CPR, ventilators, and breath
Until this year CPR - or cardiopulmonary resuscitation - was a combination of breathing for another person and causing their heart to beat. Now the American Heart Association has announced that it is sufficient simply to perform chest compressions. Providing rescue breaths is helpful, but not necessary. This announcement was spurred by the realization that many preventable deaths occur because bystanders, afraid of mouth to mouth contact, don't initiate CPR.
CPR is too physically taxing to perform for extended periods of time, and is unnecessary when a heartbeat is present. This is when mechanical ventilators become important.
A mechanical ventilator is a machine that breathes for you. It creates a preset amount of pressure to push air into the lungs, and then stops to allow exhalation. You can breathe faster or more deeply than the machine, if you want/are able to. But you cannot inhale more slowly or with less volume than the machine allows (usually between 8 and 14 breaths per minute, depending on the settings).
Breathing is a complicated process. The machine regulates numerous aspects of pressure, intake, and output. It controls tidal volume, the amount of air that remains in the lungs to keep them from collapsing between breaths. It moderates FiO2, (fraction of inspired oxygen) the actual percentage of oxygen in the air delivered to the patient - which respiratory therapists decide based on the patient's arterial blood gas levels. It also determines PEEP (positive end-expiratory pressure), which prevents atelectasis - collapse of the alveoli (little sacs where gas exchange takes place). And it monitors the patient's response to weaning. Weaning is the process of reteaching the patient to breathe on their own. After being on a ventilator, the body has to readjust to breathing for itself. Little by little, the ventilator rate and FiO2 are lowered, forcing the patient to take over. Weaning can be very difficult, but it's necessary.
You can wake up now. :) I hope that some of that has subconsciously infiltrated your understanding, because I want to tell you how mechanical ventilators - and the concept of breathing itself - have brought me to a whole new level of worship.
Just look at how much goes into breathing! For you and I, it's simple. Most of the time, I forget I'm breathing (except when I'm running, or overwhelmed, and then I can't seem to stop thinking about breathing). And yet this - even more than food, water, or temperature regulation - is what I depend on for life. And it's not simple at all. Breathing is more than lung inflation and deflation. It's pressure regulation, it's blood gas interpretation, it's need and response constantly meeting and reversing roles. We never think about how our life hangs by seconds in the balance of tidal volume. We are too busy being afraid of deadlines, of decisions or the lack thereof, of hunger and thirst and discomfort, of fear itself.
And the most amazing part is this - when we are overwhelmed, we tell ourselves and each other to "take a deep breath and count to three." Or ten, or twenty, or however long it takes. There's a scientific basis for this. Better oxygenation of our cells helps us feel calmer and concentrate better. But we're so busy counting the time that we forget where we started counting, what we are actually waiting for, where the calmness and concentration is coming from.
2000 years ago a crowd of needy people looking for handouts came to Jesus, wondering how He got to the other side of the lake so quickly after the miraculous meal He served them. (He walked. If they had really cared about how He got places, instead of being concerned that the free food would get away, they might have learned something more astonishing than that 5 loaves and 2 fish could feed 5,000 people. But they were worrying about food.) Jesus didn't tell them how He got there. He told them, "I am the Bread of Life; whoever comes to Me shall not hunger, and whoever believes in Me shall never thirst" (John 6:35). And He immediately added what seems an odd comment, "But I said to you that you have seen Me and yet do not believe" (v. 36). And at the end He concluded, "The words I say to you are spirit and they are life. But there are some of you who do not believe" (v. 63).
And of course, they didn't believe. They didn't get what there was to believe in, beyond the fact that free food could appear out of nowhere.
Not too much later He took 12 of them into a room with Him and told them the bread He was giving them to eat now was His body, and the wine they were drinking was His blood. And they ate and drank and they didn't get it until He died, was buried, and reappeared on the shores of the lake cooking fish to feed them for breakfast. Then they started understanding that God became tangible to make people taste and see He could keep them living because He was life - what they needed, and what they were made to be filled with.
