Between Aaron and the Urinator, the Paralyzer has been flushed into history. When it began its work on Thursday, Aaron’s sedatives (Propofol and Ativan…Aaron clearly prefers Propofol, but the doctors seem intent that he should have Ativan) were increased. The paralyzer Vecuronium does not suppress consciousness or pain….it is essentially a powerful muscle relaxant. Being conscious and paralyzed is frightening, so Aaron’s sleep has been near comatose…in this deep-sleep state, Aaron could undergo surgery without pain. Today, with the Paralyzer gone, Ventilator settings closer to normal (40% Oxygen, PEEP 4, 30 breaths/minute, tidal volume 400), and Aaron beginning to take control of his own metabolism, the sedatives are intermittently reduced to see if he is ready to be weaned from the tube down his throat that delivers oxygen to his lungs. Aaron begins to surface for a few minutes at a time. Fran, his day nurse who is bound to have him up an walking sooner than later, allows him to surface to the point where, when she asks if he is in pain, he shakes his head. Another time, Natalie asks Aaron if he is uncomfortable: he nods.
He is intermittently aware of the tube down his throat. The more he is aware, the more he is wracked with an apparently overwhelming gag reflex. As the day fades toward shift change and into night, these intermittent spasms continue, and seem to worsen. His body arches in violent paroxysm; silent tears burst from his still-bloody, swollen, and mostly-closed eyes.
His systolic blood pressure shoots up to 160. The Ventilator senses that something is very wrong that it can’t correct, and begins its wail of desperation. The creators of the Ventilator must have worked long and hard to give it this most disturbing and demanding voice. The Urinator complains less demandingly that blood flow is cut off, and it stops. It must be restarted immediately to prevent blood from clotting. On several occasions, it isn’t restarted fast enough. The Urinator ups the ante of its compliant; the blood has clotted, and its filter must be changed. The spaghetti of tubing threaded through the Urinator like movie film through an old fashion projector is removed, The tubes are disconnected from spigots piercing Aaron, the filter is detached, a new set of tubes is threaded, another polymer kidney is attached, the tubes are reconnected to Aaron, and blood begins its tortuous round trip through the Urinator, as it begins to fill yet another bag with pale yellow urine.
We tell Aaron what a great job he is doing, that everything is going well, that he’s getting better. It’s hard to say that he is convinced.
The fever is back and rising
