Shortness of breath, cough and wheezing plagued 70 year old John Welch while vacationing in Florida this year, and persisted even after he returned home. A former construction worker, he was admitted to a local community hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) and pneumonia. He had acute on chronic respiratory failure with an elevated level of carbon dioxide in his blood. This results from failure of the respiratory muscles to function properly due to fatigue. He needed help to breathe. He was intubated and supported with a mechanical ventilator.
John had a forty year history of smoking. COPD was diagnosed seven years ago. He used oxygen continuously at home for his COPD for the past two years. On admission to Radius he was already weaned from the mechanical ventilator. But he was still short of breath, congested and coughing up sputum. He was still weak all over and needed respiratory therapy and physical rehabilitation. However, despite adjustments of medications, his respiratory status deteriorated as his lung disease was very advanced and his prognosis was guarded at best. He was started back on intravenous steroids to quell his lung inflammation. John's wife Judith spent many nights at his bedside. She appreciated the empathy of staff that would walk her to her car and request a call back to be sure she got home safely.
John was aware of the severity of his condition. His own brief experience on the ventilator, together with that of his sister, led him to consider a change in his resuscitation status. The family received a call that John was doing poorly and requested a visit from one and all. He shared his decision to become DNR (Do Not Resuscitate). Being sensitive to end of life care, the staff asked John what he would like at this point. His response was to “share a beer with his family.” His physician agreed. John describes this time as “a living wake” and felt at peace.
But a a turn of events was about to happen. John experienced an improvement in his condition over the succeeding days with the help of the medical, pulmonary, respiratory and nursing teams! Although “some days were good and others were bad,” within in a short period of time he actually progressed to walking independently and participating in physical therapy. John soon left Radius to spend a brief period in a skilled nursing facility, and then return home to family and friends. He was greeted by his 5 children and 7 grandchildren! John and his wife expressed that “the help at Radius could not have been better! All were wonderful, respectful and caring.”
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