Alban Eilir; Let There Be

Admitted over a month ago for a persistent cough. The CAT scans showed a nasty empyema. Holy crap.



One of our very fine thoracic surgeons performed a VATS procedure that took care of most of the patient's lung problems, but he developed pneumonia and required prolonged intubation and antibiotics. His kidneys didn't like that and they failed, so he also required hemodialysis.

It seemed like he would need the ventilator for a while so one of the intensivist residents gave him a tracheotomy.



Then he lost it. He got crazy in the head. He'd pull out his feeding tube and urinary catheter. The medical team thought that perhaps he reacted to one of the antibiotics, which in rare instances can cause seizures. The neurology team thought he just had ICU psychosis. Whatever. They restrained him by tying his wrists to the bedframe.

After weeks of all that, they decided that he was well enough to be transferred out of the intensive care unit.

That's the punch line.

The morning I got him he looked awake and pleasant so we undid the restraints. He nodded appropriately and followed simple commands. He did his own mouth care with the swabs we gave him.

The wonderful CNA working with us got the patient up to a chair after giving him a good scrubbing and buffing. He got up easily and stayed out of bed until lunchtime, which for him was a can of Nepro down his feeding tube.

Then the respiratory therapist came along. She wanted to cap his trach with a Passy-Muir valve but even though this one could do the work of two, she didn't have time to stick around to see if he would tolerate it. We could all use a few more respiratory therapists.



We told her we'd stay with him to see how he would do. She deflated the tracheostomy cuff. As she was leaving I put the valve, sometimes called a "speaking valve," on the opening of his trach cannula. Then I asked him to say a word. Any word. You always have the patient say something before you turn your back on them, just in case they stop breathing.

"Thanks!" he said, then came his toothy grin. His voice was rough but after a while it seemed to smooth out. Quite a bit.

He asked for the phone so he could call his family. It was the first time in weeks he could utter spoken words. There was no stopping him.

After a couple hours he got tired so we took the PMV off, but I left the trach cuff deflated and showed him how to cover the end of his cannula with his finger, which allowed him to speak on exhalation.

"I almost died," he said. He indeed had been very sick. Still was, but I wasn't going to dig a hole for him. And I said so.

"I saved you all that work of digging one," he said. For that I thanked him!

His family members came to visit and he was still chatting with them when I left for home. It was a good day. It was Easter.