The ventilator conundrum

Frequently enough people come in really sick to the hospital- to the point that they are not able to breathe on their own; and they have to be put on a breathing machine.

Sometimes the arrangement involves just a scary looking face-mask that’s at the end of breathing machine; more often, things are worse off, and you put a tube down the patient’s throat, attach it to the breathing machine, and make the machine work as the patient’s lungs.

But that is just the start. Things snowball from here on. A tube down the throat is uncomfortable of course; so these people have to be induced to sleep with medications. And sure enough, they can’t eat through there mouths, and they need a tube down their nostrils all the way down to the stomach so you can give them some manufactured liquid food. They can’t hold pee, so you stick another tube all the way from their organ to the bladder so you can drain the pee. Most also end up getting rear ended by another tube so you can drain the poop.

If this is exasperating enough already, hold on for a while. Such patients also need some more tubing going into the veins in the body, so they can give you some fluid. Sometimes, if things are bad enough, they put down a long tubing that goes from one of the larger veins all the way close to the heart, so they can wash a lot more fluid.

And then, there is a paraphernalia of wires that’s stuck all over the chest so things can be monitored. Inflatable wraparounds go on the lower legs and another one on the arms so they can monitor the blood pressure. Sometimes however, they put a small catheter straight down the artery so they can monitor your blood pressure rather more accurately.  An arm band with a bar code goes into the hand. The breathing machine sits on the side, like an ominous looking animal guard at a temple gate;  a technicolor monitor with arcane numbers and graphs imposes on the other, with round the clock patient information on display.

As if all that were not enough, the machines and the IV pumps ding and dong at a regular interval; providing a  delirious sound track to that theater of healing.

So that’s how they dress them up for the battle. From here on, it’s a climb all the way up the slippery slope of recovery.

Some people recover. They come out alive and kicking without the machine- the myriad tubes out of their body- able to breathe on their own again. Many try hard-their bodies try hard-make a varying distance up the slope, and then fall right back. Like that proverbial king Bruce’s spider. Some never really make much of a dent in their condition.

A tube down the throat is not a great sight, but it’s an even worse feeling. After a while it starts to eat into your airway, it erodes the vocal cords, gives a pneumonia and makes one constantly delirious. The tube can’t stay there forever; and it can’t come right out either. Thus compromises are made, the tube comes a few notches down; a hole-called a tracheostomy-is made in the neck, and a shorter version of the tube goes there.

For bonus’ sake, they throw in another called a G tube. A G tube is one that goes straight to the stomach from a hole in the belly, so some manufactured liquid food can be shoved down.

That must make one feel like a stumpy tree, stuck in the bed for ever with tubes growing out of you like rootlets.

For a small fraction of people these measures are temporary. For the vast majority however, such arrangements become permanent. People then are alive alright, but unable to talk, breathe on their own, or eat through their mouth. And of course, one can’t go around walking when there is a ventilator attached to the neck- so they are essentially bed ridden throughout- for most people that is for the rest of the life.

One after the other such patients then end up at special facilities for “vent-patients”. Bed after bed after the other, such facilities are filled with patients attached to a ventilator in perpetuity.

So what if he is not eating, drinking, peeing, talking, waking- they are not dead, right?

It’s a completely different matter that once every month- or sometimes even earlier, such patients run a ritual of a trip in a wailing ambulance to a hospital or one reason or other- for a temperature, a blood count that does not look right, lab work that is not normal, a blood pressure that is a little off normal.

As they get shuttled around from one bed to the other, and one place to the other, their skin on the back sloughs off from the constant lying on bed, they catch one obstinate bug after the other, they get one imaging after the other, accumulating radiation like a frequent flyer accumulates air miles, adding up to the suffering while piling up the costs that were not entirely necessary in the first place.

What then started off as an attempt to save a  human life and alleviate suffering, protracts on to a stalemate where the life is saved, but at a gargantuan cost of immeasurable suffering and runaway costs.

It’s hard to tell who is winning on these battles in the terraces and facades of the hospitals and long term care facilities. But human life sure does not look like the winner here.

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