In and Out

Judah's past weekend was a remarkable one. It is a very scary thing to see a loved one on a respirator. The tubing is held in place around his mouth with a plexiglass rectangle that presses firmly against his lips to prevent air leakage. The plexiglass is held tightly in place with a series of straps that wrap around his head and cheeks. His body is straight and his head is tilted slightly back in an uncomfortable looking stretch. Every few seconds there is a mechanical hiss as the respirator forces gas into Judah's lungs. His chest rises and falls in synch with the machine. For all the world, he looks like he has no life and is just being mechanically inflated and deflated. Every few moments, he skips a breath and a very loud alarm sounds. His nurse, Lisa, taps him on the chest and yells out, "Take a deep breath Doctor White." as if he can hear her. Maybe he does. We all stand at his bedside and talk to him, telling him what is going on, what we know, and that we love him.
The nurse tries to find the right amount of Propofol to give him so that he will be conscious enough to control his breathing, yet unconscious enough to tolerate the intubation. There are restraints tied to the bed, in case Judah tries to pull his tubes out. As long as his family is with him, the restraints stay unused.
The next day, the propofol is diminished in strength to 1/3 of the original dose. Judah is sleeping, and he occasionally opens his sleepy eyes and looks around the room. The eyelids collapse back down, exhausted. His hands rise up slowly, indicating something that we can't read. He wants to say something but he doesn't have the strength to move with any kind of acuity. His hands float up from his bed, but his arms can't rise with them. We talk to him. He is able to nod yes and no, but with great difficulty. He floats back to sleep.
It's night again, and Judah is restless. He is dead set on talking with us but he can't. We ask him a series of yes and no questions, primarily to determine if he is in pain. He shrugs with his eyebrows. We tell him that it is Saturday night and that he has been on a ventilator for over 24 hours. He tries to move his head toward the window. It is a sign we wouldn't understand until the next morning. His hands float up toward his throat, but the nurse pulls it back down, afraid he is trying to yank out his tubes. He wags a finger, indicating NO, he will not pull out his tubes. Out of the corner of my eye, I see that he is trying to reach up to his head, but I don't know why. He tells us when he wants to be suctioned and the nurse is obliging. It is an ugly thing to watch, but he seems to get some relief when it is over.
Finally, Mom figures out what's wrong. Judah's mask is on too tight. The Respiratory Therapist (RT) comes in and reluctantly loosens the straps. Judah, appeased, falls back to sleep. Because he has been so restless for over an hour, the nurse increases his propofal dose by 25%. Judah sleeps pretty well throughout the night.
To watch Judah extubated is like watching a new birth. The RT and his nurse hover over him. Ten minutes earlier, his doctor cuts the propofal drip. Almost immediately, Judah begins to stir. He is still sedate, but his eyes, heavy with two days sleep, flutter open. His hands move. He gives a thumbs up sign and an okay sign. The RT speaks loudly to Judah, telling him that they need him to cough while they pull the tubes out of him. They prop him up, They simultaneously suction him and then induce coughing. Judah's body convulses as they yank the tubes out of his mouth. Like a newborn chicken hatching from it's egg, Judah is messy, curious and exhausted. He sits back, breathing on his own and tries to wipe his mouth. He insists on blowing his nose by himself, but he doesn't have the strength to hold a tissue against his face. The tragic becomes comic as Judah keeps grabbing at the kleenex that slides easily through his fingers. When the nurse or I try to hold the tissue up to him, he pulls away and insists on doing it himself.
In a few short minutes, Judah is able to ask questions. He wants to know what happened. He remembers everything up to the bronchoscopy, but not much after. I ask him if he remembers being in pain. thankfully, he says no. He remembers me telling him that it was Saturday night. He didn't believe me that it was night time, let alone a full day since he was intubated. He tried to look out the window to see if it indeed was nighttime. Other than that, he has forgotten everything. He has a brief discussion with his doctor who tells us the following:
The cytology report came back negative which indicates that Judah did not have an infection, nor did he have pneumonia. He suffered a type of inflammation that is not uncommon in people who have had lung damage due to chemo and radiation. The steroids he is on will reduce the inflammation. Generally speaking, this is really good news. We are still awaiting the results of the lung cultures, but so far, things are looking pretty good.
How Judah manages to endure this with such strength and courage is a miracle.