Blood Pressure Woes

The high blood pressure Graham has been experiencing over the past few days escalated yesterday and reached dangerous levels last night into this morning. The docs added a new medication and changed the dosages of his current ones. Thankfully, the numbers finally began to fall. Uneasy hours. His levels are still not ideal, but we hope to get into a normal range soon. The suspected cause of this blood pressure problem is his damaged kidneys...specifically ATN (acute tubular nephritis).
We will keep you updated as we learn more.

Extubation!

Graham is extubated and he is still resting comfortably, now, nearly four hours since that nasty ventilator tube was removed. He is breathing on his own and he is putting up good numbers. His pulse ox is in the 90's and his blood gases are great. The G-Man is getting a minimum amount of oxygen through a cannula. He is much happier and so are we.
The surgery yesterday to put in the tunnel line went well. Graham is getting his nutrition and meds through this line in the same manner he did with the central line.
G's blood pressure is still a bit high and the culprit is his weakened kidneys. As mentioned in the previous blog, this problem should solve itself as his kidneys naturally heal.
The next hurdle is to get real food into Graham's system. He is now off the pain medication necessitated by the ventilator. The morphine may have slowed the digestive process, so we are hoping the next few days will show positive signs and he can begin taking breast milk through a stomach tube.
Hour by hour. Day by day. We are cautiously letting ourselves think Graham is finally getting back his health.

Capturing Moments

Bill's cousin, Angela, came by yesterday for a visit. She happens to be an amazing photographer and captured some precious family moments.

Angela Brown Photgraphy
Carmel, IN

A Hiccup

Tummy time

Graham gave us pause yesterday when he developed a fever of 100.4 degrees. This set off a flurry of activity that included blood tests, cultures, and x-rays. The immediate worry was another infection. This development came as we were starting the countdown for the ever-so-important removal of his ventilator. The fever was coupled with an unusually high heart rate, further indicating an infection.
We do not have the blood cultures back yet, but G is back on track today...normal temperature and heart rate. We hope this was just a hiccup in his road back to health.
Graham has been experiencing high blood pressure and has not been responding to normal blood pressure medication. We found out today that he has some kidney damage that is causing the high BP. The docs feel that as his kidneys heal the BP problem should solve itself. Time.
Tomorrow will be a big day for the G-Man. A less-invasive tunnel line will be put in, which will replace his central line that was removed today. This surgical procedure will take place around 1:00P tomorrow. The tunnel line is less prone to infection and will serve essentially the same purpose as his central line. The big bonus, we hope, is that if the procedure goes well, his ventilator can be removed afterwards. The respiratory therapy team says his numbers indicate he is ready.
The attempt to introduce breast milk through his stomach tube was a failure yesterday. Although small amounts were tried (5 ml every two hours), he vomited them back up. It was disappointing ... a reminder we are always on "Graham time". But Dr. West said some part of his digestive system is just not quite ready and they will simply try again in a couple days.
The rash is still a puzzle, thought somewhat less pronounced today. The use of steroids has been put on hold for now, for a number of reasons.
After making the flight from Turkey, Uncle Ward was able to see Graham for the first time late last night. The scene of Katie and Ward looking at and touching Graham warmed Grandma and Grandpa Ryder's hearts.

Eyes Wide Open

Today was another day of progress for our Graham, who can now open his eyes with relative ease. His weight is down to 8 pounds, and he continues to pee ample amounts. Now that he is close to his normal weight, the docs are planning to lower his diuretic dosages. And if G's respiratory numbers continue to improve, they also hope to remove his ventilator. The ventilator is causing him some discomfort and for other medical reasons the sooner it is removed the better.
Tomorrow morning Graham is taking a trip to the first floor for a "MAG 3" test. It is a scan that will evaluate his kidney function, and is being performed to help determine why his blood pressure remains high.
We are also anxious for Graham to begin getting breast milk through a feeding tube and hope to do so in the next few days. We keep setting goals, but we've learned it is the G-Man who decides when he is ready.

