Into the Dark (part three)
My transfer to the Royal Brompton meant that I began to turn, if not a corner, then a long, slow bend in the right direction, albeit with a few trip-hazards along the way. I came to inside a white room, still beset with the, now familiar, combination of hallucination and pain. I lay on my right side, my left shoulder screaming in agony as the weight of the unsupported arm dragged on the socket. For two long days and nights, I suffered in enforced silence, my mouth held open by the plastic guard used to protect the integrity of my airway. Polly tells me I am on the Royal Brompton adult ICU ward in a room of my own. Around me, there is some debate about when and where to perform a tracheotomy – in theatre or my ICU room. They decide that because my room is about as sterile as anywhere can be in a hospital, they may as well do it in situ.
As it turned out, the insertion of my much-needed tracheotomy was very straightforward. The stoma from previous tracheotomies was still open, with just a layer of skin grown over it. I woke up to find I could, at last, close my mouth. Better yet, I was lying on my back, giving blessed relief to my aching shoulder. At long last, things were looking up – until, that is, sometime in the middle of the night.
Around 1:00 am, I became aware that it was becoming increasingly harder to breathe. There is a knack to breathing on ventilation; you have to relax into it, trusting the machine to take over what is, after all, an autonomic function. It is possible to override the ventilator, but it requires a conscious effort and soon becomes tiring. That night, I found myself having to take deep breaths to supplement the decreasing efforts of the ventilator. I was rapidly tiring.
On duty that night is a young nurse. He is friendly and chatty and reassuringly on the ball. I attract his attention by making the only sound I am currently able to make – a clicking sound made with my recently freed-up tongue. He looks at me, trying to assess the cause of my distress. The ventilator is working, and my Sats (saturation of O2 in the blood) are borderland normal at 94, but my lungs are severely damaged, so that is as expected. My heartbeat is a little high, but that is because it looks like I’m beginning to panic. He seeks to reassure me that all is well and that I need to relax and trust the ventilator. Nice though he is, I want to poke him in the eye with a sharp stick. I want to yell at him that I have been using ventilators since before he was potty-trained, and I know damn well that all is not well. But I can’t, of course, all I can do is make my pathetic clicking noise. I’m exhausted.
I struggle on for another half-hour or so, fighting for every breath, but it’s getting harder and harder. Then, all of a sudden, alarms start to sound. My nurse appears and starts to check pipes and leads and connections. Nothing is obviously amiss, but my Sats are sliding down into the 80s and hypoxemia is dangerously close. The nurse presses the big red button on the wall.
A blue light on the ceiling starts to flash, and another alarm is added to the cacophony. Within seconds a host of people in scrubs materialise around my bed. “Have we got an arterial line in?” someone asks. “Sats at 85,” someone else calls. “Bag him,” somebody else orders. It would all be fascinating if it weren’t happening to me. A green bag, looking a little like a camouflaged rugby ball, is attached to my tracheotomy and squeezed rhythmically. I breathed a literal sigh of relief. My Sats begin to climb. Cautiously, they remove the bag, and the ventilator hose replaced. My Sats start to drop again. They check the equipment yet again. When bagged, I’m okay, my sats rise. When I’m on the seemingly fully functioning ventilator, I have difficulty breathing, my sats fall. They swap the night ventilator for the day ventilator. There is no difference. I’m beginning to feel like I’m in an episode of House, M.D.
It is not the wise-cracking, pill-popping addict, unconventional, misanthropic medical genius diagnostician who solves the mystery, but a nurse with an attention to detail. When you breathe through your nose or mouth, the air is naturally warmed, cleaned and humidified as it passes into the lungs. The moisture helps to protect the lining of the lungs, and it helps keep secretions thin. When you have a trach tube, the air coming in through the tube does not get moistened and cleaned. To mitigate for this, the air from the ventilator passes through a humidifier, a simple device with
a perspex chamber with water in it, where the air is slightly warmed and picks up the required moisture. Obviously, this humidifier had been checked and found to be working. The humidified air now passes along a tube to the tracheotomy and into the lungs. Because the tube is semi-transparent, it is easy to see if there is a blockage.
Or is it?
Our Sherlockian nurse made a thorough inspection of the tube exiting the humidifier. He found that where the tube formed a loop, due to its excess length, condensation had gathered in the bottom of said loop, effectively narrowing the tube dramatically. The water was, of course, all but invisible. He lifted the tubing and drained the water back into the perspex
chamber. The problem was instantly solved. I could breathe easy, so to speak.
After that, it felt a bit anti-climactic. The hoard of medics and nurses dissipated, my nurse settled down to write up his notes, and I was left wondering if condensation building up in a ventilator tube because of a humidifier was a problem unique to me.