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.
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.
Thanks Fawna and David! We will wear our super masks proudly.
Super-Heroism 101 : You Need A Mask By Yvor Stoakley
Dear Friends, While the jury may still be out (sorry about the legal jargon…it means there is still no clear verdict on this issue), “Masks Save Lives” (https://www.maskssavelives.org/ ) makes some compelling arguments for wearing masks in public during this pandemic. We each have to weigh these arguments and make up our own minds but here are some of the points they offer for consideration:
Western countries are experiencing higher rates of COVID-19 infections compared to Asian countries where mask wearing is a more culturally accepted practice.
· There is broad consensus that individuals who are infected and individuals who are contagious should wear a mask in the presence of other people to reduce the incidence of infecting others.
· It is standard practice in hospitals for surgeons to wear masks to avoid transferring germs to their patients.
· Masks can protect against transfer of aerosolized droplets that may contain viruses.
· Wearing a mask during a pandemic is a courteous gesture towards other human beings.
· Masks trap virus particles on the inside preventing them from becoming airborne.
· Without sufficient testing and given that many COVID-19 carriers may be asymptomatic (i.e., not exhibiting symptoms) it is best to assume that everyone could be a carrier.
· Masks are only one protective strategy and should still be combined with social distancing, coughing into your elbow, washing your hands frequently, and other appropriate practices.
· Masks can be easily made from readily available materials without preventing healthcare workers, first e responders and others from having masks they vitally need.
· N95 masks are better than surgical masks, but anything that prevents breathing in moisture particles with viruses helps.
We clearly need more research and hard data to confirm or illuminate the effectiveness of wearing masks. And it is always good advice to consult with a doctor. But in a time when every individual is called upon to do his or her small part to “flatten the curve” and mitigate the spread of the corona virus, we can all wear a mask in public or when interacting with other people. At any rate, while you are sheltered in place, give it some thought.
And furthermore, remember that many fictional superheroes and defenders of justice (e.g., Zorro, the Lone Ranger, Black Panther, Raven, Teenage Mutant Ninja Turtles, etc.) choose masks.*
*In law school they taught us to try any argument that we thought might be persuasive.
Homelessness is a national issue. This photo was taken in Washington DC September 2017.
This point-in-time count is a snapshot of people who are homeless in Spokane, counted by local teams on one night in January, a statistic that is limited by a variety of factors and not considered the complete picture. Because more homeless people were in shelters, and fewer were outside in hard-to-find places, it was easier to get a count, according to McCann and city officials. That might apply particularly to the chronically homeless, who are more likely to use emergency shelters.
In particular, the city’s super-tight rental market – with an estimated vacancy rate of 0.7 percent – makes it very hard for people to find affordable housing and pushes the homeless numbers upward. Nearly 500 people are qualified for federal housing vouchers but can’t find a place to use them in town, said Dawn Kinder, the director of the city’s Community, Housing and Human Services Department.
This year’s count showed:
1,090 homeless individuals, an 11 percent increase over last year. Eighty-seven percent of all people counted were in shelters. Around three-quarters of those were in emergency shelters, and one quarter were in transitional housing.
* Strengthen the influence of media arts organizations, making them an integral part of their communities;
* Facilitate the support of independent media artists from all cultural communities and geographic regions;
* Integrate media into all levels of education and advocate for media literacy as an educational goal;
* Promote socially responsible uses of and individual access to current and future media technologies;
* Encourage media arts that are rooted in local communities, as well as those that are global in outlook.
This play was great. I think that those who have relationships with senior loved ones, senior lovers, parents, grandparents or who know or care for someone who is terminally ill should see Harnietiaux’s latest play. David Casteal (Bobby) and Adell Whitehead (Lee) portray this couple working through a difficult time with empathy, humor and authenticity.