The Incredible Shrinking Baby

The yellow stream continues to flow and the results are impressive. When Graham began the "Great Pee" almost three days ago, he weighed a tad over 12 pounds (his birth weight was 6 pounds 12 ounces). He is now under ten pounds. He looks remarkably better and even briefly peeked at us with one eye. We hope the loss of edema will begin to improve his lung and heart function. Fluid continues to be suctioned out of his lungs.
Mom was able to hold him again today. It is quite a process given all his connections, which include his ventilation tube, and several lines leading into the central line. We hope that he can begin to take breast milk through a feeding tube to the stomach tomorrow.
Graham is still relying on a ventilator and his need for oxygen still hovers around 30%. His is beginning to "breath over" the ventilator, which is a positive.
Overall, we are seeing a more alert and active baby, who needs pain medication less often. To our great relief, Graham was taken off all antibiotics and anti fungals yesterday. We are looking forward to when the ventilator is removed and he can begin nursing again.
Uncle Ward is flying in from Istanbul and will be here late Tuesday night. His arrival will be a boost for all of us.
Good days! What a difference a week makes.

A Well Deserved Post

It has been three weeks since Graham became very ill and we were forced to return to Riley Hospital. During this time, thoughts, prayers, wishes, flowers, gift baskets, text and social media messages, cards, e mails, phone calls, and visits have consistently reached us at critical times. You, our friends and family , are wonderful people that have battled through this with us and have provided a level of support that we will never forget. Graham is your baby too, and we are truly amazed by the love and goodwill that we feel everyday. We love you, thank you and can't wait for you to meet the G-Man!

Bill and Katie

G-Man becomes P-Man

After marking time for three days, Graham has begun to show some positive signs. Quite simply, he is peeing! And I mean peeing! The renal team and surgical team agreed on a new strategy which was implemented last night, and it has worked wonders. The hope is that his urine output will continue to increase and that the edema will soon begin to abate, which should result in improvements in his heart and respiratory functions. The swelling has impacted Graham in so many ways.
Graham had the two chest tubes removed today, which meant Katie was allowed to hold him. She is one happy mommy. The proof is in the picture.
Graham is still on full ventilation, but his supplemental oxygen is now down to 27% and he is off the nitric oxide completely. He is doing fine with these changes as evidenced by his pulse oxygen level at or near 100%.
The G-Man is still not ready for breast milk. His stomach fluids are still green, rather than the clear liquid that will indicate his digestive system is ready for his mother's milk. He is continuing to receive his nutrition through his central line.
A rash continues to make appearances. It literally comes and goes and manifests itself on different places on his body. Dermatology doesn't have an answer, but preliminary results from the biopsy taken three days ago indicate a possibility of vasculitis (sp?). But Dr. West thinks it is just another symptom rather than a cause.
We have learned to keep an equilibrium through this whole drama, but positives are always welcome. We celebrate the small improvements, like we saw today, that will ultimately bring us back our healthy Graham. We are all ready to step off this roller-coaster ride of emotions. Thank you all for following us through this horrendous week. Your words of encouragement and prayers simply make everything easier.

Day By Day

   Just a brief note to let you know that not much has changed in the last 48 plus hours.  Graham is holding his own, but can't seem to make any significant progress.  However, we are most grateful that his condition has not deteriorated.  As you may have guessed, we are a tired crew here at Riley, but we are now regaining our stride.  We will post a more complete blog tomorrow with many details.  Thank you for staying with us. 

Starting Over After the Crisis

I'm sure all of you experienced the same elation we felt when Graham rallied and survived the crisis of this past weekend. But it is abundantly evident to us that those events were costly to Graham's health. In many ways he is not as well off as he was before the dramatic downturn he suffered on Saturday.
Graham is now fully dependent on the ventilator. Before, Graham was assisting the ventilator, doing much of his breathing on his own. Now, he is fully dependent on the ventilator. But his pulse ox level is 100%, which is a positive.
Before, Graham was actually ingesting breast milk through a tube to his stomach, and he was pooping. Now, his digestive system is no longer functioning at that level. He is back to getting his custom-made nutrition (TPN) through his central line.
More worrisome, new symptoms that occurred during his crisis have not gone away. Although improving from the dangerous low of 30%, his heart function is still not back to normal, as he is now battling blood pressure and heart rate problems. He continues to need fluid removed from his lungs, though thankfully there is no longer blood in this fluid.
A new and disturbing development in the form of a rash manifested itself yesterday. After the long fight to get rid of his previous rash, this is disappointing news. The big worry is staph. The Dermatology team will do a biopsy today to try to get some answers.
Some positives ... Over the last 24 hours, the docs have started to wean Graham off the nitric oxide, which he seems to be tolerating well. He has also been taken off dopamine, which was used to improve his kidney function. This has resulted in slower urinary output, but it is still at acceptable levels.
Graham has been knocked back a few steps, but if his brief history of comebacks tells us anything, he will soon begin to charge forward. As so many of you have said and thought, he is one tough little man.

