Every Deep-Drawn Breath by Wes Ely

Author:Wes Ely
Language: eng
Format: epub
Publisher: Scribner
Published: 2021-09-07T00:00:00+00:00

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I hadn’t known it at the time, but Bonnie Harmer was a nurse with two master’s degrees and a PhD in education. She had seen delirium in patients in the wards, but more than that, she’d lived with it in her husband. She’d considered a connection between his many days of ICU delirium and his mental health and cognitive struggles since leaving Henry Ford. Eventually her curiosity had led her to reach out to Dr. Acosta at Vanderbilt.

When I tracked down Bonnie and we spoke, I was impressed by her desire to spread the word about PICS, to prevent others from going through the horror that Rob had experienced. At her nursing college, she passionately teaches students about delirium and PICS and instructs the new nurses how to use the CAM-ICU at the bedside. As she told me about Rob’s critical illness and his treatment, I nodded. It felt like déjà vu. He had received the standard care of deep sedation and benzos. Plus an antipsychotic to treat his delirium. In 2005, I would have done exactly the same thing. I would have been relieved to have saved his life and sent him home to his family. Then I probably wouldn’t have thought much about him as I turned my attention to the next patient on the gurney. Bonnie revealed that after his ICU discharge, Rob had suffered PTSD and an anxiety disorder that manifested as paranoia, nightmares, flashbacks, and insomnia. He also developed severe depression. A psychiatrist and other doctors prescribed a host of medications and several therapies including eye movement desensitization and reprocessing (EMDR), biofeedback, and counseling, but nothing had helped him.

As the years passed, Bonnie started to notice the cognitive decline. Her husband, a onetime math wizard and inventor, struggled to calculate simple problems such as 5 times 13 and could no longer help Kaely with her algebra. Bonnie recalled how much he had loved rebuilding Corvettes. He had done frame-off restorations, which meant stripping the car completely down and then rebuilding it. “He got to the point where he couldn’t remember how to put the cars back together,” she said, shaking her head at the memory. In my mind, I could see the parts of the car scattered everywhere, a jigsaw puzzle of frustration, one that mirrored Rob’s life. He just couldn’t get the pieces to fit.

After extensive neurocognitive testing, the Harmers were told what they probably already knew: that Rob was totally disabled with a dramatically slow processing speed for mental activities, and an inability to carry out the executive tasks that had made him so successful at work. I realized that Rob’s problems were similar to chronic traumatic encephalopathy (CTE), a dementia that develops in many retired professional football players in their early forties.

Rob ended up taking a two-year disability leave to get the medical support he needed. Toward the end of that time, when he was preparing to return to his job, he began to feel encouraged. Bonnie’s voice lifted: “He went from feeling total despair to finding hope again.

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