A Broken Heart

Incidence:
35,000 children are born with heart defects every year (American Heart Association)
Only 1% of those children have truncus arteriosus (many sources, including the Herma Heart Center where Turnip may be treated)
That means about 350 babies are born in the U.S. with the same condition as Turnip every year. (330 according to the Morbidity and Mortality Weekly Report from jan 6, 2006)
Treatment:
Surgery usually happens at 6-12 weeks (EPA, page 4)
15-50% of children require another surgery within the next five years (i.b.i.d.)
All heart valves are replaced after 12 years(i.b.i.d.)
Newborns with truncus arteriosus stayed in the hospital for an average of 30 days during 2003 (CDC, table 2)
The hospital charges for this stay (not including lab tests and doctor fees) ran to $200,000 (CDC, table 2)
Mortality:
In a small study published in 1996, 6% of infants died before surgery and 10% died during surgery (EPA, page 4)
In a national survey, 20% of newborns with truncus arteriosus died in the hospital in 2003 (CDC, table 1)

Saturday, May 31, 2014

New medication

So, yesterday I noticed that small boy's center chest tube site seemed a little irritated.  Papa bear got a look at it this morning and agreed.  Several phone calls and picture texts to our hospital, and one visit to urgent care later, and small boy has started another course of antibiotics.  

The surgery folks didn't seem too concerned, but the pediatrician seemed a bit alarmist in her assessment.  Of course, it probably didn't help that she had never seen us before and was being asked to deal with a medically complex little boy without complete information.

In any case, we will wait and see how things go.  The doctor today also noticed that small boy's liver is slightly enlarged. We're not sure if that is something new or whether that was present before his surgery (i should probably know this, but can't remember...and its probably in his records somewhere, but his records are rather thick and we didnt go through them).  Unless he starts to get worse or stops improving, though, the folks st the hospital where the surgery was done suggest that we just wait for his follow up cardiology appointment on the 9th.

Tuesday, May 27, 2014

good night, good day

Small boy slept well last night: no coughing fits at all, out at 9:30, up at 7:30.

Today he had his follow up appointment with his primary care provider...at our house.  I'm quite impressed with our current health care providers.  Since small boy is supposed to avoid germs for the next two weeks, I thought it would be silly to take him into the doctor's office, so I asked if she would make a house call.  And she did!

All looks good.  His incision and chest tube sites are all healing nicely.  He's down to just ibuprofen for pain control and things are moving nicely through his gut.  I think the hardest part is now upon us: keeping one very active boy still for 6 weeks so his sternum can heal.  I don't know how many times I've told him, "don't run," " no jumping," "no climbing," "no body checking the neighbors," etc.., already, and he still needs pain medication!

Monday, May 26, 2014

Good start, rocky middle

Small boy was up for a bit, really early this morning (5-5:45) coughing and coughing.  We finally got him to settle down by giving him water and warm tea.  He slept for a while, then got up and got dressed on his own and started playing with his sister on her kindle.

We have had a low key day with very little pain medication.  He put together puzzles with grandpa, watched movies with grandma and drew with chalk with our neighbors out in the driveway.  Now he's got a little fever.  After loading him up with staggered doses of ibuprofen and acetaminophen (the acetaminophen required a bribe of ice cream), I've tucked him in for a late afternoon nap.

Sunday, May 25, 2014

Best and worst

On the car ride home, I asked small boy what the best part of being in the hospital had been.  His response: watching movies with my sister.  Then I asked him what the worst part has been.  His response: getting my stickers off.

Unfortunately, he came home with three band aids (one for each IV and one got his most recent blood draw) and a mass of tegaderm (clear plastic bandaging) covering the gauze over his chest tube sites.  All of them had to come off today.  Although it is not super sticky, the tegaderm was the worst, mainly because there was so much it for him to worry about and it was stuck to some of the steri strips holding his incision together.  He got a little worried when papa got out the kiddie scissors to cut the tegaderm away without pulling off the steri strips.

With the help of the movie Brave (thanks generous friends) and sitting on mama's lap, he made it through.

To celebrate, he went outside, drew with chalk on the sidewalk, passed a soccer ball back and forth, strolled down to the playground, cried when he was told he couldn't play at the playground, and shared some Popsicles with our neighbors.  Now, he is napping while we wait for grandma and grandpa to arrive.

