I’ve done a lot of things only once in my life. Watched a sunset in Key West, for example; been atop a Swiss Alp; sat through Casablanca from beginning to end (for some reason I had only pieced it together for the first 35 years of my life); scaled an Aztec pyramid in Mexico; dipped my feet in the icy Baltic Sea; eaten steak tartar (didn’t think much of it); or …
Then there is a whole slew of things I’ve never experienced; I still haven’t managed to get my ass over to Rome, and it’s little more than a stone’s throw from Madrid; listened first-hand to an opera; walked through a birch forest in Russia; sunk my teeth in real Southern barbecue; give my jaw the chance to drop before the awesome sight of the Grand Canyon; taken a bungee-jumping leap off of a bridge; or finished reading Ulysses (I left off on page 137 about twelve years ago). I’d never seen another human die, made it nearly half a century before that moment, until that August 18th when I stood bedside my father and watched him expire before my very eyes.
Essentially what had been keeping him from passing on days before and, in all probability, would have prolonged his state of unconscious inertia indefinitely was a machine known as a ventilator. In Spanish they call it a “respirador” which I conveniently translated into “respirator”, a reasonable description from my perspective but apparently an erroneous choice and one, I’ve been led to believe, that indicates a certain degree of ignorance when it comes to knowledge of medical care. “Ventilator” sounds to me like kind of machine you turn on when someone in the room hasn’t showered in a week, but if that’s what the hosptial staff uses, I’m no one to question their choice of jargon.
Keeping people alive through artificial respiration, apparently now called mechanical ventilation, has been the concern of humans since all the way back in ancient times, though, like so many aspects of Medicine, it wasn’t until the 20th Century that serious advances were made. Even then, the road to a successful system has been rather winding. The first ventilators were invented in 1928. They were called Drinker respirators, but were known in layman’s terms as “iron lungs”. The intended patients were polio victims whose breathing muscles had become paralized by the disease. The technique worked via negative pressure, a system in which the body in placed in an airtight metallic chamber and the air pressure inside is lower, thereby forcing the lungs to expand. You might be more familiar with the effects of air pressure when you take a shower and notice that once the water is running and steaming up the room, the curtain is pushed inward because the hot air reduces the pressure. Of course, that’s assuming that you have a curtain. In any event, that’s how they managed to get air into the lungs.
In the 1950s, a marked switch towards positive-pressure ventilation took over. A number of individuals can right claim their contributions to the development of the modern ventilator, but it was a man by the name of the Forrest Bird who, it should be noted, worked a great deal on making high altitude flying possible for pilots who did not wish to suffer from hypoxia, as my father had, though from the very low altitude of this bed. Bird created the Bird Respirator, a model which is still used around the world today in places where a reliable electrical supply may not be available. Bird lived to the ripe old age of 94. In fact, he had just passed away on August 4, 5 days before Frank Gifford. He died of natural causes too. The jury was still out on what would be the cause of our father’s demise.
A positive-pressure ventilator, the kind that is used mainly today, with all the sophisticated technology to ensure breathing is controlled to a T, entails literally sticking a tube down the patient’s trachea and introducing the air into the lungs. Its assisted pulmonary ventilation; the gas exchange in the alveoli takes over from there. The was the peacekeeper. This was the machine that made Dad seem so quiet and unfazed by life.
It also kept him from suffocating, as his brain was only able to perform about 30% of task. Removing the tube means death, but not instantaneous by any stretch of the imagination. Depending on the strength of the patient and, especially the heart, the body will struggle to stay alive for 30 minutes, and hour, several hours, even days. From the expression on the doctor’s face when we asked, that last estimate went beyond the limits of reality.
Once the patient is taken off the ventilator, the body immediately reacts to the sudden limited oxygen being taken in by having the heart beat faster to increase the amount of that gas being reached to every corner. It’s like being forced to sprint and sprint until it finally gives out. To my shock, I learned that some patient’s may actually be awake for this, though, most, like my father, are unconscious. Even then, generous doses of morphine and anti-anxiety medicine both help to regulate what little breathing is going on and used to keep the body from suffering. The body is suffering, no doubt. We are just comforted by the thought that Dad wasn’t aware of it. Comforted by the hope.