As you know by this point, on top of having a CHD, Nolan has also struggled with feeding issues his whole life. Aside from slowly taking a couple bottles from me when he was a couple days old in the NICU, he’s never really eaten by mouth. He had a feeding tube placed before we brought him home for the first time and it’s been a life of tube feeds and feeding therapy for the little man. Progress on eating has really been up and down: we successfully moved him from Pediasure to using blended feeds and eventually managed to get Real Food Blends covered by our insurance, which took quite a bit of work. All the while he wasn’t really eating at all. His morning routine, in fact, involved some meds, some fluids, vitamins, and some Benecalorie, which is a high-calorie product that we mix with water or juice:
During Nolan’s stint on the rehab unit this summer, one of his speech therapists – Grace – gave us a few “local” recommendations for feeding programs. All of them were hours away, which made for a tough choice. In the end, we decided to try the feeding program at the University of North Carolina Medical Center because they had some experience working with heart kids. Once all the referrals were made we had our first appointment for early in the morning in October. Until this point, all of Nolan’s appointments are around 30 minutes away. Now we were facing this:
And not only did we face a nearly 3-hour drive, I had to take the day off work and we had to find people to drop off our other kids at school and pick them up. This was quite an undertaking. We left super early and made the drive…and barely made it there because of traffic. UNC Medical Center is on a really big campus, right next to the University. They have a massive parking deck with a $10 daily maximum and no validation in the hospital…BOO. It’s kinda weird having to go to a different facility after being so used to Levine Children’s Hospital and we didn’t know what to expect. We found the check-in relatively easily and went through all the initial paperwork and whatnot. Then we were sent to a different waiting room and were barely there before Nolan was called back. They got the usual weight/height/sats that everyone measures and then we were taken back to a room.
What’s unique about this program is that it’s run by a team approach. We had a NP from GI come in along with a nutritionist and the feeding specialist. All at the same time. Yes, you read that correctly. Working across disciplines: what a concept! The initial appointment was really, really long: they had a ton of questions, naturally, and wanted a good feel for Nolan’s needs. While they did give us some dry spoon exercises to do with Nolan at home, their first major concern was Nolan’s vomiting. Nolan has always had issues with throwing up ever since he came home from the Norwood. We talked to everyone we could about it and either no one seemed too concerned or no one could do anything about it. And absolutely no one would communicate across disciplines about it. God forbid. So this was different. They said the dose of meds he was on for his tummy was so low it wasn’t going to do anything so they prescribed him a different med – Nexium – that he would take once a day before feeding. Then they also recommended starting him on a different food blend called Nourish:
It’s a plant-based formula that they felt better met his nutrient needs (Real Food Blends apparently was short on some things, hence our need to add vitamins). Plus they said the addition of turmeric in the blend has shown to help kids with their reflux issues. I was skeptical: I just wanted to jump to the feeding and get it done as quickly as possible so we can stop driving so much. But hey, I don’t get to make that choice, right? For now, though, hey held off on the Nourish and just had us work with the dry spoon and new meds on Nolan and meanwhile they would communicate with Nolan’s current speech therapist to see if she was on-board with UNC’s recommended plan (she was, thank God).
We went back one month later and Nolan was showing a little bit of improvement with the vomiting and he did a good job taking the dry spoon. So the next step was to start him on Nourish. They made sure our DME provider carried it (great job on their part!) and told us they’d email the recommendations for switching over. What they didn’t tell us was…dun dun dun…we’d be bringing back to bleeping feeding pump. And when I say bleeping I mean literally bleeping.
This really made me pissed off because we had gone away from the previous Kangaroo pump and were giving his feed bolus by hand. Now we were back to this nonsense and we they wanted us to put him on continuous overnight feeds for 10 hours. TEN HOURS! Did they know how much this kid rolls around in his sleep?
We did try, though: we hooked him up and immediately this godforsaken machine would beep and beep and beep with some kind of error: No Flow In, No Flow Out, blah blah blah. And I hated it. Do you remember the movie Demolition Man? Where Sylvester Stallone kept cursing at that citation machine?
