Birthday Girl

It's my birthday. I'm 36 years old. Isn't it weird how birthdays change over the years?

When I was a kid and teenager, I couldn't wait for my birthday so I could open my presents. In my early 20s, it was a good excuse to "celebrate." Now, it's just another day on the calendar. I'm more interested in sipping wine and eating sushi in my pajamas than I am of going out and celebrating.

Today, my little brother, Greg, texted me. Two of my brothers have birthdays within a couple of days of my birthday. Seriously. Here's his text...

It's a Miller Family thing. My Grandma Vivian used to switch the numbers around in her age on her birthday, especially if it made her younger. That took me back to my childhood, thinking of how Grandma used to be there for every birthday. She lived a block away from us, which meant she was there for every party, every basketball game, every piano recital, every gathering. She always wore her charm bracelet that had each grandchild on it, and you could hear her coming from a mile away. The birthday party would start when we would hear Grandma's bracelet coming up the stairway. She passed away a few years ago, but every birthday I think of Grandma and how grateful I am that she was such a huge part of my life.

Grandma Vivian

So, back to today. It was a pretty awesome day! It started out with some snuggles from my two little men.

Blurry morning snuggles before sunrise.

Then I scored some pretty good seats for an Eric Church concert in April, and convinced Perry that I need a new pair of boots. I didn't really need his approval, just his credit card number.

I am in love with these boots, soon to be on my feet.

Mom and Dad stopped by and took me and Perry out to lunch at The Starving Rooster, where I got my birthday cake.

Yes I was.

I wish I could tell you that today ended on a happy note, but it was actually a very sad ending to my birthday. Today was Kalli's last day with Natalie. She's been doing respite for us for almost two years now, and she's like a daughter to us. She has a very special bond with Natalie, and she'll always be a part of our lives, but it's time for her to start her career in the special ed classroom. There are many kiddos out there who will be very lucky to have her as a teacher. More on Kalli later, but for now, a picture of these two beautiful girls:

It was sad saying goodbye for now, but the older I get, the more I realize that no matter how much you want things to stay the same, there's no way to make that happen. Life goes on, you lose people, you meet people, and you experience new things all the time.

Bring on 37.

Back to the Blog

Hello, there.

I bet you were wondering if I'd ever post to this blog again.

I was, too.

In fact, if I'm being totally honest, I wrote those first few lines a few weeks ago. Hmph. December needs one more week.

I do know that a lot of people -- for some reason -- really enjoyed my blog posts while Natalie was in the hospital. I've always wanted to take better care of this blog, and start posting about our lives raising Natalie, but it's easy to get distracted and push this to the bottom of the to-do list. Maybe this will be my New Year's resolution.

So -- where to begin? The last post was from the day we left Sanford Hospital in Fargo. Since then, Natalie has done fairly well. She has put on a good amount of weight now that she has her g-tube. She has three feedings during the day -- and a long feeding overnight. It's taken us a while to really get used to this change, but it's so much more convenient, and so much easier for Natalie.

Right now, we still have the temporary tube hooked up. In January, her doctor will replace it with a button that lies flat on her stomach. Here she is tonight, eating while watching Wheel of Fortune. She has good taste in television shows.

Calvin actually hooked her up for this feeding and was so proud of himself. (I was proud of him, too.)

Not only do feedings go through this tube, but Natalie no longer needs to choke down all of her medicine. It goes through a little port on the side, which means we can even give her meds while she's sleeping. I hear angels singing.

Also this month, the amazing staff at Edison Elementary somehow found the time in their schedules to put together a benefit event in Natalie's name. It was the most amazing night -- not for how much money was raised, but to witness how much love is present for our little girl. Her ability to speak to people's hearts without saying a word is breathtaking. Thank you to all who came, who donated money or products to the silent auction, who said such kind words, and who worked so hard to put this together.

All of Natalie's paras over the past five and a half years in one room! Four very special women, for sure.

Natalie's Night at Edison was amazing!

I'm not sure what I said, all I remember was crying. Natalie smiled, though.

Two of the event coordinators: Jen Crisp & Principal Joy Walker

It doesn't end there.

It was back in August when I really started considering what the future would hold for us as far as transportation goes. We leased a van nearly three years ago, with the thought that after those three years were up, we would probably need a handicap-accessible van. I just wasn't sure how we were going to make it happen. Natalie was getting bigger, and putting her in her car seat (a special car seat which worked well for her size) was getting more difficult by the day.

