Asthma

Guest Discussion
1

Declared another last night, and this one hurt.

A battler- she came in just as I started the first night, with bad asthma and advanced lung disease, in her 70s. Sweet, needed a lot, and wasn’t afraid to ask for it, but so grateful for everything, she offered a piercing halftooth smile.

Then last night it was harder. She was clammy, working her ass off, like my Mom in her last days. I gave her morphine and lasix, held her hand awhile, made some dumb joke and kissed her like a politician. She wasn’t satisfied, but I think she knew we were out of wriggle room; she just nodded, wheezed mesi.

Saigalator O2 sats dropped. When I bumped the O2 up, she retained CO2. Steroids and bronchodilators failed, no BIPAP or vent in Port au Prince, and I was out of outs. That’s lonely.

I’m spring loaded to treat cholera here, but asthma management- well, that’s lost in the recesses of residency some decades ago; I needed Brian Turrisi. He’d have thought of something…though Dennis Haber would tell you if you need Brian, you have a real problem, which Brian says also of Dennis.

Later I fell asleep. They woke me to her gasping, so I listened as her struggle diminished, then quit, and then two minutes longer, til her heart stopped its ragged rhythm altogether. Without the rasping breathing I could hear aortic stenosis, shoot, I didn’t hear that before! Is that just agonal? Maybe lasix was the wrong call. Well, she’s apneic now, we’re below minimums, there’s no missed approach from here.

They call me to pronounce patients occasionally, listen to a silent chest a minute, nod to the nurse, record the time of death like an umpire- they ain’t balls or strikes til I say so.

But it’s rare to listen to life as it ebbs away, whisper a goodbye and godspeed as it all runs down.

The nurse blurted she’s dead, but I said wait, wait, her daughter at the foot of the bed- they never know, it seems obvious, but they never know… and sure enough, just like my Pop, she took another rattling breath, a second, a third- then, muscle’s long memory lost at last- finally went still.

Then I told her daughter she was dead.

And all hell did break loose.

2

That, is a horrible way to go

3

Damn sobering…

4

Richard,

I am sure she was appreciative of all that you could do. I am typing this in the ICU right now with access to high frequency oscillators, inhaled nitric oxide, cardiac bypass machines, balloon pumps, cell savers, and most every medicine and device known to Western medicine. My dilemma is not always can I keep my patient’s alive, but should I. The cost of care here can be sobering. I have to go see my septic patient that has not uttered a word or been out of bed in 5 years. The family wants “everything” done to keep her alive. Such is my duty. Thanks for sharing…

5

Please do not stop posting this stuff.

Anyone who reads it will instantly feel so lucky, so content and so much more compassionate toward our fellow inabitants of earth.

I think you have already maxed out your entry-to-heaven qualifiers. You’re in. Anything from here on out is just extra credit points.

6

And unless we can do something about families that insist everything be done, we will, inevitably, bankrupt the country.

Not having to deal with such things anymore is one of the best features of being retired.