That was pretty much me.
So we fired off an email to the team and pleaded our case for not having the overnight feeds, at least. They responded that it was meant to help create a hunger sensation that would help with feeding and to trust them for awhile.
So there it was…trust. It’s hard to do, and especially hard when the team is hours away and doing something that inconveniences you. But that’s just what it is, an inconvenience for me…ultimately it’s meant to help Nolan, so we sucked it up and went with it.
Well I gotta tell you: between the meds and the feed blend, Nolan rarely vomits now. And even when it seems like he’s going to (usually when he’s upset), I’ve noticed he’s able to control himself and not do it. It’s amazing! We’ve also graduated from dry spoon practice to dipping the spoon in juice and Nolan has been doing a great job. Yesterday he sat down to feed at least 3 times and took at least 20 bites each time. Soon we’ll graduate to dipping the spoon in a little bit of puree. Baby steps. This is going to be a long process but I’m seeing some progress in our little man…and I’m starting to trust his feeding team more and more. It’s amazing what can happen when disciplines work together! So until now we’ll keep up the work and won’t head back to UNC until February, but it’s promising! As long as he keeps eating, we’ll keep driving. Whatever it takes. Go, Nolan, Go!
On Saturday, December 10th I woke up to a now-common sound: “Dad….DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD!” I hopped up out of bed and opened the door to our room to see little Mr. Nolan there in the hallway, arms held up, saying, “Take me downstairs?” I bent down and scooped him into my arms and he put his arms around my neck and rested his head on my right shoulder. Almost immediately Grant came up and I picked him up too. It was a very special day. I whispered, “Happy Birthday, big boys!” and I was immediately overwhelmed. Here they are…my two little boys…and they’re FOUR! I remember the mad rush to the hospital at 3am, the C-Section, the NICU stay for both babies. I remember being happy as Grant did good enough to go home after 5 days, and I remember the fear that grew in the pit of my stomach every day as I knew sometime soon I’d have to hand over Nolan for a major heart surgery in an effort to save his life.
In the years since, Nolan has been through so much and continues to endure quite a bit. He’s one tough little boy. And Grant has been a fantastic little (by 2 minutes) brother. Together they’re a wreck: a destructive force of giggles and tackle-hugs. There was a time where we didn’t know if Nolan would see 4…but here he is: 3 heart surgeries later and still smiling and still fighting. Each year at their birthday I reflect on what we’ve all endured. There’s so much to celebrate…so much to be thankful for. We’re thankful for our little family, for physicians, nurses, friends, family.
Happy birthday to my sweet Nolan and Grant…I can’t wait to celebrate year 5!
Every hospital has The Intersection. Every heart parent has stood at The Intersection. This is the place where it all becomes real, where it’s go-time, where you whisper that last fervent prayer before letting go. You woke up early to come to the hospital for a surgery date you’ve been dreading, you’re ushered up to a pre-op room where people come to get you to sign here, initial here. Maybe you review some last-minute information and meet the surgery and anesthesia team. But eventually the moment comes where you enter The Intersection. At our hospital, you step out of the room and into the hall where it forms a T: this is the place where a group of people (and your child) turn right while you have to let go and turn left towards the waiting area.
The Intersection is a heavy, heavy place. It’s the place where fear and doubt seem the strongest and where you muster every last bit of hope left in your body and try to project it on the people turning right. For a brief moment all those thoughts cross through your mind: did I pray hard enough, have I been good enough, have I been a good parent, did I give enough hugs, was this the right choice, are you sure it couldn’t just be me instead of him? It’s such a tough place because to turn right is handing your child over to certain fear and pain, which is necessary to live. To turn right is to be filled with fear and tears.
