Up The Farway Tree

Another Interlude

My memories of ITU...

When I woke in ITU around 10 am the following day I felt no pain at all. I was still ventilated so couldn't speak but gave everyone a massive thumbs up to signal that I was ok. The experience of being ventilated was so far removed from the last time, because this time I wasn't coughing or trying to cope with very poor lungs. Although I indicated for the tube to be removed, I was not distressed like I was before and I settled back down when told it had to stay in for a while longer. I also could not believe that I had no pain at this stage, due to a working epidural and the anaesthetic drugs. I was only allowed 2 visitors in ITU so poor dad had to stand at the window and watch from there but despite being ventilated I was able to wave cheerily at him and indicate that all was ok. I immediately began trying to write things on people’s hands again, but am told that I was just doing big squiggles which made no sense at all. Eventually the nurse handed me a piece of paper with the letters of the alphabet, so I could point to each letter. I spelled out various things..'What time is it?' 'What day is it?' 'What is that beeping?’ As the hours passed and I remained on the ventilator I became increasingly annoyed and spelt out 'I am bored!' to which the nurse quickly retorted 'well go to sleep then!'

This was easier said than done. For the first few hours I was afraid to fall asleep because every time I started to doze off, I stopped breathing and the alarm would sound. This was all just part of the process of weaning me off the ventilator and it wasn't too long before I was breathing on my own. The tube was removed around 4pm in the afternoon and I found, much to my horror that my voice was too hoarse to speak at first. It was probably also around this time that the epidural stopped working so well, and the anaesthetic drugs were wearing off...that’s when the pain really started. The doctor was on hand all the time in ITU though, so they did get on top of things very quickly and gave me extra pain relief.

Probably the first thing I felt after the tube was removed was disappointment. I had somehow expected to take a giant breath like I had never felt before, but instead I could only breath with shallow breaths due to the pain, and I felt no different than before. My mind was immediately racing with thoughts that the transplant had failed and these lungs were not working properly. The ITU nurses assured me everything was looking ok but I found it hard to believe them.

The rest of that evening is a hazy memory but I’m told everything was on track and I was settled after the extra pain relief. It wasn’t until the following afternoon that they started whispering in the background about my blood gas results. Unfortunately being a doctor I could interpret the results and realised there was something wrong. The doctor came into ITU shortly after and asked to speak to Andrew privately. My heart jumped with fear ...what on earth was wrong? He explained to Andrew that my xray showed some fluid (pleural effusion) and that my oxygen levels were not good, despite being on high flow oxygen via a face mask. He thought the poor oxygen levels was due to some collapse in the lower airways (common after surgery) and the fact I was unable to take deep enough breaths to combat this. He had decided to tell Andrew this privately as he didn't know how to tell me without worrying me, but I must admit that he worried me even more this way. I was just digesting this information when the consultant swept into the room, announced that there was some fluid on the xray, suggested it was rejection and decided that I needed a bronchoscopy the following morning. I was absolutely terrified. Still convinced that the low oxygen levels was due to some collapse, the other doctor prescribed me several different nebulisers to try and loosen any mucus in the airways and then in the evening decided to start me on c-pap. This is form of non invasive ventilation, which basically forces extra air into the lungs when you take a breath in. I was fairly comfortable on the c-pap and felt less breathless, and much to everyone delight the oxygen levels began to return to normal.

In ITU the visiting was very strict so mum and Andrew had to leave shortly afterwards, which left me feeling quite vulnerable and alone, despite the fact I had a nurse with me all the time. I think that was probably my worst night as I lay worrying about the bronchoscopy and what it might show, and also feeling so breathless that I was utterly convinced something was wrong with the lungs. After several hours of sitting upright wide awake and unable to sleep, the nurse called the anaesthetist to prescribe me some night sedation. Generally they are not too keen on using sedation in ITU but on balance it was better that I got some sleep.

By the next morning I was feeling more settled and not quite so breathless. On seeing the blood gas results, and after a repeat x-ray, the consultant decided that I didn’t need a bronchoscopy after all. I have never been so relieved. I had to stay on the high flow oxygen but this was enough to keep my oxygen levels up and I slowly began to trust that these new lungs were working after all.