So I spent a lot of time in prayer, considering what we would do. Would we buy our van and take out a loan to convert it? Would we try to find a van that had already been converted? Or would we just stick it out with the car seat for as long as possible and pretend that we would be fine without it?

Then, a few weeks later -- out of the blue -- we were contacted by someone on behalf of another person/people. The anonymous person(s) was looking to donate a handicap-accessible van to us. But not just any van...a new van of our choice, to be converted by a company called Rollx in Minneapolis. It was simply unbelievable. We weren't quite sure what to think about this. But it was all very real.

We picked out a new van and scheduled a conversion date with Rollx. It was at this time that Natalie got sick--and was later hospitalized. I have to admit that in the darkest of hours with Natalie, I thought about how, if she didn't make it, she would never get to ride in her new van. There were so many positive things happening with her, and this illness came along and derailed a lot of our hopes and dreams for her. We all know how that ended, though. No one could keep Natalie down for the count.

So we sent the van off to Minneapolis and waited until just yesterday to see it again. I flew out to Minneapolis early yesterday morning and went to meet our new transportation and to bring it back home.

It looks pretty much like a normal minivan...

...until out pops a ramp.

Natalie's new wheelchair fits perfectly inside!

It's really interesting how they convert a minivan into a handicap-accessible minivan. The whole bottom is taken out of the car and replaced. With the touch of a button, the door opens, the van lowers, and the ramp rolls out. I would show you on video, but that would mean I would have to take the van out in this frigid weather and get a video. Not gonna happen. I will later, though!

The nice thing about this company is that they are able to keep one of the captain's chairs in the middle row, so we still have that extra seating. There are some things we have to compromise on -- like the loss of some storage space -- but it's nothing compared to what we gain. In the past, I've always tried to find ways to keep Natalie at home in the winter while I do shopping or run errands, or just go visit someone. Loading her up in the cold weather and dealing with a heavy wheelchair was just more work than I wanted to handle. Now, I can quickly get her in and out and we can all enjoy some time away from home together.

To this day, we don't know who donated the money for this incredible gift. Sometimes I wish we did -- but it's also nice to just know that a kind soul or two is out there. What this person(s) did was beyond generous. By doing this, the donor has changed our lives in such a profound way. It's easy to see the bad in this world, but there are a lot of really good people who simply want to help others. I only hope that we can pay it forward in our own way some day.

So that's all for now, but I'm hoping there will be more in the days, weeks, and months to come.

We're Going Home!

A last look at Natalie's super cute hospital home

Five weeks ago today, nearly to the hour, Natalie was admitted to the hospital in Minot. Today, she gets to return home.

What an amazing journey this has been, full of ups and downs, tears and laughs. There were times, I admit, that I envisioned what it would be like to go home without her, and how we would deal with our world without Natalie in it. Thankfully, it was all just a bad dream, and life will go on with her smiling face beside us.

Her path to the hospitalization wasn't a simple one. There are many reasons she ended up in intensive care. She has cerebral palsy and low muscle tone, as well as scoliosis, which means breathing isn't as easy for her as it is for you and me. She has smaller lungs than a girl her age has -- and clearing those lungs can be difficult.

Over the years, her ability to swallow has diminished, and without a g-tube, aspirating (getting food in her lungs) has been a concern, as has refluxing from her stomach right into her lungs...something we didn't even realize was happening.

All of this combined with a virus of some sort and a severe asthma attack landed her in the hospital. Of course, we later discovered that she had undiagnosed pancreatitis...surprise! How this little girl survived it all is really more than I can understand.

We arrived in Fargo on October 15th. The leaves on the trees were the most beautiful shades of yellow, orange, and red: fall was in full swing. We leave today on a frigid day with snow on the ground and Christmas decorations lining Broadway in downtown Fargo.

The seasons have changed while we've occupied this hospital, and in many ways, it's a metaphor for Natalie's life. She came into this hospital a very sick child, and she'll leave here a relatively health girl, but with a whole new routine. A g-tube will be her source of feedings and medication administration.

Our new life will include a lot more of the preventative care, including vest treatments and a cough assist machine. I'm considering building a new wing of the house to store all of her new equipment and supplies. Ha!