I don’t write this to merely drum up our old fears, but rather I spell them out for a different reason: to thank a group that I think often goes overlooked. A couple months ago I was asked to share Nolan’s story with our surgical services team at work. This was a massive group of nearly 200 people all in their green scrubs and funny giant shower cap thingies. They have their staff meetings at like 6am, which is bonkers, but I digress. As I walked to the auditorium, I was thinking in my mind what to say and this idea of The Intersection hit me like a ton of bricks and I just had to share it. So I shared Nolan’s story and at the very end I said to them, and I’m paraphrasing here:
“There’s a place I call The Intersection. Where Nolan goes one way and I can’t follow, so I have to go the other. This is a really tough place to be because I know where he goes there is pain, and where I go there are tears. But as I stand here in front of you I want to thank you, because when he makes that right turn I’m essentially handing him over to you…the people I don’t even see…to save his life. And without you, there is no Nolan, so I thank you.”
I gotta tell you, it took everything in my power for me not to lose it there. Not to mention it was 6am so I was already a wreck as it was. But I meant it. You see, while our amazing surgeons make the news and magazine covers and whatnot, there’s a whole team of people behind those operating room doors who we will never see or meet. They keep things clean, keep things stocked, keep things moving smoothly and Lord knows what else they do. They are so important to the success of these surgeries and I’m not sure they get the recognition they deserve.
So while I know it’s painful to think about The Intersection, remember that it’s Thanksgiving week: let’s channel those thoughts into some genuine thanks for the surgical services teams who have played such an under-the-radar role in the success of our kids. I encourage you to share this post on social media, maybe write a card or note to the surgical services team at your local children’s hospital. Whatever it is, just make sure you let them know how much you appreciate that they’re there on the other side of The Intersection.
If you’re reading this and you’re part of the team who wears the green scrubs and the funny shower caps: just know that our family thanks you for your hard work. Let this recognition encourage you and your teammates to know you are loved and appreciated for your work…keep it up!
I’m sure before you had a child that was born with a critical illness, you knew of your local Children’s Hospital, but you didn’t really know about it. You’ve probably said to yourself, “I’m glad we have it, I just hope we never have to use it.” For you that wish didn’t come true and ushered in a reality that you never expected.
Like all of us, you’ve made many trips to and from these hospitals and walked through the same set of doors over and over: rain or shine, sleet or snow, holiday or humdrum Wednesday. As we left our – hopefully – last surgery with Nolan, I started to really think on the significance of the front door of the hospital.
The Door can lead to our greatest fears, but also our greatest hope. There have been way too many times where I’ve had to walk from the parking garage to these doors, and every step closer makes me more scared and more nervous. Because on the other side of The Door is something scary for my son, something unknown, something painful, but something necessary. But also on the other side of those doors is a team of people who have the professional training to give your kid a shot at a full life. This door also leads the way back home…it says “we made it.” The Door leads to thanksgiving…to joy…to peace.
The Door also leads to suffering. And before you think I’m getting too heavy, just let me say that I believe we don’t talk about suffering enough when it comes to healthcare. Because it makes us uncomfortable and carries a negative connotation. But like it or not, this is the reality of what occurs every single day at a hospital: innocent kids given a diagnosis they don’t deserve, losing time on a childhood that should be free of pain and fear. There are parents who walk through those doors everyday consumed with thoughts like: is he going to make it? How am I going to pay for this? How long? How much more can I do? What about work? And on and on and on. They suffer, too.
Healthcare workers: you have such a power within your hands to impact suffering. Sure, if my son hurts you give him something for it. If I’m cold, you give me a blanket. That’s what’s considered inherent suffering. It’s tied to the thing we’re here for. But what else? There’s another type of suffering called avoidable suffering and preventing/reducing this takes a lot of effort and isn’t something you learned in school. What does this look like? It’s the worker(s) that walk past the lost parents in the hallway, because “I’m too busy right now.” It’s the worker that doesn’t make eye contact. It’s the one who talks down to people. It’s the one who won’t realize that the hospital isn’t quite home for a sick kid, and won’t go beyond the scope of their job description to make that better. It’s the worker who operates off of a checklist instead of a heartbeat. It’s the one who sees a parent as “pushy” or “snappy” without realizing that we…are…suffering. Once you realize that and try to put yourself in our shoes, it will drastically change the way healthcare is delivered. Because human connection and empathy are a powerful way to help heal. I know you didn’t get into healthcare for checklists, productivity reports, and to spend half the day scouring the building for the last working med pump. When you empathize and see suffering for what it is, you will reconnect with the reason you got into this business.