 I think I'm going to cut back on his pain meds tomorrow so he does not feel inclined to climb the jungle gym, ride his bike, run, and dig in the dirt (we're currrnyly giving him overlapping doses of acetiminophen and ibuprofen).  The first three activities are off limits until his breast bone heals (6 weeks) and the last is off limits until the incisions from his chest tubes scab over.  Right now, they still gape open and leak a bit.  We were told to expect this and to not cover them.  Apparently, they heal best if left exposed to the air.  We are having him wear clean, old cotton t shirts  to protect the sounds from contamination.  The last thing they need is s big of dirt or sand getting in them.

Saturday, May 24, 2014

Sitting in the pharmacy ...

...in our hometown, waiting for small boy's prescriptions to be filled.

The kids giggled and played in the back seat the whole way home.

:)

Read the echo reports....

Small boy's pulmonary homograft replacement worked wonderfully, completely correcting his anatomical and physiological  problems for now.  His aortic/truncal repair did not make things worse, but, despite our high hopes as he came out of surgery, doesn't seem to have improved things much.  We're unsure whether this is because his heart is working extra hard right now (in which case, things might start looking better in the next few weeks) or whether part of the repair failed, i.e. a stitch came loose (in which case the surgery to place a mechanical valve will occur sooner than we had hoped).

In any case, small boy is walking around his room, playing with his sister and getting into stuff.  

The docs adjusted the dose of his blood pressure med this morning.  As long as his blood pressure looks good in the next little bit, were heading home this afternoon.

Small boy will go home on aspirin (to prevent clots on his thinned down valve leaflets), a diuretic (to keep his blood volume down), and an afterload reducer (to relax his vessels, further reducing the work of his heart).

.....

And now, two hours later, we have gotten the green light to go home....  We just had ice cream drumsticks with four royal friends to celebrate and small boy and big sister had fun showing their friends the garden at the hospital.

Friday, May 23, 2014

Not so fast...

While small boy's echo showed his new pulmonary conduit doing just fine, there appear to be some issues with his aortic repair.  So, for now, we are staying in the ICU, not moving to the step down unit.

Progress towards that magic H word

Chest tubes out.
Pacing wires out.
Discharge EKG done.
Discharge echo scheduled.
3 sausages, 1 milk,  1slice of peanut butter on raisin bread, 1scrambled egg, 2 Girl Scout cookies, and 12 oz water down the hatch.
Our nurse is looking for a wheelchair so we can take a little walk downstairs to see the live radio fund raiser and go outside.

Morning update

Small boy had a restless night.  He kept coughing (a good thing) and turning himself from one side to  the other (another good thing).  He is less guarded about moving and has asked to put on his clothes and sit up several times already this morning.  After getting him dressed, I transferred him into my lap in the recliner and we watched Frozen...again.

 The most challenging thing this morning is that he is not allowed to eat or drink anything until he gets his chest tubes removed.  He has to be sedated to remove them (all of them, as of ten minutes ago.  Apparently, the leak in his right lung has sealed back up.) and you can't have anything to eat or drink for quite some time before sedation.  He keeps looking at me with his big blue eyes and asking for a drink in a pitiful little voice.

After Frozen finished, small boy agreed to stand up so we could transfer him back into his bed.  This is the first time I've gotten him into and out of bed by myself.  It went well and now he's watching.....wait for it......Frozen, again.  Anything to keep him distracted until the CV surgery team, who will be taking out his chest tubes, can coordinate with the ICU team who will manage his airway and control the sedation while the tubes are removed.

I think I'll go get breakfast while they pull the tubes (small boy will be pretty out of it for a while).  If things go well, small boy and I will go outside with his nurse later this afternoon.  He'll get to walk around in the fresh air!

Thursday, May 22, 2014

Grins

Great aunt got a big grin when she arrived an hour ago.  It is good to see small glimmers of personality returning.

Afternoon update

When I arrived around 11am, small boy was sitting up in an easy chair, watching a movie while papa sat nearby.  In short order, he needed help to stand up, shuffle to his little potty and pee.  When he sat back down, he snuggled into my lap.  Midway through Sesame Street he fell asleep for about 45 minutes.  He woke up just before his physical therapist arrived.  She had him stand up and play at his bedside for a while before he sat back down in a preschool sized chair to eat his lunch: 4 mini corn dogs with catsup, a bowl of peas, and half of a chocolate milk.  After eating, I helped him get back in bed, read him a book and turned on Scooby Doo.  He just now asked me to help him sit up and is attempting to adjust the TV.