In the end, it will be a much better life for Natalie...and for us! Feedings and medicine time will be so much easier, and now I will feel better about leaving her with others if I need to go on a little vacation. That doesn't happen very often! Also, going on vacation with her will be easier. No more mixing up smoothies and spending hours feeding her. Now, we can feed her at any time...even when we're driving somewhere. It's amazing!

Right now, we're busy coordinating medication with pharmacies and equipment with Healthcare Accessories, so I have to cut this post short. There will be more to come, though!

We're ON OUR WAY HOME!

Nurses

I'm not sure I could ever properly put into words the gratitude I feel for the nurses who have cared for Natalie, but I will at least try to in this post.

This is directed at not just the nurses in this PICU, but all of the nurses who have so lovingly cared for our daughter -- and us -- over the past eight years. From the day Natalie was born, we have met the most amazing women, and a couple of men, who have spent their lives taking care of others.

The first person to present Natalie to me was her NICU nurse, Laureen. To this day, she is a part of our lives, as are many of the NICU nurses in Minot who cared for Natalie, even though we don't see them on a regular basis. They were the women who were there when Natalie struggled to survive in the first days of her life. They were there, handing Natalie to me for the first time in the NICU, two weeks after she was born.

Then came the nurses from the University of Minnesota - Fairview (the hospital name has now changed). They whisked her away on an airplane in the middle of the night and stayed with her through the roughest of hours and days. The bonds I made with those nurses can never be broken.

Now, we've come to know a whole new set of nurses at the Sanford Children's Hospital PICU. After a month of hospitalization, I've met the most amazing women...some new to the profession, others who have been around for a long time.

In between hospital stays, there are the nurses who have cared for Natalie in the clinics. They know her story and know how to react when I call the office in a panic.

All of these women are so different, and yet have one common characteristic: their love of helping others. It is amazing to watch them work, and I'm so honored to call them friends.

Over the past month, I've done some thinking about all of the things a nurse does that can sometimes go unnoticed. Her job description is a complicated one. These are a few of the responsibilities I've observed:

CAREGIVERS: They do the things that most wouldn't care to do on a daily basis, like changing diapers, cleaning up saliva, dealing with all of the various bodily fluids that are present in a hospital. They give baths quickly and skillfully, and yet lovingly. They do their best to prevent skin breakdown and bedsores. They do all they can to make sure their patients are as comfortable as possible in a difficult situation. Not only do they care for Natalie, but they care for us. They never leave the room without making sure that we have everything we need.

TROUBLE SHOOTERS: When things are going wrong with a patient, they do all they can to figure out how to fix it. A problem that arises can be the result of many causes, and they trouble shoot to make things better. The answer to a problem isn't always easy to arrive upon -- but they are often left to figure it out on their own.

PLUMBERS: Yes, plumbers. Have you ever seen a nurse sort through the lines of ten pressers to administer a medication? I'm amazed at how they have to figure out which medicine goes here, which feeding tube port goes there; it's so confusing! I can't believe they can keep all of the IVs and lines in order and keep those IVs working well.

JANITORS: They make sure the rooms are clean, in between the times when the actual janitors arrive. They keep things orderly, which may not seem like a big responsibility, but when they've got other patients to care for, and endless charting to do, they still make sure that things are tidy when they leave the room. For the past month, this room has been my home, so it is appreciated!

DOCTORS: Let's face it, the doctors get all the glory. They may make the big decisions, but they are often not there in the middle of the night, dealing with the racing heartbeat and the stomach pains. The doctors are consulted, but the nurses make the quick decisions the majority of the time. They make those decisions based on experience, and do so without hesitation. They have to know how to interact with each doctor; some doctors like to be told what the nurses think needs to be done, other doctors like to come up with the solution on their own.

ASSISTANTS: While nurses do make a lot of the decisions on their own based on what their orders allow them to do, they are there to assist the doctor in any way possible. They anticipate what a doctor needs, and even if they are racing around doing multiple tasks at once, they will drop whatever it is when a doctor asks for something. They get it all done, and often I think it is overlooked at how much they do on a daily basis.

CLERKS: Charting. They chart all day long when they're not caring for patients. Yuck.