What about those who walk back out the doors and re-enter their lives? To friends and family: you play a crucial part in alleviating suffering, too! Please realize that while the surgery was a success, and the prognosis is good, we’re going back into a world that’s forever changed. There might be medications to give, multiple appointments, tube feeds, endless stops at the pharmacy, loss of work, increase in stress, and a new schedule that basically says we can’t hang out like we used to. We want nothing more than to go back to that, but this is our new reality. And it’s really, really hard sometimes. And we need you. Don’t stop inviting us to stuff: one day we’ll surprise you and say yes. Don’t stop asking how you can help, even if you don’t know what you’re doing. Realize that while we might wear a smile, it’s not always that way in our minds. We’re always going to worry about the future, that’s just how it is. So text your friend, send a card, cook them a meal…just let them know they’re loved. And try to understand what it would be like for you if the rug was suddenly pulled out from under you and you’re left to put it back together. And I also can’t let this paragraph end without saying that unfortunately there are people who walk through The Door empty-handed forever. I cannot imagine the pain these families face. Please be there with love and patience and kindness. If it was you, you’d want the same.
The Door is a place of great heaviness, but there are things we can all do for those who are currently standing at The Door. If we realize they have fears and are suffering, we can surely do things – through compassion and empathy – to give them the power of hope and joy. They can walk into the hospital knowing they’ll be treated like family. And they’ll walk out knowing they are truly loved.
So this was new territory for us…the Rehab unit. While Nolan’s weakness was unexpected for us, we are always willing to do whatever it took to make him better. So to the 4th floor we went. We met with Dr. Tsai, who was over that unit and he was a very kind, compassionate guy…we really liked him. For some weird reason we technically had to be discharged from the hospital and re-admitted to the Rehab floor, even though we never once left the hospital. But oh well.
One thing became clear right away: we were outside the friendly confines of our usual CVICU and Progressive Care units, where caring for kids with CHDs is right in their wheelhouse. Here? Not so much, but that’s not a bad thing. We just had to do a lot of explaining and re-explaining, and – of course – resetting the blasted pulse ox machine so it wasn’t beeping every 45 seconds. A slew of therapists came through to do initial evals on Nolan and we learned that everyday except Sunday he would have up to 3 hours of therapy a day and they would come in every afternoon to post the next day’s schedule on a calendar in our room, which was pretty cool. It would have the therapy, the therapist’s name, their picture, and length of time. They even scheduled nap/rest times. I actually liked knowing who was coming and when, as opposed to other floors when people just show up (you know how that is…come on, people). Otherwise the staff worked pretty well with us as they got used to Nolan and let us kinda control how often they’d come in and bug him and even let us give most of the meds if we were able. That really ensured a more restful night…for him, not for us: we slept on an awful, skin-eating vinyl couch, but whatever.
On Nolan’s second day they jumped right into things like helping him stand and use his arms for play:
It was a rough go at first: he was still very weak and still on oxygen so things were slow-moving and he got tired easily. But this is Nolan we’re talking about, so he’s a trooper! We enjoyed walks around the hospital in his wagon and even fun time in his room…one of his favorites was playing Bingo:
The combo of letters and numbers was right up his alley. We’d use the TV in the room to tune into the radio station in the lobby and he would call and say “BINGO!” whenever he’d make a line. Then two of the interns would come up dressed like Disney characters and bring him a prize. He LOVED it.