Back From the Brink

Just a brief note to let you know Graham is doing better after a horrendous day and night. His breathing was at a desperate point, but he rallied and is now holding his own.
Will give you all the details of the ordeal soon. Still not out of the woods by any means, so keep those good thoughts coming.
I'm checking in after a few hours delay from posting the above paragraph to give some of the promised details.
We watched Graham's condition deteriorate throughout all of yesterday into this morning. It seemed whatever the docs tried to do to stop the respiratory and later heart failure, nothing worked. We soon ran out of options and the situation became acute. Graham's dependence on the ventilator was total. Unfortunately, the ventilator, even supplemented with 100% oxygen, failed to maintain normal oxygen levels. A high frequency oscillation ventilator (normally used with premature babies and newborns) was tried and did not work. For various reasons, this ventilation process necessitated heavy sedation. He then went back to his regular ventilator, but had to be bagged with ever increasing frequency. Even with the bagging, Graham's oxygen levels could not be maintained at normal levels. Comparing X-rays taken in the morning to ones taken in the evening showed a marked deterioration of his lungs. Blood started to appear in the fluid that was taken from his lungs. More invasive measures had to be attempted, the first of which was putting in chest tubes to relieve pressure on the lungs and hopefully allow Graham to breath easier. This surgery took place after midnight this morning. There was no appreciable effect. His oxygen levels were dangerously low and could not be raised. An electrocardiogram found that his heart function was about half of what it should be. It was the nadir of the day and a decision was made to go ahead with a procedure called ECMO (extra corporeal membrane oxygenation), which would connect Graham to a bypass machine that would take over his respiratory and heart functions. Given Graham's condition, the procedure was extremely high risk and would buy only a week or two for him to heal. It would be the final option. While Graham was being prepped for this surgery, the surgeons tried one last procedure. A real long shot, they introduced nitric oxide in to his ventilator. IT WORKED! And it has continued to work the past nine hours. His oxygen levels are normal; he is peeing copious (relative to the last two weeks) amounts; his blood gases are normal; and added oxygen has been cut back. We know his situation is still critical, but every hour he can hold his own and perhaps start to heal those wounded lungs is a decided plus. Even if he has to have the ECMO at a later date, he will go into it much stronger with a much improved chance of survival.
Katie and Bill are tired but strong. We have learned to keep an equilibrium. We are heartened by the events of the last few hours, but we also know the G-Man has miles to go and may hit more downticks. The love and concern from friends and family was the only thing keeping us sane last night. Please continue to keep us in your thoughts ... we truly can feel it, no matter what the distance. We might have to invent a new word, because "gratitude" just doesn't cover it!

A Bit More Information

We are still waiting for results from the cultures that were taken earlier today and it may take 24 to 48 hours to find out if there is, indeed, an infection. It is possible the high white blood cell count is being caused by something else.
The docs are now focused on Graham's profound breathing problems. He is fully dependent on the respirator that is supplementing oxygen at 100%, a level that cannot be long maintained. Ultrasound shows edema surrounding his lungs, which directly affects their function. Unfortunately, the Catch 22 is that lung function is important to relieving the edema.
There are options open to us. Much depends on finding a cause of Graham's edema. So far, it is a mystery. Graham is not following the script...maybe a preview to what his personality will be like!
The lifting of the H1N1 restrictions have allowed Grandma and Grandpa to relieve Mom and Dad in the NICU.
Thank you again for your loving support.

Downturn

We wanted you to know that Graham is going through an unexpected difficult time. Last night his breathing became labored, which necessitated increasing his dependence on the respirator. His white blood cell count is also elevated indicating an infection. As if that is not enough, he is experiencing some fluid in his lungs. His doctors are awaiting test results (cultures, chest ultrasound) to determine the cause and the site of a possible new infection.
We know you will keep special thoughts for Graham while we wait. The blog will be updated when we learn more or if there are any changes.

Big Day

I don't even know where to start!

