Oh What a Night

Deuteronomy 31:6   Be strong and courageous. Do not be afraid or terrified, for the Lord your God goes with you; he will never leave you nor forsake you.

Ruby had another low fever around dinner time last night, which the nurse was pretty confident would prove to be 'the one', but then it started to drop before bed. (*'The one' fever we are looking for is one that almost always occurs when Ruby's post-chemo levels are at their lowest - right now - because it is the proverbial 'hump' we have to get over before recovering and being released.) Ruby went to bed around 8:30, but was very restless in her sleep, moving around a bunch in her crib.

Around 10PM, the nurse came in to hook Ruby up to her fluids. We usually do that at bedtime, but they opted to wait last night (maybe waiting for the fever?). So that took some help from me; usually Ruby would sleep right through that, but the restlessness made her easily roused. I had to hold her to get her back to sleep, and then her IV alarm kept going off (I never really figured out why...the nurse fixed it each time).

At the midnight rounds, when I was just settling into bed, Ruby's fever was up high enough that they drew cultures and ordered antibiotics. This woke Ruby again because we also had to give her oral Tylenol. (Just what Ruby loves, especially in the middle of a night with no sleep.) I just held her through all of that until we got the first type of antibiotic in her (Zosyn).

Towards the end of that dose through her IV, I put her back in her bed and went to bed myself. A few minutes later the nurse came in because Ruby's IV alarm was going off signaling the Zosyn was finished. That meant it was time to start the next antibiotic (Vancomycin). I heard the nurse in here for quite a while getting it hooked up, but I eventually dozed off. Then I heard Ruby stand up in her crib and rattle around. I turned to her and told her it was ok and to go back to sleep. She got up and down a few more times and then whimpered. When I got up to hold her, I could smell that she needed a diaper change. I got the supplies and turned the light on just a little so I could see what I was doing. As I was changing her, Ruby was rubbing her face a bunch, as she typically would when woken up from sleep. But her face was all puffed up. As soon as I got the clean diaper on her I paged the nurse and the fun began.

Ruby's nurse called a few other nurses as soon as she saw Ruby. The Vancomycin was stopped immediately and Benadryl was started. Nurses were in and out as they checked the computer and made a call and checked Ruby again and again. They took her blood pressure, pulse ox, and listened to her chest about 100 times. Finally satisfied after her breathing sounded better, only our nurse remained. She had called the doctor and was going to hold off on the antibiotics until further notice. Ruby and I finally got some sleep around 4:30AM. 7AM brought more Tylenol for the fever that had gone back up, and 8:30AM was officially morning.

Ruby didn't want to eat or drink much of anything this morning, but by lunch she ate and drank a little. She was very moody this morning, but that could be the lack of sleep as much as it could be the fever or the reaction. During rounds we discussed where we go from here. The Vancomycin is preferred as it takes care of a large variety of infections. However, Ruby's reaction was severe and not typical. So, for now, she will receive antibiotics every 8 hours (until the fever goes away), and it will only be the Zosyn (doesn't cover as broad of a spectrum). I asked what our plan of attack was for the next round of chemo, as she will need to be protected from that large variety of infection as the chemo progresses. The doc on call assured me there were other options, but Zosyn is our plan for now.

Scary to think how labored Ruby's breathing was, scary to think that I would have slept through it had she not filled her diaper at that moment, scary to think a medicine that should show a side affect that severe quickly would wait until after the nurse watched and waited (20 minutes) to react. But it was not scary in that moment...God kept Mama Bear calm and awake enough to help, and He kept Ruby strong and healthy enough to withstand the craziness of the night.