Our night in the PACU

Sorry for the infrequent updates recently. As some of you know, Ruby had to have a minor surgery about two and a half weeks ago. When Ruby was first born, the delivery room doctors told us that she had a small redish bump on her bottom next to her tailbone, about 1 cm by 0.5 cm large. They said that they would have the pediatric team look at it while we were in post-partum and let us know exactly what it was. At that point I was so relieved to have pushed the baby out and to see that she was healthy and adorable that I didn't think much of her mysterious butt blemish.

The following day, the attending pediatrician and her team of residents and medical students stopped by our room and took turns examining Ruby's bottom. As the identity of the blemish could not be determined, they requested consults from dermatology and general surgery. Over the next day, more teams of doctors came to examine and take pictures of Ruby's bottom. The whole thing really reminded me of the episode of Friends where Ross has an unidentifiable growth on his butt, and he ends up in an exam room full of doctors all staring at his butt in wonderment.

Despite the many teams of specialists and an x-ray and ultrasound, no one could be sure what Ruby had on her bottom, so they recommended that we come back for a MRI in 2 weeks. Again, at the time I was just so happy to be discharged and to be bringing Ruby home that I didn't think that much about the thing on her bottom, especially since it didn't seem to bother her at all even when poked at.

It wasn't until I realized that the MRI would have to be done under general anesthesia that I got a bit freaked out. Although I was reassured by the pediatric surgery nurse that the procedure was very routine and safe, it was hard to accept that our perfect, otherwise healthy little baby had to be pumped full of drugs and hooked up to monitors. Due to the anesthesia, Ruby was also not allowed to have breastmilk for 6 hours before the procedure. Fortunately, at that age she was still so sleepy that she never woke up on her own wanting to eat, so she slept through everything, even when they were prepping her for the anesthesia.

The following day we went into the pediatric surgery clinic to speak with the doctor. We were told that the thing on Ruby's bottom was something called a sacrococcygeal teratoma. Although quite rare (occurring about 1 in every 50,000 births), it is the most common type of tumor found on newborns. And although they are almost always benign, it would need to be removed to prevent it from growing further and possibly becoming malignant. In most cases this type of diagnosis is made in utero because the size of tumor can be larger than the size of the baby (google at your own risk). Compared to this, Ruby's was obviously a very mild case, and we were very fortunate to have delivered at UCSF where this kind of thing was recognized and properly diagnosed.

We scheduled the surgery for when Ruby was 4 weeks old. Once again we were not allowed to feed her after midnight the night before the surgery. By that age she was already waking up on her own about every 3 hours to eat, so I took great effort to rock and bounce her so that she wouldn't wake up and be hungry, mostly because I don't think I could have held it together if she had started crying. The surgery only lasted about an hour, just barely enough time for me to go home, pump, and walk back up to the hospital. It was very successful, and we were called in afterwards to see her in the recovery room.

I think that the experience of going through the MRI prepared us a great deal for the actual surgery, and it was not as great of a shock to see her hooked up to so many monitors and IVs. For the most part Ruby seemed unphased by what had just happened to her, and after monitoring her for a little bit, we were moved to the Pediatric Acute Care Unit where we would spend one night.

Although the decor and layout of the PACU are pretty much the same as post-partum, the accomodations were far less comfortable. All the rooms were shared with at least one other patient, and setup only allowed for one parent to spend the night with their child. We ended up being moved twice into 3 different rooms. The first room we were brought to was shared with a crazy woman and her daughter, who from what I gathered was quite sick. As we were brought into the room, she was screaming and cursing at someone on the phone. I guess a social worker was in the room with them, and she was quietly pleading with the woman to step outside so that her daughter wouldn't have to listen to this as she was only 5 years old. The woman refused and accused the social worker of being part of the conspiracy to separate her from her child. Fortunately, the nurses took pity on us and moved us into a different room.

We shared the second room with another infant and her mother. The mother seemed quite familiar with the surroundings as her 5 month old baby had already had 5 surgeries at UCSF. We would have been happy to stay in that room, but they needed to vacate it in order to accomodate a patient who due to his condition required a private room, so we moved in the middle of the night to a third room. This time we were brought to a 3-patient room, which we shared with a little Spanish-speaking girl who had fallen and hit her head and a quiet teenager who also seemed like no stranger to the hospital.

Ruby mostly slept while we were in the hospital, and I tried to hold her very carefully as to not put pressure on her incision or disturb her IV. She was given infant Tylenol and Motrin every 6 hours, and for the most part she didn't show that many signs of being uncomfortable while we were still in the hospital. As usual, she was a big hit with the staff due to unparalleled cuteness.

There are several things I took away from our experience in the PACU. First is how fortunate we are to have an overall healthy baby, who hopefully will not have to spend another night in the hospital until she has her own baby. Second, on a purely introspective note, I feel like after having spent a night in the hospital with my child after surgery, that I am now officially An Adult. I had always wondered when that transition from being a kid to being a grown up would occur and how I would be able to tell that it had. Sometime in the midst of getting up at 3am to comfort the baby as the nurse was taking her vitals and then staying up to pump, I realized that I'm not just a kid anymore.

Probably the toughest part of the surgery has been the recovery process. Due to the nature of the incision, it is very difficult to keep clean, since it's right where the poop comes out. It has really turned changing a poopy diaper into a far greater ordeal than it already was. However, probably the toughest on us has been that Ruby got a lot fussier after the surgery. She went from hardly ever crying to crying urgently and inconsolably anytime she was slightly shifted or moved. We could tell that this was due to soreness/discomfort around her tailbone, and it was really hard to not be able to do much to make her feel better. Fortunately, in the past week or so, she has gotten a lot better. Her incision, part of which had opened up during the first week (pretty gross :-\ ), has almost completely healed, and she no longer seems to be bothered by shifting positions. She is finally back to being a happy, mellow, coo-ing, giggly baby!