Our African Ancestor’s sacrifices will matter! Only when we have economic and political power!
Life in Slavery
Charles Ball was born as a slave in the same county around 1781. He was about four years old, when his owner died. To settle the debts, his mother, several brothers and sisters and he himself were sold to different buyers. His first childhood memory recorded in the book is his being brutally separated from his mother by her buyer: “Young as I was, the horrors of that day sank deeply into my heart, and even at this time, though half a century has elapsed, the terrors of the scene return with painful vividness upon my memory.”[3]
By way of inheritance, sale and even as a result of a lawsuit, he is passed on to various slaveholders. From January 1, 1798 to January 1, 1800 he is hired out to serve as a cook on the frigate USS Congress. In 1800, he marries Judah. In 1805, when his eldest son is 4 years old, he is sold to a South Carolinian cotton planter, thus separated from his wife and children who had to remain in Maryland.
In September 1806, he is given as a present to the newly wedded daughter of his owner and has to relocate to Georgia to a new plantation. Shortly afterwards, after the sudden death of the new husband, the new plantation, together with the slaves, including him, is rent out to yet another slaveholder, with whom he builds up a relationship of mutual trust. He becomes the headman on the new plantation, but suffers from the hatred of his master’s wife. In 1809, when his dying master is already too weak to interfere, he is cruelly whipped by that woman and her brother. After that, he plans his escape, which he puts into practice after his master’s death. Travelling by night to avoid the patrols, using the stars and his obviously excellent memory for orientation, suffering terribly from hunger and cold, not daring to speak to anybody, he returns to his wife and children in early 1810.
War of 1812 Chesapeake Flotilla service
Charles Ball also served in the U.S. Navy during the War of 1812. In 1813, Ball had enlisted in Commodore Joshua Barney‘s Chesapeake Bay Flotilla and fought at the Battle of Bladensburg on August 24, 1814. An excerpt from his account of the battle, which was a resounding defeat for the Americans:
“I stood at my gun, until the Commodore was shot down, when he ordered us to retreat, as I was told by the officer who commanded our gun. If the militia regiments, that lay upon our right and left, could have been brought to charge the British, in close fight, as they crossed the bridge, we should have killed or taken the whole of them in a short time; but the militia ran like sheep chased by dogs.”[4]
African ancestry
According to Ball’s autobiography, his grandfather was a man from a noble African family who was enslaved and brought to Calvert County, Maryland around 1730.
The 1837 edition dedicates three pages (Pages 22–24) to the description of his religion as the old man explained it to his young grandson. This description has some similarities with Islam, but there are also differences, so it is not clear, if his grandfather was Muslim or not. Other Africans whose religion Ball mentions, are explicitly called “Mohamedans” (p. 165).
The precepts of that religion are contained in a book a copy of which is kept in each house, implying that the grandfather’s African society had a high degree of literacy, whereas Charles Ball is illiterate. This may be worth mentioning because contemporary apologetics of slavery often claimed that Africans had been “civilized” by slavery.[2]
Historical Document Charles Ball’s narrative: Fifty Years in Chains 1836
Friday June 19, 2020 at 12:15 at The Spokane Tribal Gathering Place (outside City Hall), SCAR and its partner organizations unveiled their full Platform for Change..
PLATFORM FOR CHANGE— RESPONDING TO THIS MOMENT
RELEASED: June 19, 2020
Spokane Community Against Racism (SCAR) and Asian Pacific Islander Coalition (APIC) – Spokane Chapter, Eastern Washington Progressives, Faith Leaders and Leaders of Conscience, FUSE Washington, Greater Spokane Progress, Hispanic Business/Professional Association, MAC Movement, Muslims for Community Action And Support, Peace and Justice Action League of Spokane (PJALS), Planned Parenthood Advocates of Greater Washington and North Idaho, Progressives of Spokane County, RAIZ of Planned Parenthood, Red Skirt Society, SHAWL Society, Smart Justice Spokane, Spectrum Center Spokane, Spokane Alliance, Spokane Ministers’ Fellowship, Tenants Union of Washington State, demand transformational change.
