PairoDocs
Well-known member
A preface is that I realize now that my intubation had been vital for my survival and I am grateful that particular piece of hardware was available to breathe for me when I was too close to death to do it for myself anymore. What I describe next is simply what happened to me.
I think I am a bit different from the others in my experience due to the severity of my lung involvement with my very precipitous fall from fairly good health to very critical condition in less than three days. There was no time to prepare myself for what was going to happen. I didn't have the luxury to get counseling or any other sort of preparation. I just started to feel "odd" the morning of Dec 9th, ER visit suggested pulmonary fibrosis--of all things--turned out to be wrong--thank God for at least this not-so-small favor! Then December 10th second ER visit--"atypical pneumonia" which went from ability to breathe room air (about 60 breaths per minute to keep O2 saturation in mid 90s) to 10 liters per minute O2 by morning Dec 11th. Then ICU, where they finally figured out it was my heart. Meanwhile my lungs were distended with fluid and my ability to breathe without help was fast diminishing.
I never really minded masks, and was reasonably comfortable snorkeling with my wife in American Samoa on our honeymoon in 1996 (btw--12th anniversary today 4/27). I actually found great relief even to the point I was able to eat a decent meal by using a BiPAP mask. The pressure enabled me to breathe well enough that I could pause to chew and eat adequately, though I was on almost pure oxygen at that point. Of course I moved the mask away during the actual eating and swallowing.http://valvereplacement.com/forums/images/smilies/biggrin.gif
It became clear by the 12th that despite aggressive diuresis I was dying and my descent into cardiogenic shock continued, plus heart failure had begun. The BiPAP, though exceptionally helpful, had reached its limits. It was becoming increasingly difficult for me to exhale against the pressure, and air leaked around my mask while I inhaled. I needed to be Life-Flighted to Boise, and could not wait any longer.
I was told I had to be intubated. http://valvereplacement.com/forums/images/smilies/eek.gif Ironically, the idea of something going down my trachea was a very phobic thing, sort of like terror of drowning despite my being an excellent swimmer. I asked for my old "milk of amnesia" friend Versed. It had saved me many traumatic memories over several operations including arthroscopic surgery on my left knee, a spermatic vein ligation, endoscopy, and colonoscopy. I requested it again when I found out I could not have BiPAP for my helicopter ride to Boise. I was going to "miss" my first helicopter ride. http://valvereplacement.com/forums/images/smilies/frown.gif However, I would also get to miss my intubation experience. http://valvereplacement.com/forums/images/smilies/smile.gif There was even a bit of retrograde amnesia, so I don't recall my fight with the football player build EMT that had to pin me down like a pro wrestler to get the thing into me. My wife said I was given a bit of Diprovan and a bit of Versed before intubation, but my condition was so fragile that they didn't dare give me any more until I was fully intubated and stable.
Next (images of cannibals in South America, poison darts, very pretty frogs...so pretty they make YOU croak) I was given a curare derivative Vercuronium, and *immediately* a, as my wife described it, very full syringe of Versed. Wrapped up in my thermal cocoon, I was then driven the 300 yards to the helipad, then loaded into the helicopter.
I was briefly allowed to awaken at the hospital, tube in place, so I could pray with my wife and the on call pastor at St. Luke's Boise hospital. The Versed had more or less worn off, but the Diprovan remained until I was extubated. I didn't fight the tube; I accepted it was there, though I didn't like it. I felt it with my tongue, a hard plastic roundness. It turned out I *did* fight the tube a lot after surgery--next paragraph. I was then brought back under. Fifteen minutes after arrival, TEE--convenient that I already had been intubated... Forty minutes after arrival, first incision. 62 minutes cardio-pulomnary bypass, mitral valve repaired, closed up, then back on the ventilator.
