The tenets of managing an ICU are relatively simple: Air goes in and out, blood goes round and round.
There’s this moment in the delivery room where everyone holds their breath. In that silence, we expect a tiny gasp or maybe a big cry. “Why isn’t he crying,” moms often ask. “Is there a problem? Is he breathing?” In that forever moment, the pediatrician in the room is wondering if they will have to put in a breathing tube or start CPR. Then time lurches back into motion as lungs fill, fluid is coughed up, and a sputtering cry follows.
Air goes in and out.
Making sure that people breathe is what I do every day. Most people breathe twelve to sixteen times per minute at rest. That’s nearly one thousand breaths every hour; more than twenty thousand each day; eight million in a year.
It’s effortless. You take it for granted. You wake, you sleep, you eat, you breathe. How can something so vital be so unconsciously trivial?
As hearts fail and infections brew, the lungs fill up with fluid. Making air go in and out gets harder and harder if you get sick.
“I can’t breathe,” patients tell me with a look of terror on their faces. Despite my efforts, I watch their oxygen saturations slowly fall and finally tell them that it’s time to go onto a ventilator. Often, they are relieved. Air goes in and out again.
When I use a machine to ventilate small babies, each breath may only be a tablespoon. Fifteen milliliters. Tiny. Trivial. Vital.
At maximum effort, Michael Phelps’ lungs can move twelve liters (three gallons) of air in a single breath, twice that of the average human being. But even for him, air must still go in and out every minute.
Breathing on a ventilator can be difficult. When possible, it’s best to let the patient regulate their own breathing rate and breath size because no machine is as smart or well regulated as the human body. Nothing can compare to a breath.
“Is he breathing on his own yet?” families ask me regularly, seeing the artificial mechanical rise and fall of a chest. When the patient recovers, we take away the ventilator, and that moment of silence returns. Will they breathe? Are they ready? Then air goes in and out again.
Families often cry with relief.
An important part of brain death testing is the apnea test. It’s relatively simple to do: We take the patient off of the ventilator and watch. Carbon dioxide is the brain’s strongest cue to breathe. As carbon dioxide slowly rises in the blood, the brain stem should be screaming at the phrenic nerve to move the diaphragm. Air should move in and out.
But it doesn’t. If the brain is dead, the rise in carbon dioxide goes unnoticed. Oxygen isn’t even consumed because there’s nothing to use it. We wait five minutes. Ten minutes. It’s the longest time. How long can you hold your breath?
Air does not go in and out.
Families who struggle with a diagnosis of brain death always understand breathing. They understand how vital a breath is. They understand how basic it is. We all do. Breathing is ingrained in our DNA, built into the most basic and primitive part of our brains as a fail-safe, steadfast, and reliable in almost any circumstance.
When families watch their loved ones make no attempt to breathe after ten minutes of waiting, they know s/he is gone.
George Floyd’s breath was stolen from him so casually. For almost ten minutes, air did not go in or out. He pleaded and cried out with the last of his strength and the last of his precious air, “I can’t breathe.”
Think about how easy it would have been for the officer to let him take even a single breath. Think about how that breath would have changed the world today. It should have been so simple. It should have been obvious. No action could have been more straightforward, more simple, or more vital. Just let him breathe.
“Rioters deserve to be punished,” you say. Yet there are so many others who deserved and will deserve breath. Can you give it to them? Let them breathe.
To my friends in the black community, I hope your beautiful children breathe at least seven hundred million times in their lives. That’s a lifetime. At least.
To those in the white community who feel the need to tell the black community how to mourn, how to feel, how to protest, and what to prioritize, you need to do something vitally important: Close your mouth and take a breath.
Michael Northrop is an anesthesiologist.
Image credit: Shutterstock.com