So now the people who call themselves Christians get together and share bread and wine (or grape juice, if they prefer, because just like the first 12 Disciples people will always find ways to be different and/or to disagree). They do this to remember that God can, and has, become flesh and food and everything else we need for fullness of life. And when they leave they feel renewed, purified, energized.
They walk away from Communion and they forget that there is a communion that never stops. Jesus reminded Satan of this when He was tempted for 40 days: "Man does not live by bread alone, but by every word (rhema) that comes from the mouth of God" (Matthew 4:4). "Rhema" is both a noun and a verb, meaning "a thing said" or "the action of speaking" (Guthrie, 1969); it is the same word Jesus uses in John 6:63.
Think about it. What is the action of speaking? It's exhalation, breathing out, and forming the breath into sound.
What marked the beginning of human life? Genesis 2:7 tells us that after providing everything people could possibly need - an incredible world full of food, water, and discovery - "the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature." This isn't in the Scripture, but I wouldn't be too surprised if the breath of God making the man live was also a word/words - just as all His other creations came into existence by His words. And yet this was more, because God exhaling became man inhaling - as in CPR - and of all creation man alone had something more than the power of God's word making him exist. He had the breath of God in him.
And so the man breathed and lived and was able to eat, drink, and discover.
But that was a long time ago, and his children forgot about the miracle of breathing, because it was so crucial a need that it felt common, and so frequent a need that it felt ordinary.
I watch my patients taking their forced breaths and fighting the machines that keep them alive. They flail and mouth swear words at me. They are angry that the tube in their mouth keeps them from eating and drinking and going places. They don't realize it keeps them from dying until they go on weans, or rip out their tubes and set off alarms that bring half the SICU staff running. They're just not used to thinking about breathing.
And neither am I. Every single day I get up and forget that I am part of a great Communion from which no being is exempt. My neurons devour oxygen to fuel my worrying that I have to take my car for an emissions check, and pay for it too, when I'd rather go running or read a book, and when I feel I have no money.
Is any of this hitting home?
Mechanical ventilators, CPR, and now increasingly the act of breathing itself remind me that maybe Jesus had to become broken flesh and broken blood, broken bread and crushed grapes, because I was so busy breathing I forgot what breath was.
Or maybe... Who.
Guthrie, W.K.C. (1969). A history of Greek philosophy: Volume III, Part 1. New York: Cambridge University Press, p. 220
CPR is too physically taxing to perform for extended periods of time, and is unnecessary when a heartbeat is present. This is when mechanical ventilators become important.
A mechanical ventilator is a machine that breathes for you. It creates a preset amount of pressure to push air into the lungs, and then stops to allow exhalation. You can breathe faster or more deeply than the machine, if you want/are able to. But you cannot inhale more slowly or with less volume than the machine allows (usually between 8 and 14 breaths per minute, depending on the settings).
Breathing is a complicated process. The machine regulates numerous aspects of pressure, intake, and output. It controls tidal volume, the amount of air that remains in the lungs to keep them from collapsing between breaths. It moderates FiO2, (fraction of inspired oxygen) the actual percentage of oxygen in the air delivered to the patient - which respiratory therapists decide based on the patient's arterial blood gas levels. It also determines PEEP (positive end-expiratory pressure), which prevents atelectasis - collapse of the alveoli (little sacs where gas exchange takes place). And it monitors the patient's response to weaning. Weaning is the process of reteaching the patient to breathe on their own. After being on a ventilator, the body has to readjust to breathing for itself. Little by little, the ventilator rate and FiO2 are lowered, forcing the patient to take over. Weaning can be very difficult, but it's necessary.
You can wake up now. :) I hope that some of that has subconsciously infiltrated your understanding, because I want to tell you how mechanical ventilators - and the concept of breathing itself - have brought me to a whole new level of worship.
Just look at how much goes into breathing! For you and I, it's simple. Most of the time, I forget I'm breathing (except when I'm running, or overwhelmed, and then I can't seem to stop thinking about breathing). And yet this - even more than food, water, or temperature regulation - is what I depend on for life. And it's not simple at all. Breathing is more than lung inflation and deflation. It's pressure regulation, it's blood gas interpretation, it's need and response constantly meeting and reversing roles. We never think about how our life hangs by seconds in the balance of tidal volume. We are too busy being afraid of deadlines, of decisions or the lack thereof, of hunger and thirst and discomfort, of fear itself.
