困
Confining
Frantically barking, the small dog under the unmade bed, was staging frequent sniping ambushes, appearing in a sudden snarl, then disappearing behind the shelter of the skirt. The brisk canine cacophony erupts in short spasmodic coughs with remissions coinciding with swift unexpected attack and retreats.
On a nearby table an assortment of prescription bottles with several inhalers occupied a corner opposite an ashtray brimmed with crumpled butts. A chipped cup laying on its side is the head waters of a coffee stream still dripping off the table. The whole table top duplicated in the tall pine tree etched ornamental wall mirror. With every second the tree bursts into red flame, the reflection of the ambulance overheads flashing in the driveway outside. On closer reflection, a red and white helicopter lands in the open pasture.
Sitting snug in the oversize Naugahyde barker lounger, a gasping barrel chest grasps the arm rests and strives to catch air in rapid short inhalations. The I/E mismatch of obstructed gas exchange in a classic and chronic respiratory failure now requiring rapid in situ emergent airway intervention. Green tubing winds from the chair and coils to an empty portable O2 tank. The heat in the double wide residence is stifling and, additionally, the EMS staff, flight crew and family member crowded close compounds the sense of suffocation. The small rotating fan is overwhelmed and brings small intermittent reliefs. One of the EMS crew asks questions of the family member, recording notes into a silver metal cased clipboard. Inexplicably, a large TV console is broadcasting a college football game and contributing to the surreal scene. The patient propped upright is semi conscious, probably hypercarbic and oblivious to the surrounding swirl of chaos. Everywhere ashtrays are full permeating a penetrating incense of nicotine.
A “FULL” green tank is cracked and an “Ambu” bag is unpacked with appropriate size fitted mask and the assisted ventilation illicit little response. Recorded O2 sats are in the 80s as a further indication for the need of a rapid sequence intubation. The family member is escorted to the small porch attached at the front door where with continued attendance, fumbles for a cigarette. It takes 3 crew to pull the chair away from the wall allowing the chair to recline to a semi recumbent airway access. An IV access with a glucostik is established. On the floor an “empty” coffee can functioning as a spittoon is tipped over then kicked out of the way, spilling a yellow viscous liquid into the worn and already hideous carpet. Cigarette butts become sinking ships on the carpet. With adequate blood pressure, the patient is dose appropriately “diazepemed” which proves to be the only sedation medication required. The mac blade laryngescope is introduced into the airway which produces a brief bradycardia but with cord visualization the intubation proceeds rapidly and the slow heart rate resolves. The patient is successfully “tubed” and simultaneously the TV erupts with cheers as “Ole Miss” scores a TD.
Extrication from the chair and the house proves to be a logistic nightmare. Lifting the patient from the chair, while protecting the precious airway, onto a backboard and stretcher a frightening first step for all. But the stretcher cannot negotiate the front door porch and the backboarded patient is lifted from the stretcher over the rail to the front yard flight stretcher. The flight stretcher cannot negotiate the rough path to the waiting helicopter. A cautious “6 point” carry finally loads to the bird. The entire endeavor frequently paused to perform various interventions, administer sedation meds, “inline” bronchiodilators, obtain a field EKG and protect the precious airway. Everyone is sweating profusely and bent over in angles depending on which side of the stretcher they were tasked with lifting. From the open bedroom window the dog hacking yaps echo into the yard, into the night.
Liu: The lake with no water: Oppression. If one indicates with words only, no one will believe.
