Sunday, August 23, 2009

Looking Back: University Rehab, Part I

Now we’re going to pick up the narrative of Brooke’s earlier hospitalization that we dropped when Brooke reached South Davis. He recalls,

I’d spent three months at the University of Utah inpatient acute rehabilitation unit, known as Rehab II—from early December 2008 to early March 2009. I came to Rehab with pneumonia. That fact determined nearly everything that happened in Rehab. The whole time I was there I was trying to recover from the pneumonia that had developed out of a bad cold I had contracted when I was working for Obama's campaign in Colorado. I had it at the time of the accident, and it continued through the whole ICU and IMCU episodes. By the time I reached Rehab it looked as if the pneumonia had abated somewhat, but that proved to be illusory. And there was fear that I had a serious infection.

My respiratory therapist at that point was a remarkable man named Gil. I had him almost every day for the first couple of weeks and he tried nearly everything to clear out my lungs: suction, chest compressions, and whatever other techniques he could come up with. Finally, the team, including my doctor, decided that they would call in Pulmonology for a more specialized effort to solve the lung problems. All this time I kept hoping that the next solution would be the right one. It's amazing how my hope remained sustained throughout this whole period, and Peggy too, as we both kept grasping at straws to try to solve the terrible pneumonia problem. But hope can also be unrealistic: all this time we also imagined I’d be well enough by the end of March to teach a Shakespeare course for adults.

Calling in Pulmonology initiated one of the most bizarre episodes in my entire experience of the results of my injury. I should include Peggy here, since she was involved every step of the way in this process. They decided to do a bronchoscopy, an effort to examine the interior of the upper lungs and clear out the secretions that were causing so much trouble.
The first bronchoscopy was held in my room at Rehab. Three men were involved: the chief of Pulmonology, a tall, broad-shouldered man with thick, wavy black hair, wearing a dark jacket and dark tie. If you were in a humorous mood, you might say he looked a little like a vampire from the Carpathian mountains; in any case, he was completely expressionless. Along with him came a compliant resident who did most of the work and the technician who was responsible for the monitor that showed my lungs as if on a TV screen. The work consisted of running a scope with a light on it and a suctioning device down through my trach and into the bronchii. I had expected that I would have some kind of anesthesia; I asked for an Ativan and they said they would take about 20 minutes to work. Being polite, I thought that was a long time, so I said I’d do this procedure without anesthesia. I looked straight into the chief’s dark eyes; they remained expressionless. I mistakenly read this as an affirmative, that the procedure had been done before without anesthesia with no problematic results. Of course, I was reading into his face, which really said absolutely nothing. Why he didn't tell me that I shouldn't select this alternative to anesthesia is still a mystery to me, because the results were a disaster. The second the probe with its suction device and its little camera and light were inserted into my throat and bronchial tubes I began to choke and continued to choke throughout the whole 25 minute procedure. At first, stupidly, I thought this was part of the whole routine. I could not look at the television screen because looking at it only increased my acute distress from the choking. Occasionally, I would stare in the face of the chief pulmonologist who still remained expressionless, almost, in my confused mind, sadistically so. Finally, after 23 minutes, to be exact, my distress became so great that I had to stop what was going on. No, he wasn't really like that. The resident said that this would be the last probe. But I had been at the end of my tether for at least the last 10 minutes.
The same team arrived to perform broncoscopies on two further occasions. The second time, they brought lidocaine—though I hardly thought lidocaine would do the job, given how much pain I’d experienced the first time around. But it did. They squeezed it onto the scope as they were inserting it; it made a great deal of difference, although there were the occasional gags. After it was over, I said, Well, the lidocaine worked; and the resident said, Well, maybe we should have brought it the first time.
On the third occasion, I was actually able to watch the procedure on the screen, and see the beauty of the branching interior structures of my lungs--described in an earlier blog, but not at all forgotten.

