Last night Aaron is double-teamed. Norma and Amelia work swiftly, each attending to different requirements. The Urinator provides Aaron some additional opportunities, which means additional observations, measurements, and adjustments. Aaron and his attendant machines together are a complex system requiring constant adjustments. As with modern, high performance aircraft, there are no stable trim settings. Just as these extreme fighter aircraft are aerodynamically unstable and stable flight is achieved through constant adjustment, Aaron is metabolically unstable and stable life is achieved only through constant adjustment.
Over the course of the day, the Aaron and the Urinator achieve a net loss of about 3 liters of fluid from his body. By the end of the day, the Urinator is outperforming Aaron’s own kidneys by about 3 to 1.
The oxygen supply concentration is gradually lowered to 60-70% and PEEP is lowered little by little to around 10cm. These are much more sustainable values than yesterday’s. With Aaron deeply sedated and paralyzed, the Ventilator is now firmly in control. Aaron’s breath rate is increased to 35 breaths/minute. He may still be lounging on an air mattress, but his lungs are running the ¼ mile. At these settings, his blood oxygen saturation stays in the high nineties. This is a much-improved situation from yesterday.
But the improvements don’t come without a struggle.
It’s not enough that the lungs take in oxygen. They must also get rid of carbon dioxide. The faster breath rate isn’t allowing enough time for the carbon dioxide to escape. The ventilator settings are tweaked to change the pressure waveform: shorten the inhale pressure pulse and lengthen the exhale relaxation time. This helps; the big yellow CO2 value the vitals CRT drops from 100 to 50.
Excess carbon dioxide in the atmosphere contributes to acid rain (as well as perhaps global warming); excess carbon dioxide in Aaron contributes to acid blood. The massive die-off of the mutants also contributes to acid buildup as they decay. Aaron’s pH drops to 7.1 as the acid keeps building. Fortunately, there’s ARM & HAMMER. One of the oldest and truest antacids can be injected straight into the blood. Whether it’s controlling refrigerator odors, baking cookies, or restoring critical acid/alkaline balance, good old baking soda works. The pH is brought to a near normal 7.3.
Aaron doesn’t look quite so bloated by the end of the day.
Pneumonia, never proved but strongly implicated and aggressively addressed with antibiotics, appears no worse.
There is no indication that the lung damage is worse.
His fever has abated.
His vitals are stable.
The constant hum of the machines, the compassionate competence of the staff, and the sublime grace of God give us hope for another day.