Reception Guests

Since the reception will be held on base Bremerton, we need to put together a guest list for people who do not have base access. If you are planning to come, please add your name to the following list:

http://spreadsheets.google.com/ccc?key=0AvFMLcw2aZr4dHRHUjlmUThjbU9NSnY0OGxNdDJfVFE&hl=en

Anyone who does not have base access that is not on this list will require an escort on base. A phone number will be left at the gate for the guard to call in case of any problems with getting on base.

Thank you,

Paul

Arrangements

Camden Jane Evans, the daughter of Paul and Cary Evans, will be buried at Tahoma National Cemetery on Wednesday, October 14. For those who wish to attend, there will be a service at the cemetery from 2-2:30, followed by a reception at the home of CAPT and Mrs. Murray Gero at 4 pm.

In lieu of flowers, donations can be made to The Tree House, A Place for Families, which is the housing available to parents of children in the NICU and PICU at Tacoma General Hospital, where Camden was born.

Addresses follow:

Tahoma National Cemetery
18600 SE 240th St
Kent, WA 98042

For donations to The Tree House

Mail to: Tacoma General Hospital
Tree House Apartments
315 Martin Luther King Jr Way
Tacoma, Washington 98405

Or click on the following link, and select Parent Apartments:
https://secure.multicare.org/cgi-bin/multicare.dll/multicare/mhfDonate.do

For the reception:
CAPT and Mrs Murray Gero
1402 Decatur Ave, Qtrs S
Bremerton, WA 98337

Paul and Cary Evans home address:
644 Longshaw Street, Qtrs VB
Bremerton, WA 98337

Rhonda (Grandma)

Our Miracle

This is Cary. I know I haven't had time to write, even though Paul wanted me to. Now I have plenty of time.

Paul was worried that God didn't have time to give us a miracle, but he did. Camden was our miracle.

I have to point out that, although we take them for granted - they happen for Paul and I very easily - each conception and pregnancy is a miracle by itself. Not everyone gets to experience those joys, and I am so grateful to have carried Camden for as long as I did.

Our first miracle was that through all of this, Paul has been home. His crew is currently deployed, and has been since June. Paul was one of two guys (out of 150) sent home in mid-August. Dads don't normally get sent home for a birth.

When my water broke on September 2nd, it is a miracle that Camden was not born in our kitchen. Most women whose membranes rupture early have a baby within 10 days. Camden was able to wait 23 more days.

Being sent to Tacoma General Hospital was our next miracle. Ordinarily, we would have been sent to Madigan Army Medical Center, but since their NICU was full, we went to TGH. After Camden was born, there was an apartment available right across the street, so I wouldn't have to have someone drive me an hour each way to go see her.

The next miracle was although I knew the ultrasound tech couldn't find Camden's heartbeat in the minutes immediately before my C-section, I felt completely at peace when the doctor shouted "splash and go" and I fell asleep, even though Paul hadn't made it to the hospital yet.

It was a miracle that I awoke to my husband holding my hand - with such sweet news of a living baby girl.

We celebrated each miracle of her looking towards our voices, her O2 stats soaring when we touched her, her perfect tiny hands. We celebrated the miraculously low level of blood in her brain (preemies tend to bleed to the point of brain damage), and each small victory of a good blood gas. I was so proud to offer her breast milk, which she easily digested, despite her underdeveloped intestines.

The very last miracle of being able to hold her for the first time was one I will treasure in my heart forever. I have never been with someone when they died before, but I feel so blessed to have held my daughter close during her last moments. I know she felt what I felt - finally, we are together, where we belong.

It still breaks my heart that our family will not have the miracle of taking our baby home, or of midnight feedings (who ever thought I would think of them as little miracles??) Every time I look in the mirror, the scar on my body will remind me of the child I don't have. We will not introduce Gabe to his sister. I will not have the luxury of complaining about how hard it is to juggle the needs of two children, and I will wince every time I see another mom holding a toddler's hand while pushing a baby in a stroller.

Gabe will not grow up with a playmate. I will not have the energy to throw a party for his birthday next week, and Thanksgiving will be a difficult time to be thankful. It will kill me to buy Christmas presents for only one child, and to only fill three stockings on Christmas Eve. Putting away her things will be so hard. One day we will tell Gabe he had a sister. She will not go to school, play sports, or talk about boys on the phone. She will not break curfew, be grounded, or go to college. She will not get married, and I will not get to argue with her about the flowers at her wedding. I wanted so much to be her mom.

