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Ventilators
Apr. 8th, 2020 10:05 amI have been talking to my sister, a pediatric nurse (LPN, so direct care with at this point well over a decade of experience), for years about the tradeoffs of various medical interventions. Her job presents her with an up close and personal view of what it is like to live (literally) with the things that are put in people to replace basic functions like breathing, eating and drinking, and pooping. Living is good ... until it is not, and we share some pretty firm opinions about what we do not ever want done for us. We were never inclined towards Do Anything To Keep Me Alive, but her experiences -- shared with me in conversation -- are absolutely convincing that there is quite a lot of medical interventions I want nothing to do with.
Ventilators were always on that list. The news, during our new Now, has been all about getting more ventilators. And the gossip, during our new Now, has been all about OMG do not ration things so I do not get a ventilator if I need one. And I keep saying, do not fucking put me on a ventilator (my husband and I are in complete accord on this as well -- and I do not mean do not put walkitout on a ventilator, I mean he does not want to be put on a ventilator, either).
We know a thing or two about airways and what can go wrong with them. Sure, we had our CPR classes and (lapsed) certifications. He was had a water safety instructor certification Back in the Day. I was once a Wilderness First Responder. We both have reactive airway disorder, and so does our son, and so do a bunch of our family members. We have seen osats drop, and I have brought my son (last November, actually) into the pediatrician's office because I was worried about his breathing, gotten back to back nebulizer treatments, a bunch of scrips and the comment, That Would Have Been Reasonable, when I said I had thought about just going to the ER this time.
That is the long winded (har de har har -- wrong time to make that joke? Sorry!) way of saying, nothing about this surprises me, altho I learned a bunch and want to know more as we figure it all out:
https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/
We have been seeing lots of things indicating ventilators are not helping, might be harming. We have been seeing lots of things about lower levels of care (CPAP, BiPAP, nasal cannula, etc.). This is a really thoughtful survey that helps re-orient away from the divisive discussion of rationing, and towards what I really care about: what is actually helpful, what has the right set of tradeoffs (not gratuitously harming a bunch of people who were going to be fine anyway, for example) and also touches on what kinds of intervention are dangerous for health care and what can we do about that part of it.
Ventilators were always on that list. The news, during our new Now, has been all about getting more ventilators. And the gossip, during our new Now, has been all about OMG do not ration things so I do not get a ventilator if I need one. And I keep saying, do not fucking put me on a ventilator (my husband and I are in complete accord on this as well -- and I do not mean do not put walkitout on a ventilator, I mean he does not want to be put on a ventilator, either).
We know a thing or two about airways and what can go wrong with them. Sure, we had our CPR classes and (lapsed) certifications. He was had a water safety instructor certification Back in the Day. I was once a Wilderness First Responder. We both have reactive airway disorder, and so does our son, and so do a bunch of our family members. We have seen osats drop, and I have brought my son (last November, actually) into the pediatrician's office because I was worried about his breathing, gotten back to back nebulizer treatments, a bunch of scrips and the comment, That Would Have Been Reasonable, when I said I had thought about just going to the ER this time.
That is the long winded (har de har har -- wrong time to make that joke? Sorry!) way of saying, nothing about this surprises me, altho I learned a bunch and want to know more as we figure it all out:
https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/
We have been seeing lots of things indicating ventilators are not helping, might be harming. We have been seeing lots of things about lower levels of care (CPAP, BiPAP, nasal cannula, etc.). This is a really thoughtful survey that helps re-orient away from the divisive discussion of rationing, and towards what I really care about: what is actually helpful, what has the right set of tradeoffs (not gratuitously harming a bunch of people who were going to be fine anyway, for example) and also touches on what kinds of intervention are dangerous for health care and what can we do about that part of it.