My lungs were in such terrible condition I had to be left on the ventilator for a whole additional day after surgery. There was so much fluid, blood, and mucus--my double chordae rupture had so flooded my lungs with fluid, there was no way I'd be extubated only 6 hours after surgery--it would kill me. Then Laura told me that whenever they let up on the Diprovan I would express a very strong desire to be extubated and tried to sign, write, or pantomime requests and demands that it be removed. I also tried to do it myself, but Laura watched me like a hawk as well as a very vigilant nurse named Sandra ("In my 25 years of nursing, I have never had a patient extubate himself.") They used light gauze restraints, and allowed me to suction myself at times--it seemed to calm me down to give me that level of control. I have one true memory from during this time--them bathing me with some sort of system involving a large warm wet towel and two blurry forms doing the washing, and moving my body around. I also recalled I could barely do more than open my eyes to quivering slits to see even this. The rest for me was blank.
(Gross out warning--skip this paragraph if you have a weak stomach). Then the wondrous moment occurred--I was extubated. Seemed I had some last minute cold feet--suddenly my tube was my buddy and I didn't want it out--maybe I knew what was coming...http://valvereplacement.com/forums/images/smilies/tongue.gif
They let up the Diprovan as the process took place. I was instructed to cough hard. Laura told them I could cough pretty hard. I could "PEEP" (positive end expiratory pressure) myself adequately--meaning I could get whatever was in there out. Boy did I get it out.
(Final warning--gross part next). When I coughed, I did a very deep one. The tube came up and so did several strings and globs of clear, yellow, blood clots (some light some dark), in all over a foot long came out with the tube. Suffice it to say, the respiratory therapist, me, and Laura were agog with astonishment at how much stuff there was. Over the next ten minutes or so, I directly coughed up at least the same amount, then I finally became connected to reality. Until this point, the Diprovan had kept my amnesia going--most of what I wrote here was from descriptions my wife and the ICU people including Sandra told me when I could record long term memories.
(Gross part over...http://valvereplacement.com/forums/images/smilies/wink.gif)
My wife said I was talking a mile a minute, starting with "Did I have my surgery?" I have a true memory of this question, as well as my total bewilderment when she said "You have a zipper on your chest." What? Metal? Nylon? Why? http://valvereplacement.com/forums/images/smilies/confused.gif Did they have to get to my heart very quickly in case something was wrong? Unzip! In again.... Was my condition that precarious??? If I had a macabre sense of curiosity could I take a look inside my own chest? I sure hoped they locked or protected the zipper pull so it wouldn't undergo some sort of fatal "gaposis" allowing pathogens to get inside me....http://valvereplacement.com/forums/images/smilies/eek.gif
Laura then explained that this was what medical people called large scars--and since I didn't have large scars, nor had known anybody with one, I had never heard that 'zipper' euphemism for a scar before that moment. With that behind me, I relaxed and had my first post surgical laugh--followed by some more coughing.
From that point on, the coughs, while productive of what I termed "blood sausage" for a short time afterward, were much less often and my recovery was rapid after that. My vocal cords were not damaged despite my size 8 tube--I guess there was room, and I made ample use of their undamaged condition. Weaned in 3 days post extubation to room air, I was released 8 days post surgery.
In summary, my fear of drowning along with real experiences with being rolled in a breaker at the beach while a kid, and a bad flip-turn during a free-style race at a swim meet, made me panicky at the feel of something foreign going where stuff isn't supposed to normally go. I can't stand the feeling of helplessness of not being able to cough up stuff, and the tube was, frankly, in the way of my properly doing so. My wife--God bless her always--convinced the respiratory therapist to extubate me even when my O2 saturation was still a bit low--and let me take out my own garbage--as it were--for a change. She was right--I was VERY motivated to prove her right even though I hugged my coughing pillow (Sir Koff-a-Lot teddy bear)until my arms shook from the effort. I didn't want to see the tube again. However, when I needed it the most, it was literally a lifesaver and for that reason I was glad to have it for every single moment I needed it.
If you need it, you need it. Just consider it something to be endured like a painful dental procedure that resulted in being able to use your teeth again to eat normally for the next ten years or so. It will pass, it will come to an end. Most likely it will be over in less than a day, and you may not even remember any of it. These respiratory people are competent and have had millions of people before you survive intubation worldwide--that probably would have died without having it done. They publish hints and improvements--and each generation gets that much better at it. Just pray that God be with you through it all--I know--He was with me.