Today we are planning a funeral to remember our sweet baby girl. I yearn to hold her again - in my body, in my arms. I'm not quite ready to accept her death, but I am totally in awe of the miracle of her life.

Goodbye Camden

Yesterday morning Cary and I had to say goodbye to Camden.

We stayed up through the night, praying, hoping and cheering her on, but her lungs just keep getting worse. The very thing that was keeping her alive, the ventilator, was killing her. We stayed in a constant cycle of turning up the pressure on the ventilator, getting some better results, then watch as her stats dwindled until we had to turn up the pressure again causing more damage.

She tried so hard. She was a beautiful girl with a strong heart. Her heart was so strong, but her lungs were just to damaged to support her life. She also knew us. When ever Cary talked to her, she would open her eyes, no matter how sedated she was or how much of the muscle relaxant they gave her, she would try to see her mommy. When ever I put my hand over her, her stats would go up immediately... until the end when she just could not keep up anymore.

Just before 6 am, Cary and I had to make the decision to stop the ventilator. Then the worst moment of my life was combined with one of my happiest as I got to hold my daughter for the first time. It took until 6:47 for her strong heart to stop beating while I was holding her.

So far the pain has come in waves. One moment I feel so intensely sad and the next I feel at peace.

I feel like one of the worst tricks God ever played on us is the miracle. We got to a point where medically the doctors knew she would be gone long before Cary and I could give up on her. I just sat all night praying for a miracle that her lungs would heal, and yet it never happened. And now the only way I feel regret for the decision Cary and I had to make is that maybe I didn't give God enough time to give us the miracle.

Cary, myself, and the doctors and nurses did everything we could. No wrong decision was made that condemned my little girl. Her lungs were just too damaged and we had to say goodbye.

I don't think there will be anything else to add to this blog after this. I don't think I could handle it. Please continue to pray for Cary and I for peace and comfort.

Paul

Camden is getting worse. She is on max support from the ventilator with 100% O2 and her stats are not holding. For those of you close to Cary and I, I am sorry if you are finding this out via a blog, I just can't talk on the phone right now. I feel awful for even leaving her to type this, but it helps me and we need the prayers.

The doctors have started to talk to us about terminating support. He lungs are just to damaged. Even if she did survive there would be many complications, all of which I would accept. We even had a social worker come by today and asked me if I wanted an Amcross (a military message sent requesting emergency leave) sent tomorrow as if she knew something I did not.

I hate that we have gotten so good at prolonging the inevitable that we have to ask parents if they are ready to let go. No one should ever have to make that decision, and yet I feel as though the doctor is just buying time until we are comfortable with it.

We are still getting the occasional victory of a good blood gas here and there, but the efforts the staff have to take to get that good blood gas is getting more and more extreme.

I know many of you are praying for Cary and I, and wish for you to continue to do so, but please give us some time before calling. Right now we just need to support each other and the support of your prayers and our immediate family. Please pray for peace and strength as we are confronted with the hardest decision we have ever had to make.

Paul

Damaged Lungs

Today was a scary day. Camden's CO2 keep going up. This is primarily because of all the damage her lungs have encountered since her birth. Though she needs a ventilator to breath, the ventilator itself can cause damage to her precious lungs. The nurses were also having a hard time maintaining her O2 stats as well, but it was not as big of a concern as the CO2.

The big problem with the high CO2 is Respiratory Acidosis. Basically, the CO2 combines with the water in her blood to form carbonic acid. This weak acid then lowers Camden's pH which in turn causes damage to her blood cells and tissues. Even with the chemical paralysis and the high frequency ventilator, her CO2 levels keep going up. Chest X-rays showed the lungs to be highly damaged and rigid. They attempted to switch Camden to a normal Drager ventilator, but this resulted in a sharp increase in her CO2 levels and a drop in her pH. After switching her back to the high frequency ventilator, they performed another X-ray and noted that one lung was not as inflated as the other. This indicated that there was possibly a small air leak in the under-inflated lung which caused pressure to build outside the lung and preventing it from fully inflating. To fix this, the doctor installed a chest tube to help relieve the excess pressure.

Since the chest tube was installed, Camden's O2 and CO2 stats have gotten a little better. Still not at the ideal levels yet, but better. Just when we thought her lungs were doing well and we should worry about her head, everything gets turned upside-down.

The real painful part is the doctors and nurses seem to get less and less upbeat. The victories are getting smaller. I am glad they found a leak, because at least that is something they can do something about. Other than that, all we can do it wait, make her comfortable, and try and set her up so she can heal. Just wait...

