Hi all, my dear rogues .
Today I have a story to share thanks to Conchi , ICU nurse in University Hospital of Torrejón, Madrid . In Living across the endotracheal tube. Personal vision of a physician in critical illness , Dr Viner Edwar tells his own story .
I would share a few touches .
considered the scientific and technical aspects of mechanical ventilation and
acute lung injury, it is time to take a break and remember that there is a
life, a thought, a feeling and a frightened human being on the other side of
is incompatible with our ideas as ‘care providers’, after having had a serious
personal experience with the disease, i can assure you that none of us really
knows what we, doctors, ask our patients
to bear, and what it means to be seriously ill as a physical and emotional
must be aware of all this, out of consideration for the patient who is at the
other end of the tube and whose illness has reduced him to a protoplasmic mass
of quivering lips.
year old hematologist who was used to work with seriously ill and near to death
patients every day. At the request of my pregnant wife, I got my first examination
and something happened in my liver… Between the check-ups, I phoned my wife
to let her know about the results of the tests and tell her that I was going to
be admitted to hospital. I called my secretary to cancel all my visits for good,
and phoned my insurance agent, my accountant and my lawyer and told them to
meet me at the hospital that evening .Like most doctors, I did not have my affairs in order so I
decided to sort them out properly in the
following weeks in order to have a clear conscience.
following morning I had a bone marrow biopsy, a colonoscopy and a barium enema,
the result of all being normal. It was
decided that an exploratory laparotomy would be practised, but it was delayed
due to the emergence of a deep vein phlebitis combined with fever, which only
served to further strengthen my certainty that It was really a malignant liver
process. Finally, on May 16, the liver was explored.
turned out to be an enormous benign hemangioma, although I did not believe what
my doctors were telling me, despite seeing the results first hand and what the Chief of Pathological Anatomy told me. Only some weeks later, after being
connected to ventilator and realizing that
attendant surgeon Dr Johnatan Rhoads was too sensitive to put me through
all that, if it had really been a malignant process, I knew for sure that the
pathology was benign.
first five post –operative days in the ICU, with tubes coming out everywhere,
but this particular experience wasn’t difficult. However, after leaving the
ICU, I started having recurrent peak fever which required being wrapped up for hours in a blanket of ice
each day and longer than two weeks.
thoracentesis , bronchoscopy and several “scanners ” didn’t manage
to find the cause of fever, assuming in
the end it could be a subhepatic abscess. For this reason, I suffered a new
following night, being intubated, I began to vomit. I was awake and conscious
and wanted to pull the tube and pluck it from my mouth to be able to throw up
on the other side of the bed. I realized
that I could breathe ( and later i learned that I had done), despite the fact
that the nurse told me :’ everything is under control; you can’t suck up due to
the endotracheal tube.
two days,I developed a combination of aspiration pneumonia and respiratory
distress, and finally, after becoming exhausted by the effort of breathing, I
wrote my wife a note telling her that I
would not last more than a few hours, unless another different person would
take care of me.
request, she phoned my close friend, former Chief of the Respiratory ICU of the
hospital, at that moment on holiday. Doctor Robert Rogers, current Head of the
Respiratory department at the University
of Pittsburg, came
immediately and showed me that using a respirator properly is truly an art.
sure of everything that he did for me, but in a few hours I was breathing
infinitely in a nicer way and the crisis had passed. But that was not the end
yet. It was necessary to perform a tracheotomy, learning later that the
complication of the PEEP is the POP (= click)) and it produced a pneumothorax that required multiple chest
statistics of my misfortunes were 120 days of hospitalization, 31 days on
mechanical ventilation, 10 chest tubes , 13 thoracentesis, 118 arterial blood gases
go by an average of 3.2 punctures per sample), hundreds of hours wrapped in ice
sheets, 3 bronchoscopies, and 7 months without working.
later I was fine, without chest or abdominal pain and without dyspnea.
Along the way , I learned many unforgettable lessons , topics that until then,
I had thought of in a trivial way.