His nasal cannula has been disconnected, his chest tubes are still in, and he seems so much more like himself than he did yesterday.

Feces and urine

What a name for a post...  Last night little boy got a suppository to help him poop. He hadn't yet and seemed uncomfortable. It worked eventually, though it was a challenge to get him on a potty. He sat on a children's training potty on his bed. He seemed more comfortable after and was willing to drink significant amounts for the first time in many hours. Which likely is a reason he had to pee later. As I was partially asleep and the lights were low, I didn't notice there was a lid on the little urinal he had to use. Pee everywhere! Oh what fun. He then slept pretty solidly from 10:30 to about 6. That was nice! This morning he seems a little better, though I think the chest tubes are still causing significant discomfort. The surgery PA just came by and said the chest tubes might have to stay in another day as the heart area tube still has bloody fluids coming out and one lung might have a slight injury causing a leak. We'll see. He doesn't have a central line in anymore, so that had to a blood draw the traditional way this morning. He survived it well.

Wednesday, May 21, 2014

Pain and progress?

O boy keeps chugging along this afternoon. We just read a fairly long book, which he was able to keep interested in. I wasn't sure he'd make it. He's struggled more today. I think taking him off the morphine has just meant more pain. He's less willing to sit up, though he's been pushed/pulled to sit up a couple times despite his protests. He's also less willing to drink/eat, which may be due to a need to poop--drinking some prune juice now to help that along.

He got his central line out, the one in his neck. He really didn't like the process, but I hope it feels better now (not clear whether it does or not). The nurse also took the oxygen canula out of his nose for a while, but the oxygen numbers appeared to drop a bit afterward, so it went back in. O wasn't thrilled about that. The amount flowing in has gone down and the numbers are staying high, so we'll hope to get rid of it tomorrow.

His big request of the afternoon was to get the tubes out of his chest. He asked something like, "Can we take these off?" Hopefully tomorrow!

Rounds

Small boy is pretty tired.  He wakes up for maybe half an hour at a stretch before drifting back out again.  The last time he was up, he watched a little Mickey Mouse Clubhouse, asked to turn on his side and complained about his nasal cannula (the tube delivering oxygen to his nose), the splint protecting the arterial line inserted in his right hand and the tape holding the IV in his left hand.  When I asked, he agreed that I should tell his doctors and find out what they could do about it.

The doctors agreed to take out his arterial line and wean down his oxygen. They've cut him back to half a liter, and if he tolerates that, will remove the nasal cannula.  They also decided to remove his renal and head sat patches (they measure how much oxygen he's using), and pull his central line (it is a line that goes into his neck).  In addition, because his blood pressure is still too high, they've increased his dose of enalapril (his afterload reducer) and given him some more lasix (a drug to make him pee off more of the extra fluid that is helping make his blood pressure high).  They've also decided to switch him over to the catoralax (the non-narcotic IV pain drug).  Unfortunately, the IVs in both of his hands will stay put.

The nurse already took off his head patch and took out his arterial line (this is the line they have used to get blood for his lab work.  He's currently down to labs once a day, instead of every 4 hours, so that should be O.k.  He'll just have to get a stick for his future lab work).  The head patch is applied with strong adhesive, some of which had stuck to his hair.  Even with the adhesive remover, taking it off hurt....so did removing all of the tape holding his arterial line in place.  But now, he's two lines down and sleeping.  I promised him he would get a break after the nurse took out the arterial line. She'll take off the renal patch and take out the central line later.


Morning update

The men had a calm evening together.  The nurses turned the lights off last night, so everyone got a bit more sleep (They were not turned off the previous night).  Small boy did manage to pee a few times, and as of right now, he's output more fluids than he's taken in since midnight (This is a change from the past two days).  Hopefully, he'll be able to avoid the extreme post-surgical edema (puffiness) he experienced after his last surgery.

There is still a significant amount of drainage from his chest tubes (There are three: one to each lung space and one to the region surrounding the heart),and he seems to have developed a small leak in one of his lungs/pleural evacuation tubes although the  CV surgery PA tells me it is small and it will go away (He came in earlier this morning to adjust things and will be monitoring small boy throughout the day).  While the drainage from his mediastinal (heart) chest tube has become more clear, the pleural tubes (lungs) are still draining a lot of blood.  All of which is to say that small boy will be keeping his chest tubes today and he will not be switching to catorolac (non narcotic, IV pain medication--it's been described to me as IV ibuprofen) as it is not given when there is significant bleeding.  Instead he will continue with morphine as needed.  One downside to the morphine is that it shuts/slows down the gut, making a poop less likely....and the doctors are starting to mention poop as a possibility.

