These would be my patient’s only words — an economy of phrasing made necessary by an all-consuming air hunger. She had just arrived in the emergency room, Code 3 critical, after a lights-and-sirens ambulance transport from her nursing home. Awake, alert and intensely focused, every effort of her frail, 90-year-old body was concentrated on the simple act of breathing. Her weak heart and failed kidneys had caused her lungs to fill with fluid, every breath becoming a mixture of water and air. The analogy to drowning is inevitable. As her physician, I was going to have to make some big decisions quickly, including this one: How much should I do to save her life?
Typically, when patients gasping for air and with very low oxygen levels show up in my emergency room, it’s obvious what to do first: You intubate them. You put a tube in their mouth down into their lungs and connect them to a respirator. It’s an aggressive treatment, and anyone awake for it will tell you it’s unpleasant. But without enough oxygen in the bloodstream, bad, often irreversible things happen to the body very quickly. [Read More]