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The cultural assumption that everyone would rather be sedated is based on the myth that sedation is “sleep”. Very few survivors can give us a comparison of being sedated vs. being awake while intubated. Lara, like Susan East in episode 3, has had it both ways and shares with us the contrast.

Episode Transcription

Kali Dayton 0:10
It’s time to bring it back to the survivors. Not many people can do a true comparison on experiencing being intubated while sedated vs. being awake. This episode is with an incredible survivor that shares her journey and insights with us to reaffirm the “Bailey method” of allowing patients to wake up after intubation before delirium starts.

Laura, thank you for so much for coming on the podcast. Do you mind introducing yourself to us?

Lara 0:22
I’m Laura. I’m 32 years old. I’m a med student, I worked as a paramedic before I went to med school. And I’m chronically ill. I have severe asthma. And I think you heard about it, because it’s on the internet a lot lately. It’s Ehlers Danlos Syndrome.

So, and my journey pretty much was that with chronicle illness, I ended up in ICU quite a lot. And I’ve been intubated and sedated. three times.

Kali Dayton 1:25
oh, my goodness.

Lara 1:28
The most days, intubated was nine ish, I think it was. And the very last time, just some weeks ago, it it was the first time I was awake. And this was a pretty different experience.

I must say, everything of it is kind of scary. But this time, I was able to advocate for myself while in this state, and this was so different and so much better, I think.

Kali Dayton 2:24
Which is amazing. I think listeners are probably like, what was the difference? Why were you allowed to be awake? Why were you not? The first few times? So let’s give some context. You and I have been in contact over Instagram for a while?

Lara 2:38
Yes.

Kali Dayton 2:39
I don’t know how you found my Instagram page. But you have shared with me some of your insights into what it was like to be sedated? Do you mind telling us what that’s like?

Because you probably understand that you work in medicine, you know, what the conceptions are that patients are sleeping, that they’re more comfortable that it’s nice and cozy? What’s the reality? What was it like for you at least?

Lara 3:03
Um, so I can only speak about the stuff I am experienced, of course, and you are in such a different mental state. You don’t know what’s real and what is not. Which is scary, which is the most scary part of it.

And even when you get woken up and rehabilitate afterward, you’re it’s possible that you’re still hallucinating. And it’s visual and acoustic. You hear stuff, which isn’t true. You see stuff, which isn’t true. And I think this is the hardest part of it, I think, because with the experience in medicine, I pretty much know what’s going on.

Kind of but then when you’re laying there and the bed and with the beeping and stuff, it’s completely weird. And I did some rotations. When I was in training for being a paramedic. I was on rotation in ICU and I mean when it’s beeping you just run and look after it and usually it’s nothing and when, when you’re lying there at least I’m okay. You’re not sure if it’s something or not.

Kali Dayton 5:06
Like “Am I dying?”

Lara 5:07
Yeah. Because when you walk out, you just woke up from something you could have died of. It’s like, “Oh my god, is it happening again?”

Kali Dayton 5:24
That’s terrifying. Yes, it is. And I was just that the American Delirium Society conference and I was starting to ask people if does anyone know why when patients get lost in this alternative reality? Why is it so? Scary? I mean, I think it’s like you said it’s scary to not know what’s real, what’s not. I think even if I was seeing rainbows, and I wasn’t sure if it was real or not, I would be concerned. But what was the nature of your reality? Was it graphic and gruesome? Like so many report?

Lara 6:00
Um, yes, it was graphic. I, I mean, it always depends on which sedation you’re on. This is what my experience was the most scary part was with Ketamine.

Kali Dayton 6:20
Interesting and thank you because there’s such a big movement towards ketamine. Yes. We know it causes hallucinations. It’s, I mean, startling, yes, it doesn’t suppress respiratory drive in the same way. I think that’s why we’re getting excited. It may not last as long but it causes hallucinations.

So why would you take patients that are so vulnerable to delirium? I risk of having terrifying hallucinations and give them a hallucinogenic.

