Darren Markland

Ok, now take a deep breath, all the way. Trust me. Just do it. Now hold it. That’s your new starting point. I want you to take your next breath from there. And your next. Don’t cheat. Pretty anxiety provoking, right?

To keep people with this lung disease (it’s call ARDS) from ripping their lungs apart we need to sedate them very heavily. Sometimes even paralyze them. It can make people incredibly weak, but there are no other options.

No for weeks we wait. Waiting for the lungs to heal. To relax. There is no clear way to predict who will get better and when. It’s an unclear pathway dictated by genetics and immunity. It’s heralded by the ventilators silence as it can relax and not push the air so hard.

At that point we can start to wake our patients up. There emergence is often dramatic, like coming up from deep water. We need to be gentle. Too much struggling and we can lose all of our gains.

I’ve seen some get better quickly. They act like good old bacterial pneumonia. Others take longer. We talk to families about tracheostomies and long term ventilation. They make progress but they will have long term complications from their journey.

There is however a subset. They seem to improve initially, but despite everything we do they deteriorate after a week on the ventilator. No matter what we do their lungs get stiffer and stiffer. Instead of healing, their lungs are replaced be scar tissue.

We search for hidden infections, scan them for blood clots, look for strange drug reactions and autoimmune disease. Over the ensuing weeks, their hearts start to fail from the tremendous work of pushing blood through fibrous lungs.

Deprived of blood the kidneys fail first. Dialysis will keep them going forward a while longer, but without lung transplantation the heart eventually stops. Often we sit down with families before these final things happen to let them know the path their loved ones are on.