A faint sound pierced the cloudy haze. An echo through a long corridor.
Darkness, but light sort of on the periphery. A greenish glow that grew brighter at regular intervals. I wasn’t quite sure what it was. I didn’t know where I was.
I smell antiseptics. Hear voices growing louder. Shouting!!
Sort of floating. I wasn’t walking. I was being dragged. My legs outstretched behind me. Feet limp. I had no control of them. There was pressure under both of my arms. I slowly opened my eyes and recognized the green tile floors and walls. I was in the emergency room at the air base hospital.
Two airmen in uniform each had an arm under one of mine as we burst through the double swinging doors into the treatment area.
I heard the doctor asking what was going on and one of the airmen yelled, “He passed out in the waiting room!”
The familiar face of the doctor said, “Oh, he’s ok, he just needs some rest.”
The airman protested, “Well, he doesn’t look so good me. We picked him up off the floor out there.”
Doctor, “I gave him some medicine. That’s to be expected.”
The next voice I heard was my mother’s frantically asking what was happening. She had gone out to the parking lot to bring the car up to the door.
After we were all dismissed by the doctor, the airmen carried me to the car and put me in the back seat. A fog enveloped me and I was out.
I woke up eight hours later in my bed at home. I struggled for breath, coughed, stumbled to the floor and called out for my parents. I was a nice shade of purple. Cyanosis. Not enough oxygen. Thirty minutes later I as back in the ER, only this time I was being given epinephrine.
My heart rate picked up. Lungs cleared. I could breath after getting the third dose of .3cc. They followed that with a shot of susphrine, a long-acting form of epinephrine.
These were the meds I should have received on my first visit to the ER, standard treatment for an asthma attack at that time. But I had unluckily come in when a certain doctor was on duty. One that believed asthma was a mental illness so he had given me a shot of 50 mg of thorazine, a powerful antipsychotic medication. A big dose for a 50-pound kid. And this was exactly the wrong medication to give to a person in respiratory distress because it depresses respirations further. I would learn later that it was amazing I even woke up after that.
It was time to package me off to home again. But I’d be back.
1965. This was a rough year. Almost 80 trips to the ER – that was one to three times a week, depending on the week. I knew all of the ER staff by name. The medical knowledge was limited and the treatments were primitive. I used to say that if the disease doesn’t kill you, the medicine will.
There were so many things the docs didn’t know or understand about the disease back then. And they were not of the mindset to listen to their patients either. Especially a child patient. No, these docs were educated old-school that they were the keepers of all of the knowledge. It was a dictatorial approach, not a collaborative one.
A couple of very simple things really threw these guys off balance. If I had been in respiratory distress for a while and finally got relief from the epi, I would go to sleep. My body was totally exhausted from having struggled so hard to breathe. You use all of your chest muscles fighting to inhale and you can’t seem to be able to exhale. It’s like lifting weights and running at the same time while you’re really just lying in bed.
They didn’t get it. Epinephrine doesn’t only dilate your bronchioles, it really kicks up your heart rate. It’s a stimulant so they expected you to be bouncing off the walls after getting a shot. More than once, I woke up on an ER gurney being slapped around by doctor screaming “WAKE UP” after the epi finally broke the attack. A look of panic and fear filled their faces.
Another thing they couldn’t grasp was what absence of wheezing meant. Wheezing, or air whistling through a constricted airway, was a hallmark symptom of an asthma attack. But you reach a point where your airway is so constricted that you can’t exchange enough air to produce a wheeze. The docs know now that this is an ominous sign. You’re near death. But back in the day, if they didn’t hear a wheeze, they’d send you home and try to tell you that you weren’t having trouble breathing.
They could have drawn arterial blood gases to measure the oxygen content of your blood, but even that was a new technology at the time, people weren’t skilled with drawing blood from arteries, and most hospitals didn’t have the equipment to analyze such a blood sample.