Lara 6:45
Yes. I mean, because of Elhers Danlos, I’m also in chronic pain, and I happen to have pneumothorax which were treated with, you know, this chemical talcum powder reduces it in one lung cavity.

Which is not up to date anymore, because it makes severe pain. This is what happened to me. And so when I’m in an asthma attack, I have this really, really great pain in my chest as well with asthma. Which is really hard. And there was one time where I got this ketamine but but with bensaude The it’s a pain.

And it was fine, because this time there I was in an operative ICU, which were handled by different doctors. And they kind of got this better, better level between the these two drugs. And after this, I was pain free. And this was great.

I mean, the very first time and I wasn’t hallucinating, but later on when I was on this drug because they love to use it when you’re having an asthma attack and need to get intubated they use this rather than other ones. But when I was sedated and intubated for this nine days I have this this pictures in my head and this this memories, this really real, weird memories, which don’t make sense, but it’s really scary.

Kali Dayton 9:27
And real to you.

Lara 9:29
Yes. And it’s interesting, because the day before I watched the documentary, and it really caught me emotionally. And I went with these completely different emotions in this new situation and During this whole time, sedated, I had the same emotions and then woke up with them as well.

And, and because they were kind of scaring beforehand, and I was scared all the time, I was sedated. And I got out of it in the same emotion. And this is so weird. Like another time I had this. i It was when the new real the movie, Lion King was on the new one. And I had this “Just Can’t Wait to be King” song in my head. Uh huh. And, and this whole time, it was just playing in my mind the whole time. And then I got into this situation and then woke up with it in the head into my head. And this is so weird. How strange.

Kali Dayton 11:06
When other survivors when she’d been watching a movie about fish with her kids the day before. And then throughout her whole delirium, she believes that she was turned into a fish. You’d never see her again. That so I don’t know how the mind works that way. But that is interesting. And but no, I would think that that’s a happy song. Yeah, I know that it feel happy.

Lara 11:29
Um, yeah. During during this time, I think it wasn’t that scary. Good thing. It was just four days I was intubated there. But yeah, it was. It wasn’t as scary. But I couldn’t get the song out of my head for the next couple of days afterwards as well. It was just and now all the time I hear this. I remember. This time they’re in ICU and

Kali Dayton 12:07
….just shudder?

Lara 12:08
Yeah. A little bit.

Kali Dayton 12:10
Like the songs ruined for you?

Lara 12:12
You know, that is a scene and they may get made it for 3D Movies. Where were all these animals go round and you think you are in a kaleidoscope?

Kali Dayton 12:29
Uh huh.

Lara 12:31
And during which there was like, a waste going through this kaleidoscope?

Kali Dayton 12:39
Oh, wow.

Lara 12:40
And similar. It was a second time when I had this bad emotions. It was just different color. But but it was the kind of Yeah, going through a kaleidoscope and not knowing what were you and then

Kali Dayton 12:58
It was happy pretty thing it turned into a scary, startling thing. As images are blurred. i And then you mentioned before that you self extubated at one point.

you just mentioned. You said it’s terrible, had delirium. And it’s your thrashing your heading you pull out your breathing tube.

Lara 13:41
That’s what Yeah, it’s was that when I was there, that that’s a long time. And at first, I was intubated for a day I think it was and they extubated me and I had another episode just after a couple of hours and was reintubated.

And at some point, I pull pulled out the tube after nine days. And I don’t remember a thing because I was in my kaleidoscope. And yeah, that the first thing I remember was I kind of sat there in this bed and the doctor was there and the nurse and they were telling me “oh, you just slept nine days.”

And “no, you’re kidding.” Because I couldn’t believe it because it was the very same situation. I was after they extuabted me the very first time after one day. Uh huh. And and I had this deja vu.

Kali Dayton 14:58
Yeah. “I was just here situation before,”

Lara 15:02
I don’t know, because I was so confused with everything. And yeah, I was then extubated after eight days, and it was it was just weird because there was this huge gap. And I couldn’t figure out what was happening, what the process was when I was asleep.

