A US lung specialist shows the stages a corona patient goes through when they are admitted to a hospital. It paints a depressing picture of a battered body that is getting weaker and weaker by the virus – to the bitter end.
What patients and doctors go through during this difficult time – from arrival at the hospital to their last breath – is usually only known to those affected. In the “Los Angeles Times”, however, the lung specialist Karen Gallardo gives an insight into the stressful everyday life in the intensive care unit. It impressively describes in seven phases how devastating a serious illness can be.
Feeling of drowning
Phase 1: You’ve experienced terrible symptoms for a few days, but it’s now so difficult to breathe that you go to the ER. Your oxygen saturation level indicates that you require assistance, with a supplemental flow of 1 to 4 litres of oxygen per minute. We admit you and begin antiviral, steroid, anticoagulant, or monoclonal antibody treatment. You’ll be exhausted for several days in the hospital, but if we can wean you off the oxygen, you’ll be discharged. You make it.
Phase 2: “It becomes harder and harder for you to breathe. “Like drowning,” many patients describe the feeling. The bronchodilator treatments we give you provide little relief. Your oxygen requirements increase significantly, from 4 liters to 15 liters to 40 liters per minute. Little things, like relieving yourself or sitting up in bed, become too difficult for you to do on your own. Your oxygen saturation rapidly declines when you move about. We transfer you to the intensive care unit.”
Phase 3: “You’re exhausted from hyperventilating to satisfy your body’s demand for air. We put you on noninvasive, “positive pressure” ventilation — a big, bulky face mask that must be Velcro’d tightly around your face so the machine can efficiently push pressure into your lungs to pop them open so you get enough of the oxygen it delivers.”
Phase 4: “Your breathing becomes even more labored. We can tell you’re severely fatigued. An arterial blood draw confirms that the oxygen content in your blood is critically low. We prepare to intubate you. If you’re able to and if there’s time, we will suggest that you call your loved ones. This might be the last time they’ll hear your voice.”
“We connect you to a ventilator. You are sedated and paralyzed, fed through a feeding tube, hooked to a Foley catheter and a rectal tube. We turn your limp body regularly, so you don’t develop pressure ulcers — bed sores. We bathe you and keep you clean. We flip you onto your stomach to allow for better oxygenation. We will try experimental therapeutics.”
The necessary machines are rare
Phase 5: “Some patients survive Stage 4. Unfortunately, your oxygen levels and overall condition have not improved after several days on the ventilator. Your COVID-infested lungs need assistance and time to heal, something that an ECMO machine, which bypasses your lungs and oxygenates your blood, can provide. But alas, our community hospital doesn’t have that capability.”
“If you’re stable enough, you will get transferred to another hospital for that therapy. Otherwise, we’ll continue treating you as best we can. We’re understaffed and overwhelmed, but we’ll always give you the best care we can.”
Family has to make a decision
“The pressure required to open your lungs is so high that air can leak into your chest cavity, so we insert tubes to clear it out. Your kidneys fail to filter the byproducts from the drugs we continuously give you. Despite diuretics, your entire body swells from fluid retention, and you require dialysis to help with your renal function.
“The long hospital stay and your depressed immune system make you susceptible to infections. A chest X-ray shows fluid accumulating in your lung sacs. A blood clot may show up, too. We can’t prevent these complications at this point; we treat them as they present.
“If your blood pressure drops critically, we will administer vasopressors to bring it up, but your heart may stop anyway. After several rounds of CPR, we’ll get your pulse and circulation back. But soon, your family will need to make a difficult decision.”
Phase 7: “After several meetings with the palliative care team, your family decides to withdraw care. We extubate you, turning off the breathing machinery. We set up a final FaceTime call with your loved ones. As we work in your room, we hear crying and loving goodbyes. We cry, too, and we hold your hand until your last natural breath.”
At the end, pulmonologist Gallardo writes:
“I’ve been at this for 17 months now. It doesn’t get easier. My pandemic stories rarely end well. Get vaccinated.”
Image Credit: AFP