On Thursday I had yet another adventure with hospitalizations brought on by a pair of lungs that just aren’t doing what they ought to do. I had already been hobbling around the house in an awkward boot due to breaking my toe on the coffee table. Our kids had both been sick from contracting a pretty funky GI bug. Poor Rowan had been carrying a bowl with him everywhere for each time he would get sick and was moving considerably slower than his usual two speeds of fast and faster. My wife Catherine was already starting to feel ill and I was hoping to avoid it but questioning how long that luck would last.
I had felt completely fine throughout the day until the early evening. I quickly found myself succumbing to a massive wave of nausea that confirmed it was time for me to take my place among his the ranks of my sick family members. We had anti-nausea medicine in the house so I attempted to use some of it but found it to be of no help.
About an hour later I got sick again. I then felt the altogether too familiar sensation of breathlessness returning. Feeling abnormally out of breath I decided to use one of my inhalers. Sometimes I feel relief quickly but this time seemed different. I told Catherine that I needed a few minutes. Remembering that our children needed blankets that night I briefly took a trip to the basement to switch the washer load to the dryer. I then went up to the second floor to lay down for a few minutes.
Upon reaching the foot of my bed I felt a sudden and jarring spell of difficulty breathing come over me. There was an old pulse oximeter lying on the table nearby from my missions kit that Devlin had been happily swinging around earlier. I put it on noting the sudden pallor of my hands and saw the numbers come back at 85%. The numbers continued to decrease until they said 79. My first thought was having trouble believing that the numbers were real. Most people I have seen with numbers like that (should ideally be above 92 for my age) have not been conscious. Suddenly I started to feel cold and felt my fingers going numb. The world was also starting to seem fuzzy.
I reached for my phone and texted my wife ‘blacking out’ hoping that she had it nearby. As I did that I sat on the foot of our bed and laid back. I suddenly felt colder than I can ever remember feeling in my life. My hands started to shiver violently and were tingling more and more with numbness. I tried to bend my right index finger and now found I couldn’t. Curious if it was still able I gently pushed on it with my left wrist and it easily closed into a fist. I just couldn’t move my hands normally.
I have had moments of tingling with previous episodes of difficulty breathing. I had always been told it was due to breathing too rapidly and not having enough carbon dioxide left in my blood as a result. I tried to slow my breathing but found I was completely unable. It felt like I had just sprinted half of a mile. Laying back seemed to help a little as the world started to refocus. About this Catherine walked in and asked what was going on. Between gasps I managed to blurt in broken phrases “can’t” and “breathe.” Catherine asked if I needed EMS to which I nodded yes.
As Catherine called for a bus I started to feel better. The numbness and tingling were going away and I could use my hands again. I tried standing up and saw that I now could normally again. After a moment I told Catherine that I was going to wait for the squad downstairs in our living room. She immediately inquired about the wisdom of moving given what had just happened. I told her I felt semi normal for the moment and have found in past episodes that the weird stuff typically hits in windows. I wanted to try to get myself to an area that didn’t have to navigate the stairs later when I might have more trouble again. She didn’t stop me though I suspect that still made her uneasy.
EMS was at our front door in less that 5 minutes. Catherine let them in as Rowan tried to watch. Rowan watching was not my first choice but Catherine said he would be fine. The lead medic started asking me questions and I answered in broken phrases between breaths. He asked if I any medical history. Through previous events I have learned it is easier to keep that info in a note on my phone so that it is accurate, immediately available and one less thing for me to try to verbalize while having trouble speaking. I immediately got a feeling from the medic that he felt it was strange that I had this info already typed up. I watched his eyes move down the list. As he got to the last entry(PTSD) I immediately saw his head cock back about 5 degrees, his eyes winced slightly and there was a small but simultaneous inhalation seeming to indicate that everything made sense to him now. He let me know that on his oximeter my oxygenation was 100%. He commented: “You seem worked up.”
Catherine quickly said to the medic “this isn’t what he looks like when he’s worked up. He’s just struggling to breathe.” I could feel the medic watching his pulse ox reading of 100%. He responded: “Here’s what we can do. I can give you a breathing treatment but then I have to take you to the hospital.” I thought back to the last time I had felt like this and had a cat scan that showed air trapping despite the 100% reading I had at that time. I elected to go to the ER. I knew that it was the right response but as I answered I could feel my pride taking a hit.
****************
Working with patients is often difficult, particularly in acute care. They are frustrated by the fact that their bodies don’t work the way that they should. They often have a longing for their varsity days in which they could do more that now remain a distant memory.
Having been through this a few times now I have had plenty of chances to see the 100% on my oxygenation and have caregivers determine that this means I must just be having an anxiety attack (this is not a blanket statement; some nurses and most doctors appear fairly good about not doing this) I wonder how these folks would feel if they had been out with our unit in Mosul doing presence patrols, searches for high value targets and in active combat. I don’t want to seem like I am setting up the medic as a villain; anxiety is not an unreasonable consideration. I do want to suggest that I think we in the medical field jump to that conclusion a little too quickly. It should be one that we settle on after we have ruled out other options. I have seen too many times in which it did not appear to be a diagnosis of exclusion (I have been guilty of this too). While giving this matter a lot of thought I remembered something: if a person is struggling to breath then would it be normal for them to not seem anxious? How many people would respond: ‘Well I can’t seem to catch my breath and my chest under constant pressure as my airways burn. What time does the game start?’ As a caregiver that scenario would seem ludicrous to me but we seem too frequently to have varying degrees of this expectation from our patients.
I wish to express nothing bad about the EMS workers in any way. They were exceptionally fast, they were professional, they got me to the ER , and they never treated me disrespectfully. If my oxygen levels did drop they would be available to help me. Those are biggest concerns I can ask for during a singular event. At the same time I am in a position in which my ability to breath has been slowly but steadily declining and is only now starting to show itself in ways that can be measured. It is concerning and frustrating to have to justify myself as having something legitimately wrong while attempting to breath. Even if everyone acts with courtesy and professionalism I have to wonder: are people missing things they might otherwise catch if they hadn’t already settled on the easiest answer? Fortunately, I have had some wonderful care providers that have kept open minds and it has been enormously helpful during this process.
Burn pits, Sand and IEDs 