breathing space.

We inhale oxygen, and we exhale carbon dioxide. This has been fundamental knowledge taught to us in grade school, brought up again in biology class, and resurrected in clinical parlance during medical school. It is the most basic respiratory process there is, and yet, every single minute, or fraction thereof, is a continual affirmation of the dynamism of life, as we take in and give off each specified quantity of air in a repeated process that we so easily take for granted in our daily humdrum.

For my part, I guess all it takes is one glance at a bedridden patient, stricken with end-stage lung cancer and/or COPD and perpetually hooked to an AC mode mechanical ventilator, to realize the fact that the ability to breathe – fully and freely – is tantamount to being greatly fortunate.

It is all about breathing space, I thought. Hypoxia, hypercarbia, ventilation-perfusion mismatch, shunts, and similar mechanisms lend themselves to a host of airway diseases, parenchymal pathologies, and other pulmonary aspects of systemic disorders, the result almost always a harrowing, inhuman sense of difficulty to breathe. As pulmonologists, we can’t always bring our patients back to the fullness of normalcy (COPD and lung cancer being hard or altogether impossible to reverse, for instance) but we can at least alleviate their difficulty and help them avail, in one way or another, of this basic respiratory instinct of humankind.

Of course, there are the usual culprits. PGH as a whole continually reeks of PTB; in my two week rotation alone, just when I thought TB couldn’t surprise me any further, I was able to witness the metamorphosis of this dreaded mycobacterial disease in all its notorious forms and stages: from the completely asymptomatic suspect to the patient with active disease to cases of relapse, retreatment, and multi-drug-resistance, on to tuberculomas, tuberculous effusions and heavily disseminated cases. Even with the earnest efforts of the TB-DOTS programs that abound in the country, I believe much is still to be done and overcome in the long, hard battle against TB, in changing preconceived notions and false practices, and in the due encouragement of both collective and individual vigilance.

These diseases, I saw engraved on paper, thanks to the spirometry sessions that provided a breath of fresh air from the atmosphere of wards and clinics. My PFT sessions were a joy in themselves, as we went about trying to instruct patients on how to blow properly and then gradually seeing the graphic lines evolve on paper. It didn’t take me long to recognize the power of such a simple procedure. By merely looking at values and ratios alone, one could already determine the general pattern of pulmonary dysfunction and consequently take steps in further addressing and preventing functional deterioration.

But perhaps the most significant moment for me was when I stood inside the endoscopy unit keenly observing the conduct of video-assisted bronchoscopy being performed on a patient with a bullet to his chest. From an ordinary bystander, the airways seemed to look like ringed tubes with occasional streaks of mucus here and there, and I reckoned this is where one must submit to a flawless mastery of pulmonary anatomy, the scope poking and scouring the sturdy bronchi for potential problems.

Emerging from that endoscopy unit, I can’t help thinking how pulmonologists, in treating respiratory ailments and helping our patients to breathe, can create so much impact and difference in their quality of life. My meager experiences are but a slight preview of what lie ahead, the long road towards flawlessly performing endotracheal intubation, doing thoracentesis dexterously, or tinkering with the finer points of MV settings, but I hope I’m getting there. All it takes is one simple, genuine desire to help patients get better – and assure them their share of ample breathing space in the world.