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Emergency Intubation

During my first year of anesthesia training I was called to open an emergency airway for a patient struggling to breathe in the Medical ICU. When I arrived amid a flurry of activity and billowing yellow isolation gowns, the monitor was crying DING DING DING to alert us that the patient’s oxygen saturation was hovering in the mid-80s–dangerously low. The patient’s small face was obscured by the oxygen mask, his frail body covered by a hospital gown.

The patient was too confused to follow any instructions, and the loud noises of the ICU machines didn’t make things any easier. I tried to communicate: “I’m from anesthesia and I’m going to put in a tube to help you with your breathing.” A nod. I positioned myself at the head of the bed and quickly checked to make sure we had everything we needed: suction, laryngoscope, styletted endotracheal tube and a clear view of the monitors. Check.

“We’ll take good care of you, Sir,” I said as my senior resident started pushing the drugs that would render the patient unconscious and immobile.

I held a firm seal on the mask while the respiratory therapist bagged. A moment later I opened the patient’s mouth with my right hand, while my left hand advanced the laryngoscope until I could see epiglottis–the flap of cartilege covering the windpipe. Then I inserted the tip of the scope and lifted the epiglottis. A perfect view! I swiftly placed the endotracheal tube between the vocal cords, then removed the stylette–the rod that ran through the middle of the endotracheal tube to make it stiff enough for the insertion. Then one, two, three, four, five, squeezes of the breathing bag, and the patient began breathing–with assistance–once again. The respiratory therapists artfully taped the tube in place and connected the patient to the ventilator. 

I went to the chart to complete a procedure note, and that’s when I realized: the patient was a woman. The chart said she was receiving chemotherapy, and it occurred to me that quite possibly the last words she would ever hear were my calling her “Sir.”

A lump rose in my throat. I hope she was eventually able to be extubated to hear words from her loved ones who weren’t able to be there with her in the hospital in the middle of that night.

But maybe…probably…not.

Sydney Brown
Philadelphia, Pennsylvania


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