Small boy still merits a nurse all to himself for today.

Tuesday, May 20, 2014

Evening status

Fun fact: morphine makes some people's faces turn red.

Outcome: small boy's afterload reducer appears to have  brought his blood pressure down.

Achievement: small boy finished off his second jello as well as a smoothie.

Goal:  pee

Tonight's superhero:  Papa

Dinner and a movie...

Small boy just requested to sit up while he ate 1/2 a jello cup, drank 1/2 an icy smoothie, and sipped some beef broth.  The act of sitting up and then the act of lying back down hurt a bit, as evidenced by pitiful whimpers.  Now, he's once again watching Frozen.

Docs just stopped by

They're doing the day shift-night shift handoff.  Since they stopped the infusion of the sedative and afterload reducer this morning, small boy's blood pressure has stayed a bit high.  The thought is that his body is used to having an afterload reducer on board (he's been on one ever since his first surgery) , so they're going to put him back on the same drug he was on before, with the thought that he'll be weaned off of it after we leave to allow his body to gradually adjust.

Otherwise, we're just chilling, watching Despicable Me.  Papa has gone off to stretch his legs.

OT came by

The OT came by. She asked O boy to move his arms around, which he was able to do well. She then helped him sit up - he shared that he was worried it would hurt. Once he was up, he seemed content though. He looked around and spotted his unfinished lunch and said he wanted more. He fed himself the rest of the chicken broth, downing it quickly and picking up the bowl to drink the remnants. He also ate most of his jello. OT and nurse seemed impressed. He was clearly hungry. Laying back down seemed a bit painful for him. Now he's back to the Croods. I think PT is supposed to come by around 3. Likely time for a nap soon.

Ate some food

While mama is sleeping, I thought I'd give an update. O boy ate some jello and chicken broth - seemed to enjoy eating the jello especially. It has stayed down for a half hour, so that's good (seems like it probably won't come back up). His temperature has been running a bit high, which I think is why he seems a little less comfortable right now (wiggling around). He's asked about specific tubes and wires and bandages on his body - what's this one? Why is this on me? He's now watching the Croods after having a break from movies for a while. 

Times

small boy was on bypass for just under 3 hours, cross clamped for 2.

Mama has gotten maybe that much sleep since 4:30 am yesterday.

Big sister and the great grand aunt are watching Despicable Me with small boy... It is about 2 hours long, also.

Even if big sister and the great grant left right now, she would get to attend less than 2 hours if school.  We're going to let big sister just skip school for today.  She can write a blog post or do some Moby Max math.

morning update

Small boy's heart rate is down, blood pressure is up and temperature is down.  He is almost to his normal pre-surgery ranges. 

Last night was fairly uneventful.  He spiked a fever, but it has since come down.  His fluid balance is being carefully managed.  He got a couple of doses of diuretic to pull fluids off and quite a bit of fluids (with albumin).  He was in and out of consciousness due to the sedative used to keep him calm.

Around 11 pm,  he asked for a movie.
Around 1 am, he was finally awake enough to realize that Home and Garden TV was not an acceptable movie, so I put on Teenage Mutant Ninja Turtles.
Around 1:15 am, he asked for his waterbottle (it has Teenage Mutant Ninja Turtles on it).
Around 2:30 am, he was finally allowed to have a few ice chips.
Around 3:30 am, he got really upset because he wanted all of the stickers off of him--I covered him with blankie.
Around 8:00 am, he had his left atrial line removed.
At 10:00 am, the staff rounded.  They agree that he looks good.  They took him off his backup external pacemaker, and are going to discontinue the afterload reducer (milrinone) and the sedative (dex......), remove the Foley catheter, and allow him to drink clear liquids.  

Monday, May 19, 2014

stable

Small boy is in the ICU.  He has his very own nurse for the night.  His heart is beating by itself, but he has a pacemaker attached that will kick in if needed.  He's currently only on one afterload reducer/ionotropic drug to reduce the work of his heart and one sedative.  They gave him an epidural shot of morphine before surgery that is still helping with pain control.  The anesthesiologist on duty just stopped by and mentioned that it will probably wear off around 3 am at which point small boy will either fall entirely asleep or be really unhappy.  

