Most of us have seen images of the ICU (Intensive Care Unit) in the movies, tubes hanging down from bags of fluids, and the ventilator tube extending from the patient’s mouth. We’ve heard the rhythmic sound of the ventilator and seen the visual images of graphs and numbers on a screen, all representing the patient’s life force—their vital signs.
It’s entirely another matter when it’s your own mother.
She looks lifeless, with the whooshing sound of the ventilator breathing air into her fluid filled lungs. She is receiving an IV drip of a powerful sedative, which prevents her from moving or pulling the tube out of her throat.
It’s an alien landscape for family members. It is frightening to behold.
When she arrived in the Emergency room she was short of breath and in distress. It turns out that she had a heart attack (bigger than the previous one earlier in the week) and had developed pneumonia. The doctors hoped that by giving her antibiotics, reducing the fluid in her lungs with medications, and keeping her oxygenated she would heal.
For a 91 year old, every hour on the ventilator weakens her ability to breathe on her own. Already weak with pneumonia and simply from lying in bed, this heroic treatment is a race against time and her age. In the early 20th century, pneumonia was called an “old man’s friend” because it was a way that older adults came to natural end of their life. But today, with modern technology and medications this condition can improve. But its treatment, in someone her age, may simply put off the inevitable for a short time.
When I arrived, she had been on the ventilator for three days and the clock was ticking. We asked the nurse to turn down the sedation so my mother could respond to our questions. We explained to her what was happening and she nodded yes when we asked her if she understood. She made it clear that she did not want life support or intubation. She wanted to let nature take its course.
We spoke to the respiratory therapist, her ICU nurse, and later the doctor who all agreed, that she could have a “spontaneous breathing trial”, where she would try to breathe on her own. If she could, they would take the tube out of her lungs (extubate her). My mother had made it clear that if she could not, she would not wish to continue ventilation or be re-intubated with the breathing tube.
The actual process of weaning her off the vent and taking the tube out was harrowing for my mom and for us. They have to stop the sedation and see what happens when they stop pumping air into her lungs. My brother and I didn’t know what would happen. Would she be able to breathe on her own? Or would she come to the end of her life? After a few minutes without sedation, She became acutely uncomfortable, as she gagged on the tube. I held her hand, and talked her through her acute discomfort. I thought that the respiratory therapist would have preferred that we were not at the bedside while he did his job. But we wanted to be with her. We didn’t want her to be alone. We both choked down tears as we watched her struggle and suffer.
Thankfully, she was able to breathe on her own and after what seemed like a lifetime, (about 30 minutes) he finally pulled the tube out of her throat. They gave her oxygen by mask, and she was launched into the next chapter.
That was four days ago. She continues to make progress, still receiving supplemental oxygen, and is out of the ICU. But her recovery is day by day.
Caring for our elderly parents as they struggle through these health crises is not for the faint of heart. There were many times during that day, that my brother and I sobbed uncontrollably, imagining her death. While we expect that sometime in the relatively near future she will come to the end of her life, we will still feel grief and sadness over our loss.
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