It takes me about twenty minutes to drive to Clara Maase. As I drive, I think about what awaits me in the ICU. I prepare myself for incredible sadness, but I also hope there will be some victories. I tell myself to focus on the victories. I will start this post with sadness and end with victories.
I arrive in the ICU and before the team rounds on the patients, a medical assistant is facetiming with a family member. The medical assistant calls me over to speak with the daughter of a patient. The patient is a 52 year old Spanish speaking only women. This is not the patient I had spoken about in a separate blog, unfortunately that patient died after her daughter spoke with her. This patient has been otherwise stable from a respiratory and cardiovascular stand point. A patient that I could extubatne, remove from mechanical ventilation, if she would just wake up. I had spoken with this daughter many times before and she said she thought her mother was just being lazy. I had obtained a neurology consult to assess why the patient was not awakening. They recommended a CT of the brain. It was inconclusive. So I spoke again with the daughter over FaceTime at the mother's bedside. The daughter was sure that her mother was responsive, despite my never seeing that. We sat at the bedside with an iPad, the daughter pleading with her mother and a 10 year old granddaughter pleading with the grandmother but got no response. The daughter of the patient assured me she had seen her mother respond at different times. I did not challenge that. Instead I told the daughter, although her mother's respiratory status was encouraging, even if her mother was responding to her by nodding her head, I her mother to be more responsive to remove the breathing tube. I would need her mother to be able to follow simple directions. I told her that if I removed her mother from mechanical ventilation, and she was unable to adequately breath, there was a possibility I would not be able to replace the breathing tube because of swelling and if that happened, her mother would pass away. I said for now we would have to wait for her mother to be more awake. Later I saw the daughter not pleading, but speaking very sternly to her mother. Unfortunately, neither tactic seemed to be working. It breaks my heart.
As you know, I had been off for two days. The team working those two days made such progress it seemed likely several patients might be ready to get off the ventilator. Our team looked at labs, checked X-rays, and evaluated respiratory status and decided we would remove the breathing tube from three patients. We gathered all the necessary equipment, and as we went to the first patient, all of the nurses, respiratory therapists and pharmacists in the unit gathered around the patient. The first patient was a woman in her sixties, I asked her if she was ready to get that tube out. She nodded her head vigorously, I suctioned her mouth and pulled the tube. We all cheered, some people held hands, and we all congratulated the patient. We moved on to our next patient that was ready to be removed from the ventilator. Again, this was a woman in her late sixties, had been on the ventilator for a month, and over the last week had made significant progress requiring less and less oxygen and was able to do more of her own breathing. I asked her, "want to get rid of that tube?" Again, vigorous nodding. I pulled the tube as everyone cheered. Patient coughed and said thank you to everyone. We headed over to our last patient, a fifty year old man and by this time, our team was almost giddy. When I asked him if he was ready to have the tube removed he mouthed, "Yes". I removed the breathing tube as again everyone cheered, and once the tube was out, he gave us all a two thumbs up and smiled. It was one of the most beautiful smiles I have ever seen. I wish I could share a picture of that moment but because of patient privacy, I can't. I circled around checking on each patient recently off the ventilator, so happy, I almost forgetting I was in a COVID ICU. I went back to check on the fifty year old man and a nurse had an iPAD, allowing this man's wife to see him newly off the ventilator. I believe she was speaking Arabic but then broke into English and said, "you are so beautiful, dear". I had to step away as I started to cry, they were tears of joy. That's as good as it gets in a COVID ICU. That's all for now.
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