He's still pretty groggy, but is awake enough to whimper that he is thirsty, to tell mom she's being to loud, and to look over and reach for his sister, when he heard her voice.

Ran into the surgeon...

...on our way out.  He was heading to small boys room.   Small boy is being paced, but he was starting to see some sinus rhythm in the OR so he thinks the pacing will not be permanent.

He had also already talked to small boys cardiologist, who shared my plans for next academic year, and he offered co ngratations.

We have seen the boy

The breathing tube is out.  He is sedated.  Going to get dinner while his team gets him settled in the ICU.  He is being paced.

Post surgical surgeon visit

The surgeon came in smiling.

 He explained that the RV to PA conduit he placed in small boy is adult sized.  This means that there is a good chance that the next time small boy needs work done on this part, it will be able to be done via catheterization, which carries much less risk than open heart surgery.

He also explained how he repaired small boy's truncal valve.  Small boy's truncal valve looks kind of like a circular pizza, cut into three large and one small triangular pieces.  Most people's valves look like pizzas cut into three, equal-sized triangular pieces.  In addition to having an odd number and size distribution of pieces (these are called leaflets), the points (apices) of small boy's leaflets were extra thick (called excrescences) and two of the leaflets were partially stuck together at the edge.  Imagine a pizza with toppings piled high in the middle, cut into four unequally sized pieces, with one of the cuts not quite making it through the crust.   This makes it harder for the leaflets to open and close properly--and contributed to the leakiness (insufficiency) of this valve.

To help small boy's valve work better, the surgeon removed all of the extra toppings (shaved down the excrescences), cut through the crust (plicated the commisure), and sewed together some of the extra tissue to make the entire valve smaller (sorry, my pizza analogy broke down!).  The surgeon thinks this repair will be very durable (I didn't press him on what that means) and indicated that it has reduced the leakiness of this valve to the trivial-to-mild range.  Small boy has never before had trivial insufficiency!

The upshot: His heart now works better than it has ever worked before.

The surgical team is placing the final stitches in the skin of small boy's chest.  Then, they plan to try to remove the breathing tube before moving him to the PCICU.

Papa and I will get to see him en route.

The surgeon didn't mention small boy's electrical conduction system...I'll have to ask if he is being externally paced when we see him.

Update

Small boy is warmed up and off the bypass machine.  Both the RV to PA conduit and the aortic repair are functioning well based on the echocardiogram they did.  The aorta has some mild insufficiency (leakiness), but the surgeon feels that it is good enough.  Next, the surgical team will control any bleeding and close up small boy's chest.  It may take some time to control the bleeding due to the scarring from his previous surgery.

Papa and I should be able to say a quick hello as small boy is wheeled to the ICU in about an hour and a half.

Special Update

Hi! big sister is here and she says hi how do you do I do not want small boy to get hurt or sick and if I  could change one thing in the past It would be small boy getting better so he does not have to go to the hospital or get surgery any more.

Updates

The surgeon is still working on the pulmonary end of the RV to PA conduit.  He was able to place a 22 mm conduit, but has to do some patching to reconnect the pulmonary arteries.

They hope to begin rewarming soon, so they can do an echocardiogram to determine whether the repairs are functioning as intended.  Right now, small boy's heart is "asleep."  He's been given medication to ensure it does not contract while the surgeon is working.

In other news, we just got a call from the Ronald McDonald House.  A room opened up, so we have a place to sleep tonight.

Update

The surgeon repaired small boy's truncal valve (the homegrown valve that he has in the aortic position--it controls the flow of blood to his body) and is placing his new RV to PA conduit (the tube that takes blood to his lungs).

The nurse who gave us the update was cautiously optimistic that the repair to the aorta would be good enough.  However, she reminded us that they will test this valve after they take small boy off of the heart lung machine.  If it does not look like it is functioning adequately, they'll put him back on bypass and place a mechanical valve before they close him up.

We are cautiously hopeful about this turn of events.  When we met with the surgeon earlier, he expressed reservations about doing a repair instead of simply placing a mechanical valve.  There are many pros and cons for both options....For me, the biggest con for a mechanical valve is the need for a lifetime of Coumadin (The idea of parenting a super active 5-year old on blood thinners is a bit daunting).  The biggest con of the repair is that it pretty much guarantees small boy another open heart procedure to place an adult sized mechanical valve when he gets older/bigger.