Meanwhile, in other parts of the hospital, a machine that could have cleared this problem up was already in use, something called CoughAssist. But it wasn’t in use in Rehab, for reasons that still aren’t clear to me—apparently because although some of the respiratory staff were already trained in its use, it simply hadn’t been cleared yet. What went on now was behind the scenes, out of view from us, the politics we suppose of hospital hierarchies. We know that someone from Pulmonology—not the team that had been in my room—had gone to bat for me. We know that a very young and otherwise unassuming respiratory therapist, distinguished largely by a diamond stud punched though her cheek, also went to bat, fearlessly (we assume) pressuring the higher-ups for the use of CoughAssist.
It’s a pretty simple machine. It puts air into the lungs under positive pressure, sucks air back out under negative pressure. It sits on a little stand, with wheels that let it be rolled around from one patient to the next; it’s got a dull green housing and just a few knobs, and just one dial, a completely simply dial with a needle that flips back and forth between negative and positive pressure. It’s even cheap, one of the least expensive pieces of medical equipment we’ve encountered. But it made a life of difference for me: this seemed to be what made the biggest gain in control of secretions and overcoming of the lung problems that had plagued me for so long, and that had made my condition more threatened than we had realized. What’s been so striking for us is that CoughAssist came to my rescue thanks to the willingness of just a couple of people—incidentally both women--to go to bat for me, something it must not have been easy to do in the often intensely hierarchical environment of a modern hospital.


Brooke was the first patient in Rehab to get CoughAssist. He was told by Gil, the respiratory therapist he liked so much, that might have to help some of the other therapists in understanding how to use it. Indeed, Brooke became enormously exacting with all the new therapists: “Count 1-2-3, then say ‘Take a deep breath,’ then tell me to exhale coughing, then count from one to five while I’m exhaling. Then wait a bit and do it over again.” He seemed to be training most of the therapists. But within a week, we were told, several other patients in Rehab were also getting CoughAssist.
He still gets CoughAssist, four times a day. It’s routine at South Davis.

4 comments:

Lorraine Seal said...

Brooke

During my 18-month adventure with with nursing homes, rehab hospitals, and a specialised unit at the University Medical Center, I found that some care givers were empathetic and responsive to unique individual needs while others seemed less able to be so. Some seemed to subvert the patient's need in the moment in the interest of procedure or self interest. A couple seemed downright mean, possibly even sociopathic.

Despite our romanticised notions of Nightingale, in their capacity for empathy or lack thereof, medical professionals display the same variability as the rest of us, as you've pointed out before.

I'm grateful for the unknown member of the pulmonology team and respiratory therapist that pushed for you to receive CoughAssist. I'm glad it's helping. Lord knows you didn't need the additional stress of invasive procedures when less traumatic therapies are available.

Lorraine

Susan Wurtzburg said...

Brooke, I am not commenting on the post today but actually some posts of a few days ago. I am so excited to hear re. the breathing alone progress & the writing progress. Truly wonderful news. I also read today about some of the challenges you have been experiencing recently. Lyle & I don't send emails often & are often remiss in phoning but we are thinking about you & Peggy a lot & sending you positive thoughts (although we certainly don't want to take credit for the extremes in heat & cold that you suffered recently!). Love Sue & Lyle

Dana Wilson said...

Brooke,

I was stunned to read your account of that first bronchoscopy. What an incredible lack of compassion and understanding on the part of the Head Honcho Pulmonologist! What was he thinking ... or was he even aware of your distress?

I had an experience with a different invasive procedure, one too personal to describe in any detail. As he got to work the operator commented, "I don't believe in anesthesia", "It doesn't work unless you wait 20 or 30 minutes", and "This will be quick". Like you, I didn't know what to expect as a patient, on the receiving end of things for the first time. How much more terrifying it must have been for you! I could have gotten up, grabbed my trousers, and run out of the clinic, in theory at least!

I can only imagine what "fight or flight" physiology feels like when one hasn't the motor ability to initiate either.

If I had my way such individuals would not be allowed to teach residents, no matter how technically skilled they are. I would make evidence of "humanity" a requirement for tenure in the clinical disciplines.

You write as if you've taken your experience in stride. I am still angry about mine and stand in awe of your courage and temperate reflection on your own episode.

You must know this bit of verse. I came across it just now as I was looking up "Struwel-Peter", a sadomasochistic German tale that must have warped the minds of countless children who would someday go to medical school.

"And now with sudden swift emergence
Come the women in dark glasses,
the humpbacked surgeons
And the Scissor Man."

Edward Scissorhands. Dracula with a bronchoscope. Freddy Krueger with a chain saw. Whatever ...

Warmest thoughts from Lynn and me.

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