Filet o' baby

So here's the very long update on Emme's surgery.

Friday night

Emme had her surgery almost three weeks ago now, and a lot has happened since then.  She recovered from the surgery itself pretty well.  She woke a bit more often the first and second night but then went back to sleeping through the night.  On the fourth or fifth night, though, she started sleeping horribly.  For several hours after she went to bed I would hear her up there, rolling around and banging her cast against the side of the crib.  She would cry this sad, pathetic cry.  She would wail several times.  No one slept well.  One night, I put Oliver into bed with Wes and slept upstairs in the hopes that at least some people would wake more rested.  Downstairs, without me getting in and out of bed, the boys got one solid night. Then we gave Emme a bath and rewrapped the cast and she went back to sleeping pretty normally.  I even took her to the pediatrician's office one afternoon just to make sure she didn't have an ear infection -- she didn't.

We saw the surgeon one week post-op.  She looked at Emme's abdominal incision and since the cast looked like it hadn't moved, sent us on our way.  We went back two week post-op and got the cast off.  And what we found was a relatively healthy looking graft with one spot that hadn't taken.  One big, red, nasty spot on the side of her foot.  At first I thought it was an ulceration from the cast rubbing again it (which happened on her heel after the first and second surgery), but it turns out that for some reason, the graft just hadn't taken there.  Emme was funny getting the cast off.  As soon as it was peeled away, she was wiggling her toes, stretching her ankle and rotating it, and scratching the dry skin under the cast.  Dr. Chester rewrapped her foot with layers of Vaseline gauze (Xeroform), regular gauze, Kerlex, and an ace bandage and sent us our way with an appointment for five days later.  Emme got fussy before we left, but I thought it was just because that sore spot had been irritated by her rotating her ankle around.

Her battle wounds

I dropped her back at daycare with things for the teachers to watch for and headed off for meetings and class.  At 4:30, with more than an hour of class left to go, I got a call from the main teacher, Kendi, who told me that Emme had been fussy all afternoon -- unless she was being held.  I ended up leaving a little early from class to pick the kids up and found Emme in the arms of one of the part-time student workers.  She was a little sleepy but not terribly fussy the rest of the evening.  The next morning, she seemed find.  I  took her to daycare but dosed her before she went in case she was in some kind of discomfort.  I saw her at lunch and she seemed fine.  I didn't even give her another dose of pain medication.  Four hours later, I got a call from Kendi saying that Emme had a fever of 102.6.  I immediately called Dr. Chester, then Wes, and then picked up the kids.  Emme was really got and clearly uncomfortable.  We hadn't changed her dressing yet since we'd decided to do evening changes.  Wes got home, pulled the bandage off, and then called Dr. Chester to chat.  Dr. Chester decided to hold off on any antibiotics until she saw Emme the next day.

Monday night

Emme was clearly feeling very poorly Friday night.  She slept soundly, but when I got up to nurse at 5:30, she was burning up.  Her temperature was 102.9.  She slept most of Saturday morning.  Wes took her to see Dr. Chester at 11:00 AM, then called less than an hour later to say he was taking Emme to the pediatrician's office.  Dr. Chester wanted them to check her over and make sure there was no other explanation for the fever, then figure out what to do next.  Wes saw the pediatrician who was available, not our usual doctor, and was less than impressed.  He said he kind of wanted to send everyone else out and just do what needed done himself.  They saw that her ears were still clear, took a urine sample (with a catheter -- ugh), and checked for any other issues but found none.  They considered briefly admitting her to the Children's Hospital but decided instead to do two intermuscular shots of a broad spectrum antibiotic, one on Saturday and another on Sunday.  Wes and a very tired Emme were home around an hour later.  She slept much of the afternoon and had another solid night of sleep.  She had a long afternoon with no wet diaper, which started to worry us, but then started peeing again late at night.  We switched to twice-a-day bandage changes, using Silvadene on the spot where the graft didn't take.

Emme woke up the next morning with a fever, somewhere around 101.  She was still pretty sleepy, went for her second shot, but then, according to Wes, was a little more active in the afternoon (while I was finishing my last paper for the semester in anticipation of her being home on Monday).  She slept fine Sunday night.

Monday morning she woke up much more normal.  She still had a 100 degree fever, but not even high enough that she'd be sent home from daycare.  She was very active and just seemed much closer to normal.  Dr. Chester said her foot looked much improved from the weekend and felt that, even though it didn't entirely make sense, the fever must have been from the graft.  She's on Keflex orally three times a day for the next week.  She still isn't at 98.6, but she's close enough.  She went back to daycare on Tuesday and did fine.  Dr. Chester thinks the spot the didn't take will be small enough to scar over and not need another graft, which was a consideration for a short time.  She'll have to wear the bandage until the scar forms.  We're hoping there's enough healing by Friday that she can get a bath!

At this point, it seems like Emme's graft will be okay.  She will put weight on her right foot, but the bandage is thick enough with all the gauze that she won't try to stand independently or take steps (though she will walk while holding on to my fingers).  We're really happy that this small bump didn't necessitate any hospital time and that Emme seems to be feeling better so quickly. 

Hospital charges for one skin graft: $31,993.40.  A happy, health baby girl: priceless.