Updates

Little boy is on bypass.  As expected, there was a lot of scar tissue from his last surgery.
Big sister is en route.  She should arrive in two hours.
We are on the wait list for the Ronald McDonald House.

No updates: nervous

We had a nice breakfast, walked by the river and sat in the sun.
Now, we're back in the waiting room.

Met with surgeon...

Small boy is sedated and having his transesophageal echocardiogram.
Once he's done with that, they'll start the surgery.
The nurse will call us once Oliver is on bypass.
We are going to get breakfast.

Parents in the waiting room

After visits from:
Pre-op nurse who put name tags on Sarah (the penguin) and blankie and gave little boy Versed
CV surgery PA
Anesthesia Fellow
Anesthesiologist
and the CV surgery nurse, who wheeled little boy away after he was really relaxed

We have to wait here until the surgeon and another CV surgery nurse come to talk to us before they start the procedure.....

....then, it's off to go hiking, because, let's face it, 7 hours in a waiting room is a very bad idea!

Sunday, May 18, 2014

What will be done tomorrow?

Turnip will be mildly sedated, taken back to the OR, have IVs placed (3-4 probably), be intubated, have a catheter placed, and have anesthesia administered.

His chest will be marked to show the location of his previous scars, nipples, and belly button.

He will be draped with cloths to show only the surgical site, opened up, and placed on the heart-lung bypass machine. His body temperature will be lowered.  (I'm not sure about the order of the last three events).

The surgical team will remove and replace the RV to PA homograft (pulmonary artery) he has outgrown and determine how best to treat his aorta and homegrown truncal valve.  Depending on what they see, they will either attempt to temporarily repair the aorta or they will place a mechanical valve.

Once the repairs are completed, they will spend some time watching to see how his heart is working before closing him up, warming him, and gradually weaning him off of bypass (again, I may have the order of some events confused).

As they close his chest, they will leave behind electrical pacing wires in case his heart needs a little extra help beating.  To help his breastbone heal, they will tie the two halves together with metal wire.  They will also insert some drainage tubes in his chest.

At this point, they will transfer him to the PCICU.  We will be allowed to see him during transfer and then again after they stabilize him in his new room.  

During the next hours to days, he will lose the respirator, Foley catheter, drainage tubes and IVs.  Before he is discharged he will have his pacing wires removed.  

By the time he comes home, he should be down to Tylenol for pain management.  He will also likely be on other medicines to reduce the workload on his heart and, if he gets a mechanical valve, he will be on a drug to prevent blood clots.

When he is discharged, he will need to avoid  people (germs) for a couple of weeks, and will need to avoid bumps and bangs for a month and a half.

This is a description of the expected course of events.  Various complications are possible and planned for.  These include bleeding, nerve damage (phrenic nerve (breathing) or recurrent laryngeal nerve (speaking)), damage to the electrical conduction system of the heart, air embolism or thromboembolism...and others that are less likely.

Sunday--Monday schedule

Go hiking with friends in morning 
Hand sanitizer when we get in car
Play outside with neighbors in afternoon
Hand sanitizer when we come inside
Bath in evening
Three minute scrub down with special washcloths after bath
Clean PJs, clean bed sheets, clean stuffed animals, clean blankie
NPO after midnight except clear liquids.
In car by 5:15 a.m.
No clear liquids after 5:30 a.m.

Friday, May 16, 2014

Pre Op Sum Up

Cleared for surgery. 

Pre Op Appointment

Anesthesia exam and visit--check
Surgery exam and visit (including detailed surgical description, risks assessment, consent forms) -- check (dad signed, mom left the room)
Echo -- now (Turnip is watching Frozen)
EKG--next
X-ray -- after that
Blood work --final stop

Tuesday, May 13, 2014

Anticipation

How are we doing, you may wonder.

The kids and their dad seem remarkably nonplussed.  I, on the other hand, am another matter entirely.  Two examples:

1) Last week, after driving the kids home from gymnastics, I parked the car in our garage and had the kids help shuttle all of our stuff into the house.  Two minutes later, Turnip came to find me. 

"Mama, our car is across the street," he said.

Indeed, I had forgotten to set the parking brake on our manual transmission and so, in neutral, our car rolled out of the garage, down our driveway, across the street and up into our neighbor's yard.  

2) Just this morning, I sent my daughter scampering out to catch the bus--an hour early!