So on and on it went: Nolan continued to work really hard and began making some good progress. He even got some visits from the therapy dogs:
We got to meet some families there in that unit who had been there for some time and would be there for some time. Their kids were going through some real difficulties and my heart went out to them. We knew Nolan would regain his strength and for that I’m thankful. Nolan started getting more energy (and got pushier and bossier, as is his custom) and eventually we got to this point:
That is a post-Fontan, little beast, completely walking on his own with NO oxygen! YEAAAAAAAAAH BOY!
So the next step, then, was to get the heck outta this place and get back home! WOOHOO! And then finally…33 days after we went in for the Fontan…Super Nolan walked back through those hospital doors and we made our way back home, where we can focus on an amazing future for this little nugget:
After a long, exhausting day of waiting for Nolan’s surgery to be done, we were ready to begin to road to recovery. As I’m sure you know, all heart kids are different, so recovery times can vary…but we were hoping for something like 2 weeks, 3 tops. They managed to extubate Nolan late that same night and then they continued to work on stabilizing his blood pressure and managing his pain. You could tell he was in some discomfort because his brow would furrow from time to time.
Eventually he settled down a little and even asked for some water and agreed to watch an ABC video (he is obsessed with he alphabet). It seemed like he was showing some definite signs of himself.
Still, he did just go through a major surgery, so he was pretty agitated and restless. He would try to toss and turn, I’m sure it was an effort to be more comfortable since he likes to sleep on his side. He even almost rolled completely over at one point, it was like trying to hold down an angry eel. But we settled him down. His belly was distended so we held off on feeds for the time being and we just let his awesome medical team work their magic. According to the physicians over the next several days, the Fontan looked like it was working properly and the fenestration was doing what it should. If anything they wanted to keep an eye on some narrowing in his pulmonary artery, which they already ballooned once during his cath earlier this year.
Nolan continued to be restless and fussy and it was really difficult to keep him calm. He was draining quite a bit from his chest tubes, which is good, and the plan was to get his belly to calm down and to get him up and moving to help with the drainage. Eventually we got one chest tube out while the other continued to drain. Every day they came to do an x-ray to see how his chest was doing and eventually they had to put in another chest tube. I wasn’t thrilled about that, since those are obviously uncomfortable for him, but if it’s one step closer to home it needed to be done.
The biggest concern was around Father’s Day, where I noticed considerable weakness in Nolan’s arms. In fact, he didn’t really move them. I brought this up to his medical team, and the next day, and the next day, before someone finally looked into it. That was extremely frustrating because, you know, you want to be heard as a parent. But with his nurse’s help, we were able to advocate for a closer look. They some neuro checkups and a couple EEGs to rule out any neurological problems, and determined that some big-time therapy would get that function back.
Eventually we got Nolan’s agitation under control and got him moved from the CVICU to the Progressive Unit. While up there he was able to get out of the bed and ride around in the wagon and even got some visits from the therapy dogs. We began some in-room therapy with him and he was happy to realize that those two little legs still worked great and were getting stronger. We got feeds re-started on him and eventually both chest tubes came out and those daily x-rays looked clearer and clearer.
Now normally we would be discharged from the Progressive Unit and head home, but since Nolan was still very weak, we had to be transferred to the Rehab Unit. This would be a whole new experience for us…
Early in the morning of June 16th, we woke up Nolan to make the 35-minute drive to Levine Children’s Hospital for his third open-heart surgery, the Fontan Procedure. I think it took everything within me to get out of bed and just get through the process of loading into the van. We dressed Nolan in his Super Nolan cape (courtesy of Heart Heroes – THANK YOU!) and mask and he felt super special. Because, well, he is!
As you can imagine I was a rollercoaster of emotion: basically I kept going back and forth between scared to death and completely confident and calm. I wasn’t as terrified as I was before his Norwood, and I wasn’t as calm as I was before his Glenn. It was somewhere in the middle. I’m sure it had something to do with the length of time between surgeries. Anyways, we made it to the hospital just fine: we parked and took Super Nolan inside and he walked around like he owned the joint. He definitely loves some attention.
