The Next 15 Hours

All through the night, nurses and doctors were rushing in and out of Abigail’s room in the picu. Time flew by, but each moment took forever. A blur of faces came and went, as many doctors came to talk to us… the picu pediatric doctor, the GI on call, and a few surgeons.

Through it all, Candice was our nurse and was amazing. She was yelling out orders to all of the other nurses, taking orders from multiple doctors, and doing the hands-on stuff to keep Abi alive.

There were doctors standing outside of Abigail’s room in groups discussing what their next step would be. They drew blood cultures from the central line in Abigail’s neck. They took a urine culture from the catheter. They were giving Abigail all types of blood products… plasma, platelets, red blood cells, and cyro (I think its called..?)… 18 units of blood product total through the night. They brought Abigail to get a ct scan of her abdomen. It showed blood throughout her GI tract, but not the source of blood. The pediatric GI doctor tried to do an endoscopy and go into Abigail’s stomach to find the source of bleeding. She found Abigail’s stomach packed full of blood. The surgeon came in and started suctioning out blood from Abigail’s feeding tube hole, instead of just letting it drain. A massive blood clot had formed and plugged the draining tubes. The doctor pumped a suctioning device up and down through the feeding tube hole… pushed water in and suctioned blood out. Blood started going everywhere… at one point it squirted up several inches and splattered the doctors and nurses! The doctor put a huge blood clot in the sink after it came out of Abi, and the sink got plugged! A plumber had to come in and plunge the sink drain! It was total chaos!

The head surgeon came to talk to us, said it was starting to look like the only option was to cut Abigail’s abdomen wide open, clean out the blood and find the source of the hemorrhaging. He said he was holding out on surgery as long as possible because Abigail was likely to die during surgery, since she was so unstable! The picu doctor (who had just come on shift and taken over an hour before) came to talk to us. She said that they needed to stop the hemorrhage within the next 3 hours or she expected Abigail to die. It was 8:30am by then.

The head surgeon then looked at the ct scan again, along with an adult GI doctor… and after careful examination, they determined where the blood was coming from!! They came and talked to us and said that they knew the blood was coming from an artery in the upper GI, near the esophagus.

The adult GI doctor was going to do another endoscopy and put two tiny metal clamps on the artery to stop the bleeding. First, they had to place a second central line, since they had lost a few IVs and needed another place for blood products. So they placed one in Abigail’s groin area. Then they started the endoscopy procedure. They had us step out into the hallway, but we were able to watch the entire thing. There were two GI doctors, two surgeons, 4 nurses, and the picu doctor all in Abigail’s room. They had tools going down Abigail’s mouth, nose, and feeding tube hole… some were sucking the blood out, some were putting water in, and some were being used to place the clamps. And it was broadcasted on a monitor for us to see. It took a good 20+ minutes, but the GI doctor finally got the clamps in place at approximately 10:30am! A collective sigh of relief went through the room and spilled out into the hallway where us and others were watching. You could see everyone start to breathe again. Immediately Abigail’s vitals improved! The adult GI doctor and head surgeon came out to talk to us and we could’ve hugged them… there were teary eyes all around. After clamping the artery, they pumped out an additional 1.5 liters of blood from her stomach and her intestines were still packed full of blood.

Candice, who had been there since 7pm the night before, was still there and we were able to thank her for fighting so hard for our girl all night. (She ended up being our nurse on nights 3 & 4… and called in the middle of night 2 (Saturday) just to check on Abigail because she had woke up worried about her! We loved her for how much she cared about Abigail!)

Throughout it all, they let us stay at Abigail’s side… we think it is because she was barely “hanging by a thread” as the nurses said many times. Once the artery was clamped, the nurses insisted we go eat downstairs while they cleaned up Abigail and the room. While we were eating, my step mom Sue arrived after driving a few hours to get there.

And so though the initial threat to Abigail’s life seemed to be resolved, little did we know that there was still some threats to come. 🙁

They told us that what Abigail had was a very rare condition called “Dieulafoy’s lesion”.
From Wikipedia:
“Dieulafoy’s lesion (exulceratio simplex Dieulafoy) is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage but is relatively uncommon. It is thought to cause less than 5% of all gastrointestinal bleeds in adults. It was named after French surgeon Paul Georges Dieulafoy, who described this condition in his paper “Exulceratio simplex: Leçons 1-3” in 1898. It is also called “caliber-persistent artery” or “aneurysm” of gastric vessels. However, unlike most other aneurysms these are thought to be developmental malformations rather than degenerative changes.”

(Part 1)