And they were telling me all the stuff for the next two days, and I couldn’t remember the thing that they that they told me this already and yeah, I was really confused. But I have to say, that is not diagnosed because of insurance problems. But they think I have this poor metabolizer syndrome, this polymorphism where you don’t metabolize the drugs as fast as normal people. And because of this, I think it’s a little bit longer that takes me to get out of this delirium by this drugs.

Kali Dayton 16:28
Yeah, that makes absolute sense. Everyone we’ve seen at the bedside, everyone responds different to the drugs, they come out of it differently. The timing is different. So I’m sure there is a genetic component to how you respond to medications. The loss of times that survivors have frequently mentioned to me even if they didn’t have traumatizing delirium. Just the fact that the last time.

My husband went to had an endoscopic procedure a couple of weeks ago, he went in a three and afternoon and came out, you know, at like 5:30. And he was walking and talking, he was fine. But then the next day, he’s like, “What happened?”

He doesn’t remember anything and it’s it just kind of bugs them. And I thought that was a few hours. That was an afternoon. Not a week or weeks for some of the survivors that loss of time. I don’t think I don’t understand it. Right. But I think until you experience it, you don’t appreciate how traumatizing that alone can beat that you lost that time. You did things or things were done to you that you have no idea of.

Lara 17:31
Exactly. and I know because people told me that in this day and under this drugs I can be very aggressive. Which bugs me because I don’t want to be this way. I don’t I want everyone to be fine to be happy and I really….

Kali Dayton 18:03
Yeah, it’s not who you are.

Lara 18:05
Yes it but but the thing is, people think I am

So you’re labeled that way and treated that way.

Kali Dayton 21:07
When you when you went to the ER this last time, where you integrated in the ER and how did you approach intubation? How to how did you advocate for yourself?

Lara 21:16
No, no, it was I was in ICU already I, I had this infection, it was in fact triggered. And but by now I know that there’s a different component to it. What gets me intubated? Because we know now after this last episode. It’s because when when they put me on non invasive ventilation, and I’m getting hypercapnic- is that what it’s called?

Kali Dayton 22:04
uh-huh!

Lara 22:07
When your co2 gets too high in your blood. Then I get drowsy and tired and so on. And when then they put up the pressure of the non invasive ventilation, my vocal cords will just shut. Oh, so they this is laryngospasm. And the only option is to intubate them.

Kali Dayton 22:36
Yeah. It’s a crisis.

Lara 22:38
Yes. And they did that. And they needed to put me on muscle relaxants for this. And when they were off, they woke me up again. So it was kind of straightaway it was, like late in the night. And a couple of hours later, I was woken up again.

And I don’t have a problem with waking up with the tube in. Really. It’s because it depends on the drug I’m on. And this time it was just propofol and then I knew, “okay, we’re in the situation now.”

Kali Dayton 23:29
Yeah.

Lara 23:29
So then I woke up and I was able to advocate for myself and I was like, “Okay, let’s wait some another hour for this drugs to wean off and then let’s take it out. And when they took it out, I had another laryngospasm straightaway because of this and they had to reinubate me.

A couple of hours later I was awake again. And then I was awake for the next couple of days because it worked out and it was the very first time this hospital did that with anybody with anybody

Kali Dayton 24:21
With anybody? Did you tell them that’s what you wanted?

Lara 24:28
No, it wasn’t communicated that way. But because of the first time I was awake and I was able to tolerate tube.

Kali Dayton 24:41
So the first time they didn’t expect you to stay on it for for longer than a few hours. So they they wanted to get you extubated so they had you awake and they realize that that worked for you and that works for a lot of people’s let them wake up right afterwards. But they had never had the occasion to do that or to try that approach.

Or they never had never tried it before, I would say, I don’t say that they “didn’t have the occasion to”– I’m sure they had other occasions in which it would have been really beneficial to let patients wake up right away. But they just hadn’t. Yes. Maybe maybe change their perspective. What do you think?