I think I am a bit different from the others in my experience due to the severity of my lung involvement with my very precipitous fall from fairly good health to very critical condition in less than three days. There was no time to prepare myself for what was going to happen. I didn't have the luxury to get counseling or any other sort of preparation. I just started to feel "odd" the morning of Dec 9th, ER visit suggested pulmonary fibrosis--of all things--turned out to be wrong--thank God for at least this not-so-small favor! Then December 10th second ER visit--"atypical pneumonia" which went from ability to breathe room air (about 60 breaths per minute to keep O2 saturation in mid 90s) to 10 liters per minute O2 by morning Dec 11th. Then ICU, where they finally figured out it was my heart. Meanwhile my lungs were distended with fluid and my ability to breathe without help was fast diminishing.
I never really minded masks, and was reasonably comfortable snorkeling with my wife in American Samoa on our honeymoon in 1996 (btw--12th anniversary today 4/27). I actually found great relief even to the point I was able to eat a decent meal by using a BiPAP mask. The pressure enabled me to breathe well enough that I could pause to chew and eat adequately, though I was on almost pure oxygen at that point. Of course I moved the mask away during the actual eating and swallowing.http://valvereplacement.com/forums/images/smilies/biggrin.gif
It became clear by the 12th that despite aggressive diuresis I was dying and my descent into cardiogenic shock continued, plus heart failure had begun. The BiPAP, though exceptionally helpful, had reached its limits. It was becoming increasingly difficult for me to exhale against the pressure, and air leaked around my mask while I inhaled. I needed to be Life-Flighted to Boise, and could not wait any longer.
I was told I had to be intubated. http://valvereplacement.com/forums/images/smilies/eek.gif Ironically, the idea of something going down my trachea was a very phobic thing, sort of like terror of drowning despite my being an excellent swimmer. I asked for my old "milk of amnesia" friend Versed. It had saved me many traumatic memories over several operations including arthroscopic surgery on my left knee, a spermatic vein ligation, endoscopy, and colonoscopy. I requested it again when I found out I could not have BiPAP for my helicopter ride to Boise. I was going to "miss" my first helicopter ride. http://valvereplacement.com/forums/images/smilies/frown.gif However, I would also get to miss my intubation experience. http://valvereplacement.com/forums/images/smilies/smile.gif There was even a bit of retrograde amnesia, so I don't recall my fight with the football player build EMT that had to pin me down like a pro wrestler to get the thing into me. My wife said I was given a bit of Diprovan and a bit of Versed before intubation, but my condition was so fragile that they didn't dare give me any more until I was fully intubated and stable.
Next (images of cannibals in South America, poison darts, very pretty frogs...so pretty they make YOU croak) I was given a curare derivative Vercuronium, and *immediately* a, as my wife described it, very full syringe of Versed. Wrapped up in my thermal cocoon, I was then driven the 300 yards to the helipad, then loaded into the helicopter.
I was briefly allowed to awaken at the hospital, tube in place, so I could pray with my wife and the on call pastor at St. Luke's Boise hospital. The Versed had more or less worn off, but the Diprovan remained until I was extubated. I didn't fight the tube; I accepted it was there, though I didn't like it. I felt it with my tongue, a hard plastic roundness. It turned out I *did* fight the tube a lot after surgery--next paragraph. I was then brought back under. Fifteen minutes after arrival, TEE--convenient that I already had been intubated... Forty minutes after arrival, first incision. 62 minutes cardio-pulomnary bypass, mitral valve repaired, closed up, then back on the ventilator.