Spokane has a problem.
American policing tactics are rooted in white supremacy, fear, and violence. Spokane is not exempt from this, even though our mayor, police chief, county commissioners, and sheriff refuse to admit the true nature of the problem. In fact, Spokane has the 5th deadliest police force in the nation. We must end the cycle of fear and violence in our community and seize the opportunity during this tumultuous time to enact structural changes.
Death at the hands of police is not the only measure of racial violence. Here in Spokane, Black and Native Americans are disproportionately arrested, receive higher bail amounts, and are more likely to die in jail than whites. Our city and county officials know this. They have hired several consultants for millions of dollars to tell them so, yet they continue to ignore the good advice we all paid for.
We don’t trust them to understand, because they keep proving they are not listening.
At the invitation of the city and county, community members have spent thousands of hours sharing their testimony and lived experience in the name of community engagement. Yet elected officials have failed to honor this engagement by fulfilling their promises to decarcerate and advance racial equity.The residents of Spokane have fought officials numerous times to avoid building a new jail. Still—despite the wishes of the community—the County Commissioners and the Sheriff’s office continue to pursue a new, larger jail without first enacting the totality of humane, cost effective reforms which have been recommended to them over the past decade.
Sheriff Ozzie Knezovich continues to defend bringing the creator of “Killology,” a method of police training that teaches officers how to “…overcome the powerful reluctance to kill…” to train his deputies. He has doubled down on his support for killology training despite receiving thousands of petition signatures calling for the two-day seminar and workshop to be canceled. Spokane demands transformation. The unwillingness of the Mayor, Police Chief, County Commissioners, Sheriff, and other elected officials to heed expert advice and community lived experience, their stubborn insistence on expanding incarceration and entrenched racist systems, and their failure to listen to the community, convinces us that the elected leadership of Spokane does not grasp—or is not willing to meet—the needs of our community. We do not need more studies, consultants, conversations, forums, or media stunts. We are not interested in incremental change, but in drastic action.
To that end, we present the following Platform for Change. While we cannot hope to provide every comprehensive detail of necessary policy, we know the shape that change must take. This is the product of ongoing work within our community and around the country and is meant to serve as a mandate—it’s up to our leaders to help us all live up to its intent.
PLATFORM FOR CHANGE
DEFUND THE POLICE: INVEST IN COMMUNITY
SCAR rejects the idea that the only way to increase public safety is to increase policing. The power of state-sanctioned force and threat of lethal violence wielded by police is often inappropriate and inadequate to address the diversity of situations they are sent to resolve. Police are frequently tasked with handling homelessness, addiction, mental health, intimate partner violence, and other conditions in which they have no formal expertise; the result is often harm, injury, or even death for those whom the police are supposed to protect. The weight of these injuries and deaths falls most heavily upon people with medical or mental health conditions, people of color—particularly Black and indigenous people—and people with disabilities. This is not a problem that can be solved with more training. Expanding the power or authoritative scope of police in our communities will not make us safer.
Instead, SCAR embraces a holistic vision of public safety, one that accounts for the root causes of crime, and recognizes that shared prosperity and community care are at the heart of a safe and healthy society. When people’s basic needs are met, and experts are empowered to work within their expertise, communities are free to flourish. The City of Spokane and Spokane County will be safer when our leaders follow the advice of their expensive consultants, and the best practices indicated by decades of research in this and other cities. We demand investment in historically underserved communities to create a vibrant and healthy environment where all families can thrive:
Addiction and Mental Health Services
We demand public investment in culturally appropriate chemical addiction treatment and mental health services and diversion programs. These services should include crisis care, long-term in-patient, and out-patient care. Police are not mental health professionals and incarceration should not be a stopgap for healthcare or an underfunded social safety net.