I got to hold my baby Graham today for the first time in two weeks. As you can see in the pictures it was a process, but totally worth it. As soon as I got him in my arms he fell asleep, I think we have both missed that time together. I couldn't believe how heavy he was, he weighs over 12 lbs. He has almost doubled his weight from the time he was admitted. Most of it is water weight from all the swelling, but we also think he has grown a little bit with the nutrition supplements and breastmilk he's been receiving.

Next, Graham got Tummy Time! Jeff, our respiratory therapist made a makeshift mat with a little scooped out portion for the omphalocele. Graham laid on his stomach for the first time in his whole life. He actually liked it and slept for about an hour.

THEN, the H1N1 policy restricting visitors other that Mommy and Daddy was lifted. All that waiting around paid off and Grandma and Grandpa got to come in and spend some time with their grandson. They were just so pleased, you should have seen the smile on my mother's face when she walked in and saw him. And you can see Grandpa was happy too!

You Should See the Other Guy!

Today Graham surprised us all and opened his eye all on his own! No help from Dad this time. It was the best moment we've had in a week and a half, so we thought we'd share it with you. He was so alert today, moving around and getting some of his personality back.

He also started on breast milk this morning (through a tube). I think we'll start to see some of his strength come back over the next few days. Now if we could just get that swelling to go away. They say the edema is the last to go and it looks like we're following that trend.

Saturday will be two weeks that Graham has been back in the hospital and also two weeks he has been on antibiotics. They will reassess whether or not to continue antibiotics then, and we should have a better idea of how long our stay will be. The new goal is to be out by the time Uncle Ward comes back from Turkey at the end of January. If not, we've already devised a scheme on how to sneak him in to see his nephew.

Bill and I and Mom and Dad would also like to take this opportunity to thank everyone who has come to visit us here at Riley. Uncle Andy and Aunt Kirsten brought us an amazing homemade dinner, Grater's ice cream, and lots of other goodies. Auntie Jen and Heidi took me out for a girls lunch in downtown Indy. Steve, Jodi, Aaron and Lisa were great friends and made the trip down from Fort Wayne. Derek, Joe and Sallie are right here in Indy and have popped in to see us. Our Hoopeston family has sent wonderful representation with Mrs. Anvick, Mrs. Foster, Mrs. Nelson and daughter Julie, the Shaffers and today we saw the Roots. It's hard to put into words how it feels to see you come into our world of worry and help deflate that stress. It really helps us to sit back and laugh and talk about other things. We just wish you could have met Graham while you were here. The visits, along with the many cards, phone calls, comments on our blog, texts, facebook messages, all make us feel surrounded by support and love.

Catching a Glimpse

Tonight Bill and I saw (with a little prying from Bill) one of Graham's eyes. He even focused in on me for a couple seconds! That was a good moment.
As you can see in the picture, Graham's rash is completely gone, but the swelling is still there. My little 7 pounder weighs more than 10 lbs now with all the fluid that has settled in his body.
The top priorities now are getting rid of the swelling and getting his platelet levels up where they should be.
Today, G had an ultrasound of his spleen to make sure it was not enlarged. It was not. They also took a head ultrasound (I saw his brain!) to make sure blood was not present. It wasn't. Whew! They are looking for potential reasons why his platelet levels are so low, and docs were able to rule out both of those possibilities.
The Surgery Team, Dermatology, and Infectious Disease are all duking it out right now on what they think is the source of Graham's infection. Surgery is still thinking viral, and ID and Derm are thinking a staph infection affecting the skin, hence the rash and extreme peeling of the skin we're seeing now. We're still in wait-and-see mode, since some of the test results can take up to 2 weeks before showing anything.
I apologize to all of Graham's adoring fans for not posting these last couple days. I will definitely try not to let that happen again ... don't want to incur the wrath of Graham's fan base. : ) But don't worry if we miss a day or two ... sometimes there is little change from one day to the next. Please consider no news to be good news.
Thank you all for your concern for our little boy. Believe me, I understand how he just grabs onto your heart.

On the Mend

Graham has had a good couple days. From Bill and my standpoint, although the swelling has only gone down a bit, we can see that he is trying to open his eyes and is acting a little more alert. Dr. West is very happy with the way things are going. His rash is going away and he is still peeing. His platelet levels are a little concerning. Those levels are not staying up which means those little infection warriors are fighting hard and needing to be replaced. They have given him the same amount of platelets that they would give to an adult. He is fighting a good fight, that's for sure.

