There is something to be said for being stubborn
Well, the patient from yesterday, seems today to have not suffered any brain damage. She told me "I don't feel good today." I giggled and said, "You are feeling a hell of a lot better than yesterday." "No I don't." she replied. I giggled again, "You are going to have to trust me on this one. Yes you do." Mind you, I've become rather adept at reading lips. I find it funny when I ask patients that are on the vent to repeat what they've said and they just try to say what they already said LOUDER. Usually, I ask them to repeat themselves again, because I didn't understand it the second time and they try again even louder. It is either the third or forth time that I catch on to what they are doing. At that point I let the patient know, you can't speak louder for me, we need to use the first letter of the key word in your sentence, so I know what you need or want.
Anyway I digress. My patient, who will now be known as Missy for lack of a better name other than her own, tried to demand that her endotracheal tube be removed. I looked at her square in her face and said, "We've known each other for a while now. I'm going to see to it that you get better despite yourself. I will not, remove anything and futher more... I spoke to her as a true caring friend, one who has to tell the truth even if it hurts. I told it like it is, she cried but said she understood completely. I then said, "I know it sucks, and it isn't fair. The truth is your lungs are so sick that you are never going to be "all better". "The next time this happens more than likely you will not survive. Fact of the matter is, you are damned lucky we are able to have this conversation. You were down nearly an hour. We almost were not able to intubate you because of all the scar tissue in your trachea. You will leave here with a tracheostomy, and you will have it for the rest of your life. There are no ifs ands or buts about this, if you don't, the very next time you go into respiratory failure, you will die. The scar tissue is so bad now and will be worse next time, which means we won't be able to gain an airway. Do you understand what I am saying?" She said that she did. I told her doctors that I had had this conversation with her. When they talked to her they came back to me and said something along the lines that I must have made an impact on her, and they hope that it sticks this time. I hope so as well.
Anyway I digress. My patient, who will now be known as Missy for lack of a better name other than her own, tried to demand that her endotracheal tube be removed. I looked at her square in her face and said, "We've known each other for a while now. I'm going to see to it that you get better despite yourself. I will not, remove anything and futher more... I spoke to her as a true caring friend, one who has to tell the truth even if it hurts. I told it like it is, she cried but said she understood completely. I then said, "I know it sucks, and it isn't fair. The truth is your lungs are so sick that you are never going to be "all better". "The next time this happens more than likely you will not survive. Fact of the matter is, you are damned lucky we are able to have this conversation. You were down nearly an hour. We almost were not able to intubate you because of all the scar tissue in your trachea. You will leave here with a tracheostomy, and you will have it for the rest of your life. There are no ifs ands or buts about this, if you don't, the very next time you go into respiratory failure, you will die. The scar tissue is so bad now and will be worse next time, which means we won't be able to gain an airway. Do you understand what I am saying?" She said that she did. I told her doctors that I had had this conversation with her. When they talked to her they came back to me and said something along the lines that I must have made an impact on her, and they hope that it sticks this time. I hope so as well.