We acknowledge and support the recently passed Public School Resolution Supporting the SPS Student Community Related to Racial Equity, and we believe this resolution represents a promising beginning to the work of racial equity and inclusion in Spokane Public Schools (SPS). In the interest of continuing this work, we demand an end to the contract between the Spokane Police Department and Spokane Public Schools.
SPS has the largest school policing budget in Washington State at $2.2 Million. That’s $2.2 Million spent to support the School-to-Prison Pipeline, a system which disproportionately funnels children of color from educational settings into the criminal justice system. Using police to address student behavior positions students as potential criminals who require management through the threat of legal and physical force, instead of recognizing them as children who are learning to manage conflict and their emotions.
We demand investment in school counselors, restorative conflict resolution practices, and activity programming which provides youth with constructive outlets and interpersonal learning environments. The ACLU of Washington has been at the forefront of this issue, listen to them.
CHANGE POLICE CULTURE
Public trust in the SPD is broken. It’s the 5th deadliest police force in the nation, and officers have been using the same knee-on-neck restraint that killed George Floyd until June 8th, 2020. We believe it is necessary to start fresh.
Disband the Police
Disband the police department, and hire a smaller group of officers to carry out narrowly defined, law-enforcement duties. In 2016, the Police Leadership Advisory Committee (PLAC) put together recommendations for the hiring of a new police chief. These recommendations, which could have helped revolutionize the culture of the SPD, were ignored. We believe these recommendations should be applied to all officers hired to work in the City of Spokane. PJALS has been deeply involved in this work, listen to them.
De-escalation Training for SPD and County Forces
While we do not believe the fundamental problems with American policing can be trained away, we support the will of Washington State Voters who voted decisively in favor of Initiative 940. Passed in 2018, Initiative 940 requires police receive training in de-escalation and mental health, and enforces the duty of all police officers to render first aid. It is our hope that with these tools police will be less likely to use lethal force, and that when they do, that force is less likely to result in death.
De-escalation and mental health training have the potential to not only act as positive tools in the current policing toolbelt, but to provide an additional standard to which police can be held accountable.
Demilitarize the Police
Our city is not a warzone, and weapons of war should not be used on our streets. This includes tear gas—a chemical weapon which is banned by the Geneva convention—and all repurposed military surplus equipment. Military uniforms, vehicles, and weaponry communicate to the residents of Spokane that the police view them as enemy combatants. Furthermore, militarized uniforms encourage a “warrior” mindset in police, which emphasizes readiness for violent conflict over the relationship-based work of building community trust. Spokane does not need street warriors, Spokane needs public servants we can trust; from their uniforms to their equipment, police should be equipped for the job that is needed.
POLICE OVERSIGHT
Independent Oversight with Investigative Power is a necessity at the Spokane Police Department and the Spokane County Sheriff’s Office.
No Contract without Office of Police Ombudsman Independence
We demand that the Office of Police Ombudsman (OPO) be empowered to conduct independent investigations and publish public closing reports. We demand that the OPO be free to conduct these independent investigations without fear of reprisal by the Police Guild.
A poison pill amendment to the Police Guild’s contract with the City of Spokane, which is still being negotiated, would allow the Police Guild to preemptively file a grievance against an Ombudsman candidate in an effort to prevent their appointment. It further empowers the Guild to attempt to have the Ombudsman or an OPO Commission Member removed for “exceeding their authority under the collective bargaining agreement.” Police cannot control the fate of the body that oversees them. We demand that the Spokane City Council reject any contract that fails to protect OPO independence.
NO CONTRACT without independent investigative power and public closing report. NO CONTRACT with police guild oversight of the OPO.
Mandatory body cameras for SPD and County Forces
Body cameras should be mandatory for every SPD officer and County deputy as a tool for reviewing police encounters with Spokane residents. Body cameras do not prevent violence, but they can be valuable for holding the police accountable. Turning off a body camera should come with an automatic charge of destroying evidence.
