Saturday, July 4, 2009

Happy Fourth of July

Happy Fourth of July to everybody out there. Every year our next-door neighbor around the corner, Mike Evertsen, our favorite real estate agent, and his partner Mark, plant little American flags in the lawns outside all the houses in our neighborhood. For the first time in seven years, Peggy says, I haven’t run out to uproot the thing; I’ve been delighted to see it there. Brooke, whose whole early troubles with pneumonia had come from a cold he caught campaigning for Obama a couple of weeks before the accident, is celebrating these little flags too.

But there’s something less political, more personal to celebrate today as well: a new milestone in the breathing that Brooke’s been working on so hard for so long. He’s been at South Davis undergoing vent-weaning for exactly four months and one day, and this morning, for the first time, he reports, he was able to breathe with his lungs. His lungs! They’re breathing on their own, he says, and his chest muscles are moving up and down, automatically! All he has to do is get the process started early in his trach mask trial, he says, when his breathing is switched from the vent that pushes air in, to vent-free breathing where the diaphragm creates a vacuum that sucks air in, and then his lungs and muscles take over, by themselves.
Just like everybody else. That’s the point.


A word from Brooke about the hard and often frustrating work of the past four months. As those of you who’ve been keeping up with this blog know, this has never been particularly easy for me except on those rare occasions when there have been significant increases in the length of time I’ve been able to stay off the vent. These have been followed by plateaus that have lasted up to several weeks, plateaus that are often discouraging and intensely frustrating. I’ve tried often without success to push through to longer lengths of time, but the amount of time I can go without the vent has hovered around an hour and a half, maybe an hour and three quarters, not much more. The therapists have said awesome less frequently, and there’s been a sense of having stalled. Of course, I assume my muscles have been getting stronger without my really knowing it, but it’s still been the same picture: like practicing for a race. You work hard for days, unable to outdo the time that you set for yourself.
And then suddenly, because of all the work you’ve done, you spurt ahead.

A week or so ago, Brooke had the extraordinary experience of actually feeling his breath enter his lower lungs. This was a physical feeling as well as a mental one, both at the same time. It was aided in part by something he’d seen months ago, back when he was in Rehab at the University hospital: they’d used a bronchoscope to detect and try to suck out secretions from the lungs. We described it on the blog some months ago, how you can see on the monitor the branching tubes of the bronchii, and it was this that Brooke could re-envision and actually feel as he was breathing a week ago. This past week had its small triumphs as well as periods of frustration, but what the respiratory therapist said on the day that Brooke could feel air coming into his lungs stuck in his mind—he had been puffing out his cheeks during the breathing sessions for the past one or two months, and the therapist had said, you’re going to have to stop that. You’re retaining too much CO2; you’re breathing with your head, and not allowing the breathing to take place naturally, on its own. Brooke was bewildered by this and not a little annoyed, since he hadn’t realize that this method of puffing out his cheeks was counterproductive. But the next day he decided to try the therapist’s new method of just breathing without puffing out his cheeks, and it seemed to work with no discernable problems.

Early on in the vent-weaning process, the only way Brooke could breathe at all off the vent was to utilize his neck and upper shoulder muscles—these were of course unaffected by the injury—and then later on he’d rock his head back and forth as he tried to breathe. Then he took up puffing out his cheeks, holding the air inside, as he tried to get into a rhythm in breathing. He worked and worked at breathing, having only his accessory muscles to use, and it required complete silence and total concentration, with only Julian Bream playing Bach preludes on the guitar in the background. Of course, all these were necessary stages in getting to where Brooke has just arrived in the past 24 hours; neck and shoulder hunching, headrocking, cheek-puffing, and all the rest of it has been necessary because he couldn’t do anything else to make himself breathe until just now.
Perhaps another factor in this process of vent-weaning has been Brooke’s experience in doing Vipassana meditation practice. As some of you may know, he says, introductory Vipassana courses take place over a ten-day period, characterized by total silence, starting meditation at 4:30 in the morning and meditating in a sitting position for up to nine hours a day, and having a last full meal at 11:00 in the morning. Brooke has done five of these courses—the first in about 1982, and the most recent a couple of years ago. He says that a ten-day period like this can be excruciating, often all the way through to the sixth day or so: it’s uncomfortable, it’s anxiety-producing, and the last minutes of an hour-long sit are almost unendurable at first. Slowly, however, the body learns patience with itself, learns how to relax and perceive pain not as pain, but as discrete sensations. Vipassana emphasizes a kind of mental body-scanning, where you begin by becoming aware of what the breath feels like as it flows out beneath your nose; then you mentally scan the way the whole rest of your body feels. This body-scanning can produce a feeling of rather extraordinary liberation from one’s early fears and anxieties. By the end of a ten-day course, one doesn’t want it to be over; one wants to build on what one has achieved over the ten past days. Training in this technique has helped Brooke enormously, he says; he can push himself past limits he could not have imagined at first that he could ever surpass.
Trekking has helped as well. The last trek Brooke took was a 21-day trek in the Peruvian Andes. He’d started out the trek as sick as a dog, he says, suffering from diarrhea and then a very bad cold; then he had to face along with his trek-mates 17,000-foot passes and amazingly steep descents into valleys where they camped, and then further ascents for 21 days, with only one short break in between the first and second halves of the trek. This helped his mental and physical endurance too, he says, and has played a major role in his being able to go through this even more demanding trial happening right now here at South Davis, or to put it another way, this more demanding adventure.
This adventure is different though, even if it is both physically and mentally demanding: it means learning how not to breathe with your head, but allowing your body to do your breathing for you. It must sound amazingly simply to all of you out there; to Brooke, it’s been the hardest thing in the world.

Last night, in a moment of discouragement Brooke said, “Maybe I’m too old for this.” Today the same, very experienced respiratory therapist who was there last night says that when she heard this, she knew a breakthrough was just about to occur—awesome, she said, that’s always the way it is. Perhaps she knows that plateaus are only temporary; to us, they’re all too real.

1 comment:

norm said...

Just got around to reading the July 4 blog. The image, Brooke of your puffing out your cheeks while breathing, brought to mind - who else but the great Dizzy Gillespie, who was the only (all least only really well known) who puffed out his cheeks while blowing that incredible be-bop sound.

Norm