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Dear Gov. Ducey: Here's what it's like to watch a loved one die on a ventilator

Dear Gov. Ducey,

You never met my dad, but chances are, lots of people you know who work in state government knew him. His name was Hugh Holub and he was an environmental attorney, a lobbyist, the city attorney and then the public works director for the City of Nogales, and a tireless advocate for water rights in Arizona.

In September of 2011, my dad passed away from complications from pneumonia. He was 65 years old. The day of his death he spent hooked up to a ventilator in the ICU at St. Mary’s Hospital in Tucson; he passed away at about midnight.

I’ve been thinking a lot about how I don’t think enough people have real first-hand experience of what it’s like to watch someone you love be hooked up to a ventilator and die of respiratory complications.

I’m wondering if you do. Because if you did, you might be a lot more willing to wear a face mask in public and require people to do so, or be a lot less cavalier about insisting that we’re OK as long as we have enough hospital beds and ventilators for people who get sick with COVID-19.

Related guest opinion: Tucson ICU nurse: COVID-19 is real & people are dying

If you did, you might implement stricter guidelines for reducing the number of coronavirus infections statewide. As of this writing, 1,194 people have died from COVID-19 in the state of Arizona. That’s 1,194 individual human beings who had families who loved them, and who didn’t have the luxury of sitting with them in the hospital while they suffered.

So those families maybe don’t know what it looks like to be on a ventilator either, and it’s not like you can go to the hospital and see it for yourself.

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So I’ll do you a favor and I’ll tell you about what my father, someone who played an important role in the history of our state, experienced at the end of his life.

Maybe, just maybe, it’ll motivate you to allow local municipalities the power to enact their own protective measures, or even implement stricter statewide guidelines to actually slow and stop the spread of the coronavirus. And save human lives.

Sunday morning, September 18, 2011. I arrived at St. Mary’s with all of the things my dad requested after he’d been medivaced there the previous evening after experiencing heart arrhythmia. He’d gone into cardiac arrest upon arrival and I had to stand back as they shocked his heart back into rhythm in the ER, but that night he’d been talkative, asked me to bring him a danish and the Sunday New York Times.

But when I got to the ICU that morning, my dad’s wife and I were immediately told that they needed to ventilate him.

He was terrified. Ventilation means being put into a medically-induced coma. It means gigantic tubes are inserted down your trachea and a machine breathes for you. “We need to let your lungs rest so they can heal,” the nurses said. “We need time while we wait for the chest scans to find out what’s wrong.”

My dad had been fighting some kind of respiratory ailment for about three weeks, and hadn’t really improved. He’d been to a pulmonologist the Wednesday before, who said it could be anything from an infection to lung cancer, and ordered chest scans which had to be approved by Medicare.

He joked to me, “If whatever I have doesn’t kill me, Medicare will!” Now, as the respiratory therapists and nurses crowded around him, he held his wife’s hand and said, “Someday we’ll climb that mountain,” meaning Mt. Wrightson, which he could see from his house in Tubac.

Those were his last words.

I had to leave the room while the medical professionals hooked my dad up to the ventilator. My friend Mel Mason, an RN who worked in the emergency room at Tucson Medical Center for just under three years and who was called back to the ER to work with COVID patients for a while, described the process of intubation to me.

“The patient must be sedated — or unconscious — and paralyzed, to prevent a gag reflex,” she said. “Two drugs are given in rapid succession through an IV to accomplish this. Once the patient is unconscious, a metal blade is placed into the throat to move the tongue and epiglottis to expose the larynx — or voice box — and help guide the placement of a tube in the trachea, the structure which leads to the lungs. A balloon is inflated inside the trachea to hold the breathing tube in place. After the doctor verifies the tube is in the right place, the portion of the tube hanging out of the patient’s mouth is taped to the face to prevent it from slipping out. This end of the tube is then connected to a ventilator, or breathing machine.”

