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Breathing space

Godfrey, Alexandra MS, PA-C

Journal of the American Academy of PAs: July 2015 - Volume 28 - Issue 7 - p 66
doi: 10.1097/01.JAA.0000466595.38411.9a
The Art of Medicine
Free

Alexandra Godfrey is an assistant professor in the PA program at Wake Forest School of Medicine in Winston-Salem, N.C., and practices emergency medicine at Catawba Valley Medical Center in Hickory, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

Figure

Figure

My mother collapsed from a subarachnoid hemorrhage this past October. Her condition was critical. I immediately caught a plane to Scotland where she was hospitalized. One afternoon, as she slept on the neurosurgery ICU, I decided to go out for some fresh air. I needed breathing space.

The Museum of Modern Art, Edinburgh.

The struggling breath sounds of human suffocation greet me as I walk into the Scottish museum of modern art. The noise catches me by surprise. My primal instincts recommend flight and fight. I squash them, favoring modern art over ancient senses. I follow the noise to its source. Just a short stretch along a hallway, I find a display so macabre that bold black lettering warns sensitive visitors not to enter. I watch as a father previously immersed in some text on his cell phone suddenly pays attention to the unnatural sounds emanating from the display. He halts his son at the door. Placing a hand on the child's shoulder, he turns him gently around, whispering in his ear, “Let's pop downstairs for tea and cake, son. ”

I walk into the room undeterred and curious. I am made of tough ED stuff. Still, I reel at the footage of a short film that depicts two men slowly suffocating; each image flickering by on the whitewashed walls of the room.

The two men have no room to breathe. Plastic grocery bags are tightly wrapped around their heads, making respiration difficult. The plastic is sucked in; then forcefully expelled. Surround sound amplifies their constricted inhalations and expirations. The plastic crinkles in time with the opening and closing of their alveoli. They are suffering and suffocating: crackles, resistance, spasms, hypoxia, lethargy, failure. As their tidal volumes drop and their respiratory rate rises, their struggle for survival makes it harder for me to witness. I feel a little sick. I try to apply some Socratic reasoning: is this display of pain, pleasure, torture, chaos, and rebellion a form of self-exploration? This desperate attempt to survive asphyxiation mirrors a broader human struggle, I decide. The artists called the film Breathing Space. I prefer dead space.

Dead space?

The dead space in the pulmonary tree consumes about 150 mL of tidal volume. A patient with emphysema has increased dead space. Dead space must be considered in V[Combining Dot Above]/Q[Combining Dot Above] mismatching.

I teach students about dead space. Dead space obfuscates often.

I imagine how in medicine we could understand this scene. Maybe we could do a special project, write a reflection, formulate an acid-base equation, or perhaps look for common ground? I would ask: is this an artistic depiction of human weakness or a simulation of the neurochemical control of respiratory drive?

As the partial pressure of oxygen drops and the levels of carbon dioxide rise, the central chemoreceptors send efferent impulses to the muscles of respiration, triggering an increase in respiratory rate. If the carbon dioxide rises too steeply and the body cannot compensate, or hypoxia does not resolve, the blood becomes acidic and respiratory failure ensures.

Or

The film Breathing Space emphasizes our macabre dance with mortality as we engage in risk, encounter adversity, seek out pleasure, encounter disease, and ultimately die. Like the two men in this scene, we (humans) are together and apart. The plastic creates a literal and metaphorical barrier that symbolizes the synthetic nature of the separation (space) that we create between ourselves, and between life and death.

I leave the museum, still musing as I step out into the fresh air, air that feels more vital now. I inhale deeply, enjoying the miasma of damp earth, stone wall moss, and sea salt.

As I wind my way across the hospital campus to my mother's ward, I pass patients sheltering in doorways sharing stories, rich tea biscuits, and nicotine. Cigarette in one hand, IV pole in the other; the patients look content as very different types of medicine infuse their lungs and vessels. They have come away from their rooms and their beds, still in their gowns, seeking ... air. Is this pain, pleasure, torture, chaos, and rebellion?

Maybe the Scottish museum of modern art is onto something.

I climb the stairs to the ICU. My mum is awake now. She asks me where I have been. I wrap her fingers in mine, telling her I went out for a walk and some fresh air. She reaches out and gently strokes my hair as mothers do and will do for eternity. I watch her chest rise and fall peacefully. I am so thankful in that moment for breathing space.

Major industries and consulting firms are consulting firms are rushing to participate in quality improvement efforts.

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