Echo of Hope

There are three states of readiness during wartime:

Condition One: Attack is present, or imminent. This alert places the ship at its highest state of readiness. All crews go to their combat posts. Bulkhead doors are closed in case of decompression. Additional Viper pilots are scrambled to supplement the Combat Air Patrol and the Alert Fighters, and flight support crews man their stations. The Combat Information Center (CIC) is locked down and the ship’s commander is on station.

Condition Two: Threat probable, but not present. Crew readiness is somewhat more relaxed than full readiness. This is usually ordered directly after the end of a Condition One alert.

Condition Three: This is the “all clear” alert, returning crews to their normal, day-to-day non-combat duties after Conditions One or Two. This is normal cruising during wartime. Weapons are partially manned, but the ship is at less than full readiness.

Every time we are told “gear up for surgery,” this scene turns on in my head. I see it. I hear it.

Every time.

Right after what you see in the clip, Commander Adama makes the following announcement over the ships 1-MC:

This is the Commander. Moments ago, this ship received word of a Cylon attack against our homeworlds is under way. We do not know the size or the disposition or the strength of the enemy forces, but all indications point to a massive assault against Colonial defenses.

“How? Why?” doesn’t really matter now. What does matter is that as of this moment, we are at war. You’ve trained for this. You’re ready for this. Stand to your duties, trust your fellow shipmates, and we’ll all get through this. Further updates as we get them. Thank you.

When we first got the diagnosis, this is how I felt.

How and why didn’t matter. What mattered was turning on the sirens, gearing up, and running in the direction that I’d like to say I’d trained for and was ready for, but just plain scared the hell out of me.

Back to the Galactica. Shortly after this scene, the call to action stations rings out again. But it turns out a little different.

Heard over the ship 1-MC: Action Stations. Action Stations. Action Stations.

Lieutenant Gaeta: We have multiple contacts coming through the storm towards the anchorage. Looks like more than 50 ships.

Colonel Tigh: Cut us loose from the station. Launch the alert fighters. Set Condition One throughout the ship. Prepare to launch…

Specialist Dualla: Wait…wait. I’m getting Colonial signals now.

Tigh: Confirm that. Don’t just accept friendly ID.

Dualla confirms friendly ID in about 5 seconds.

We’ve been waiting on ID for 4 days now. We’re not expending friendlies, but perhaps neutrals for a time. A visit from the Swiss – if you will  – between tilts with the Cylons.

Ari came out of the cath lab last week with systemic pressure in his right ventricle. As noted previously, this is bad, and limits surgical options. In his post-cath echo, the gradient across the valve was still reading 40 to 50, and the doctors suspected his scar tissue was negatively altering his right ventricle function.

The doctors told us based on the readings that he needed immediate surgery because this pressure level in the RV is not sustainable, and thus we should prepare for surgery as soon as hospital logistics allow.

We called Action Stations, and set Condition One.

“Based on the readings” however, were the operative words. (Operative…see how I did that.)

As the surgery requires cutting scar tissue that measures in the millimeters (turns out, 3.5 millimeters or so) out of a heart the size of a strawberry, they wanted a detailed map of the scar tissue and thus scheduled an MRI.

Since you can’t tell a 6 week old “hold still for 2 hours or so,” MRIs require general anesthesia. Anesthesia itself carries risks, and Ari can’t eat for hours before the procedure. No fun watching your kid cry because he’s hungry and you can’t feed him.

They also decided to get another echo as he was under. Bang for the buck, and all.

We went home late to try to get some sleep (didn’t work). On the way in on the phone the next morning, we were confused when the nurses mentioned that after they get the test results, the doctors would make a decision on whether or not to have surgery.

We said we were told “surgery coming right up,” and they said they heard at rounds “surgery possible pending results of tests.”

Two things had, indeed, changed:

1. More doctors gathered to look at the post-cath echo. They had an evolution, so to speak, in their interpretation of it. While it’s not exactly as simple as “depending on the angle,” but, essentially, depending on the angle they looked at it, the gradient read 50…but it also read 30, 40 and 60. This matters.

2. Ari was eating better. Breathing better. And looking hearty and hale.

The update we got when we arrived at the hospital went something like this:

First, if the gradient isn’t as bad as originally thought, the culprit in the RV pressure is likely the EFE (scar tissue) as much as the aortic stenosis. When we see the MRI results, if the EFE is thick and pervasive enough to indicate it’s causing high pressure in the right ventricle, our hunch will be sorta-confirmed. (Sorta, because this is all guesswork at some level. Comforting.)

Second, he looks good. Eating like a horse. Seriously, if you didn’t know any different, you wouldn’t know he was sick, never mind this sick.

The MRI results indeed showed a good amount of EFE. The “tie breaker echo,” as one of the doctors called it, while not exactly conclusive, indicated that the gradient isn’t as high as originally interpreted from the post-cath echo. It’s probably (echos are imperfect) somewhere between 30 and 40.

The decision as of 1:30 p.m. yesterday: wait.

Why wait? The pulmonary hypertension is dire, yes?

Yes, but they believe it will resolve after surgery, even if surgery comes in a few weeks or perhaps a month or two. Left at high pressure, a heart will permanently remodel that way, and the high pressure would never come down. We have been told with new treatments this may be manageable, but historically it ends in heart failure. However, they believe that a few months won’t cause it to permanent-afy.

Open heart surgery including the valve work and EFE resection on a 7 and 1/2 pound 6 weeker is not as effective or safe as it is on a baby even twice as old or twice as big.

If he’s eating and breathing OK (he is right now), let’s see if we can get him twice as old and twice as big, and then come back and re-assess options.

We are told – just as we have been since day 1 – expect open heart surgery. It’s still coming, and coming soon. It’s in the womb of time. On the knees of the gods. It’s looming. It’s gathering. It’s in the cards.

But, by George, don’t rush it!

We are now told it’s very likely to happen within weeks or months, mostly depending on how Ari’s eating and breathing. In other words, just like before, he’s setting the pace and the schedule. We’re reacting to him.

At least, starting tomorrow, we can do from the house after we get discharged.

Action Stations stand down. Set Condition Two throughout the ship.

Looks like a nice weekend, too.

DISCONCERTINGLY JARRING TRANSITION GOES HERE. SCREEEECH!!

6:30 p.m. last night.

I’m in the hospital library supposedly still working, but I’m on to writing this post and figuring out how to boost sound levels in a video for y’all so you can hear the calls to Action Stations along with me when they come. (Yep, had to make the video. Technical editing not my strong suit.)

Erica’s in the room in 8 East with Ari.

Kevin the attending cardiologist comes charging in (we don’t know Kevin).

“There’s been a change in thinking. Dr. Lock (brilliant cardiac surgeon #1) wants Dr. Del Nido (brilliant cardiac surgeon #2) to weigh in before Ari goes home to see about surgery. Don’t plan on going home tomorrow.”

Oh, and Dr. Del Nido is away this week.

We’re working on sorting this out right now.

For those of you that don’t know Erica, she has a lot of rope. If she was a Home Depot, she’d be overstocked.

This put her at the end of it.

Mommy not happy!

She’s recovered some of that rope, sort of (me, too), but now we gear back up for possible immediate return to Action Stations pending ID of incoming ships.

Whether the word from Dr. Del Nido is Enemy or Swiss, open heart surgery is coming. When it does, we will sound the call to Action Stations. We’ll man our posts, you man yours. Stand to your duties. Trust your fellow ship mates. And we’ll all get through it.

Further updates as we get them. Thank you.