JUSTICE REFORMS
We urgently need to adopt effective, restorative policy solutions that are driven by the needs of those impacted by our justice system.
Jail Reforms
We demand divestment from the prison industrial complex: NO NEW JAIL; end policies that criminalize poverty, homelessness, and addiction; end cash bail; and end draconian drug charging decisions by the County Prosecutor’s office.
Instead, the city and county should invest in racial equity tools throughout our justice system; release criminal justice system demographic data; and adopt least-restrictive alternatives to jail with fully funded pretrial services. Smart Justice Spokane has been leading on these issues, and we demand our government listen to and collaborate with them.
Judicial Accountability
Impartial judges are the ideal, but we know that their decisions are vulnerable to the forces of systematic oppression and unconscious bias. For this reason we demand that the county, in cooperation with the courts, release sentencing data dis-aggregated by judge and defendant’s demographic information, including race and gender. With this data, voters—and the community groups who help keep them informed—will be empowered to identify racial sentencing disparities, and if necessary, right them at the ballot box.
Establish an Office of Civil Rights
The City of Spokane needs a fully funded and staffed Office of Civil Rights. This office would work within the City government to advance civil rights and end barriers to equity. It would regularly assess the city’s approach to racial equity, and provide education and training to government and local entities. The Office of Civil rights would receive civil rights complaints from the residents of Spokane, address hate crimes, and ensure that laws against illegal discrimination in employment, housing, public accommodations, and contracting within Spokane city limits are equitably enforced. The Office of Civil Rights Exploratory Committee and Greater Spokane Progress are already working on the structure of this office. Listen to and collaborate with them.
These are just some of the changes that Spokane needs. These demands are rooted in the data-backed reality, and the spiritual conviction, that a punitive approach to public safety has never, and will never, yield a free and equitable society.
Policing can no longer be the bandaid we affix to every social wound. Instead, we must build a Spokane where everyone is free to thrive. The time for incrementalism and half measures is past. This community demands transformation, and will continue to do so in statements, in public meetings, at the ballot box, and in the streets. It is up to our leadership to listen, and to do the jobs for which they were elected. The people are watching.
If you take only one thing away from this essay, I hope it’s this: do not talk to cops. But if you only take two things away, I hope the second one is that it’s possible to imagine a different world where unarmed black people, indigenous people, poor people, disabled people, and people of color are not routinely gunned down by unaccountable police officers. It doesn’t have to be this way. If you take only three things away from this essay, I hope the third is this: you and your community don’t need bastards to thrive.
Let me tell you what probably won’t solve the problem of bastard cops
Increased “bias” training. A quarterly or even monthly training session is not capable of covering over years of trauma-based camaraderie in police forces.
Tougher laws. Cops do not follow the law and will not hold each other accountable to the law.
More community policing programs. Many of the cops pepper-spraying journalists were probably the nice school cop a month ago.
No tweaks
Instead of wasting time with minor tweaks, I recommend exploring the following ideas:
No more qualified immunity. Police officers should be personally liable for all decisions they make in the line of duty.
No more civil asset forfeiture. You lose more cash and property to unaccountable civil asset forfeiture than to all burglaries combined.
Break the power of police unions. Police unions make it nearly impossible to fire bad cops.
Require malpractice insurance. If doctors have to have it, police ought to have it.
Defund, demilitarize, and disarm cops. Cities are not safer when unaccountable bullies have a monopoly on state violence and the equipment to execute that monopoly.
One final idea: consider abolishing the police.
The above page has been paraphrased. If you want to know how this insider came to these conclusions read the complete story:
There are mobilizers and there are organizers. The demonstrations you have seen and participated in for George Floyd here and across the globe have been successful mobilization events. What is needed now is grassroot organization.