Graham's skin is still peeling and there are a couple theories as to why he is peeling so much. We have made it so his dry skin is not uncomfortable by putting a gel-like product on called Vigilon. The clear tape-like stuff on his hands and feet is the Vigilon and it's working like a charm.

So right now, we are just waiting for the swelling to go down enough to take out the breathing tube. Slowly but surely, we're seeing our little boy come back to life a little bit at a time. Each day he is better than the last and that is all we can ask for. Keep it up, Graham!!!

Still Healing

We took some pictures of Graham's omphalocele today during his dressing change. They have trimmed away some of the vicrylmesh that was covering the omphalocele and are happy with the tissue that is starting to form that will soon be skin. The white part that you see is granulation tissue. It looks very open and scary, but we are assured this is what it is supposed to look like. It is healing well. When Graham has his final surgery in the fall, all he will have is a small incision down his abdomen and even have a belly button! It's hard to imagine.

Our little baby is still battling horrible swelling. He has gained over 2 lbs just in fluid. The skin on his hand and foot is actually starting to peel off. Dermatology was just here and they are keeping an eye on the rash and the peeling. Poor little guy. We shift him from his back to one of his sides every two hours because the fluid starts to pool. Even though Graham's kidney function is getting back to normal, the swelling will take some time to go down.

G is still on the ventilator. His lungs are better and he's basically breathing on his own, but with all the swelling, that can make it difficult to breath, so the tube stays in for now.

As all bacteria and viral cultures come back negative, there are still no answers as to what has caused all this to happen. As frustrating as that can be, I am focusing on making sure Graham is comfortable. All that swelling makes his skin very tender to the touch. Mommy and Daddy are having to refrain from the kisses on the hands and feet to the forehead only : ) He is getting morphine and another pain med I can't spell to help him get the rest he needs to mend.

I have to say, Graham is quite the heartbreaker here in the NICU at Riley. He's got all the nurses wrapped around his puffy little finger. He gets lots of visits from nurses he's had in the past and they all dote on him and give him nothing but the best care in the world.

Upswing

It finally looks as though things are turning around for Graham.
Throughout yesterday, lab results were coming back looking better and better.
Tonight he'll start receiving nutrition through his central line which will help him build back some of his strength.
Also, he is peeing! It hasn't helped with the swelling too much at this point, but we are happy it's finally happening.
He is still on the breathing machine, but they are starting to ween him because he is not needing as much help taking breaths.
They are still doing two dressing changes a day and keeping a close eye on how the omphalocele is healing. To our untrained eye, it looks pretty nasty, but the doctors say it is healing well.
No report back on the bacteria or viral cultures taken, so Graham still has us and his doctors a little puzzled as to what exactly he caught. We're hoping with time we'll know, but have been informed that sometimes it remains a mystery. As long as he gets better, that is what matters right now.
Time is what is needed now for our little guy to start to recover. We feel the worst is over, but we've been warned there could be some down ticks still in the future. It's such a relief though to start getting more and more good news.
You would all just be amazed at how much of a little fighter Graham is. Everyday, I just look at him and can't believe what he's been through and how he must be feeling, yet he's still kickin'.
On our end, we are anxiously waiting for those sweet little eyes to open up and look at us the way they used to. I also haven't held my baby since Saturday, so I'm itching to get him in my arms again.

Baby Steps in the Right Direction

This is Grandpa and Grandma Ryder relaying today's message. Katie and Bill are with Graham in the ICU following a surgical procedure to put in a central line under his right clavicle. Most importantly, this line will allow a variety of nutrients (and calories) to be given to our G-man. Also, blood can be drawn from the this central line...no more sticks!

Yesterday, Graham gave us a scare when he began to struggle to breath, so it was decided that the CPAP should be replaced by a ventilator. Since then, his ability to breath has improved immensely. This, combined with a little morphine and another blood transfusion, made him considerably more comfortable and less stressed, which will better enable him to fight the infection battle. Seeing him more relaxed has helped his anxious parents to also breath a little easier.

Another positive sign is that Graham's urine output has increased ... not drastically, but every little drop is golden, literally and figuratively. Dr. West said blood tests indicate that his kidney function has improved. Also, his swelling seems to have gone down a bit.

Today Graham will be given a echo cardiogram to determine if his heart function is normal. Specifically, Dr. West is interested in his ventricular efficiency. He is doing well in this department, but she wants to make sure all is okay.