My lungs were in such terrible condition I had to be left on the ventilator for a whole additional day after surgery. There was so much fluid, blood, and mucus--my double chordae rupture had so flooded my lungs with fluid, there was no way I'd be extubated only 6 hours after surgery--it would kill me. Then Laura told me that whenever they let up on the Diprovan I would express a very strong desire to be extubated and tried to sign, write, or pantomime requests and demands that it be removed. I also tried to do it myself, but Laura watched me like a hawk as well as a very vigilant nurse named Sandra ("In my 25 years of nursing, I have never had a patient extubate himself.") They used light gauze restraints, and allowed me to suction myself at times--it seemed to calm me down to give me that level of control. I have one true memory from during this time--them bathing me with some sort of system involving a large warm wet towel and two blurry forms doing the washing, and moving my body around. I also recalled I could barely do more than open my eyes to quivering slits to see even this. The rest for me was blank.
(Gross out warning--skip this paragraph if you have a weak stomach). Then the wondrous moment occurred--I was extubated. Seemed I had some last minute cold feet--suddenly my tube was my buddy and I didn't want it out--maybe I knew what was coming...http://valvereplacement.com/forums/images/smilies/tongue.gif
They let up the Diprovan as the process took place. I was instructed to cough hard. Laura told them I could cough pretty hard. I could "PEEP" (positive end expiratory pressure) myself adequately--meaning I could get whatever was in there out. Boy did I get it out.
(Final warning--gross part next). When I coughed, I did a very deep one. The tube came up and so did several strings and globs of clear, yellow, blood clots (some light some dark), in all over a foot long came out with the tube. Suffice it to say, the respiratory therapist, me, and Laura were agog with astonishment at how much stuff there was. Over the next ten minutes or so, I directly coughed up at least the same amount, then I finally became connected to reality. Until this point, the Diprovan had kept my amnesia going--most of what I wrote here was from descriptions my wife and the ICU people including Sandra told me when I could record long term memories.
(Gross part over...http://valvereplacement.com/forums/images/smilies/wink.gif)
My wife said I was talking a mile a minute, starting with "Did I have my surgery?" I have a true memory of this question, as well as my total bewilderment when she said "You have a zipper on your chest." What? Metal? Nylon? Why? http://valvereplacement.com/forums/images/smilies/confused.gif Did they have to get to my heart very quickly in case something was wrong? Unzip! In again.... Was my condition that precarious??? If I had a macabre sense of curiosity could I take a look inside my own chest? I sure hoped they locked or protected the zipper pull so it wouldn't undergo some sort of fatal "gaposis" allowing pathogens to get inside me....http://valvereplacement.com/forums/images/smilies/eek.gif
Laura then explained that this was what medical people called large scars--and since I didn't have large scars, nor had known anybody with one, I had never heard that 'zipper' euphemism for a scar before that moment. With that behind me, I relaxed and had my first post surgical laugh--followed by some more coughing.
From that point on, the coughs, while productive of what I termed "blood sausage" for a short time afterward, were much less often and my recovery was rapid after that. My vocal cords were not damaged despite my size 8 tube--I guess there was room, and I made ample use of their undamaged condition. Weaned in 3 days post extubation to room air, I was released 8 days post surgery.
In summary, my fear of drowning along with real experiences with being rolled in a breaker at the beach while a kid, and a bad flip-turn during a free-style race at a swim meet, made me panicky at the feel of something foreign going where stuff isn't supposed to normally go. I can't stand the feeling of helplessness of not being able to cough up stuff, and the tube was, frankly, in the way of my properly doing so. My wife--God bless her always--convinced the respiratory therapist to extubate me even when my O2 saturation was still a bit low--and let me take out my own garbage--as it were--for a change. She was right--I was VERY motivated to prove her right even though I hugged my coughing pillow (Sir Koff-a-Lot teddy bear)until my arms shook from the effort. I didn't want to see the tube again. However, when I needed it the most, it was literally a lifesaver and for that reason I was glad to have it for every single moment I needed it.
If you need it, you need it. Just consider it something to be endured like a painful dental procedure that resulted in being able to use your teeth again to eat normally for the next ten years or so. It will pass, it will come to an end. Most likely it will be over in less than a day, and you may not even remember any of it. These respiratory people are competent and have had millions of people before you survive intubation worldwide--that probably would have died without having it done. They publish hints and improvements--and each generation gets that much better at it. Just pray that God be with you through it all--I know--He was with me.
