Hektoen International

A Journal of Medical Humanities

Intubation incarceration: A true tale of torture

Abram Gabriel
Piscataway, New Jersey, United States

The Custody of a Prisoner Does Not Call for Torture (La seguridad de un reo no exige tormento). Goya (Francisco de Goya y Lucientes). ca. 1815; published ca. 1859. Metropolitan Museum of Art.

For five days, I could not speak at all.

In November 2010, I had a brainstem stroke resulting from an arteriovenous fistula. I spent nearly a month in a coma in a regional teaching hospital, and seven weeks in an acute rehabilitation center. While my mind is now clear, my body is shattered. I cannot walk, I see double, I have tremors in my hands. I also have very slurred speech. With difficulty, I have managed to make a life beyond this catastrophe. But some months ago, although my swallowing is normal, I choked on a slice of ham while eating lunch on a Friday. My wife told me I was in cardiac arrest by the time the ambulance arrived. This was my second near-death experience. I did not wake up until Sunday, when I discovered myself intubated and restrained so that I would not pull out the breathing tube. I also had a Foley catheter in my bladder and an IV running in my arm. I was trapped in the intensive care unit (ICU) of a local community hospital.

I do not know what the medical staff did while I was unconscious, but after waking up I had a chest X-ray done and blood drawn, including two blood cultures. The X-ray showed an aspiration pneumonia and both blood cultures grew the same organism that was recovered from my sputum. I had developed sepsis, a bloodstream infection. Infectious disease specialists came to see me and recommended repeat blood cultures. I also had a visit from a cardiologist. She recommended an electrocardiogram. Being intubated and tied down, I could not communicate with any of these consultants, although they talked to me as if I could.

The breathing tube kept filling up with bloody mucus from my lungs, which caused me to cough. The respiratory therapist or a nurse had to frequently suction the tube, which made me seize up with uncontrollable hacking. I do not remember eating anything while I was in the ICU except the applesauce that invariably accompanied each of my medications. I lost over twenty pounds and wondered why I could not have been fed through the IV or a nasogastric tube.

After four days, one nurse finally gave me a piece of paper on which she had drawn the alphabet. Why wasn’t this offered to me immediately? I used this makeshift board as much as possible given my tremors and the restraints on my wrists. I would spell out words for friends and family, who were relieved to find my mind still intact. The nurses gave me IV Fentanyl at bedtime, which was all that was required to get a good night’s rest and wake up feeling refreshed. Only after I was extubated did I learn that the reason the staff could give me Fentanyl at all was that if I experienced respiratory arrest, the tube would take over my breathing for me.

I am a physician and acknowledge that my care in the ICU was medically correct. The psychic impact of my complete inability to communicate may have been made worse by my relative inability to do so since my stroke. I am lucky to be alive, the result of my wife’s quick thinking and the good fortune that she was at home at the time of my choking. However, the fact that a nurse so instantly eased my frustration with her rigged-up communication board is significant. It is surprising that still today, patients—even medically sophisticated ones with supportive friends and family—can be left in desolation for want of a simple aid that could easily be stored in the nursing station. In retrospect, the ICU was the most necessary part of my stay at the hospital, but I could not appreciate it at the time. I was too incensed about being intubated and restrained. Though not physically harmed, I was psychically scarred by the experience and have renewed compassion for patients on ventilators, such as those who are in ICUs with COVID-19.

ABRAM GABRIEL has been writing informally since he was a kid. In November 2010 he had a stroke, and can only communicate a bit. Recently, something clicked in his brain, and he started writing again. To write he uses a large monitor, a “big-keys” keyboard, and his right thumb. He is a tenured faculty member in the Department of Molecular Biology and Biochemistry at Rutgers University. He has published in Nature, Science, and The New England Journal of Medicine, among other journals. He was an undergraduate at Harvard and received his MD degree as well as his MPH from Johns Hopkins.

Highlighted in Frontispiece Volume 13, Issue 2– Spring 2021 and Volume 14, Issue 3 – Summer 2022


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