The Rear View

Riding in the back of the ambulance laying in a gurney, it is 6:30 in the morning. I have quite a view out the back window of the sunrise projected against the clouds above. Admiring the array of oranges, pinks, and purples, I smile. This view is only available to me because of my orientation to the rear, as we travel west on the highway bringing me back to my apartment after a night in the emergency room. I was accompanied by Sarah, a tall slender young woman of few words, and David, a seasoned EMT and cheerful robust man. Do not let Sarah's lack of verbal engagement fool you. She engaged from within with a keen eye and a quiet mouth, as I observed her notify David right away that he was pulling my breathing machine tubing as he was loading me into the ambulance. She just didn't know most of the nurses on shift that night like David did and it wasn't her nature. Let's be honest, you don't need both your EMT drivers to be telling jokes. They were a good team.

At about twelve that night I decided I needed help. I had been struggling to breathe for about an hour and it wasn't showing any signs of improvement. I called for my mom by rolling my head into a call button that sets off an alarm in her room. My neck is one of the last parts of my body that I can move. She was quick to understand that I was in distress because of the way I was using my whole body to grasp for air. Since I can't talk and don't have my eye tracking communication device setup in my bedroom, I needed to spell out my answer to her question of what we should do with an alphabet card. We tried the cough assist machine a couple times. It basically mimics a normal cough because I am too weak to move enough air to clear my airways. It does that for me, forcefully sucking air out of my lungs and then pumping air back in. it is rather intense. This usually can help dislodge mucus from my airways, like a good cough, but not this time. So we were left with no other option than to call 911.

I was really struggling each breath to get air. Fortunately, the fire department is just across the street from our apartment, so they arrived in no time. They took my vitals and found that my oxygen saturation was much below normal. It is funny to need technology to prove the obvious, I was suffocating. I understand of course the usefulness of getting a baseline to assess treatment on, I am a doctor, but in the moment I'd skip that step to get me breathing first. They got me on oxygen, and I calmed down a little and my oxygen saturation came up to low normal. Although I was still having difficulty breathing and whatever was obstructing my airway was still there. The EMT expressed the concern that as soon as they took me off the oxygen my numbers would return to worrisome levels. It was clear that I needed to go to the hospital.

They slid me out of bed directly onto the gurney and I was loaded into the ambulance. On the way to the emergency department they gave me a cocktail of bronchodilators through a vaporizing machine called a nebulizer. Upon arriving at the hospital, they ran a bunch of tests; chest Xray to check for pneumonia, blood work looking for infection, and even did a pulmonary angiogram to check for a pulmonary embolism. It had been three hours of exceedingly difficult breathing and feelings of suffocation before I finally began to breathe easily again. It took a few hours for the results of all the tests to come back negative. They settled on a diagnosis of a mucus plug. It must have resolved after the bronchodilators created enough space in my airways for the plug to clear. Saran and David loaded me and my ventilator back on a gurney to be transported home.

We have come full circle in the story, and I am being driven west on the highway looking out the rear window of the ambulance soaking up the sunrise colors. It was critical to know the back story to grasp how elated I was to be breathing freely. I had an ear to ear grin, totally blissed out feeling each full unrestricted breath coming in and out. To top it off, I was gifted with the finest of nature's art painted on the canvas of the clouds.

Life can be that simple. Happiness can be that simple. Although, if we are always looking out the front window in the car of our lives towards the longings we hope the future will fulfill , we tend to miss the opportunity to appreciate what we already have. Through this process of ALS I have been stripped of innumerable aspects of my previous life. I'm down to the most basic of pleasures and elements of gratitude; breathing, my communication device, and my friends and family that I can share with my love of life. My circumstances have forced me in a large way to orient myself out the rear window because of the uncertainty of my future with an uncurable terminal illness. It has shown me many things about being content with the simple things.

There is nothing wrong with looking to the future to ask for more. It is the nature of our longing to be ever reaching for greater understanding of our environment and ourselves, to discover new technologies that further simplify our means of survival, and continuing to purify the expression of the soul through the arts. Although, like the expansion of the universe through infinite space, our desires are also unlimited. As soon as one is fulfilled, there are ten more to fill it's place. It will never be complete. Therefore, it is wise to seek balance between our expanding desires and consolidating in our appreciation of what we see around us through the rear view.