COUNSELORS: I don't know how many times I've cried in front of nurses, or how many times I've asked for advice. They listen and understand. They're a shoulder to cry on, and they are there to tell me what I need to hear. Sometimes that what I need to hear is the absolute truth, other times it's just offering up the best case scenario so I don't lose it. They are there for the best times and the worst times, and everything in between. Which leads to...

FRIENDS: I've spent a lot of time in the NICU and PICU, and typically my favorite time to be here is in the evenings and overnight, because I can sit and talk to the nurses without the hustle and bustle of all that goes on during the day. I've made some pretty awesome friends over the years. Natalie's hospital stays have thrust us into the world of these professionals, but they always become more than nurses to us. We are so blessed to be able to know these people, and even when we leave here, we know that they're always in our hearts and never far away.

They do all of this on long shifts, at odd hours, over weekends, and on holidays. Sometimes they have to stay longer than they want to because extra help is needed, but you won't find them complaining about it. You can tell they do what they do because they love to do it.

While nurses are a huge part of Natalie's care team, so are the many respiratory therapists who have spent countless hours doing their best to help Natalie breathe. They have a tough job, and are constantly being called to different rooms to help treat patients and tend to equipment. All of you have been amazing, and I'm so glad we got to know each and every one of you.

We may be leaving soon, but our excitement to be home doesn't mean we are excited to leave you. We love you all. Thank you from the bottom of our hearts.

Leaps & Bounds

It appears as though Natalie is ready to get out of the hospital. Since Sunday, she has made incredible strides in her recovery. It's as though a light switch flipped, and she decided she wanted to breathe on her own.

Since extubation last week, she was on the high flow (blended flow) nasal cannula. It's a step down from the large BiPap mask, but still provides a little bit of pressure to help her breathe, as well as some oxygen support. It makes her so happy to have the mask off!

On Sunday, the plan was to let her do a 40 minute trial on the blended flow. In the past, she hadn't done very well with it. The first test on Sunday went really well...so well that a second test was planned for later that evening. It was supposed to last 45 minutes, but she did so well that it lasted over five hours. She went back on the BiPap overnight, but it was so encouraging that she was showing us she was ready to breathe on her own again. Maybe it was because Daddy visited on Sunday and got in some Natalie time.

Natalie got out of her bed for a while on Sunday while her sheets were changed

I know it gets to be a lot of medical terminology, but basically what happened was that Natalie's lungs healed enough, that what looked like another two weeks (at least!) in the hospital turned into just days. For the past few days, the doctors have been weaning her off of the oxygen support, in the hopes of getting her on a regular cannula -- or even just plain room air.

A peaceful afternoon, resting with the high flow cannula

This news is wonderful! I can see the end in sight...but the biggest hurdle right now is getting her off of the medication she's received over the past three and a half to four weeks. Being on the ventilator means being on some really addictive medicine, including morphine and Precedex (a sedative). She's no longer receiving the morphine, and she's now nearly done with her Precedex. I can't even begin to imagine how difficult this is for her, but I'm able to witness it with her high heart rate, jitters, sweating, and general grumpiness. I don't blame her..it must be horrible. She does get some medicine to combat those side effects, but mostly she'll have to just get through this, and hopefully it won't last much longer.

In the meantime, she has a new g-tube and is dealing with whatever pain is felt following that surgery. She also has a new anti-seizure medication, so we're also cautious of how she's reacting to that. So far, so good.

It seems like a lot for a little girl like Natalie to handle, but the most important thing of all is that we've got our old Natalie back. She's smiley. She's happy (when she's not having a rough spot with her withdrawals). She's snuggly. The sparkle is back in her eyes.

She couldn't stop smiling when she got back on the cannula

So the million dollar question is: when will she get to come home? I''m hoping it will be in a few days or so, but it's hard to predict something like this. She still has her PICC line, and needs a bit of oxygen support, which means she still is ICU status. Pretty soon, we'll be moving out of the PICU to a regular room, which seems weird. I was hoping we could just go from the PICU right back to home, but it's best that she's not taking up a bed in the PICU if someone else needs it.

Our home away from home

This room has begun to feel like home to me...isn't that sad?!? So much has happened in here in the past few weeks. She arrived here via helicopter, nearly died here, celebrated her 8th birthday and Halloween here. There have been many tears, smiles, and laughter in this room, along with a lot of suffering. We've prayed, read books, sung songs, and whispered thoughts here. The walls are lined with colored pictures and get well signs, and balloons and stuffed animals are everywhere. I've slept for four weeks on the uncomfortable little couch...I'm fairly certain my bed at home is going to feel like a cloud. I've met some incredible men and women of the nursing and respiratory therapy staff. It's our little corner of the world.

