Hope Pogemiller (MP4) and the arrival of the incentive spirometer

Posted on behalf of Hope Pogemiller (MP4) as she tells the legend of the day Adam Foss (MP4) brought the incentive spirometer to St Luc

St. Luc hospital cares for patients 13 years and older.
Since the doctors are trained primarily in adult medicine, the style of care
delivery leans toward the adult end of the spectrum. As is often topic of
discussion in the med/peds realm, delivery of care to children and adults is
fundamentally different. This has remained constant in our observations at St.
Luc.  

In the past few weeks, we have been
able to help patiently tease out history and current complaints from young
patients at St. Luc. Noting a dire need for incentive spirometry,  Adam introduced bubbles today to a 15 year
old male with a severe respiratory infection that leaves him sweating in rigors
each evening and unable to sit up in bed due to generalized weakness.  

Adam Foss (MP4) making incentive spirometry

His chest xray, unstable respiratory status,
and continued fevers have raised concern for tuberculosis. 

He was therefore
ordered to produce an early morning sputum during rounds one morning. 

He cried
out and mumbled something that was translated by staff as him refusing to
cough. 

Hospital pain scale

We contemplated a change of perspective. 

We helped him sit and
encouraged him to try to cough, but he finally explained that he was afraid
because it was so painful in his chest to cough. 

We mentioned that we could
possibly obtain a gastric sample instead of a sputum sample, and the physicians
agreed. They threatened him with insertion of a tube down his throat to
convince him to cough. 

This had not been our idea, and we were beginning to
feel uneasy when Adam enthusiastically announced that this child absolutely
must blow bubbles. 

We left his bedside as he crumpled in a heap on his bed in
relief that the team was moving on to discuss the next patient. 

After rounds,
the local physicians helped Adam find a piece of circular plastic (formerly
used to hang IV fluids) and an old medicine bottled filled with soap. 

Our
incentive spirometer was born. 

Despite my reservations that an adolescent,
severely ill Haitian boy would muster up the courage to try the bubble-blower,
our patient became suddenly enthusiastic as his face lit up with joy when he
was able to blow bubbles. Despite his fatigue and chest pain, he was able to
produce bubbles for 5 minutes and promised to try once each hour while awake. 

The local physicians and patients in the adjoining beds shared our patient's
enthusiasm, and Adam has effectively added creative incentive spirometry to the
treatments available at St. Luc.