Chapter 8 - THE WAKING
Seventy-two hours later, the storm had completely cleared from central Illinois, leaving behind a crisp, cloudless Friday afternoon.
In Bay 14, the mechanical chaos of Tuesday night had quieted into a peaceful, rhythmic hum.
The chest X-ray on the PACS monitor showed dramatic clearance of the bilateral infiltrates. The dense white consolidations had receded, replaced by healthy, dark lung tissue. Her PaO2/FiO2 ratio had climbed to 320. Her white blood cell count had normalized from twenty-four thousand down to eight point two.
Lauren was ready to breathe on her own.
"Spontaneous breathing trial completed, Dr. Santos," Marcus reported, standing at the foot of the bed with a clinical clipboard. "She’s been breathing on pressure support of five over five for thirty minutes. Rapid shallow breathing index is forty-four. Negative inspiratory force is minus thirty-two. She passes every extubation metric with flying colors."
"Good," I said, pulling my stethoscope from my lab coat pocket.
David was sitting in the corner armchair, holding a small, framed photograph of their daughter Sophia. He looked showered, shaved, and remarkably grounded, his eyes tracking every movement I made with quiet, unwavering reverence.
My parents had gone home to rest on my strict medical orders; I had promised them I would call the moment the tube was out.
I walked to the right side of the bed.
The continuous propofol infusion had been turned off two hours earlier. Lauren was awake, propped upright at sixty degrees.
She wasn't thrashing this time. She wasn't fighting the machine.
She sat quietly, her hazel eyes clear, calm, and fully oriented to her surroundings. When I stepped beside the bed, her gaze lifted to meet mine.
There was no confusion in her expression. She remembered everything from Tuesday night—the suffocating terror, the paralyzing drugs, the moment her heart nearly gave out, and the sister who had held her shoulders and ordered her to breathe.
"Good afternoon, Lauren," I said, my voice gentle, clinical, and calm.
She gave a small, slow nod around the plastic tube.
"We are going to take the breathing tube out now," I explained, showing her the suction catheter in my hand. "I am going to suction your mouth and your windpipe one last time. It will make you cough. When I tell you to take a deep breath, I want you to fill your lungs as much as you can, and then cough as hard as you can while I pull the tube. Understand?"
Another slow nod. Her eyes never left my face.
"Marcus, deflate the pilot balloon."
Marcus inserted a slip-tip syringe into the small white valve, drawing back five cc's of air. The balloon collapsed.
"Cuff is down," Marcus announced.
"Suctioning now," I said, passing the catheter down the inside of the tube.
Lauren gagged softly, her eyes watering, but she remained completely cooperative.
"Okay, Lauren," I said, gripping the endotracheal tube with my right hand and holding a sterile towel with my left. "Deep breath in... big breath..."
Lauren pulled air through the open tube, her ribcage expanding fully.
"Now, cough!"
She coughed with everything she had.
With one smooth, practiced, continuous motion, I withdrew the eight-millimeter plastic tube from her trachea and tossed it onto the disposal tray.
Lauren coughed violently into the towel, her chest heaving, clearing the residual secretions from her vocal cords.
Marcus immediately fitted a clear plastic nasal cannula over her ears, resting the soft green prongs beneath her nostrils, delivering two liters of supplemental oxygen.
"Breathe normally, Lauren," Marcus said, placing a warm hand on her shoulder. "Just breathe through your nose."
She inhaled.
A natural, quiet, unassisted breath filled her lungs.
Her chest rose smoothly. Her lips were a healthy, radiant pink. The pulse oximeter chimed with a steady, musical rhythm: ninety-eight percent.
Lauren leaned back against the mountain of pillows, her eyes closed, tears leaking silently past her lashes and soaking into the cotton pillowcase.
David stood up, dropping the picture frame onto the bedside table, and rushed forward to take her left hand, pressing his lips against her knuckles. "You're okay, baby. You're okay. You're breathing on your own."
I stepped back to the workstation, writing the post-extubation orders on the terminal: NPO for four hours. Incentive spirometry every hour while awake. Transfer to step-down unit tomorrow morning if blood gases remain stable.
"Dr. Santos?"
David's voice came from the bedside.
I looked up from the monitor.
David had stepped aside.
Lauren was looking across the room, directly at me. Her right hand, weak and bruised from multiple arterial line attempts, lifted off the mattress.
She pointed a trembling finger at the bedside table.
Sitting beside her plastic water pitcher was a small, spiral-bound notepad and a black ballpoint pen that the nursing staff had left for her during her sedation lightening.
May you like
She reached for the pen, her fingers shaking so hard she could barely hold the plastic barrel.
She opened the pad, pressed the tip to the lined paper, and began to write.
