Once again, we woke and headed to Children's Surgery Center bright and early; I drove Cortlan, while John dropped Everly off at school. By the time that John arrived at the surgery center, Cortlan and I were already in the exam room. We saw a million different people, each of whom asked us to confirm Cortlan's birthdate and the reason why we were there. I was tired of saying "to have his tonsils and adenoids removed"; eventually, Cortlan began to answer for himself.
After a while, we got to the point beyond where we had last time - all approvals were given, booties and robe were on, they had given me an awesome outfit to wear so that I could go back with him to the operating room to be there with him until he was asleep, and we would soon be on our way.
Cortlan held my hand as we walked to the OR, a very nice nurse talking to him about Santa Claus the entire way. When we got there, he climbed up on the table, initially curling up as if he was going to take a nap. They asked him to flip to his back, which he happily did, and then they put the mask on his face. The nurse was still talking to him, asking him what he wanted for Christmas, asking if he had any brothers or sisters, how old she is, what she wants for Christmas, etc., and all the while, he was smiling. Jingle Bells came on in the music that was playing through the OR speakers; I called his attention to it and at his favorite part, I started to sing. His eyelids started to droop, I gave him a kiss on the cheek, and he fell asleep, still with a smile on his face.
I went back to the exam room, where John was waiting for me, and I got a little emotional. It isn't easy seeing your child laying on a table in the operating room, but I was more overcome with emotion at how brave and strong he was, how trusting and confident he was, and at what a good kid he is. I took off my lovely white jumpsuit, and we headed for the waiting room.
We were told the surgery would take about 45 minutes, so John went to get his coffee while I got comfortable with some grading I needed to get done. I was surprised when, ten minutes later, a nurse came to get me to talk to the anesthesiologist on the phone. I spoke with him; he needed permission for them to perform a procedure that was not initially expected and that I had not yet consented to. They needed to do a tracheoscope and a bronchioscope. I consented.
I headed back to the waiting area with John and explained to him the conversation that I had just had. Less than thirty minutes later, the surgeon came out to speak with us.
The first thing she said was that Cortlan was doing well. The second thing that she said was that he still had his tonsils and adenoids. Our reaction was not necessarily positive, and she said, "Let me explain."
When they had tried to intubate Cortlan, the tube that they would typically use for a child his age and size wouldn't fit. They tried the next size down and it wouldn't fit, either. Neither did the size below that. They needed to do the scope to determine what the issue was preventing the tube from fitting. They discovered that his trachea is not much bigger than that of a typical two-year-old's.
This is and has been an issue on several fronts. First, we have been focusing on the upper respiratory issues, which are still present, but never thought of lower respiratory issues. This small airway restricts his breathing somewhat and is what causes his croup-sounding coughing and loud breathing. Second, the three attempts at intubation followed by the scopes was traumatic enough for the day such that the surgery could not go on. (Further, if I understood correctly, the intubation tubes they had at the surgery center that were small enough in diameter were for smaller children and would not have been long enough.)
The doctor recommended that we hold off on the surgery until he grows and his airway is larger. However, she also recommended that we see one of her colleagues and get a second opinion. We have already scheduled that appointment. We had been convinced that the removal of his tonsils and adenoids will provide much needed relief for Cortlan. He can hardly breathe through his nose. The allergy issues that he has are compounded by the fact that there is no room for drainage. His tonsils are so large that his tongue doesn't have enough room in the back of his mouth, which will likely (but not definitely) cause issues with his palate and which already seem to be causing some speech problems. These are convincing reasons for us to go forward with the surgery, but we are certainly interested in another specialist's opinion.
If the surgery does take place sooner than later, we have been told that it will not be at the surgery center. He will be a slightly higher risk patient and it will be done at the hospital, possibly as an inpatient therefore requiring an overnight stay. They only do the simplest cases at the surgery center, and not that this will be overly complicated, but everyone (including us, obviously) would feel better with him being at a fully equipped hospital.
After waking up, Cortlan did have some coughing and breathing issues, so they gave him a breathing treatment. When we went to see him, he was somewhat groggy, but not at all upset. He was happily watching TV, had already had a slushie, and was about to start his first of many Popsicles. The nurses couldn't say enough good things about him. Due to the breathing treatment, we had to wait there for four hours until it wore off. In the case that the issues returned after it wore off, we would have had to have him transported to the hospital and he would have stayed overnight. Thankfully, this was unnecessary. We hung out in our little room, playing on our phones, watching TV, playing on his Explorer, and when he had to go to the bathroom, we wheeled his IV cart along with us. Nothing seemed to bother him... Except, perhaps, the fact that he had to face his friends today at school after telling him that he was going to get his tonsils out and wouldn't be in school for a while (again).
Cortlan was back to normal by the time we left. He even wanted to stop and get food on the way home, which we did. I am incredibly proud of him for how well he has handled all of this. We will continue with the doctors appointments and will see what others say regarding the surgery and will hopefully see the end of this process soon.
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