Unable to speak…

Unable to speak, I could only scribble short messages on writing pads my wife provided. During the day she would transmit my questions and requests to the nursing and medical staff. But looking over those notes, which my wife saved, I can see that constantly scribbling messages, many of which were of no conceivable importance, was my desperate attempt to maintain contact with the world. At night, when I seemed most in need of ventilatory support and suctioning of my mouth and respiratory tract, the nurses would try to understand my written requests and do their best to comply. My neck pain was often severe. I asked for the least amount of morphine to relieve it, because I wanted to remain alert. I feared morphine would suppress my respirations and increase the possibility of pneumonia. However, the record shows that in the first two or three days I received considerable sedation and morphine.

Despite the medication, my physical distress and utter helplessness made these first days in the ICU a terrible ordeal. I survived by concentrating on each physical problem. My life hung in the balance, as did the risk of quadriplegia, but I did not think much about these threats because I was totally concerned with relieving my immediate symptoms.

Worst of all were the endless nights. I slept very little and spent most of the time watching the minutes go by on the big wall clock in my room, waiting for daylight and the return of my wife, and other family members. They tell me that I seemed more affectionate than usual; perhaps it was because I needed them so much.

In “On Breaking One’s Neck” (The New York Review of Books, 6 February 2014), ninety-year-old senior physician Arthur Relman describes his experience of the hospital system.  Critically ill after a fall in his home, he has had a tracheostomy and describes the “physical distress and utter helplessness” and the “endless nights”.

Two-and-a-half years have passed and yet I vividly remember “watching the minutes go by on the big wall clock” and, when I finally dozed off, waking to find that only three or four minutes had passed.

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