Lara 25:20
I don’t know. I had the feeling a lot of the nurses there. And the doctor, they were like, “Whoo, interesting.”

Kali Dayton 25:32
Haha.

Lara 25:34
Interesting situation. But some nurses, they were annoyed because they had didn’t have this “sleeping patient”.

Kali Dayton 25:49
Or a patient they believed to be sleeping.

Lara 25:52
Yes, exactly. Right, exactly.

Kali Dayton 25:56
And you were able to write, or were you texting on your phone? You texted me! You sent me a picture of yourself. You took a selfie. You send it to me via Instagram. And you said, “It’s really annoying that I’m intubated. But this is so much better. I’m awake. And I’m oriented.”

Lara 26:11
Yes.

Kali Dayton 26:12
And I used that picture in my presentation for the American delirium Society Conference. And said, “This is what the ‘Bailey-method’ looks like.” Polly Bailey is my mentor. And she’s been letting patients wake up after intubation for almost 30 years. And seeing what they need.

Lara 26:28
Yes.

Kali Dayton 26:28
And so I, I use you as an example to say the patient herself while she’s intubated, saying “This is so much better. And she’s had it both ways.”

Lara 26:37
Yeah.

Kali Dayton 26:38
And that’s powerful.

Lara 26:39
Yes. I don’t know if they will try it on other patients. I know, from my friend, she, she’s intubated because of here severe asthma as well. All the time. And she’s like, “No, I don’t want… I don’t want to know anything. I want to be asleep the whole time.”

Kali Dayton 27:07
But, but I had in the past that in I know this asleep, you know, when you wake up from when the sedation is a little low or the body is needing more to be really asleep? Because it knows the drug already, you know, when when the body needs more and more to really…..

You build up a tolerance.

Lara 27:47
Yeah, yes. Yes, you build a tolerance. And I had, before that, I’ve I knew what’s going on. And, and I wasn’t in a delirium, but I wasn’t asleep. I couldn’t move. I couldn’t do anything. But I could hear people around me. And to experience this. And I mean, they were fine.

Except for I think, one that didn’t talk to me. Because you really should talk to people that are sedated and intubated. You should really should, because you never know what they can experience. And I it’s scary when you like, touch the they take away your blanket. And it’s like, what, what’s happening now and you’re thrown onto your side, you get a lumbar puncture. And it’s like, “What the hell is going on?”

Kali Dayton 29:10
And you’re totally vulnerable.

Lara 29:11
Yes.

Kali Dayton 29:12
And I’m sure it’s gotta be that’s probably the most dehumanizing parts is have all that done without being informed or communicated to and,

Lara 29:21
yeah,

Kali Dayton 29:22
yeah, that’s really what does it mean to you this time to be able to communicate to your providers?

Lara 29:29
A lot because even though I couldn’t you know, sign stuff. I had my dad and my sister or my sister come in for things like that. But I was, I was able to say, “No, I don’t want it this way. Please, Let’s try a different attempt”. Even the basic stuff like, you know, when you’re sedated, and you lie there. And you really, really need to poo– you cannot tell anyone and it’s so yeah, depressing.

Kali Dayton 30:33
Yeah, that is I mean, when I do trainings, I that’s when you go through possible causes agitation. We turn on sedation, someone comes up agitated, we go through, we don’t try to get people to think through pain. They’re afraid. They’re delirious, blah, blah, blah.

But one of the things listed is bowel movement!

Lara 30:51
Yeah.

Kali Dayton 30:51
So often patients come up panicked, or they’re trying to tell us something, it’s because you have a bowel movement. But we’re…. we don’t expect that we don’t allow them the opportunity to tell us and then we resedate them. And there they are just panicked about it still on the inside. Yeah. Because

Lara 31:06
you really don’t want, you don’t want to shit yourself.