Paul

A rough night

Yesterday afternoon we got the results back from the follow up cranial ultrasound. Camden's brain bleed has increased to a class 2 on the right side of the brain and a class 3 on the left. A class 3 is defined by swelling of the ventricle as a result of the bleed. Her swelling is slight and is only very distinguishable since we have a previous ultrasound to compare it with. Right now there are no corrective actions the doctors can take, we just have to wait and see. If the swelling gets bad enough, which is noticed by an increase in head size or swelling of the soft spot in her head, they may have to consider surgery to install a shunt in her head to relieve the cranial pressure. Here is an article about this problem, specifically IVH.

This is a slow moving problem and not an immediate threat to her, but can have some significant longterm effects. Needless to say, it is tough news to take.

Sometimes it is hard to see her. With the muscle relaxant she is taking, we don't get to see her move or react to us and there are so many problems that we just know about but can't do anything about but wait for her body to heal itself.

So far, she is steady, we just have to keep watching her and helping her body heal. This is the hardest thing I have ever done, and there is nothing I can do...

Paul

A small step back

Just so everyone knows, if a nurse calls you at 7:30 in the morning and tells you they had to chemically paralyze your daughter, it is not as bad as it sounds.

Camden's O2 and blood pressure has been looking great, but her CO2 got pretty high. One of the biggest reasons is that she is trying to breath over the ventilator. Typically this is a very good thing, our baby girl wants to breath. But with this type of ventilator it actually decreases the efficiency of the ventilator. So to help her not fight the machine (and it is great that she is showing a bit of a fight) they gave her a muscle relaxant which in effect makes her muscles not respond to the signals they are getting from the brain (hence paralyze). Right after they did this and made some adjustments to the ventilator settings, her CO2 dropped in half within 2 hours which is great. The muscle relaxant they are using is metabolized very quickly so if they decide she does not need it any more, they do not have to wait long for the dose to ware off. So far the follow up CO2 tests are looking good, but they are going to maintain the muscle relaxant for a bit longer. She also back on the photo-therapy light for jaundice which she is expected to go on and off while she is there.

We also just got word that she is going to be getting the PICC line today. Good news, though since her veins are not that prominent, she has to get it through the scalp. This is actually a preferred connection than the arms or legs from a medical point of view, but less appealing. Either way, this is good news for Camden.

It is actually a little bit of a good thing that we are not worrying about a rise in CO2. Her first couple of days, the CO2 was fluctuating a lot, but there was other things to worry about. Now, the minor problem has become the major problem because our original major problems have gone away.

On a lighter note, there was a small miracle on Tuesday night. We have friends gracious enough to allow us to barrow their truck so Cary's grandparents can use our car. Well, on Tuesday night I was running a little late to take Cary's mom to the airport and ran out without my wallet. Well about a third of the way to Seatac Airport the low fuel light came on. Again, we were running late so I push ahead for the airport, drop off Rhonda, and head back towards the hospital with no money (btw, I don't think Rhonda realized the light came on or that I did not have my wallet else she would probable given me $10, otherwise we need to talk =). Well, the miracle is I somehow was able to drive ~40 miles in a F-150 with the low fuel light on, make it back to the APT, get my wallet, and fill the tank. Thank God for not being stranded on the highway at midnight.

Paul

Milk

Camden finally has some milk in her belly. This afternoon they were able to give her 2ml of breast milk through a tube. So far she seems to be taking it well.

Two big things now need to happen before Cary and I can hold her and have "Kangaroo Time."

1. First is to give Camden a PICC and remove the 2 lines in her umbilical cord. This will give the nurses and doctors a better, more longterm path to inject medication, electrolytes, and fats. We expect that to happen in the next couple of days.

2. Camden needs to shift off the high frequency ventilator and to a traditional ventilator.

We are still tweaking in the ventilator settings to keep her blood gases where we want them, but overall she is doing very well and showing improvement.

Sorry this is a pretty choppy entry. We are going to get some sleep so our writing can improve.

Paul

No more DOPamine

Dopamine was the major of the two blood pressure medications Camden has been on. As of this morning, there is no more medicine pump labeled "DOPamine".

One less drug!!!

She has continued to improve on the ventilator settings and is feisty as ever during care time. She is showing a lot of spirit which is good.

We also have such wonderful friends. Even an hour away, we have people bringing us food and just stopping by to spend the evening with us. A good friend of Cary's is flying in from out of town for the weekend on Thursday. Rhonda, Cary's mom, is heading out tonight. Just a continuous stream of support has come our way.

