Often there is an illusion of rock solid stability to our lives, when the truth is the biochemical parameters for our existence are as thin as the edge of a piece of paper.
When we unravel, things fall apart frighteningly fast. 1/
ECMO.
The problem is her patient isn’t the only one who needs it, and availability is limited.
Decisions have to be made on who gets it, and who doesn’t. 2/
It was invented in the 1950s and the modern iteration is seeing use in severe COVID-19 cases.
It’s a precious resource. 3/
She was able to make a convincing case, supported by the data. Her patient will be going on ECMO tonight.
It will be potentially lifesaving therapy, at least for now.
She invites me to see. 4/
These provide a window into how well the lungs, and the ventilator, are doing their job.
In this case, the data shows a severe build-up of carbon dioxide.
Lethal. 5/
Briefly, the intensivist sketches a quick diagram to show me how ECMO works.
To me, it’s kinda like dialysis for your lungs. Kinda.
My brain is wired to simplify. 6/
They arrive pulling large carts stacked with equipment, all wearing backpacks.
They look like mountaineers getting ready to climb a mountain.
In a way, they are. 7/
Every member of the ECMO team moves with a purpose. Exchanging data with our ICU team, asking about our PPE arrangements, making space for the equipment and setting up methodically.
They move like a well-oiled machine.
This isn’t their first rodeo. 8/
One doc stands on each side of the patient.
Between the two of them they have over 50 years experience.
They begin. 9/
Tonight, watching a team of highly trained and highly skilled individuals work together to save a total stranger, I feel something else.
Hope flares wildly to life. 10/
There is no wasted effort.
No wasted words.
I am frankly in awe. I’ve done my share of access procedures in the femoral veins.
Nothing like this. 11/
The blood pumps through the circuit.
Repeat ABG analysis shows carbon dioxide levels coming down and oxygen levels rising.
The ECMO team carefully re-packs their equipment to move out, and transfer the patient to their center.
“Let’s roll.” 12/
Silence.
The intensivist’s night is done.
I’m still on call overnight.
But I’m grateful. I know why she showed me this.
The darkness isn’t infinite.
We have each other’s light.
In the depths of the night, hope finds me.