Kali Dayton 31:12
Yeah! You’re a grown adult, you’ve been independent. You don’t do that. So that’s so stressful.

Lara 31:20
Yes, and this is the most basic thing, and it’s so depressing to not be able to communicate this.

Kali Dayton 31:33
So the ICU that I come from, there is a toilet in the corner of the room that’s very accessible. So a lot of times when we’re getting patients up to go on a walk, or even to the chair, we don’t even have to disconnect the ventilator, we can just they can just walk over the toilet.

You know, if they’re really reliable, we can close the curtain. They can do their business, even though they’re intubated. They can kind of do their business by themselves wipe, wash their own hands.

Or we can have a commode I mean, a lot of patients can toilet themselves. And that’s so different. And really the ultimately that is easier for nurses. They don’t have to clean up everything in the bed while the patient’s still in the bed completely flaccid.

Lara 32:17
Yes. Yes. And you know, this is one part you don’t think about. When straightaway when you are out of nine days of intubation sedated. But later on is like, “Huh. How did they do this? I know how they did. What’s happening then?”

Because I worked in an ICU. But and it’s when you work there. It’s normal. I mean, it’s completely normal. And you don’t don’t think a thing about it. But when you’re laying there a completely different situation.

Kali Dayton 33:11
You feel violated?

Lara 33:13
Yeah. Yeah,

Kali Dayton 33:16
I would imagine if you didn’t have delirium that led you to believe that you were being sexually assaulted. Just knowing that all of that was done without your knowledge. And I guess your consent to a certain degree. That all of your business was being closely investigated the whole time? Well, you were not cautious. Yeah, no, I must be disturbing.

Lara 33:37
Yes, but I never thought about it being sexually abused.

Kali Dayton 33:42
Good. Some do. Especially if they have past trauma.

Lara 33:48
Yeah. I don’t have this experience. Yeah.

Kali Dayton 33:53
Thank goodness. Yeah. I mean, but it’s still you’d come out you’re like, “Oh, I I know how that was done. But I wasn’t a part of that.” This happened with my body? Absolutely.

Well, what recommendations would you give to ICU clinicians that want to help patients be awake, calm, compliant, comfortable on the ventilator?

You said that you’ve you have pain in your chest during asthma attacks. This was an asthma attack. What are the hang ups to letting patients be awake, clinicians will say, “But it’s not right to let them be in pain.”

There’s a misconception especially with nurses that “Sedation is pain management, that if they’re not moving, and they’re not showing signs of pain, they’re not in pain.”

So there you were awake, you have chronic pain. You’re in a painful situation, but you were awake. So how did you help your team navigate pain management?

Lara 34:47
The clinic I was in the the very first time I was there. I was in that pain clinic. So there is a really good pain management program in this clinic. And I wasn’t of any sedation, I was a little bit on propofol and sufentanil. Yep, for tolerating the tube for this long.

And with this little bit of sufentanil, it was okay. And if it wasn’t, I got a little bit extra. But I was able to tell them and I was ringing the bell, and they were giving me that extra pain medication, it was fine.

Kali Dayton 35:50
But that is that is the ABCDE F bundle, A, the very first letter of people really like to go sequentially. So A is assess, prevent and treat pan pain. And I really insist that that’s best done, when patients can tell us what they’re experiencing, what they need, what’s helped, and help guide that.

So this is not a sedation-less approach. This is not especially not an opioid-less approach. This is giving the tools or the reigns into the patient’s hands so they can tell us what they want and need.

The objective is to help patients be awake, oriented, communicative, autonomous, telling us what they need. That is exactly what they did.

And so, fentanyl boluses can help, a low dose fentanyl drip. All of those are great tools that can be used to achieve the presentation that you had as a patient being communicative oriented, delirium free and calling the shots.

So I would just insist that we can and must do proper pain management. But oftentimes, it’s much more easily facilitated when patients can tell us what they need.

Lara 37:00
Yes.

