Inevitably (but you’ve heard all this before, and you’ll undoubtedly hear it again in these pages), the payback comes. Seven hours off the vent yesterday, a new high, followed by four this morning, brings exhaustion. CO2 levels rise, respiratory rate increases, SATs go down, and the feeling of exhaustion overwhelms, bringing depression and leading ultimately to the wish that this were all over. That’s the way it’s been this afternoon, just a day after Thanksgiving, when we had such a good time eating the traditional turkey feast with close friends.
Why doesn’t one learn from past experience? This pattern has happened over and over again: the euphoria blinds one to what is coming. The euphoria involved in breathing is all-consuming; when it’s happening, there’s nothing quite like it--even though it not only doesn’t last, but gives way to something as dark as the euphoria is luminous. You can imagine just how dark that is. That’s where things have been this afternoon—even though we can remember the triumph of yesterday, seven hours off the vent.But we do learn from past experience, once the worst of it is over. This pattern is actually recommended by some experts in trach-weaning: push, push, push, then collapse. Then do it over again. Despite the overwhelming interval of despair, Brooke is really on a roll.