Now they have pulse oximeters that give you an instantaneous oxygen saturation reading. Just clip it on your finger and it compares infrared to red wavelengths of light to tell you how much oxygen is in your blood. I even have my own at home. If they had had those then, I’m sure they would have been shocked to see how low your oxygen sat was.
In those days, it was sort of off-the-cuff, hit-or-miss treatment. So, I was frequently misdiagnosed, given the wrong medication, or overdosed on the right medication. You name it. You could die with or without the treatment. Take your pick.
An upper respiratory infection could quickly turn to pneumonia, trigger the asthma, and I’d be spending the week in the hospital. A scary place for a little kid. Once, when I as in an oxygen tent, a technician walked into the room smoking a cigarette. Hospitals weren’t smoke-free then. Patients and staff smoked all the time.
Of course, oxygen is not explosive, but it will rapidly feed a fire. You don’t bring fire, in any form, near an oxygen tank or tent or mask. That’s just asking for trouble. Not to mention that cigarette smoke can cause an asthma attack. Stupid. Even as a little kid I knew better.
For maintenance treatment, they prescribed theophylline-based drugs. I would use a liquid form of this to swallow the other pills ordered. But theophylline wasn’t cutting it, and good inhalant meds didn’t exist yet. So when an allergy specialist rotated into that hospital, he started me on steroids.
It took high daily doses of prednisone to bring my asthma under control, and the docs weren’t aware of the long-term side effects. They controlled the asthma but they stunted my growth. Big time. A bone age study when I was thirteen put my bones at an eight-year-old developmental level.
The docs told me I’d never get off the steroids, but I weaned myself off and proudly handed a bottle full of pills back to the doctor. I thought he’d be happy. Instead he berated me, “I can’t be your mother and make sure you take your medication!”
Once off those meds, I grew a foot in height in just one year and normalized my weight a bit. I never approached my father’s or my brother’s heights, but hey, there are advantages to being short 🙂
While I had gotten off the steroids, and as time progressed, the docs kept increasing the dosage of theophylline and added terbutaline, another bronchodilator. On these meds, my resting heart rate was 120 beats per minute and my hands would shake so violently that I couldn’t even write my own name. So the wise doctors added three doses of valium a day to take the edge off. What a mix.
I could tell you a lot of crazy near-death stories from back then, but it might get boring after a while and I don’t want you think I’m whining or feeling sorry for myself. I’m not. It’s all just experience. I have a great appreciation for life.
And it’s important to realize that healthcare practitioners aren’t gods. They don’t know it all. You need to be an active participant in your own healthcare.
I will end with another brief tale, though. When inhalant drugs were first introduced, there were no hand-held, pocket-sized devices. You had to own an air compressor and hook that to a plastic or glass nebulizer attachment, mix the solutions for the nebulizer, and then fire up the machine and breath in the mist.
One of the first inhalant meds they tried in the early 60s was Isoproterenol (Isoprel). (An incredibly potent heart medication I would be administering to my patients in the ICU as a critical care nurse years later.) But the cardiac effects were way too strong and they were giving little kids heart attacks. I remember two different times showing up for the allergy clinic where we got our twice-weekly allergy shots only to find a face missing from the group.
Two kids I knew died from this medication at an age when I really didn’t have a full concept of what death was yet. I just knew I never saw them again . . .
Postscript: The inhalant drugs would continue their evolution through Isoetharine (Bronkosol), to Metaproterenol (Alupent), to Salbutamol (Albuterol or Ventolin), and with the addition of Beclometasone (Vanceril or Q-Var), a steroid inhaler, things really improved. My condition stabilized in 1982 with the addition of Beclometasone, and that was the last year, so far, that I’ve been hospitalized with asthma being the cause. Of course, now we’ve gone even generations further and have such products as Fluticason (Flovent), a long-acting steroid, and Formoterol (Foradil), a long-acting beta-2 agonist that targets the lung more and the heart less. Progress.
Photo: The big skies of Montana. No better representation for the air we breathe. The oxygen we crave. The ease of living.