The map on the left are the communities in Spokane where this discussion needs to take place. Suggestions of what you can do in your community are at this link: Mobilizing to Organizing
Sunday June 7, 2020 started off at 10:30 am with meditation and yoga exercises at the Red Wagon. At 2:00 pm the NAACP had one of the largest outside rallies in Spokane’s history. The tone of this rally was set by Kurtis Robinson, Kiantha Duncan, and Le’Taxione. Kurtis Robinson welcomed a large standing crowd at the Lilac Bowl. Kiantha Duncan followed asking everyone to sit down on the grass and center themselves. She had three messages that she wanted to deliver to three groups of people. She thanked all who showed up to nonviolently express their outrage and disappointment with police brutality throughout the country. If there were those who came looking for trouble with signs with hateful speech, she wanted them to take those signs and sit on them. Then she called upon all law enforcement agents to obey the law and treat all demonstrators with respect and human dignity. My observation was that there were no visible signs of law enforcement. Le’Taxione told the audience that he was not speaking to make anybody feel good, he was there to express his strong objections to brutality and the status quo. But he made it quite clear he and the youth he brought would not allow anybody to hijack this peaceful demonstration. If so, they would be escorted out of town. These photographs bear witness to the unified desire that everyone should receive equal justice.
After your demonstrations at the Red Wagon or City Hall you could:
Ask 5 of your new or trusted friends for their email addresses and mobile phone numbers so you can set up a meeting regularly via Zoom to discuss strategies and planned measurable actions. Assign someone to send information about the measurable actions you plan to info@4comculture.com so they can be shared at the website 4comculture.com. Hopefully when the city opens up and you can have meetings in public places such as coffee shops you will be able to have these discussions face-to-face.
If you can find 4 people that will accompany you to an arterial in your neighborhood each could stand on a corner displaying their signs for an hour or more
Walk up and down the block or cul-de-sac where you live with your sign and handout sharing why you march and what others can do to help. This is something you can do alone.
Stand in front of the house you live in with your sign and have a discussion about why you march with anybody that will join you. Have two socially distant chairs nearby.
Being Black I am always visible! I am asking you to shed your invisibility.
History Lesson On Organizing
Kwame Ture: Converting the Unconscious to Conscious
There are 10% we will never be able to reach. There are 80% who are waiting, for leadership and direction. Maybe waiting to see how the wind blows. There are 10% who have already boarded the train and moved out. While waiting let’s listen to Curtis Mayfield
Robert Lloyd, Spokane Civic Activist, May 30, 2020
What do you want?
By now we’ve all seen what’s happening in Minneapolis, Detroit, Louisville, Atlanta, New York, Washington DC, Phoenix, Denver, Columbus, Dallas, Chicago, Memphis, Bakersfield, Albuquerque, Los Vegas, Oakland, San Jose, Los Angeles, Portland, Seattle and more – twenty plus and growing – due to the killing of Floyd. The question is why and who benefits from these protests. We all know the why – systemic racism and injustice for people of color and the poor. But who benefits?
We have all seen this before – be it Martin Luther King’s death Memphis, be it the Rodney King beating in Los Angeles, the Chicago fire truck killing, be it Ferguson, Trayvon Martin in Florida, Eric Garner in New York, Freddie Gray in Baltimore, Orlando Castile in Minnesota. The lists goes on. The question is “Who benefits?”.
All of these demonstrations had three components. There are those who want to mourn. The parents and loved ones will bring flowers, teddy bears and pictures of the person lost.
There are those who will hold non-violent protests. The politicians, the ministers and the status quo organizations will express their dissatisfaction with articulate speeches and venting rhetoric.
Here are some of those who on Sunday May 31 between 2 and 4 pm non-violently protested the killing of George Floyd by Minneapolis police officers. They met at 2 pm at Spokane’s Riverfront Park and marched to the Spokane County Courthouse and Spokane City Courthouse/Jail. I asked those pictured here to tell us in their own words WHY THEY MARCHED.
