Math is hard for at least three liberals

[_Icarus]

It occurs to me that I have advanced directives and I'm a "no" on mechanical ventilation. (Like a lot of critical life-sustaining care, it's awful, guys.) However, with COVID, the odds of you going under and actually being brought back with not-too-bad harm relatively quickly aren't terrible. I just don't want to be in a medical coma on a ventilator for a longer stretch of time or as a critical treatment to keep me alive despite prior oxygen loss. That's bad news. I probably should look into what I'm doing here as a just in case.

That all said, because we need vents to save people's lives, that might be obscuring that a lot of people whose lives are being saved with vents are probably gonna have a hell of a time in recovery with enduring psychological damage. I'm sure someone's written about it, but I haven't seen that talked about in this context yet.

Last week Andrew Cuomo said in New York, getting on a ventilator meant you had an 80% chance of dying as only 20% who went on it actually got off it.

[_EAllusion]

Going on a ventilator can be a harrowing experience. When you live, you might come to with functional cognitive or motor deficits, delirium, PTSD, permanently damaged organs...

Some people who go on vents don't fully go under and retain some truly horrifying semi-conscious experiences. For some, this can last a long time as people can be kept stable on vents for a long time.

It's a big deal to go on a ventilator with a lot of potential for harm. For the normal reasons people end up on them, my decision is to refuse that critical care. People with medical experience, which I suppose includes me, are much more likely that average members of the public to refuse end-stage critical care because there's greater understanding of the down-side. I definitely don't want to be kept around with an anoxic brain injury.

With COVID, however, you are getting a nontrivial number of situations where people go under and make it back out relatively quickly seemingly not significantly worse for wear. It's not the dying I'm concerned about. It's the living with a bad vent experience. Maybe I should change my decision given present circumstances? *shrug*

[_EAllusion]

So I attended a team meeting for an older developmentally disabled women who was making her advanced directive decisions. It was me, a nurse who specializes in ID/DD, a case manager, guardian, and caretakers. My job was to help people help explain to her the cares/treatments. For this particular person, she could understand and relate to examples of cares she'd seen in people she knew. And every single thing we had to talk about - which is a bit of a list - she had direct experience with someone who had that done. This made the job easy, but also, think about that.

With every item, there was a "Remember so and so..." followed by an "Oh yeah..." with a pretty well-informed description of what that looked like and meant. Only, because she was so blunt about it, it was also a list of horror stories told matter-of-factly. It was a challenge not to bias her decisions by reacting to them.

[_Doctor CamNC4Me]

I told my wife that I never want to be intubated. She told me she’ll ensure I am if it comes to that. That scares me, To be honest.

- Doc

[_Jersey Girl]

EA I was just reading your posts about ventilators logged out, and logged in to comment. If it's any help to you or anyone else, in the last 12 years of her life, my mother was put on a vent at least 3 times if not more. Hard for me to remember the exact number of times because I no longer lived at home during those years and I was either getting the information via a close friend, a relative, or her doctor. Not one time did she come out with cognitive dysfunction, PTSD, or organ damage. That said, I can't say if the vents did further damage to her lungs.

After each recovery, and once she regained her strength, she carried on as usual. She was one of those people who took every challenge in stride. Even at the end stage of her illness, when placed on a vent she could still communicate until she lapsed into a coma. Nothing in her communication (answering yes/no questions or notes she wrote to me) indicated there was anything wrong with her mind. Nothing was "off" even with some sedation going on there. When she was in that lucid state, she wasn't restrained in any way at all. I do recall being there for respiratory therapy where they suck the junk out of your lungs. It didn't look comfortable but it didn't last for only a few minutes.

I don't doubt that there are folks who have PTSD and whatnot from their time on vents. I'm just giving you one example where a person was not damaged in that way.

Vents can be a life saver to get someone over a temporary hump. They can also be something that prolongs the inevitable. We all know that. I'm sure that's why you hear Cuomo saying the longer you stay on it the less likely you are to survive. Those are typically older folks who already have some underlying conditions whose lungs become compromised by the virus and then finally, the damage to already fragile air sacs from the pressure of the vents to the heart, and I guess a cascade of organ failure. I notice they are putting people on the vents now in a prone position to allow the lungs to more easily expand.

What to do? I have really no blessed clue. When I ask myself if I'd want to be intubated, I tell myself that I've already been intubated during surgery. I have no memory of it at all. Woke up with a hoarse voice and that's it. I lean more towards let me give it a shot, give me a chance, and see how it goes. If I tank to the point of no return, then that's the end of the story of me.

[_Jersey Girl]

I told my wife that I never want to be intubated. She told me she’ll ensure I am if it comes to that. That scares me, To be honest.

- Doc

Have you ever undergone surgery? If so, you've probably already been intubated. If not, I am sure that you know someone who has been intubated.

Because you know me and I have. :-)

[_Jersey Girl]

EA what do you think about this in terms of memory. I shared a bit ago that I had hallucinated under proprofol and the thing I hallucinated was a vision of the covid case charts by state. If some part of me could "think" and "see" under sedation, I wonder why I don't remember the shock and like I just said in my last post, I don't remember being intubated during surgery at all either?

Got anything to share on that? Is that luck of the draw? The nature of the specific anesthesia? I'll probably end up asking my geek kid about that, too.

[_EAllusion]

Elon Musk, the pedo guy, is a bad dude part 76:

https://paleofuture.gizmodo.com/elon-mu ... 1843149917

[_EAllusion]

Grimes is one of my favorite musical artists, incidentally. The fact that she is in a relationship with Musk is like Shades knowing that Perfume are in a polyamorous relationship with Kim Jung Un. Has nothing to do with the music, but it seems vaguely unfortunate.

[_EAllusion]

There's been a lot of Musk is a bad dude news inbetween late April and now, but given that he's on Twitter today encouraging people to get red-pilled, he's achieved a level of awfulness worthy a one-time thread bump.