Way to go! 2

“Jaded Julie, in last week’s posting you were playing the role of a senior citizen hospitalized with a serious lung disease. Please bring us up to date on your condition.”

“Do I have to, Curmudge? I don’t want to be an ill person, even though it’s just imaginary. It was much more fun when you and I were pretending to watch the sun come up over the city of Florence, Italy 400 years ago.”

“That posting was a year ago in Curmudgeon’s Wastebasket. Now please, Julie, let’s go back to the script.”

“So there I am in my bed on a med/surg floor. It is around 11:00 Saturday night and oxygen is flowing through the cannula into my nostrils, but the percentage oxygen saturation in my blood is dropping. Crisis! I would have died then and there, but the ‘partial code’ on my chart directs the hospital to try to maintain my respiration until the rest of my family can arrive from out of town. That requires that I be moved to the Intensive Care Unit (ICU) and be put on a ventilator.”

“Why must crises occur in the middle of the night? The physician and available family members are called, and they rush to the hospital. There you are, apparently asleep, intubated with the ventilator puffing regularly for you, IVs in each arm, and monitors blinking out your condition in impersonal digits. What can we do? The experienced nurse is seeing to your every need, and the doc feels that you can hang in there for a few more days.”

“But Curmudge, aren’t the family members going to stay with me and keep a vigil?”

“Some families do, but we are confident that you are in good hands. For us, it’s back to bed.”

“It’s now Sunday, and I sense that some of my family have returned. Of course, I can’t say anything with all of this hardware down my windpipe. In addition, the IVs are giving me fentanyl (more potent than morphine), lorazepam to manage anxiety, and vecuronium bromide, a paralyzing agent. The result of all these meds is that I am feeling no pain and not attempting to breathe in opposition to the ventilator. Oh, I almost forgot; there are electrodes stuck to my forehead to sense my brain activity.”

“Family members say, ‘good morning,’ and squeeze your hand. We believe you can hear us because your brain monitor goes up. Actually, I now know that you could hear us because of a story I heard (1). A man was on a ventilator in an ICU, and his nurse kept singing the familiar polka, ‘Roll in the Barrel.’ After he recovered and was off the ventilator, he asked why the nurse couldn’t get the lyrics right for ‘Roll out the Barrel.’”

“Despite the nurse’s combing my hair occasionally, I must be quite a sight. Friends who hadn’t seen me for a couple of weeks come into my room, look at me and squeeze my hand, and walk out with tears in their eyes.”

“It is evident that you are failing irreversibly. The nurse turns off the monitors so visitors will focus on you and not on the steadily falling numbers. You are being weaned off the drugs so your body will not be paralyzed and will be physically able to attempt to breathe when the ventilator is turned off. The high carbon dioxide content of your blood is acting as your body’s own sedative.”

“I am able to rest more easily after my sons arrive—one on Monday and one on Tuesday. The end is near.”

“The family members are ushered out of the room; and according to your wishes, the ventilator is turned off and all the tubes and IVs are removed. The family and clergy return. You make a few snoring-like sounds and become quiet. The physician puts his stethoscope to your chest and pronounces, ‘she’s gone.’ After prayers appropriate for your religion and last good-byes, it is over.”

Affinity’s Kaizen Curmudgeon

(1) Personal communication, Bernardine Nitz.

Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.