Snuggle time is much easier now that she's on the cannula

And yet, I'm so excited to leave it! But leaving means I'm taking Natalie home, and this will be much like taking home a newborn baby...in fact, it's even more intimidating! With her new g-tube, we will have a whole new regimen for feeding and administering medication. We'll also be doing much more preventative therapy to keep her lungs from failing again. It seems a bit scary, but it will all be much easier than before once we get used to the new schedule. She's also getting a new wheelchair -- that was in the works before she was hospitalized -- and we'll soon have a new wheelchair-accessible van. Life is going to be so much different in the weeks to come!

P.S. Many people have encouraged me to take care of myself during this whole process, and it's easier said than done. However, a very good friend in Minot set up a special treat for me the other day -- a pedicure! Thanks to the help of another friend here in Fargo, I was able to enjoy a little time away from the hospital.

Pedicures were a fantastic treat

Day 27: Frustration & Faith

The days are just flying by here in PICU room 477. Another week has passed, and the improvement is slow, but steady. There are many things to be thankful for, but there are also many rough spots along the way that leave me scared and frustrated.

This morning, Natalie is resting peacefully in her bed, with her BiPAP mask on, snuggling her little puppy friend.

A peaceful Saturday morning

BiPAP is a tricky thing for Natalie. Since she was extubated, she was also taken off of some of the sedation she's had for a long time, as well as the morphine. Of course, she's become addicted to the morphine. So now, along with the switch to the somewhat scary BiPAP mask, she is going through some pretty nasty withdrawals. Sometimes it's hard for her to relax into the mask's air pressure. It's like watching someone who has never ridden a horse before start out at a gallop. She can't understand how to relax into the motion of the air unless she gets a sedative. 

At times, she does really well and slows her heart rate and respiratory rate down to a really comfortable level, as evidenced below. 

Other times, though, she fights it so badly that it looks like she's suffocating. The key right now is to keep her sedated enough to relax into the mask, while at the same time keeping her awake enough to take the good breaths. Hopefully the withdrawal phase will pass soon. As long as she is in this state, weaning her off of the mask will be tough...so she may be on the mask for a while before she can handle the cannula. 

The good news is that she is taking full feedings through her new g-tube, and it's going really well. Since she no longer needs any IV nutrition or morphine, she also got to say goodbye to her central line. The central line was an IV in her femoral artery, on the inside of her thigh. It was in such an awkward place, it's nice that it's gone. I'm sure she's much more comfortable without it. Now we're down to just the PICC line in her arm, which has been there for quite a while. I'm hoping that will go away soon, too.

The PICC line - hopefully it will be gone soon, too!

This would all be so much more bearable if I didn't have two little boys at home, who continue to grow up while we're gone. They miss their big sister, and they miss Mommy. Thank goodness for technology...especially FaceTime. I see the boys at least once a day and talk to them, and they talk to and sing songs to their sister, too!

FaceTiming Natalie while eating spaghetti: my multi-tasking Dexter

Calvin likes to hear his bedtime stories from me. Oh, I miss him.

The days actually do go by fast for me. There's always something going on here, or someone visiting. I've learned how to make the best of cafeteria food. I've created some pretty awesome salads with the salad bar. I'm actually reading books and doing my nails; two things I rarely get done at home. I also get a lot of one-on-one time with the most amazing little girl in the world, so that's pretty awesome. 

A quiet night in the PICU

I know many people think I'm so strong for how I'm handling all of this, but I can assure you that deep down inside, I'm a mushy mess. Being optimistic and upbeat is how I handle stress. It's easy to feel sorry for yourself, and I do often...but what good does that do me? I'd much rather be happy, so I won't wallow in my sorrows for long. I keep the mushy mess part of me hidden away until I need a good cry, and then I feel bad for the nurses who witness it! Ha!

On a similar note, I met a new friend a couple of weeks ago. We've both had some pretty traumatic experiences with our children, and talking to her was so therapeutic. I felt like I'd known her all my life. We both have a strong relationship with the Lord, even though it's been tested so many times. 

