08/08/2021
Like many of you, I’m still wondering, “What happened?” I still find myself waking up thinking my baby needs to have food because she’s been too long without, her medications are due, time for this weekly appointment, time to get up and let the nurse in, etc.
Prior to this point, I’ve been the parent reading that a child close to my child’s condition has passed and the fear sits in of how and could I do anything to protect my child? For that reason, I want to share the details of how we got here.
Ella wasn’t acting herself a few days before the hospitalization. She had a pretty bad neuro storm and it is my belief now that she aspirated secretions during…and that a few days later it turned into pneumonia. We subsequently raised her medications that control neuro storms that very day to better address the problem.
The morning before I took her into the hospital the nurse and I also noticed a very small amount of edema in her feet. I had a telehealth visit with palliative care reviewing her symptoms and none of which were severe enough for medical intervention. She slept a lot of the day and by evening had a fever, increased seizures and required oxygen. I packed up our hospital bags and called 911 for transport to the hospital since I wasn’t sure I was able to safely transport her without the help of a medical team.
We arrived to the hospital around 2:30am without going to the trauma bay (we’ve been there so many times so that was reassuring) and we went to a regular ED room. Testing showed pneumonia, some labs off, and the usual GI problems.
I was then informed that of course she needs to be hospitalized, but was extremely stable and we didn’t even have to go to the ICU. We were back with our TCC family. It was even said that if she does her usual and reacts well to the antibiotics, they would even consider discharging her home the next day to acknowledge her comfort care needs.
That day involved a lot of rest and sleeping and that evening her feet and hands got really cold while the rest of her body had a fever. With the fever came seizures. We knew something was wrong with her circulation and with her having a fever so much it was likely she was dehydrated.
She got a water bolus and reacted extremely well to it. They got her back to being comfortable and relaxed. She was requiring more oxygen and they were shocked she wasn’t reacting as quickly as usual to the antibiotics. She’s usually looking better by then, but wasn’t.
They did another work up, placed her on the watcher list for going to the ICU, put her on stronger IV antibiotics,and gave her a phenomenal overnight nurse who watched her very close. She seemed very stable and was even slowly weening off of the high amount of oxygen.
At 7:00am I hear her gasping for air in her sleep. It sounded like her usual secretion burden so I attempt to suction to clear as that always resolves the issue, but it didn’t this time so I called in the medical team…and this is where it starts spiraling.
Within minutes I had a room full of hospital staff, was told her circulation was back to having problems and this time her fever was nearly 104. She was not responding to the antibiotics. I told them the water bolus worked last night and they started another one.
The next thing I knew ICU was in the room and said she needed to go to the ICU, but they wanted a chest X-ray first. The X-ray port comes to the room and I hear the staff talking amongst themselves as they looked at the X-ray say the dreaded words “pulmonary edema” multiple times. They come to me and tell me that she doesn’t look well and has pulmonary edema throughout both lungs.
I look over at Ella and she is coughing up blood tinged secretions from her trach and I see her pulse ox declining. I asked them to give her more oxygen and they inform me there’s no more they can give her as she’s receiving 100%.
It then becomes evident that she is needing more support than her ventilator can provide her and there is an urgency to get her to the ICU now so she can get on their biggest ventilator. She has to be bagged the entire way to the ICU because she can’t get enough support with her ventilator. We get to the ICU where it takes a minute but they sedate her and get her on all of the support she needs.
Palliative care comes in and explains that this may be Ella’s time, but we can safely give her an hour to see if there is any hope of recovering. Over that hour, child life comes in and I tell them she doesn’t need toys and we need to focus on her right now. I see her pulse ox continuing to slowly decline as the hour passes on and palliative care returns to tell me that she is not recovering as hoped and that it’s time to start our plans of how I would like this to go.
Child life comes back in and I’m so confused. They explain that child life does provide toys and comforts for children in the hospital, but they also provide support to families when children are at the end of life. They then help us do memory making with Ella. It was a special time as she was as stable as she could be and comfortable.
We took time as a family and then had to let Ella go. I got to hold her, have “Remember Me” from her favorite movie Coco playing and we were surrounded by her grandparents. They provided her medications so there was absolutely no pain. She left her body 15 minutes later and 10-15 minutes after that her body was finally at rest.
It’s still a lot to process, but I am so thankful to Cincinnati Children’s for taking such good care of my daughter and giving her a peaceful time leaving this earth.
I want to make this very clear, if you have a child with POLR3A and especially the rarest form as Ella had, I’m here for you. I’m willing and want to talk about her and will tell you anything I can about the condition. Ella was one of the longest living children with her severity so I don’t know if there’s anything we could have done differently at this point as we surpassed the researcher’s recommendations for her care.
Regardless, I know many are hurting so much that they can’t talk about it, but I can and will. Just reach out. I’m currently overwhelmed with emotions and messages, but I will get through them all and happily get back to you. Please be patient.
We were blessed to be able to donate specimens to the researchers studying Ella’s condition in Canada. Unfortunately, Ella could not participate in organ donation because of her condition, but I am thankful she will go on to contribute to the research that will hopefully help many other children.