"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: These stories can be downloaded in their entirety from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the downloaded or print versions, please go to 1st Books Library and enter the first part of the title in their search engine. Below are the first few paragraphs of ASTHMA IN THE LAST TRIMESTER

About five percent of the population in industrialized countries suffers from asthma. An asthma condition can range from minimal symptoms, with little or no impact on daily activities, to severe and life-threatening disability. Asthma can develop at any age. I have often seen asthma develop for the first time over age 60 and in people with and without an allergic history.

In an asthma attack smooth muscles lining the bronchial tubes, the airways of the lungs, contract or tighten. This contraction (also called bronchospasm) leads to narrowing of the airways. At the same time the bronchial walls become inflamed and secrete thick mucous into the airway, causing further narrowing. To gain some idea of what it feels like during a severe asthma attack, try breathing through a straw with your nose plugged. As you breathe gradually pinch the middle of the straw until it closes about half way. Now jog in place.

In people with asthma a variety of stimuli can bring on an attack of bronchospasm, including allergic reactions, upper respiratory infection (including the common cold), exercise, climatic changes, cigarette smoke, and emotional distress. Whatever the precipitating event the result is the same: obstruction to air flow, wheezing, and a feeling of air hunger.

In a desperate attempt to bring in more air the asthmatic recruits 'accessory' breathing muscles (mainly in the neck and shoulders) and breathes faster. At the height of an asthma attack the patient looks like he (or she) just ran a marathon race (keep breathing through that pinched straw and you will too).

By definition asthma is reversible airways obstruction. The bronchospasm and excess mucous usually abate with appropriate medication. The operative word is 'usually.' Sometimes asthmatics don't respond to treatment, or respond so slowly that their condition requires hospitalization. Fortunately only a small percentage of asthmatics ever reach this stage.

Delores Buchanan was 24 when she came to the medical intensive care unit (MICU). Diagnosis: severe asthma, complicated by a 36-week pregnancy. As a child Delores suffered from hay fever but not asthma. She received allergy desensitization shots from age 12 to 15. At 18, just out of high school, she first developed symptoms meriting the label of asthma: some wheezing and shortness of breath on exercise. These symptoms were controlled with oral and inhaled medication and over the next three years she never required hospitalization or emergency room treatment.