After Mighty Z had her loop recorder
placed on her heart I felt relieved, relieved to know that if Mighty Z’s heart
was pausing, now we would catch it. The first month that we downloaded her loop
recorder through the telephone lines, I received a wonderful call from the EP (electrophysiology)
nurse saying Mighty Z’s heart showed no signs of pausing (whew). The same with
the next month when I downloaded Mighty Z’s loop recorderand I felt like we
were on a roll, until Mighty Z came and told me she had had another episode.
I know what you’re
thinking. Why wasn’t I there when this episode happened and what is an “episode?.”Sometimes, not all the time,
Mighty Z will faint -- it is very random and you have no idea when it is going
to happen or what triggers it. Since Mighty Z is twelve, she hates when I
follow her around like a lost puppy and, let’s face it, it gets annoying for
both Mighty Z and myself. So, I let her
walk around without me tagging along after each step. Mighty Z told me this
“episode” was not a bad one, it was just a little episode. However, being who I
am, I quickly downloaded Mighty Z’s loop recorder and waited once again for the
EP nurse to call. Waves of dread came over me because I knew Mighty Z’s heart
had paused, and I knew that it meant she would have to have a cardiac pacer
implanted. This was confirmed when the EP nurse called and said that Mighty Z’s
heart had paused for 4 seconds and then again for 5 seconds. Knowing what I
know, that was almost double the legal limit for a heart to pause, so I waited
to have confirmation from her cardiologist. Within minutes Mighty Z’s cardiologist
called and told me the heart-breaking news, that yes indeed, Mighty Z would
need a cardiac pacemaker implanted.
I always knew that it
wasn’t IF
Mighty Z would get the cardiac pacemaker, but that it was WHEN. When would
Mighty Z’s heart stop? And would I be able to catch it in time to save her
life? I will confess, I put on a brave face, called Mighty Z’s daddy, and both grandma’s
and calmly told them that Mighty Z’s heart was pausing and that she would need
to have a cardiac pacer implanted. My voice was strong with no waver to it as I
called each person to relay the news. It wasn’t until that night when the tears
started coming and the fear and anxiety started to wash over me. I first got
mad at myself, because you see, I knew Mighty Z’s heart was pausing and I kept
pushing the cardiologist to listen to me. As I lay in bed and cried, I felt
like I had gone on a witch hunt looking for Mighty Z’s heart to pause and I
finally found a witch. Yes, I know completely irrational, however Mighty Z was
going to have to endure so much more and I wanted to spare her this, even
though I knew this was so important.
The cardiac pacemaker surgery was set for the next Monday and I
was ok until the Saturday and Sunday before. I had to breathe through those
waves of fear and anxiety as they attacked me over and over again.
When Monday morning came, I bravely packed Mighty Z and my bags
and headed up to Children’s Medical Center of Dallas Texas to be admitted. Once
through admitting, we were brought back for pre-op, and Mighty Z was given what
I always call a cocktail (a mixture of 2 vials of Versed and 4 vials of Lortab,
in what looks like a shot glass). With Mighty Z already on her breathing pacemakers,
I felt confident that she would be fine, however once she fell asleep, she
needed to be bagged (an
ambu bag is a hand-held device frequently used by trained professionals as an
essential part of resuscitation to provide positive pressure oxygen to a
patient whose breathing is insufficient, or has ceased completely. The act of
using the device is frequently referred to as bagging. The ambu bag has a long
tube that connects directly to an oxygen outlet or tank to force 100% oxygen
into a patient’s lungs). For a couple of breathes the EP Nurse and I worked on Mighty Z and
then Mighty Z was able to breathe with the breathing pacers , with just a bit
of oxygen to help her. Even though that
was a bit scary, I still felt comfortable with the cardiac surgery. The surgery
lasted for about three hours and the EP surgeon came out and told us that
Mighty Z did great and that we could see her in recovery. When her daddy and I
got to recovery, Mighty Z was responsive, yet groggy. Her oxygen levels were
great without the need to supply extra oxygen.
The only issue was that Mighty Z’s blood pressure was going crazy -- at
some points it was reaching 160/102 and then dropping to 74/50 (normal blood
pressure is below 120/80). Mighty Z’s heart rate was spiking to 180 and then
dropping to 50 and each time it dropped to 50 we could see on the monitor
Mighty Z’s shiny new cardiac pacemaker go off. The cardiac pacemaker went off a
total of nine times just in the first hour after her surgery. 
Then things started unraveling quickly…Mighty Z started needing
oxygen -- not just a little bit -- we are talking 5 liters of oxygen and then
Mighty Z’s daddy noticed that her breathing pacers were not breathing for her
like they were designed. Quickly her daddy and I began to work on Mighty Z. We
changed the antennas to her breathing pacers, then we repositioned them, and
then we realized Mighty Z was not breathing at all. I called the PACU (post
anesthesia care unit) nurse and told her Mighty Z was not breathing. Quick as a flash, the PACU nurse started
bagging Mighty Z as I hyper extended Mighty Z’s neck and held the mask securely
to her face. The PACU nurse then called the attending in the PACU, saying that
Mighty Z was unresponsive and not breathing at all. The attending came over and
started bagging Mighty Z and had the PACU nurse call the CICU (Cardiac
Intensive Care Unit) doctor and have him come down STAT!! The CICU doctor came
down and bagged Mighty Z for 30 minutes and then magically her breathing pacers
started breathing once again for Mighty Z, however Mighty Z was still
unresponsive. The CICU doctor gave her six shots of Narcan (a narcotic
reversal) as the CICU nurses pinched and prodded Mighty Z’s little body to get
some sort of reaction out of her. It wasn’t until the 6th shot of
Narcan that Mighty Z finally opened one eye. We tried to keep her responsive without much
luck until several hours later. Finally at 9:30 pm, Mighty Z was able to wake
up and talk, although it took tons of stimulation from her daddy and I, and
unfortunately that lasted for only thirty minutes until she once again feel
into a deep sleep. She was still requiring five liters of oxygen for the rest
of the night until she woke up the next day, still very groggy and blessedly
with no idea of the trauma her little body endured (I praise God for that).
So to answer the obvious
question, “What happened to Mighty Z and why did her breathing pacers stop
working, then all of a sudden start working again?” The answer is simple, the anesthesiologist
gave Mighty Z Fentynal on top of the Versed and the Lortab -- it was too much for her little body with
all those drugs racing through her system. It made Mighty Z unresponsive and
her CO2 levels go through the roof and made her body go into respiratory acidosis, which basically
paralyzed her muscles since the breathing pacers make the diaphragm (and the
diaphragm is a muscle) expand and contract. The acidosis was not allowing her diaphragm to
move even though the breathing pacers were telling the diaphragm to move -- the
more the doctor bagged Mighty Z and lowered her CO2 levels, the more the
breathing pacers were able to make the diaphragm expand and contract. The
Narcan reversed the overdose of anesthesia and made Mighty Z responsive again.
