During call shifts, one of my responsibilities is responding to any “airway emergencies” across the hospital. I’ve performed countless emergent endotracheal intubations in scenarios ranging from cardiopulmonary arrests to impending respiratory failure and self-extubations.
In many of these situations, securing the airway is a priority above everything else. There’s very little time to ask for a detailed history from the primary treatment team or nurses. Airway – breathing – circulation!
With more lucid patients, I spend an extra 30 seconds informing them about what we’re doing and why we’re doing it. I proceed to position myself behind the bed to begin preoxygenating the patient with a face mask, BPAP, or whatever else the particular situation calls for. During this critical preparation period, I’ve been faced with the same bombshell question twice as a resident:
“Doc, will I ever talk again?”
Usually I’m pretty good at knowing how to relate to my patients, understanding what’s important to them, and putting them at ease; however, this question left me unsettled on both occasions. I instinctively replied along the lines of:
“You’re doing great! Keep focusing on your breathing. We’re going to take great care of you!”
… but I know I didn’t answer their question.
The reality is many of these individuals will never be weaned from mechanical ventilation. Some may even die in the hours or days after without being able to communicate with their loved ones. I am literally the last person they would have talked to in their lives.
I rationalize my actions by knowing that securing the airway is of paramount importance in critically ill patients. Without this step, many more would face increased morbidity and mortality right off the bat. Yet the humanistic part of me can only hope that these patients will ultimately be extubated or vocalize through a tracheostomy. Regrettably, this just isn’t the reality of medicine and life. ?
