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The art of being alive is the art of balance.
Often there is an illusion of rock solid stability to our lives, when the truth is the biochemical parameters for our existence are as thin as the edge of a piece of paper.
When we unravel, things fall apart frighteningly fast. 1/
Often there is an illusion of rock solid stability to our lives, when the truth is the biochemical parameters for our existence are as thin as the edge of a piece of paper.
When we unravel, things fall apart frighteningly fast. 1/
The intensivist is on the phone. She is arguing the case for her patient to receive a potentially life-saving therapy.
ECMO.
The problem is her patient isn’t the only one who needs it, and availability is limited.
Decisions have to be made on who gets it, and who doesn’t. 2/
ECMO.
The problem is her patient isn’t the only one who needs it, and availability is limited.
Decisions have to be made on who gets it, and who doesn’t. 2/
Extracorporeal membrane oxygenation (ECMO) involves taking blood out of the body to artificially oxygenate it and remove carbon dioxide, then returning it.
It was invented in the 1950s and the modern iteration is seeing use in severe COVID-19 cases.
It’s a precious resource. 3/
It was invented in the 1950s and the modern iteration is seeing use in severe COVID-19 cases.
It’s a precious resource. 3/
I see a look of relief wash over the intensivist’s face as she hangs up the phone.
She was able to make a convincing case, supported by the data. Her patient will be going on ECMO tonight.
It will be potentially lifesaving therapy, at least for now.
She invites me to see. 4/
She was able to make a convincing case, supported by the data. Her patient will be going on ECMO tonight.
It will be potentially lifesaving therapy, at least for now.
She invites me to see. 4/
We stand outside the patient’s room as the intensivist reviews the latest arterial blood gas (ABG) results.
These provide a window into how well the lungs, and the ventilator, are doing their job.
In this case, the data shows a severe build-up of carbon dioxide.
Lethal. 5/
These provide a window into how well the lungs, and the ventilator, are doing their job.
In this case, the data shows a severe build-up of carbon dioxide.
Lethal. 5/
It feels like we’re holding our breath, as we await the arrival of the ECMO team from another medical center.
Briefly, the intensivist sketches a quick diagram to show me how ECMO works.
To me, it’s kinda like dialysis for your lungs. Kinda.
My brain is wired to simplify. 6/
Briefly, the intensivist sketches a quick diagram to show me how ECMO works.
To me, it’s kinda like dialysis for your lungs. Kinda.
My brain is wired to simplify. 6/
This particular ECMO team is made up of two critical care docs, and four nurses.
They arrive pulling large carts stacked with equipment, all wearing backpacks.
They look like mountaineers getting ready to climb a mountain.
In a way, they are. 7/
They arrive pulling large carts stacked with equipment, all wearing backpacks.
They look like mountaineers getting ready to climb a mountain.
In a way, they are. 7/
Introductions are brief.
Every member of the ECMO team moves with a purpose. Exchanging data with our ICU team, asking about our PPE arrangements, making space for the equipment and setting up methodically.
They move like a well-oiled machine.
This isn’t their first rodeo. 8/
Every member of the ECMO team moves with a purpose. Exchanging data with our ICU team, asking about our PPE arrangements, making space for the equipment and setting up methodically.
They move like a well-oiled machine.
This isn’t their first rodeo. 8/
The plan is to place large tubes (they look like garden hoses to me) in the patient’s femoral vessels to circulate blood through the ECMO circuit and back.
One doc stands on each side of the patient.
Between the two of them they have over 50 years experience.
They begin. 9/
One doc stands on each side of the patient.
Between the two of them they have over 50 years experience.
They begin. 9/
The experience of being in the midst of a COVID tsunami has been alternately terrifying and soul-crushing.
Tonight, watching a team of highly trained and highly skilled individuals work together to save a total stranger, I feel something else.
Hope flares wildly to life. 10/
Tonight, watching a team of highly trained and highly skilled individuals work together to save a total stranger, I feel something else.
Hope flares wildly to life. 10/
The two docs and the nurses in the room are mostly silent, occasionally communicating, backing up each other when needed.
There is no wasted effort.
No wasted words.
I am frankly in awe. I’ve done my share of access procedures in the femoral veins.
Nothing like this. 11/
There is no wasted effort.
No wasted words.
I am frankly in awe. I’ve done my share of access procedures in the femoral veins.
Nothing like this. 11/
The procedure is a success.
The blood pumps through the circuit.
Repeat ABG analysis shows carbon dioxide levels coming down and oxygen levels rising.
The ECMO team carefully re-packs their equipment to move out, and transfer the patient to their center.
“Let’s roll.” 12/
The blood pumps through the circuit.
Repeat ABG analysis shows carbon dioxide levels coming down and oxygen levels rising.
The ECMO team carefully re-packs their equipment to move out, and transfer the patient to their center.
“Let’s roll.” 12/
After they leave with the patient, the room is empty.
Silence.
The intensivist’s night is done.
I’m still on call overnight.
But I’m grateful. I know why she showed me this.
The darkness isn’t infinite.
We have each other’s light.
In the depths of the night, hope finds me.
Silence.
The intensivist’s night is done.
I’m still on call overnight.
But I’m grateful. I know why she showed me this.
The darkness isn’t infinite.
We have each other’s light.
In the depths of the night, hope finds me.