And then there are those who will co-opt your non-violent protests. The extreme left and right, the anarchists and those who would like to destroy your community, institutions and trust with violence and chaos and destruction. Sometime after 5 pm and late into the evening groups like this looted downtown Spokane stores, broke windows and had confrontations with police that resulted in their use of flash bangs, bean bags, rubber bullets, and tear gas canisters.
After demonstrations like this people will go back home to cynicism, apathy, complacency, self-medication and risky behavior, and party and bull shit and party and bull shit. And there will be no change. The question should be what is it that you want and what is the price you are willing to pay and how do you go about getting it.
Will you build a grass root organization?
If so form small groups of 5 – 10 people. Get to know and vet who your people are. Are they actors, allies or accomplices? Are they people who will sit down and meet regularly to discuss strategies and planned actions? Meet in a public place or Zoom. Let us know what your results are at 4comculture.com. Email info to: info@4comculture.com
I’d suggest that you make this message go viral through your social media outlets. I’d suggest that you print this out on your home printer and distribute it at upcoming non-violent protests. You can become a civic activist and work between horrific events and elections.
Sometimes we can’t wait on the cavalry! Let’s put the wagons in a circle. The battle has begun! We are under attack, we must do the best we can with what we have. The creative will have the best chance for survival. It’s good to be prepared and independent but in times like this we need to be inter-dependent.
What does it mean to be a brotha? Is that a term based upon skin color or ethnicity or is it an understanding of common goals? We are in a war that’s being fought on two levels. One is the immediate problem with COVID-19. The other is the systemic problems that lead to a disproportionate number of deaths among people of color and the poor.
If we are brothas we need to support each other in this war at both levels. We need to support each other in measurable ways, not just throw around cultural symbols. We need to start by asking little things of each other.
If you are a friend you will wear a mask because it protects you from me and me from you.
We need to believe in and support the idea of one justice indivisible. If you don’t know what I am talking about a starting point would be The 14 Principles listed at 4comculture.com.
The Spokane School District Board of Education wants to name several new school buildings. It would be nice if two of those schools were named after people of color. You can nominate someone: Nomination Link. I have nominated Frances Scott and Ruben Trejo.
It would be good to let us know your personal level of commitment: Ally, Actor or Accomplice. See page at 4comculture.com.
You need to have an online presence. You need to let your other brothas know what it is you stand for. One simple way to do this is to participate in online posting and messaging at Facebook.
Let’s become civic activists. Participate in local social justice organizations or engage in new methods of non-violent action that include physical, virtual and hybrid actions.
We each need to develop a social justice budget. It would be nice if you would donate on a regular basis to the things that you believe in. Let me suggest that you make a donation to anybody or any group that you choose, but do it in the name of Spokane Brothas. The reason I suggest doing that is to build a power base that would be respected. I would suggest a budget that would express your volunteer time as well as your cash contributions. For example a budget of $100 a month could include:
Volunteering: 7 hours a month at the national minimum wage of $7.25 per hour would be about a $50 in-kind contribution. What if you showed up to volunteer in a Brothas T-shirt?
Send a check to the Black Lens. About $4.00 a month buys a subscription.
Contribute to an informational issue campaign. For example about $16 pays for a MailChimp service that will send your message to a mailing list of thousands that you have built. In times of quarantine and isolation you have to find ways other than community meetings to deliver information about your issues. You could buy a yard sign with your message or issue or candidate.
Give $20 to local and/or regional progressive organizations or blue political parties – to the same organization/s every month so they can feel your presence.
Give $10 to national progressive organizations or blue political parties – to the same organization/s every month so they can feel your presence.
If we only had 14 brothas contributing at this level this would be $1400 per month or $16,800 per year. Imagine what would happen if we had 100 brothas.
Your comments are welcome. If I haven’t heard from you by June 12, I will assume you are not interested.
