On Death's Door

Sunday Morning, February 5th

I got to tell Elle I love her. I had the satisfaction of seeing that she knew I was there and that I knew what had happened. I got to reassure her that we were doing everything we could to help her. I got to see in her eyes that she was not registering any pain or any fear.

On that note, friends and grandparents leave for home.

With the trauma she suffered, the worst is yet to come as her body deals with the physical responses of her crush injury in shock. She requires large amounts of fluid to keep her blood pressure sufficient to sustain her life, but the fluid volumes cause swelling in her lungs and intestines. Within a few hours, her abdomen swells and gets rigid, which requires emergency surgery.

Her oxygen levels are dangerously low. At about 3:00 a.m., the trauma surgeon cuts her open from the top to the bottom of her belly to allow the swelling organs more space to swell without crowding the lungs and heart. He and the ICU doctor are also able to look around internally and assess the damage to her other organs. What they had anticipated would be a 1–2 hour surgery requires only 30 minutes. The news is good. Cutting her belly open revealed incredible swelling but solved the immediate oxygen and respiration deficit, and the damage to her liver and spleen is not as extensive as they had thought. Rob and I smile through tears and are so relieved. Her intestines and liver sit outside of her body in a clear plastic dressing. 

Not long afterward, her oxygen levels dive again. The swelling continues to increase and crowds her lungs and heart once again. They open up Elle's dressing to create more room and stitch the bag to her muscle walls instead of taping it to her skin. Her oxygen levels aren't recovering well, so the doctors tell us we need to put her on life support, called VV ECMO.

ECMO is a heart/lung machine, and it is the highest level of life support a child can receive. The machinery pulls all of the blood out of her body, oxygenates it, then puts it back in. The blood must be thinned with heparin in this process, which causes significant risk of bleeding out through her damaged organs, but in her state she will die without it. ECMO also comes with 10% risk of brain bleeds and stroke, with a stroke being more common for someone Elle's age. The doctors hook her up to ECMO respiratory bypass successfully, which solves her oxygen problem, but suddenly her blood pressure is plummeting.

And then she codes.

One of the nurses jumps on top of the bed, straddles her and begins CPR as others scramble for the crash cart and adrenalin injections for her heart. Rob stands holding me as I shake and sob hysterically into his chest. After three minutes, Elle's heart rebounds with the adrenalin shots, but she has persistently poor cardiorespiratory function, and the doctor tells us he can only do one more thing for her.

The ECMO machine can both pull and push blood in the body. Currently, it is only pulling blood (VV ECMO). He cannulates her for the push function, VA ECMO, but her blood pressure remains critically low.

At this point, the trauma surgeon and the ICU doctor with tears in his eyes sit down with us and tell us there is nothing more they can do. Elle's body is cycling in shock, and they don't think she is able to cycle out of it, which is fatal. It is about 5:30 a.m. We ask if we should call our kids to come to the hospital to say good-bye. "Yes."

Words can't describe the grief and horror of those hours. Her death was to be a reality.
An impossible reality.