November 16, 2001 (Ira Pilgrim)

A Case of Asthma

He has been a doctor a year now and has had two patients no, three, I think -yes, it was three; I attended their funerals.

Mark Twain (1835-1910)

It was in the early 1950s. I was a graduate student in Zoology at the University of California in Berkeley. I had 4 children and, to support them, I had a job as a laboratory technician at Children's Hospital in Oakland. I had been taught the trade in the army and had passed the California state examination for laboratory technicians. It was the perfect job for a student. I was paid a full time salary for being on call every night of the week as well as working a full day on Saturday and half a day on Sunday. My days were free for classes and I didn't get called too often. Usually it was for something like a case of meningitis which couldn't wait until morning, or for a child who needed an immediate blood transfusion.

One evening I was called out to do some blood tests, which could have easily waited until morning, on a patient of one of the more difficult pediatricians. He was the sort of person who, if you suggested something, would let you know in no uncertain terms that he was the doctor and that you were just a lowly technician. This was in contrast to most of the other doctors who treated me as a fellow human being and respected my skills.

I arrived at the bedside of a boy about 7 years old who was gasping. He was breathing out with great force. It was like someone trying to puff out a candle, only it was over and over with every breath. His mother and father were at his bedside, helpless as they watched their son in great distress. The boy's face showed panic. This had been going on, they told me, for days.

I had been studying the anatomy and physiology of the lung and I knew that in asthma the bronchioles, the smallest of the air passages, were narrowed and that the big problem was not getting new air in, but getting the old air out. When the boy tried to force air out through constricted bronchioles he increased the pressure in his chest, which narrowed those passages further. As a consequence, less air was able to get out. The more he panicked, the harder he pushed. The harder he pushed, the harder it became for him to breathe. I had never seen a case of asthma, but I understood the principles involved.

I put my tray aside and sat down next to him. "Let me help you to breathe," I said. I put my hand on his belly, pressed very lightly, and said, "Let me do the work; you just lay breathe in......slowly breathe out slowly." In less than a minute his breathing was almost normal. The panic was gone from his face as he breathed easily. He had gone from a panicked child who seemed to be suffocation to a normal breathing one.

The parents stood there astonished. They looked at me with the awe reserved for a miracle worker.

I said to them, "You saw what I did. All that you have to do is the same thing. The trick is to get him to breathe out slowly."

Then I took my blood samples.

Both parents thanked me profusely. As I was leaving, the father said, "What can we do for you?"

"Don't tell the doctor," I said as I walked out the door.

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