Respiratory Compromise
“ICU Subsequent Care Note: Delirium; pt remains very agitated on fentanyl and received dose of haldol this AM. Will again attempt to decrease fentanyl but we have not had any success. Once it is decreased she becomes agitated and has respiratory compromise. We will continue to attempt to wean fentanyl so that we may assess her for extubation. Neuro consult obtained.”
Except for the lighting, it was as bleak inside the 5th Floor ICU as it was out on the rain swept streets of Baltimore. Fluorescent white shown upon the linens of the dying and the recovering alike—and upon Pam, who was stuck somewhere in between, in a world of bruises and stitches and blood and gauze. For all the chirping electronics and humming machines and dripping drips, she wouldn’t wake up. She was spiking fevers of unknown origin. Grim fluids oozed through a tube that had been inserted between her ribs.
I can see it as if it were happening right now, right in front of me. Gagging on the ventilator tube lodged in her throat, choking and gagging, wrists tied to the bed rails and she pulling against them, pulling herself up from the bed, heaving forward, straining, neck muscles taught, choking, the pressure popping her eyes open, red veined and raw, hot tears, and the fierce frantic struggle for air, for breath, for life itself.
Then sedation, and then calm for a while.
Now I understood what she had sensed after the botched ablation, in the foreboding over open heart surgery — that sooner or later they will kill her. She would never get out alive and I’d been wrong to reassure her, I’d been wrong to believe in this place, wrong to bring her here.
Collateral Damage: A Patient, a New Procedure and the Learning Curve 