Thank you all for your continued thoughts and prayers.

Paul

The Treehouse Apt

Tacoma General Hospital provides an amazing service called the Treehouse Apartments. These apartments are recently renovated and very nice. The building is secure and safe. The rooms are nice, big, and clean. There is a large common area, a playroom for kids, a resource center with computers, and a conference room open for use. There is a very large kitchen with 6 cooking stations so multiple families can cook dinner. There is a small fridge in our room and several large fridges and freezers in the kitchen for open use. There is a common pantry for use by all guest to use that is filled by guests and donations.

All of this is available for donations only. They request $20 a night, but payment is not required to stay.

This is an amazing program and again I can not say how amazing it is we were sent to Tacoma General and not Madigan.

http://www.multicare.org/home/tree-house-place-2

Paul

Good Morning

This morning we got the results back from the crainial ultrasound.....

And the results are good: Camden has a Class 1 brain bleed.

Basically there is a scale of brain bleeds of 0-4. Class 1-2 are minor and will often resolve themselves. Class 3-4 are major and require a shunt to remove the excess fluid. With the nature of Camden's birth, she was expected to have a major bleed. The doctor and the nurse were both surprised at how minor the bleed was. The doctors also did not notice any significant problems with the brain otherwise. There is still a small chance there is some damage based on the lack of O2 for the period of time after birth, but this is a major step in the right direction for Camden.

Also for the first time last night they were able to turn down her blood pressure medication. Her blood pressure is actually too high. Now she is still on a fairly high level of blood pressure medication, but for the first time we are able to wen the medication slightly.

The next small milestone is the blood culture to confirm if the Strep bacteria has been eliminated, which we should find out tonight/tomorrow. Other than that, we are on the long road of lung development. So far this has been a series of small victories as we turn down the ventilator and the O2 levels since she is able to pick up more and more of the load on her own.

Camden is also becoming more responsive each day. When Cary and I go in to do care, take her temperature and change the diaper, she has opened her eyes and moved her arms more.

There is still a very long road ahead. She still needs a lot of support, but every little step ahead is a small victory.

Paul

Good things in bad times

Even with all this bad stuff, amazing things are happening.

1. I should not be home now. At this moment I should be underwater with my crew in the submarine, but because they wanted to send me to a school, I am home.

2. In this situation, we should be a Madigan Army Hospital being in the military. We instead were sent to Tacoma General because Madigan was full and Tacoma General has apartments for us to stay close to Camden at no cost.

3. If Cary had not gone back to the doctor because of bleeding, she never would have been sent to Tacoma General (she has been here for 2 weeks since her water broke) and Camden would not be alive now because we never would have made it to the hospital.

The doctors and nurses here have been wonderful and without their very decisive and precise action, Camden would not have made it this far. The support we have received from the families on my boat, our church and our family has been overwhelming in a wonderful way.

The short of it is, No matter the outcome, we feel so very blessed to have Camden right now and all the support everyone has given us. Please continue to pray for our little girl.

Paul

Camden is Born

Camden was born by an emergency C-Section. Cary was experiencing some contractions and when the nurse checked Camden's heart rate, it was very low. They did the emergency C-section and delivered Camden. She needed resuscitation and was transfered to the NICU.

Since then she has been on a ventilator and has been on blood pressure medication and antibiotics for a bacterial infection. At first she required the ventilator operating at as high of a capacity as possible to keep her where she needed to be. Since then she was put on a Nitric-Oxide (not Nitrus-Oxide) which has helped her blood absorb more O2 and exhale CO2 and we have been able to lower the amount of life support she needed. She is also having problems with maintaining her blood pressure and has a bacterial infection which they believe to be Strep. We will find out tonight/tomorrow if the antibiotics got rid of that. Friday evening she also had a severe "episode" where her O2 and blood pressure dropped dramatically. The last concern is the damage to the organs from the O2 deprivation during delivery. There is a cranial ultrasound on Monday night to look for a brain bleed which could be a result of the low O2 and the trauma she encountered at birth.

Camden is trending up well. Her O2 and CO2 Stats are responding very well to treatment and her blood pressure is improving, but very slowly and they have not been able to wen any drugs to support that. Even with improvement, she is still a very sick girl and needs lots of prayers.

You can see pictures of her at:

http://picasaweb.google.com/r.cary.evans/CamdenJaneEvans#

Cary, is doing very well. She is able to walk without support and pain has been easily controlled with oral drugs for the last day.

Paul