And you were just fine. You didn’t need to be a RASS of negative three to have your pain managed. That doesn’t make sense. But culturally, there’s this belief that the less patients move, the more comfortable they are. But yeah, you are deeply sedated in the past. And you were in a lot of pain.

I have this once where I was intubated, and they were trying to get me awake. But at this time, they didn’t know I was having this problems with sedation medication that I went over very slowly.

And my parents, they visited me and they went to the staff and told them that they feel that I’m in pain. And I don’t know if I was because I was at this time I was sleeping when they were saying I was a little bit agitated and not so still and making faces.

Kali Dayton 38:29
And they know. I think families can be a really good gauge of pain. I mean, there’s so many different reasons to be agitated to be moving, but the families know their loved ones.

Lara 38:41
Yeah.

Kali Dayton 38:42
But sometimes the inclination is turn up sedation when we see movement. when really they need more today, more pain management. So it’s it feels like your last situation was best case scenario. And after…. what was the difference in your rehabilitation process?

Lara 39:03
This time, I was I tell you of the nine days with sedation first. After this, I woke up, I couldn’t hold my phone. I couldn’t grab my phone. I was so weak. I couldn’t lift my head. I couldn’t sit up for a day when they were trying to mobilize me to stand beside the bed. I couldn’t help myself up my feed, didn’t know how to hold the weight. And they didn’t know the pressure under the feet anymore.

My mind you know how it feels when you’re You’re lying on your hand and it felt fall asleep. And then it’s pins and needles when I’d wake up. So when I stood up the first time it was pins and needles in my, in my foot because they didn’t know the sensory anymore. And it was so weird and it was really hurtful. And I was a little bit scared to do this again.

Kali Dayton 40:27
Yeah, when survivor said it was like walking on shards of glass.

Lara 40:31
Yes, it is.

Kali Dayton 40:32
And I as a nurse and nurse practitioner, I never would have thought of that.

Lara 40:36
It is.

Kali Dayton 40:39
Add that dose of reasons why to keep our patients moving.

Lara 40:42
Yes, it is. And this, from from this ICU, I was moved to a hospital close to my city because it was far away. Because I was in rehabilitation on the coast, where it happened, and they moved me back to my place where I live. And they put me in the other ICU again, for some days.

Because they didn’t read the paperwork from other hospital and trying to figure out what’s wrong with me. And this is another story. Yeah. Yeah, and in this time, I think the physiotherapist came, they came once a day for 10 minutes.

Kali Dayton 41:42
After being sedated for nine days, that’s all you got?

Lara 41:46
Yeah, for the next five days, I think. And I was on the cables. And I was trying to stand beside the bed. And every time they came in and saw that they were like, “oh, no, you need to lay down”. And I was like, “What?”

Kali Dayton 42:02
“I’ve gotta get going! Gotta get out of here!”

Lara 42:05
And, and I was trying to walk beside the bed on on the spot like just trying to get my feet, you know, the pressure again.

Kali Dayton 42:17
You’re trying to rehabilitate yourself.

Lara 42:19
Yeah. And in this 10 minutes, that physiotherapist came in, they brought this sitting bike to get my strength back. So it took me I think, two weeks to like. Yeah, walk 100 meters.

Kali Dayton 42:49
Well, we had a recent study come out, looking at dose of early mobility. But the two groups as a team study, and the two groups were very close, they only had 12 minutes difference, and they both had been a median RASS of negative three for three to five days.

So I mean, the methodology was questionable, but it didn’t see a difference between the two. But hearing that approach to rehabilitation, 10 minutes a day, after nine days of deep sedation, and that just can’t be enough.

And that’s probably why it took so long. Had you had more frequent and aggressive rehabilitation….. there’s no question in my mind that you would have been walking longer, further, sooner.

Lara 43:32
Yes. I was glad my mom brought me this Thera band.

Kali Dayton 43:41
Brilliant.