In the summer of 1965 the people listed below and I shared a common experience. Hundreds of us shared this experience. The experience changed my life. Student and parent protests against the Chicago School Board were focused by CORE in 1962, reaching a peak in the summer of 1965 with the Daily Daley Marches from Buckingham Fountain to Mayor Richard J. Daley’s house to protest school segregation and conditions.
As my friend Earless Ross and I marched we asked individuals in the line why they marched. We gathered numerous testimonies from those marching with us. I would like to know how that experience affected their lives.
If you are one of those listed below, know any of them or other people who participated in the Daily Daley Marches, please contact me:
Robert “Bob” J. Lloyd text: (509) 999-1263 rdlloyd@comcast.com subject: Why We March 3314 S Grand Blvd. Spokane WA 99203
Authors of the Statements
James G. “Allen Jr.”, Marla Bollin, Dave Canon, Kathy Casey, Mrs. Ronald Crawford, Jesse Daniales, Ken Davis, Arnelle Douglas, Clevon Edgerson, Charles E. Gant, Mrs. C. R. Gillies, Lucille Gipson, Walter D. Glanze, LeRoy Griffin, Elihu Harris, Jerry Herman, Carol Hill, William Hollins, Margaret Hollowell, Walter Ireland (Freloud?), Jesse Jackson, Nathaniel Jackson, Thomas Richard Joiner, Russell D. Jones, Oliver Julius, Sue Kaply, William Kennedy, Helen Kitterer, Joh Kles, Len Lazar, Marchain Lightfoot, Mrs. Limbo, Robert Lucas, Garrick Madison, John Maloney, LaMar McCoy, Earl D. Mosley, Bill Murphy, Jack Ongemach, W. Robinson, Earless Ross, Mary S (Sroges?), Chuck Sanders, Janice (?) Saylor, Mary Settles, Laurie Shortreed, Charles Smith, Fred Smith, Ollie M.Smith, Robert Shively, Dan Solomon, Dick Sroges, Jesse Stanton, Tanya Stewart, Peggy Terry, Cheryl Thompson, Barbara Wakefield, Margaret Walker, Patricia Washington, Harvey Weiner, Mrs. Williams, Ronald G. Williams, Susan Williams, James Wright, Cara Young Coordinating Council of Community Organizations Statement Written by Marchain Lightfoot
Others involved whom I would like to contact: Ted Manheart, Pat Packard, Rita Walford, Dennis Shriver, Gerald Thomas.
Physician Jerry LeClaire in his Indivisible email newsletter of Thursday April 8, 2020 shared this article from the New York Times in order that we can understand exactly what it means to be on a ventilator.
“I can verify everything Dr. Kathryn Dreger presents in her article. We all need to hear it, think about it, and proceed accordingly. Now might be the time to discuss with your loved ones how you want them to manage your care if the unthinkable happens.
If you live in Washington State and you do not already have a “Physician Orders for Life Sustaining Treatment” (POLST), now might be the time to consider one. (Click here.)”
It breaks my heart that patients who will get sick enough to need them won’t know what desperate situations they face.
By Kathryn Dreger
Dr. Dreger is a doctor of internal medicine in Northern Virginia and a clinical assistant professor of medicine at Georgetown University.
April 4, 2020 New York Times
Day by day, as the number of Covid-19 deaths soar, we see more clearly that many of us will not survive this storm.
In the most serious cases, breathing becomes so labored that ventilators have to be used to keep patients alive. That there may not be enough of these machines is horrifying and infuriating.
But even if there were, it breaks my heart that Americans who get sick enough to need them won’t know what desperate situations they face, nor will they understand what ventilators can do to help, and what they can never fix.
As hard as the facts may be, knowledge will make us less afraid.
Let me begin simply. When we take a breath, we pull air through our windpipe, the trachea. This pipe then branches in two, then again into smaller and smaller pipes finally ending in tiny tubes less than a millimeter across called bronchioles. At the very end of each are clusters of microscopic sacs called alveoli.The lining of each sac is so thin that air floats through them into the red blood cells. These millions of alveoli are so soft, so gentle, that a healthy lung has almost no substance. Touching it feels like reaching into a bowl of whipped cream.
