Asthma and Allergy Awareness Month: It’s Just Asthma
COPD and asthma, although different, do have similarities – and they tend to run in families. If you have COPD you should learn about asthma and understand that it can be serious – very serious – even deadly. This is based on a true story, told from a respiratory therapist’s perspective. The names of people and places have been changed.
It was 11:15 pm on Labor Day evening as I sat down at the conference table for respiratory therapy staff report at Lakeside Hospital. I was exhausted – but relieved. I sighed, thinking, “It’s after 11:00 pm at the end of a long holiday weekend of perfect summer weather in a resort town and we haven’t had one bad car accident or drowning come through our doors. A good weekend, indeed!
Shift report took place at this table and typically consisted of the evening shift therapists telling the night shift therapists what was going on with the more remarkable patients in our facility; that there were currently a few chest pains in the ER, a premature baby in the nursery on oxygen, doing better now and stable; and passing along whatever therapy and tests needed to be done during the night to make sure everybody kept on breathing and living.
I was looking forward to going home, first checking on my husband and children, making sure all were safely tucked in their beds, then pouring a glass of wine and watching television until about 1:00 am when I’d turn off the lights and tumble into bed. As I unclipped the pager from my scrubs and slid it across the table to the night therapist, it went off. “Respiratory, Stat, to the emergency room – Class one.”
A “class one” in medical terms is a patient with no respirations and no heartbeat. Our staff of three dashed quickly, but calmly, to the ER, walked into trauma room one, and put on disposable gloves and yellow paper gowns. I grabbed the ambu bag and my colleague opened our sealed box of emergency respiratory supplies. Thoughts of punching the clock and going home were gone.
“Hey, Karen,” I said to the night nurse. “What do we have?”
“A child. Nine years old.”
My heart sank and thoughts flashed to my oldest child, a nine-year-old girl.
“No way. From where?”
I immediately began to think of all the children I knew who were about that age, from that area, our regulars – “frequent flyers” we called them — who came to our hospital often with poorly controlled asthma.
No time to speculate. The automatic doors from the ambulance bay opened, we heard the boots of the paramedics and the click, click of a gurney with a light load cross the metal threshold to the ER.
Ryan was a nine-year-old boy with a handsome little face and brown hair. His hazel eyes were open. His stare was blank and empty. His body, pale and limp. The paramedics were doing CPR.
I turned up the oxygen as high as it could go, connected the ambu (a heavy plastic oval-shaped device a bit smaller than a football) to the oxygen and also to the tube in Ryan’s mouth and began to breathe for him. My colleague did chest compressions according to American Heart Association specifications for a child that age.
“He’s really stiff,” I reported, as I worked hard to push air into his lungs with both hands.
“Breath sounds?” asked the doc.
“Tight,” answered another therapist, as she moved her stethescope from place to place on the child’s chest. “I can hardly hear a thing.”
The paramedics had done everything right, initiating advanced life support at the scene and getting Ryan to the hospital as quickly as possible. Emergency room staff took over, lead by a top emergency doc who calmly gave orders for state-of-the-art protocol. We – about ten of us – worked together, each doing our part to try to save this child. After almost an hour there was no change in his condition.
His parents were called into the room. They shuffled in, his mother’s eyes red and swollen, her face soaked with tears. She could barely stand. Ryan’s father, also weeping, held her up on one side and their pastor, on the other.
I’d witnessed too many of these scenes. Mom and Dad coming in to see their child, holding each other up as they walked, sobbing, looking over their child and touching an arm or hand, telling him how much they love him.
You know, terrible things happen. In the ER we know that. Kids on bikes get hit by cars. Kids fall off of roofs and horses. Kids drown. It’s beyond horrible – but it happens. Our job is to not let our feelings get in the way of our work, but to remain calm and use every skill we have to do our best to help patients survive. But this one hit me. Hard. This kid was dying…and now was all but gone… from asthma!
Their pastor was a big man, probably six feet, six inches tall. He stood behind Ryan’s parents at the gurney, his arms around their shoulders, engulfing them as he prayed. As he did, we continued. When the prayer was done Ryan’s parents kissed their son and patted his hand. They turned toward the door and their quiet weeping became wails of anguish. Shortly after they left the room, it was determined by the doctor and staff that nothing further could be done. Ryan’s life was gone.
I snapped off my gloves and prepared our equipment for the next emergency. Alone in the room with Ryan, my job now done, my composure turned to anger. I just had to know. One of the paramedics came back into the room to retrieve his equipment. I stepped into his path, head on, nose to nose, and quietly, deliberately, angrily asked him, “What the hell, Scott? How did this happen?”
“Well, they’re from out of town and they were at their cottage for the weekend. Family said he’d been struggling all day, but they figured it was just asthma and they didn’t think it could get that bad. Then tonight they had a camp fire.”
I gritted my teeth, stepped on the pedal of the metal trashcan, slammed in my gown and gloves, and said, “Dammit, how could they not know that?”
But as soon as I said it, I thought, “It doesn’t matter now. No time for blame. They’re suffering terribly, and they will for the rest of their lives.” Then it came to me, “If they didn’t know, how many others out there don’t know that a person can die from asthma?”
That night I didn’t just glance in on my sleeping daughter. I went to her bed, stroked her hair and kissed her cheek as she slept. “Ryan’s mother can never do this again with her child,” I thought. “We’ve got to do better telling people about asthma. Ryan is gone, but what we have to do now is to not let this happen – ever again.”
Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of http://www.Breathingbetterlivingwell.com and author of Breathe Better, Live in Wellness.