As late as half an hour before Annika was wheeled into the O.R. today, her surgeon was debating with himself whether or not it was a good idea. It's fascinating to watch the back-and-forth thought process of someone as high-powered as Dr. Superina, although also, as a parent, a bit disconcerting. The fact of the matter was that she did not look like someone who was suffering from a massive abdominal infection. She had spent the morning dressing and undressing her tiny Ariel doll in her many strange little rubber outfits, and discussing the various shapes of cookies she would eat "when her tummy was fixed." But the results from interventional radiology yesterday had them worried that perhaps they were missing a large infection that could turn very dangerous.
Then there was also the fact that the results from the lab had come back, and the version of E. coli that had been cultured from her abdomen was susceptible to pretty much any kind of antibiotic. In fact, this bug was so weak that even a mean look from a lab worker could kill it off. While it's good news that she didn't have some sort of super-bug, it was worrying that the high-powered antibiotics that she had already been on for a week hadn't cleared the infection. This most likely meant that the infection was located someplace that the antibiotics just weren't reaching.
But on the other hand, Dr. Superina wasn't looking forward to going back into her abdominal booby-trap
and working his way through all those newly-formed adhesions
without knowing for sure that such a drastic measure was called for. Finally he just threw up his hands and said, "OK. Let's take her back."
Annika engaged in her usual procrastination tricks to delay having to leave her room, but overall she took the news relatively well as we explained to her what the doctors had to do. They wheeled her off to the O.R. after I leaned down and sang "Twinkle, Twinkle Little Star" softly into her ear, which is our new way for me to "put my voice inside her head" in case she gets scared. Clutched in her left hand was her new lucky stone, a smooth resin-encased organ donation ribbon that she got in a package from Riley and Shelby
. The doctors told her that they would put it in a bag that they would keep by her head throughout the surgery.
A little over an hour later, we saw her PICU nurse running by, stopping just long enough to report, "She has a huge abscess and will need to stay intubated." Annika was rolled out of the O.R. 10 minutes later, and we had a chance to talk to Dr. Superina. Again, we saw that look on his face that said he just couldn't believe how difficult our little girl can be.
She did indeed have a very large abscess in her abdomen, and they also discovered that her bowel was perforated. Because of the massive infection, they were unable to close her abdomen back up again. And the hole in the bowel will likely be very difficult to close. They are planning on taking her back to surgery on Monday to change the packing in her abdomen and to check whether or not the suturing of the bowel has held or not. If all goes well, they might be able to start the very slow process of closing her back up again in a week, but it's going to take a long time to accomplish.
Meanwhile she will need to stay on the ventilator and be paralyzed for her protection.
Since she is going to have an open abdomen for a while, Jörg is going to take Frankie and my parents back home tomorrow. We'll need to be careful about minimizing her exposure to germs until she can be closed up. And it's not like she's going to be up for a lot of company for a while, anyway. I'm awfully glad that we took Frankie and my mom back for a visit with her before they took her back this afternoon.