During rounds in the ICU, crowded around an intubated, ventilated patient, the attending perused his platoon of intimidated interns and said “Repeat after me: Ventilators are not Therapy”
This particular attending, a plucky, pontificating pulmonologist, was short, both of stature and temper, and I nicknamed him Nappie. This sobriquet served up the delightfully duel indignities of being both, redolent of whiny babies in diapers, and also cleverly ‘short’ for Napoleon.
“Ventilators are not Therapy” droned the flock.
“Respiratory Therapist,” nipped Nappie, “why didn’t you chime in?”
I do have a name. It’s there on the badge in fine print underneath the giant capitalized “RESPIRATORY THERAPIST.” But that’s not important. We’re just there to smile and push buttons.
“I’m sorry, I couldn’t speak because all my energy was focused on not rolling my eyes at you,” I smiled. “Did I succeed?”
The only person in the room that laughed was the patient. I couldn’t hear him of course. Intubated. But his peak pressures shot up for a moment. So I took that as a sign of approval.
“Ventilators are not Therapy!”
Medicine is chock full of these kinds of axiomatic absolutes. Maxims meted out mindlessly generation after generation and regurgitated time and again as indisputable truths.
Sound and fury, signifying nothing.
The fundamental point being made by this particular dictum is actually a solid one. What Nappie means when he says that ventilators are not therapy is that ventilators do not cure the underlying illness that makes ventilation necessary. They only support the patient until the pathology resolves. I’m totally on board with this idea. Also, giant DUH. You mean my tidal volume and PEEP settings didn’t cure the sarcoidosis?? No way!! But, anyhow, reducing concepts to these pithy little precepts does exactly that, it reduces the concepts. It reduces them into something unchallengeable, leaving the student at an educational dead end where further thought or analysis is not only dispensable, but discouraged.
“This is box that pushes air into patient. It is not therapy. I is edumacated now. I be doctor.”
It all boils down to semantics. It is a definitional argument. If the delineating factor between “therapy” and “support” is that therapy battles the disease while support helps the patient survive the disease, well then 99% of what we do isn’t therapy. We’re left with surgery and antibiotics. We might as well shout out “Medicine is not therapy!”
So, fine. Let’s say ventilators are not therapy. But, there’s yet another common soundbyte one hears in respiratory care: “Oxygen is a drug!” So I guess you can call the ventilator ‘pharmaceutical support’ if you’re in the “not therapy” camp or call it “drug therapy” if you’ve joined the “Oxygen = Drug” cult or call it “Skynet” and wait for it to become self-aware so it can push its own buttons. The point is, it doesn’t matter what you call it as long as you know how to use it to benefit the patient. And ventilators absolutely benefit the patient. I think on this point, although he was not nearly as amused as the patient, Nappie and I agree.
“The art of medicine consists of amusing the patient while nature cures the disease.” – Voltaire