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David Lat is the founding editor of Above the Law, a website covering the legal profession, and a managing director at Lateral Link, a legal recruiting firm.
The ventilator has become an object of national fascination — and controversy. The previously obscure medical device, which mechanically helps patients to breathe, has shot to worldwide fame during the coronavirus pandemic. Many patients with serious cases of covid-19 suffer respiratory failure and will die if they can’t be connected to ventilators.
I should know. I spent six days on a ventilator, in critical condition in the intensive care unit at New York University Langone medical center in New York City. I would not be here today without a ventilator.
On March 16, I was admitted to the hospital with the coronavirus. I had a number of flu-like symptoms, including fever, chills, aches and fatigue. But my most serious complaint — as someone who suffered from asthma as a child and has exercise-induced asthma as an adult, albeit managed well with an inhaler — was difficulty breathing.
I spent my first few days in the hospital in stable condition, receiving supplemental oxygen. But on the evening of March 20, I took a turn for the worse. Late that night, I learned that I would need to be intubated, or placed on a ventilator.
This terrified me. A few days earlier, after my admission to the hospital, my physician father had warned me: “You better not get put on a ventilator. People don’t come back from that.”
As the nurses prepared me for the intubation, I thought to myself: It’s not my time to die. My husband and I have a 2-year-old son. I want to see him graduate from high school, graduate from college. If he gets married or has kids of his own someday, I want to be there. I started praying the Hail Mary, over and over.
I have hazy memories of the intubation. My anesthesiologist was a woman with a slight Caribbean accent and an authoritative, reassuring demeanor. In my overwhelmed state, it seemed that a dozen people were in the room, when, in reality, it was probably just a handful. Aided by anesthesia, I soon fell asleep.
I spent the next six days basically asleep, under sedation, the ventilator serving as my lungs. I remember nothing from this period. I have since learned that some patients have nightmares or hallucinations while on ventilators, so I view myself as very fortunate.
Eventually, my doctors faced a choice: take me off the ventilator and see if I could breathe on my own, or give me a tracheostomy, which would have required an incision into my neck to insert a breathing tube directly into my windpipe. After conducting tests to assess my ability to breathe on my own, the doctors decided to take me off the ventilator or extubate me. The extubation succeeded. With the aid of supplemental oxygen, I could breathe independently again.
As a patient whose life was saved by a ventilator, I believe it is an outrage and an embarrassment that a nation as wealthy as ours is even discussing possible ventilator shortages. Thankfully the United States has managed to avoid widespread rationing partly due to ventilators being sent from places of low need to places of high need. We need to make sure that every patient who needs a ventilator can get one so that as many of them as possible can survive.
This is especially true because survival rates of ventilated patients are low. My father’s dark comment reflected a grim reality: 40 percent to 50 percent of patients with severe respiratory distress do not survive being on ventilators. In New York City, where I was hospitalized, 80 percent or more of coronavirus patients who end up on ventilators have died.
For those of us lucky enough to get off ventilators, our lives are not the same. Many patients who come off ventilators suffer lasting physical, mental and emotional issues, including cognitive deficits, lost jobs and psychological issues, such as depression and post-traumatic stress disorder.
For me, my lungs must rebuild their capacity. I experience breathlessness from even mild exertion. I used to run marathons; now I can’t walk across a room or up a flight of stairs without getting winded. I can’t go around the block for fresh air unless my husband pushes me in a wheelchair. When I shower, I can’t stand the entire time; I take breaks from standing to sit down on a plastic stool I have placed inside my bathtub.
Being on the ventilator for almost a week damaged my vocal cords, and now my voice is extremely hoarse. My speech pathologist expressed optimism that the damage is not permanent. Only time will tell.
I’m not complaining. I am incredibly grateful to be alive. And for that, I have the ventilator to thank.