The team checked us in, validated our parking, and escorted us to the pre-op area, where we would go through the familiar – but not comfortable – process of speaking with the surgical team, the anesthesia team, and nursing team. We watched TV with Nolan, gave him lots of hugs, and walked around with him looking at all the room numbers. I really, really didn’t want to let him go…and that became stronger as each second ticked by on the clock. Finally, Nolan got his loopy meds and the team came to take him back. They went one way and we went the other way, and I felt a total wreck…probably the biggest mess I’ve been in a long, long time. Now it was just time to wait in the waiting room…and wait, and wait, and wait. We knew that a long wait didn’t necessarily mean the surgery was going poorly, but mostly likely meant he had a lot of scar tissue to work through. Regardless, we received regular updates and I just did my best to occupy the time.
Finally we got the call we had been waiting for: Nolan’s surgery was done and successful. After a lengthy wait, we got up to see him – it’s hard to see him intubated and on all those med pumps again:
But I was so happy to see some good sat numbers and just to hold his little hand and tell him we were there for him. Next step? Get outta here.
Hi Friends! Guess who’s back! I’m sure some of you were wondering when on earth I’d be updating the blog. I wanted to let you know that Nolan had his Fontan procedure and after 33 days we got to go home in mid-July. I decided to use that time for all of us to get back into the swing of things. Now that school has started back up and life is chugging along again, I’ve decided to fire up the blog again and let you know how Nolan’s surgery went. Over the next several posts I’ll be telling the story of Nolan’s Fontan procedure and recovery, so stay tuned!
Before I do that, though, I really wanted to thank all my readers for visiting Nolan’s facebook page and leaving kind comments and sending supportive messages there and on this blog. It really meant a lot to have your support behind us, it really made a difference! “Thank you” doesn’t seem like enough, and if I could thank you all in person, I so would. I’m grateful to be part of this supportive community.
Well everyone, it’s finally Fontan time. Earlier today we took Nolan for his scheduled pre-op appointment. We dressed him in his own green surgical scrubs and doctor kit and he was looking majorly adorable:
As you can imagine, Nolan doesn’t do the best with doctor’s appointments anymore. I mean he’s super happy to go to the office and super happy to see everyone, but the minute they slap a blood pressure cuff on him, he is DONE. And an EKG? Forget it. So we tried to talk up the appointment as much as possible: I had him squeeze my arm like a bp cuff, packed stickers that he can put on me while getting his EKG stickers put on. Even our oldest son came along to help and be a good big brother.
The staff at Levine Children’s Hospital- as always – was awesome. They decided not to do the EKG until surgery day when he got his versed and was calm. So they let him play, did a nose swab for MRSA, and had us sign a bunch of papers. I went with him for his chest x-Ray and he did awesome. He didn’t fuss and thought it was fun. Then came time for the biggie: blood work. We sang the ABCs over and over again and the phlebotomist got it on the first shot! And Nolan didn’t cry or fuss once! That lady was a total boss!
So tomorrow, June 16th we’ll get to the hospital at 7am for Nolan’s scheduled Fontan procedure. We’re as ready as we’ll ever be. We appreciate all the thoughts and prayers: thanks so much to all of you for your emails and comments. They’re always much loved!
If you want to keep up on Nolan’s updates over the next several days, please like and follow his Facebook page: http://www.facebook.com/SupportTeamNolan
So as you know from reading this blog, Nolan was scheduled for his Fontan Procedure on Monday, June 6th. Weeeell…so much for that. Turns out Nolan had a small (thank God) bout of the poops which gave him a bit of diaper rash. And that, my friends, led to the next installment of “let’s postpone the Fontan.” When I got the official cancellation, at first I was like:
So it goes. It’s alright though: the nursing team said that even a diaper rash can cause dangerous issues if they need to put a line anywhere near his groin area. They said it’s a risk they never take. And I can definitely appreciate that.
The hard part is the lead-up to the surgery and all the preparation, only to hit the brakes. Now we have a little time: Nolan’s new surgery date – God willing – is Thursday, June 16th. Until then we can hope he stays healthy!