And the most amazing part is this - when we are overwhelmed, we tell ourselves and each other to "take a deep breath and count to three." Or ten, or twenty, or however long it takes. There's a scientific basis for this. Better oxygenation of our cells helps us feel calmer and concentrate better. But we're so busy counting the time that we forget where we started counting, what we are actually waiting for, where the calmness and concentration is coming from.
2000 years ago a crowd of needy people looking for handouts came to Jesus, wondering how He got to the other side of the lake so quickly after the miraculous meal He served them. (He walked. If they had really cared about how He got places, instead of being concerned that the free food would get away, they might have learned something more astonishing than that 5 loaves and 2 fish could feed 5,000 people. But they were worrying about food.) Jesus didn't tell them how He got there. He told them, "I am the Bread of Life; whoever comes to Me shall not hunger, and whoever believes in Me shall never thirst" (John 6:35). And He immediately added what seems an odd comment, "But I said to you that you have seen Me and yet do not believe" (v. 36). And at the end He concluded, "The words I say to you are spirit and they are life. But there are some of you who do not believe" (v. 63).
And of course, they didn't believe. They didn't get what there was to believe in, beyond the fact that free food could appear out of nowhere.
Not too much later He took 12 of them into a room with Him and told them the bread He was giving them to eat now was His body, and the wine they were drinking was His blood. And they ate and drank and they didn't get it until He died, was buried, and reappeared on the shores of the lake cooking fish to feed them for breakfast. Then they started understanding that God became tangible to make people taste and see He could keep them living because He was life - what they needed, and what they were made to be filled with.
So now the people who call themselves Christians get together and share bread and wine (or grape juice, if they prefer, because just like the first 12 Disciples people will always find ways to be different and/or to disagree). They do this to remember that God can, and has, become flesh and food and everything else we need for fullness of life. And when they leave they feel renewed, purified, energized.
They walk away from Communion and they forget that there is a communion that never stops. Jesus reminded Satan of this when He was tempted for 40 days: "Man does not live by bread alone, but by every word (rhema) that comes from the mouth of God" (Matthew 4:4). "Rhema" is both a noun and a verb, meaning "a thing said" or "the action of speaking" (Guthrie, 1969); it is the same word Jesus uses in John 6:63.
Think about it. What is the action of speaking? It's exhalation, breathing out, and forming the breath into sound.
What marked the beginning of human life? Genesis 2:7 tells us that after providing everything people could possibly need - an incredible world full of food, water, and discovery - "the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature." This isn't in the Scripture, but I wouldn't be too surprised if the breath of God making the man live was also a word/words - just as all His other creations came into existence by His words. And yet this was more, because God exhaling became man inhaling - as in CPR - and of all creation man alone had something more than the power of God's word making him exist. He had the breath of God in him.
And so the man breathed and lived and was able to eat, drink, and discover.
But that was a long time ago, and his children forgot about the miracle of breathing, because it was so crucial a need that it felt common, and so frequent a need that it felt ordinary.
I watch my patients taking their forced breaths and fighting the machines that keep them alive. They flail and mouth swear words at me. They are angry that the tube in their mouth keeps them from eating and drinking and going places. They don't realize it keeps them from dying until they go on weans, or rip out their tubes and set off alarms that bring half the SICU staff running. They're just not used to thinking about breathing.
And neither am I. Every single day I get up and forget that I am part of a great Communion from which no being is exempt. My neurons devour oxygen to fuel my worrying that I have to take my car for an emissions check, and pay for it too, when I'd rather go running or read a book, and when I feel I have no money.
Is any of this hitting home?
Mechanical ventilators, CPR, and now increasingly the act of breathing itself remind me that maybe Jesus had to become broken flesh and broken blood, broken bread and crushed grapes, because I was so busy breathing I forgot what breath was.
Or maybe... Who.
Guthrie, W.K.C. (1969). A history of Greek philosophy: Volume III, Part 1. New York: Cambridge University Press, p. 220
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