This is a posting based upon an interaction I had with a doctor years ago while in Boston. We reached out to him and he prepared this posting for us.

A Bird in the Hand:Rationing Health Care

It was the late Winter of 1976 and we were taking care of lots of young adults with influenza and respiratory failure. There were rumors and some early reports from Fort Dix, NJ that we were seeing a form of swine flu similar to that of the dreaded 1918-1919 pandemic. All I knew was that young adults were dying and I had one on my hands right now. She was 19 years old and a college student who had been previously healthy but was now breathing 50 times a minute and tiring quickly. Even though I was in the early years of my training as a pulmonologist, it was obvious to me that she was going to require intubation (securing of the airway with a breathing tube) and support from a mechanical ventilator. My problem was that our University hospital had received dozens of similar patients over the past few weeks and we had run out of ventilators.

Fast forward to 2009 when Mr. Obama and the Congress are trying to re-engineer our system to establish limits that halt the massive cost of health care. Here is the perfect bureaucratic out – we simply have exhausted our resources. Some therefore will have to go without. She (our college student) had arrived too late. Musical chairs with a lethal outcome for the last standing. There is simply no other way to describe how we can expand coverage and cut costs simultaneously without using the “rationing” word.

But doctors are stubborn advocates for the individual patient that we are caring for. That’s our job. And when that ends, we will see the end of medicine as a profession. So I went looking for a ventilator for my dying 19 year old. In the basement of the hospital we had rows of “outdated” equipment including iron lungs left over from the 1950’s polio epidemics. Among these battalions were a number of “Bird Mark VII ventilators” that had been mothballed because they were superseded by the new wave of volume ventilators. But when you looked closely at these green plastic cubes, the elegance and simplicity of their design and function became apparent. Their source of power was compressed gas – they did not even need electricity (imagine their value in the care of patients following a natural or hostile emergency when electric power is destroyed). The pressure in the patients airway and lung caused the device to cycle from one breath to another which was why they had been passed over by newer designs. That characteristic made them more challenging to use in the patient whose lungs were stiff from influenza. They had a tendency to cycle too quickly and to not have the power to overcome the damaged and stiff lung.
An alternative for me was to swap out a “volume ventilator” in use by a less sick patient or to try to coax the Bird into saving my patient. I opted for the latter although it meant that I had to monitor her very closely and “tweak” the ventilator from time to time to be certain that it was providing the life saving ventilation that she needed.

She survived and I gained a whole new appreciation for the marvelous device that Dr. Forrest Bird had created. It used valves and magnets and was housed in a green plastic cube but it did everything that I asked it to do. But it required going beyond the norm, seeking a solution, and making sure it was implemented. I just don’t see that happening in the Obama world of government and its minions trying to parcel out limited resources to favored constituencies. Who in that world is going to go into the basement, recognize genius in the form of a ventilator and advocate for the single patient?

Who indeed… (editorial addition)