Shunt hit the fan

Back at the hospital. Thomas is in surgery to repair a shunt malfunction. We came back in because his stridor had gotten worse. We went to the ER and it became what was the most terrifying few minutes of my life. We checked into the ER and they took us back to triage. The nurse was asking me the basic questions about Thomas while she was hooking him up to the monitors and then an alarm went off for his oxygen levels and she told me to get my stuff and she called for the emergency response team as we were hustled into another room. I spoke of the emergency response team in one of our NICU posts. It is crazy. 30 people came swarming from out of nowhere and started hooking up wires to him and manipulating him, feeling his lungs and throat. One doctor was yelling instructions and another asked if I was mom and told me to sign this paper. They grabbed a breathing thing-a-majig (scientific name) and it looked like steam was coming from it. They held it over his mouth. All while he is screaming and I can barely get glances of him between shoulders that are surrounding his bed. I hear someone explaining to me that his saturation level was 90 (out of 100) and they were giving him some medicine to relax the airway to see if that would help. A voice is still asking me questions...does he have normal temp? How much does he weigh? How long has he had the stridor? Does he have Chiari? They are finally satisfied with how he is doing and he is stable enough to get a chest and airway x-Ray. So we are whisked off to the X-Ray room. Accompanied by an MD and still hooked up to a machine because he could de-sat again. Once the films are done we are put in an ER room and this is the first chance I have had to sit and believe what just happened....this is serious. But before I can even call John and fill him in, a neurosurgeon comes in and starts asking questions. Has Thomas' temperament changed? Are his eyes sunsetting? Has head circ changed? No, nothing is out of the ordinary as far as his temperament. He starts looking at Thomas and examining him. Everything looks normal, but he doesn't flinch when the neuro puts a hand to his eyes....how have I not noticed this? I knew he wasn't focusing on us yet, but we expected that to be delayed, but I hadn't noticed the no flinch. You could tell that it struck the surgeon, he kept going back to it and trying again and my thoughts raced....he should be flinching....does he flinch at home....it's too bright in here....does that matter....should I have noticed this....has damage been occurring inside his brain that I could have prevented....then an ENT comes in. She scopes him and sees what we already knew:partial paralysis of the vocal cords. She doesn't know what is causing it but wants to keep him overnight for observation if he is cleared by neuro. We just did that, it's called a sleep study, why do I need to stay again?

Next thing I know we are off to get pictures of the shunt taken. Now Thomas is hungry and not shy to let us know. Now he's inconsolable...but I can't feed him just in case it's a shunt failure and he needs to go to surgery. After the shunt pics are taken we are back in our own room. And now he's really mad at me for not feeding him and there is no doctor in sight. LOOK AT THE FILMS!!! Everything is fine, just like last time...let me feed him. Well turns out I am the worst mom ever. Everything is not fine. His vents have increased and we need to do surgery tonight. Shunt repair surgery is pretty straightforward and they do it often here, but another brain surgery on a 3 month old is not ideal. Plus he has some croup that showed up on the x-Ray, so when they put the breathing tube in for surgery, they most likely won't be able to take it out in the OR. Which means they have to keep him sedated until the inflammation goes down. This could take days.....just hope for the best. He is in surgery now, will know more in two hours or so! They think it was the proximal catheter of his shunt that came out of place and that is causing the malfunction. It isn't completely in the ventrical and not draining effectively. If it is truly that simple that will be great!