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For most of the day my dad died, I sat in the room and watched his chest inflate to an unnatural size, his whole chest cavity expanding as if it might burst, and then dramatically deflate.

Over and over and over again. It’s unsettling, robotic, a gross exaggeration of what breathing is. Instead of the natural rhythms and nuances of human breath, a ventilator turns a human body into an oxygen pump. It is utterly dehumanizing, while it is intended to be lifesaving.

What I didn’t know then, what no one told me, is that the chances of survival are low once you’re hooked up to a ventilator. That being hooked up to a ventilator means your lungs cannot breathe enough for you; they cannot bring in enough oxygen for the rest of your organs to work. A ventilator is a hope and a prayer. It’s not a fail-safe solution. It’s the best medicine has for a worst-case scenario.

A ventilated patient is exhausting to watch and listen to; for the person themselves, it is so debilitating that if they survive, they have to recover from the ventilation itself.

My friend Tyler Martino, who is an EMT, has an MS in Cellular and Molecular Medicine, and has logged many hours working in emergency departments, put it this way: “Breathing is a process that involves many muscle groups, the most notably of which is the diaphragm. Since the ventilator is creating pressure changes in the thoracic cavity rather than the diaphragm, all muscles involved in breathing weaken and thus, are quite ineffective upon being liberated from the ventilator. The recovery is long and often accompanied by depression and post-traumatic stress.”

My dad had a catheter; a bag of odorous urine hung from the side of the bed. More machines than I could count surrounded him, beeping, buzzing, a constant cacophony of last-ditch effort. The only signs of life. His skin was pallid. Nurses had to come make adjustments, rotate his unconscious body slightly, every hour or so.

I finally went home around 10 p.m., only to be called back at 11:30 p.m. by the ICU nurse, who told me to get back to the hospital as soon as possible.

By the time I got there, around midnight, I’m pretty sure my dad had already passed. You just know when someone close to you has died; you can sense that their energy is gone. You can see the lack of life in their face. The official time of his death is a few minutes after midnight, when they finally pulled the plugs on everything, after his wife and I said our goodbyes.

But I was lucky, Gov. Ducey. I got to be there for my dad. He knew I was there when he went under.

COVID-19 patients do not get this luxury. As my friend Mel Mason, the ER nurse, explained to me, “COVID-19 changes the process of intubation. Because intubation may cause fine droplets of saliva to be sprayed into the air, referred to as aerosolization, extreme precautions must be taken to keep the staff safe.”

This involves personal protective equipment for the staff as well as the patient, including removing the patient’s gown and placing the patient under a plastic sheet. Mason continued, “Patients have been spending days, even weeks on ventilators. Eventually, the patient may have to be turned onto their stomach — or ‘proned’ — since studies show this improves chances of proper oxygenation.”

“Patients must endure all of this without the comfort of family or friends; other than the company of masked strangers, they are alone for what is most likely the most traumatic experience of their lives.”

Is this what you want for the citizens of Arizona, Gov. Ducey? To die alone, hooked up to a machine, naked under a plastic sheet, without the comfort of friends or family around?

Or even if they do survive, to simply endure this trauma alone?

Sure we may have enough ventilators and ICU beds for COVID patients. But I certainly do not want to spend a single moment in one, nor do I want any of the people I love to either.

Your insistence that Arizona is OK because we have hospital capacity sounds cruel and ignorant to those of us with experience watching loved ones die in the ICU hooked up to a ventilator.

If my father were alive, I’m sure he would have choice words for the situation we’re in.

Many of us in Baja Arizona are begging you: Do something. Allow mayors to enact their own restrictions. Mandate masks. Close non-essential businesses. Social distancing is not enough.

Arizonans are dying, Gov. Ducey. Their breath is in your hands.

Sincerely,

Annie Holub

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courtesy Annie Holub

Hugh Holub, with daughters Annie and Beth, in 2010.

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