OF MY EXPERIENCE IN ICU
all, doctors do not really know what we
ask our patients to endure, both physically and emotionally, all at once, precisely when
they are most vulnerable, physically and emotionally. Patients would benefit a
lot if everyone who cares for the sick could experience the terror of the
preoperative process, when you think that you may have a malignant process in
end-stage, the nostalgia inherent in thinking that they will not see their
children grow up, and preterminal affliction, apart from the thought, that they
are turning their back on everything they know and love. It is clear that if the disease
is severe enough
Until I began to feel strong , physically and emotionally , at the end of day
31 of mechanical ventilation , I had come to feel as weak as the pulsating blob
that my doctors had seen at the other end of the endotracheal tube. The patient
lives in a very restricted world. Accordingly, each person who enters their day
has an outstanding role. Although the
doctor is the ‘main character’ in the distribution of the roles, it is so only during a few minutes at a time
or, at most, several times a day.
therefore the nurse that lives literally her day with the patient, being in
fact the most important person of all.
addition, the world of the patient also includes another kind of people, who don’t belong to the Health hierarchy
(staff of maintenance, cleaning, etc).
regrettable that these people do not realize the importance of their roles in
the life of the patient, and are not prepared for this responsibility. A warm
smile, rather than the air of unconscious indifference, would make more
pleasant the relationship of the patient with the respirator.
nurses , not doctors, are the most important person in the life of a seriously
ill patient . The most important attribute of the nurse is if she/he really
cares . I could tell if a nurse did or did not do it and quickly sorted them
into two types: angels and witches.
is also true that there was a third group of nurses who, undoubtedly, had been
excellent, but had been too long in the ICU. Although they were good
technicians when they had to aspire to a patient or perform another procedure,
the human qualities were lost I’m trying to define what is meant by” a good
nurse”, and I have finally decided it is
a combination of sensitivity and kindness with a significant degree of
that there is an important kind of nonverbal communication between patient in
ventilation and nurses. Their attitudes , moods, basic intelligence and skills
, personality and personal problems affect the patient in the background .
about who would be next on duty. Some inspired confidence; from others I could only expect confrontation.
basic topic also applies equally to doctors, nurses and all health staff.
on the other hand, to which I show some
affection, even now, in spite of the only experience that my illness provided
to me, and that is the negligence of listening to the patient.
countless examples during the weeks I spent in the ICU, when this basic failure
made my life hard and, sometimes, even dangerous for me.
previously, the night in which I sucked, which seemed several liters of gastric
juice to me, I was awake and I tried to tell the nurse in
charge that I was sucking and that I would feel better if she pulled the TOT
and could withdraw the ‘bite’ and simply
allowed me to be sick.
first neumotórax, I tried to tell to her that I had dyspnoea, but her attitude
was that I was well for a week and nothing new happened. Well, this
was new and different, and I knew something was wrong ,but I did not know what . Finally was
the respiratory physiotherapist , not a doctor, who realized I had a tension
pneumothorax (Surgery Resident refused to let the nurses to listen to my
problems were varied and severe. During the weeks I spent on the ventilator ,
it was very difficult to write everything on a blackboard. Therefore, one of my
favourite visitors was a researcher at the hospital who was completely deaf
since his youth, and as a result, could read easily on the lips. For him,
communication with me was not different from the others. He amused me easily,
which helped me to stop thinking incessantly about myself.
finally brought me a radio, and suddenly I began to worry about the outside
world. At that time there were moments in which the problem of communication
was dangerous. On two occasions, the caretaker, by moving the respirator, unintentionally unplugged it , and left me
without being able to breathe. I knew that the respirator alarms were not
working, and I remember trying to take away my tracheostomy respirator to be
able to breathe room air.
this experience with a great concern of which patients should receive the kind
of extreme effort that saved my life.
course very grateful that they had all worked so hard to achieve this, and it
is obvious that the patient pays affectionately in such circumstances, both
physically and emotionally. So, it seems clear for the patient who is not going
to get better after having diagnosed a malignant process in the final stage, or
any other type of terminal illness, that this type of care is completely
that the essential purpose is not only to live but keep the dignity and quality
far as I am concerned,, the two major decisions with regard to the use of the
respirator are whether it should be used in all patients, and then, when they
should be disconnected if the patient is
not to be saved.Nevertheless, non-using
an aggressive treatment does not mean the end of the ‘intensive care’.
however, acceptance of different goals, such as patient comfort and emotional
support for the family.
think that my experience has helped me to be better in other basic aspects. I
hope and trust, it will be easier for me now to listen to the patient, not to use the machines and other support
procedures for a long time, simply because they exist. Now I am able to speak
more easily with the patients than before, and I understand that these people
are worried that they may die, and, therefore, want to talk about it.
more generous with the use of the Morphic provided that they are listed, and I
can accept convenienceas an end in itself.
can better come to terms with the fact that some sick people should be allowed to
die quietly, with dignity and without machines.
my final message is that we should not be a battery of specialists who bring
only a treatment, while patient care is absent.
must be the beneficiary of what we are doing, and not the victim.
never lose our perspective in the maelstrom of our technology. We must always
be aware of what we are doing with our machines, not only from the medical and
scientific point of view, but also humanly, morally, legally and economically.”