A Surgeon's Long Night's Journey into PTSD

As a neurosurgeon, the Intensive Care Unit used to be my safe place. Over the past few decades, I have consigned thousands of individuals to be intubated and placed on ventilators. As a veteran of Desert Storm, have participated in research studies to evaluate brain function among my fellow veterans afflicted with PTSD. It never crossed my mind that I might experience PTSD myself as a result of being intubated inside my own ICU.

- By Allan Hamilton, MD

I had to undergo surgery for an abscess that had ruptured in one of my lungs. It is perfectly normal after such a surgery to keep a patient intubated and on a ventilator. This maneuver allows the patient to rest the lung and recover respiratory function while the ventilator does the work of breathing. I fully understood what to expect after surgery. I know the ins and outs of intubation and figured I could deal with it as well as anybody.

When intubated, individuals have a wide-bore, flexible plastic hose inserted into their windpipes. Remember the last time you accidentally had a drop of water head down the “wrong pipe?” Remember how you sputtered, coughed, and choked half to death on that one swallow? Over millions of years, humans have evolved an exquisite “gag reflex,” meaning that anything that threatens our airways can be counted on to produce a violent physical response. Your heart can race up to nearly two hundred beats a minute. Your blood pressure can soar to dizzying heights. I have had several patients who were undermedicated for intubation and their blood pressure took offlike a rocket, and they developed an intracerebral hemorrhage. I met those patients because I had to remove the blood clot from their brain.

There is almost nothing you can do that will unleash as powerful a fight-or-flight response as intubation. For this reason, we go to great lengths to heavily sedate patients and blunt their sensorium. Basically, you want to zonk them out so thoroughly that their bodies will not react to the endotracheal tube. The overwhelming majority of patients never recall being in the ICU, let alone on a ventilator, because we have them snockered on medication. That is how it is supposed to work.