Graham continues to get antibiotics. One has been changed to be more kidney-friendly and another was added to prevent a staph infection. There is still no word from the cultures on what, specifically, is the cause or causes of his infection, so they are covering all bases.

Even given these positives, we remain keenly aware that Graham is still at high risk and his situation is dangerous and unpredictable. But these hopeful events boost our spirits.

Your warm and supportive thoughts continue to carry us through yet another day.

Sick Baby

Graham a week ago compared to yesterday.

We were told that in cases like Graham's, it often gets worse before it gets better. I think that's what we're experiencing now. Poor little Graham, as you can see from the comparative pictures, has some horrible swelling. His kidney function is way down, perhaps in order for his body to compensate his other organs. We're now all doing the pee dance because he is retaining all the fluids he is getting through his IVs and not peeing them out. They gave him a diuretic last night and it didn't work. Not a good thing.

The mask with the tubes attached is a CPAP machine. Yesterday, a chest X-ray showed Graham's left lung had collapsed. The CPAP helps build it back up without having to put him on a ventilator and it's working slowly but surely. Another X-ray at midnight showed some improvement.

Today we're anxious to talk to all of our doctors and find out what they can do about the swelling and see about getting those kidneys functioning again.

Graham is such a brave boy. He does better than Mommy when they stick him for IVs. He has very small veins and with the swelling they are even harder to find and then the IV doesn't stay in very well. He's been stuck 10-15 times over the last 2 days along with having blood drawn every 4-6 hours. Such a trooper!

In the picture above, he is getting a blood transfusion to get his red blood cell count up and that is beginning to work. His levels are not yet where they want them to be, so he'll get more blood today.

We should know today exactly what the infection is when we get the results from the lab cultures. The infection most likely originated from the surgical wound around the omphalocele. He is still very, very sick. The docs said it takes 24-48 hours for those antibiotics to take full effect, so hopefully after today we'll start to see some improvement. We'll let you know about the changes. Thank you so much for your comments and prayers, your support is felt and helps more than you know.

Back To Riley Hospital

After a difficult and anxious week at home, we are back in the NICU at Riley. Graham evidently contracted an infection before he was discharged from the hospital on Christmas day. He appeared normal the first few days home, even to his Ft. Wayne pediatrician, whom we saw Tuesday. But things began to deteriorate as the week went on. His incision started opening up, he was a fitful sleeper, spit up often, had minor rashes that came and went, and was not a hearty eater. At first, his symptoms did not raise alarms with the phone staff at Riley (with whom Katie was in constant contact), but yesterday they told us to bring him in to the emergency room. We were coming anyway!
Graham is fighting a bacterial infection called pseudomonas, commonly contracted in hospitals. In the ER, his temperature was a dangerously low 94.4 and his white blood cell count was very high (26k), both of which indicated infection. His rash had become more pronounced, and his feet in particular were very red and very swollen. When the doctor unwrapped Graham's omphalocele, he recognized the specific odor created by pseudomonas. Graham was immediately started on an antibiotic through an IV, beginning with a large initial dose, and then a second antibiotic was added.
Our Baby Boy is very sick and he has a long battle ahead of him. His status is now listed as "serious", thankfully down from "critical" when he was in the ER. Chief concerns now are his fluid levels, kidney function, electrolyte balance, and platelet levels. He'll also have to be given blood because of the many blood draws needed for testing. He has IVs in both arms---one for antibiotics and one for fluids, and has had to catheterized again. All fluids going in and coming out are being strictly monitored, so Katie cannot nurse him right now, but once his electrolytes are up, she will be allowed to start. It is difficult to see him hooked up to so many tubes and machines again.
We expect many ups and downs during the next seven to ten days as Graham fights this systemic infection. Although his little body has many challenges ahead before he gets through the infection, we are confident our tough G-Man will prevail. What is very comforting is the staff at the NICU. The Surgery team is now working with the Infectious Disease team to come up with the best plan of treatment. We should know more tomorrow.
We could not be at a better place. (He has to be in an isolation unit in the NICU, and Katie says it has a more comfortable chair than the other modules ... small silver linings in the big dark clouds!) Bill and Katie were also lucky enough to get back into the Ronald McDonald House on very short notice. Thanks to generous friends with extra beds, Grandma and Grandpa Ryder are back in Indy as well as wonderful moral and laundry support.