Lara 43:42
I was able to do some things in my bed and I did with this. But yeah, it wasn’t by the hospital rehabilitation. I mean, my sister, she’s a physiotherapist. Okay. And she, she knows she sent me pictures, what I should do and videos like, how to do it the right way.

Kali Dayton 44:11
Yeah, that’s, that’s validating because when I’m working with teams, we’re working on family packets. And we’re putting in pages that go along with those bands that we’re gonna provide to say, the loved ones to say, you can help with rehabilitation. These are things that we can do in the bed when we’re not even in the room. Yes, but that was your family’s instinct.

Lara 44:31
Yes. And, you know, this time around, when I was awake, I was sitting in my bed the whole time holding my cell phone straight up. This is I mean, I was weak afterwards. I had my problems with sitting up at my desk straight for studying for the exams because straightaway after I went out of hospital I had an exams.

Kali Dayton 45:02
Yeah. You also have Ehlers Danlos Syndrome, or EDS. So that I would just think that it would be even more important to mobilize early on. You have weak connective tissue, you have chronic mobility issues. So preserving your baseline is really important.

Lara 45:24
Yeah. But being awake, I was able to, you know, they had the taller chairs have my bed where I was able to go when I needed and I was able to work out with the physiotherapist during this time. And it was fine.

I I mean, it wasn’t long, but I was able to do something every day and I didn’t get rusty. Yeah. I didn’t get restless so much. And, you know, the day after I was activated, I was able to go on a different word, a normal ward, but the surgery ward.

They had a big bathroom and I went and washed my hair and had a shower. And it was the next day after they extubated me and I couldn’t see this the time around where I was the last time when I was intubated for this nine days.

Kali Dayton 46:44
Yeah, those things that we don’t think about in the ICU. I mean, the value of a shower. I mean, I’ve showered intubated patients, but I haven’t seen other ICUs have shower rooms on the unit.

Lara 46:53
No, they didn’t have but yeah, we had to walk across the hospital to this other war. But you could you could have. I could Yeah, amazing. This is this was so valuable to me.

Kali Dayton 47:11
Yeah, it’s for your sense of sanity, humanity, dignity, comfort all of it. No, it makes absolute sense. When do any of us go weeks without showers? Yeah, with real running water.

But your insight and your experiences having had it both ways is so invaluable? From the deliriums the ICU acquired weakness to the hygiene to the autonomy to the communication. I mean, night and day, you you get it, you know it all.

Lara 47:40
Yes. And I, I know how I want to approach patients when I’m a doctor, and in this country, we have a university hospital that is working with intubated patients that I would wake, but it’s just this one hospital. And I don’t know of any other hospitals that do that.

So I was really glad to that this other hospital now gave me this opportunity to get this different experience. I don’t know if if it happens again, if it will be this way. Because it always depends on the people working there the day.

Kali Dayton 48:45
You can also I mean, at least here in the states, we have advanced directives, we can say what our wishes and wants are, we can tell our primary arrow or our are advocates, but our preferences are so past survivors that I’ve talked to they they written out orders protecting themselves from unnecessary sedation.

So I hope you have that opportunity to I hope you never end up in the ICU again. First of all, but you have some chronic conditions where you know, that could happen.

And I’ve had other survivors when episode three of the pop my podcast is from an three times ARDS survivor. The first time she had the “classic treatment”. And she had a terrible experience and rehabilitation. And then she had an attorney draft of documents to protect her from sedation.

The next two times she was awake texting your same experience. Yes. And she said so she said I’m not afraid of ventilators. I’m not afraid of the endotracheal tube. I’m terrified of sedation. Yes, sedation is what I’m afraid of. And so thank you for sharing your insights with us. I wish you the best of health and luck. We’re all we’re all behind you in this so if anyone wants to reach out to the ICU revolution, so we end up in the ICU again. We’ve got your back

Lara 50:00
yeah thank you

Kali Dayton 50:03
Thanks so much Laura Keep us posted. Good luck in your studies. You’re gonna be a great doctor.

Transcribed by https://otter.ai

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