Not so very long ago, I took care of a rather young patient in her 30′s. She had a respiratory illness that quite frankly baffled us. We couldn’t figure out exactly why someone so young and healthy was being completely knocked on her butt by a pneumonia.
The illness progressed to the point where she required bipap to help her breathe. This is a conforming mask that goes over the mouth and nose and gently (?) pushes oxygen into the patient’s lungs. It’s considered non-invasive and is something we typically try before intubating patients. Although most patients tolerate it fairly well, I know it’s uncomfortable. It can be difficult to put the mask on the patient and achieve a good seal so that no air escapes around the mask. For this reason, we don’t take it off very often – just to do mouth care, give meds, sometimes give a meal if the patient is up to eating. Some patients can’t even tolerate coming off the mask to eat more than a few bites of dinner.
So my rather young patient was experiencing what it was like to have a bipap mask on to help her breathe. I know in some ways it was giving her a break since she didn’t have to work so hard to breathe, but in other ways it was pretty bothersome. When I was getting report, the nurse told me that the last time they’d tried to take the mask off to give her a break she only lasted a few minutes before becoming short of breath again and dropping her oxygen sats.
So it was with an inward sigh that I explained how breakfast would go. I told her we could take the bipap mask off for her to eat, but that I wanted her to hold an oxygen mask over her nose and mouth between bites. She readily agreed; I think she would have done almost anything to get the bipap off.
Breakfast came and I got her all set up. The respiratory therapist (RT) got the bipap machine off, and we gave her a regular oxygen mask. I didn’t have high hopes that she would last very long off the bipap and watched her very carefully from my desk across from her room.
She was very good about using the plain oxygen mask between bites. She lasted 5 minutes, then 10, then 15…. a half hour later she was still doing great just using the oxygen mask. I was thrilled! I went in and told her that she could just keep using the plain mask but to let me know immediately if she became short of breath. I told her I’d be watching her oxygen sats and if they started falling, she would go back on the bipap immediately.
To my complete and utter surprise, she lasted through lunch! After lunch I could tell she was pooping out some, even though her sats were holding just above where I wanted them. I told her I thought she should go back on bipap and rest over the afternoon. She somewhat reluctantly agreed. I was personally delighted with how long she lasted and told her and her parents that it was very encouraging that she did so well for so long.
About 20 minutes later, I was sitting out at the desk when I saw the patient’s mother come out looking a bit dejected. I wondered if my patient was okay so as she walked by I asked if she needed anything. She replied that she was just a little sad and I was genuinely curious as to why. So I asked, of course.
She replied that she had been so encouraged throughout the day while her daughter was off bipap, and now that she was back on it, it seemed like a step backwards. It was her 30 year old baby sitting in that bed and she was very understandably worried about her.
So while I was inwardly (and a bit outwardly!) cheering that my patient lasted a good part of the day without bipap, my patient’s mother was very dismayed about the same event. I tried to tell her that her daughter was doing great, better than I could have even hoped, and that seemed to mollify her a little. It just never would have crossed my mind to be sad about the whole thing. I’m glad she came to talk about it. It definitely provided a different perspective.