It got me thinking about what faith really is. My faith in God is not simple. I don't blindly follow Him, hoping that one day I'll go to Heaven. I look for Him in the times when it's most difficult to find Him...the times when I'm wondering if He's there for me at all. When I come out on the other side, whether it's good or bad, I know He was there all along. I can feel it inside, because I don't feel alone. Life doesn't always go the way you want it to go. 

I have a lot to be thankful for these days, and now I'm making an extra effort to share my happiness. We're in a place where there is a lot of sickness and sadness. You'd be surprised how many elderly people in wheelchairs will light up if you just look them in the eye and say hello or strike up a conversation in the elevator. 

Anyway, it's time for me to get off of my soap box and get back to admiring Natalie. Please pray for her strength to make it through this tough stretch and stay on the BiPAP so she doesn't take any big steps in the wrong direction. Thank you for all of your amazing support!

A joyful heart is the health of the body,

but a depressed spirit dries up the bones.

Proverbs 17:22

Day 24: Extubation & Exhaustion

It's a rainy, snowy, cold day here in Fargo...three weeks to the day that Natalie arrived here. I remember packing for our trip here thinking the stay couldn't possibly be any longer than a week. So much has happened since then. It feels like we're in the homestretch sometimes, and other times it seems like there will never be an end to this.

This morning, I had so much hope that the end could be near. After all, yesterday was a big day...Natalie was extubated!

Unfortunately, being extubated means it's back to the BiPAP mask, which is very irritating for her. In the video below, you can see how the mask fits tightly against her face and blows the air violently into her mouth. You can imagine how uncomfortable that must be.

She's making this change at the same time that her pain medication/sedation is being cut down, and that results in her being more aware of what is going on. Now her heart rate is shooting back up, as is her respiratory rate. She's doing a great job of keeping her sats up and coughing up all of the mucus from her lungs, but she's working harder to do it, and that's not a good thing.

The BiPAP takes up her whole face...you can see why she doesn't like it!

Hanging out with my little one while she wears her lovely BiPAP mask

We've tried the high flow nasal cannula a couple of times since yesterday, and although she loves it, it just doesn't provide her with the support she needs at this point. I finally got to see a smile last night, during the short period of time she tried out the cannula. It's been two and a half weeks since I've seen that, and I can't even begin to explain how therapeutic that was for my heart and my soul. Her smile is so precious, because many times it's the only way she can express to us if she's happy.

A SMILE! It's a beautiful thing.

Although things seem to be moving in the right direction, I was reminded today by Dr. Gheen that he won't allow her to struggle through this process. If she continues to work too hard to breathe, he will put the breathing tube back in. Hearing that was like a knife in my gut this afternoon. I need to believe that she is nearing the end of her hospital stay; the thought of going backward is devastating. I'm not one to cry very often, but this afternoon, I broke down in front of her nurse an respiratory therapists. I want to make things all better for her right now. I want our lives to return to normal.

The sad thing is that I'm getting used to this. I'm forgetting what life is like outside of a hospital. Thankfully, Natalie and I have met some very special people. The nurses and respiratory therapists are just fantastic. Watching them work has been fascinating. They are so caring and so knowledgeable. I've learned so much from them, and at the same time, they've been so encouraging to us. By now, we've met just about every nurse on the floor, but somehow I've only managed to get pictures of Natalie with a few of them.

Lori and Caitlin--we LOVE them!

Roxanne is an amazing nurse

Meanwhile, one of the worst things about being in the PICU and pediatric unit is that every once in a while we'll encounter a family going through what we have gone through in the past. I walked past a family whose baby was being put on a Life Flight. We've seeing crying families in the PICU; the parents who can't make eye contact because they don't want others to see what they're going through. My heart aches for these families because I know that you can't just tell them that everything will be all right. Sometimes it won't be all right. Other times I see the babies who have no family by their bed side. I wish I could be there for them to show them the kind of love that Natalie receives.

Speaking of the love she receives...a recent present from a neighbor back home is a wonderful addition to Natalie's ever-growing cast of stuffed animal characters on her hospital bed. Many of our friends will know and appreciate this teddy bear from Metigoshe Lutheran Church. Thank you, Kim, for this...

...and also for this. :) Would it look odd if I pour myself a glass of wine in the PICU?