Covid-19 changes all that.
It causes a gummy yellow fluid, called exudate, to fill the air sacs, stopping the free flow of oxygen. If only a few air sacs are filled, the rest of the lung takes over. When more and more alveoli are filled, the lung texture changes, beginning to feel more like a marshmallow than whipped cream.
This terrible disease is called acute respiratory distress syndrome. Covid-19 can cause an incredibly lethal form of this, in which oxygen levels plunge and breathing becomes impossible without a ventilator.
Specially trained health care workers insert a 10-inch-long tube connected to a ventilator through the mouth and into the windpipe. The ventilator delivers more oxygen into the lungs at pressure high enough to open up the stiffened lungs.
It’s called life support for a reason; it buys us time. Ventilators keep oxygen going to the brain, the heart and the kidneys. All while we hope the infection will ease, and the lungs will begin to improve.
These machines can’t fix the terrible damage the virus is causing, and if the virus erupts, the lungs will get even stiffer, as hard as a stale marshmallow.
“I feel like I’m trying to ventilate bricks instead of lungs,” one intensive care unit doctor who has been treating Covid-19 patients told me.
The heart begins to struggle, begins to fail. Blood pressure readings plummet, a condition called shock. For some, the kidneys fail completely, which means a dialysis machine is also needed to survive.
Doctors are left with impossible choices. Too much oxygen poisons the air sacs, worsening the lung damage, but too little damages the brain and kidneys. Too much air pressure damages the lung, but too little means the oxygen can’t get in. Doctors try to optimize, to tweak.
Nobody can tolerate being ventilated like this without sedation. Covid-19 patients are put into a medically induced coma before being placed on a ventilator. They do not suffer, but they cannot talk to us and they cannot tell us how much of this care they want.
Eventually, all the efforts of health care workers may not be enough, and the body begins to collapse. No matter how loved, how vital or how needed a person is, even the most modern technology isn’t always enough. Death, while typically painless, is no less final.
Even among the Covid-19 patients who are ventilated and then discharged from the intensive care unit, some have died within days from heart damage.
Even before Covid-19, for those lucky enough to leave the hospital alive after suffering acute respiratory distress syndrome, recovery can take months or years. The amount of sedation needed for Covid 19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.
All this does not mean we shouldn’t use ventilators to try to save people. It just means we have to ask ourselves some serious questions: What do I value about my life? If I will die if I am not put in a medical coma and placed on a ventilator, do I want that life support? If I do choose to be placed on a ventilator, how far do I want to go? Do I want to continue on the machine if my kidneys shut down? Do I want tubes feeding me so I can stay on the ventilator for weeks?
Right now, all over the country, patients and their families are being asked to make these difficult decisions at a moment’s notice, while they are on the verge of dying, breathless and terrified.
If patients get worse after being put on a ventilator, critical care doctors are having to ask their family members what they want done. Covid-19 is too contagious to have these conversations in person, so they are being done over the phone. It is yet another heartbreaking reality of dying during a pandemic. Patients cannot tell us what they want. Family members aren’t able to be with patients and may not know what they would want.
No one can make these choices for us, and no one will know what choices we would make unless we tell them. If you don’t want to be put in a coma and placed on life support, please let your family know. Appoint the person you want to make decisions for you and let your doctor know your wishes. The truth is we are facing a disaster. Let’s not use up precious resources on someone who doesn’t want them. We will still care for you to the end, but we won’t put you on a machine if you don’t want to be on it.
If the person you love is on a ventilator right now, find out exactly how bad his or her lungs are. The doctors will tell you the truth. And the truth, no matter how painful, eases fear. The understanding that comes with it helps us make the best choices for the ones we love.
