General Question
Can those of you who don't want to get a flu shot explain to me why you won't get one? (See details)
The patient is a 40 year old woman with two children, no significant past medical history. She came to the hospital in acute respiratory distress and rapidly needed intubation, which means put a tube down the throat and put on a ventilator. Usually when people are placed on the ventilator they improve, but she continued to deteriorate. Her chest x-ray, which normally has nice clear lung fields, was “whited out” meaning that her lungs were full of fluid, although one side was worse than the other. Her oxygen requirements continued to climb until finally I was at the complete maximum of 100% oxygen. Despite that her O2 saturation, which for any of you will be above 95%, was 55%, indicating, basically, that she was dying. I increased the pressures on the ventilator (for the medically minded—I had to turn up her PEEP to 22), which markedly increases the risk of pneumothorax, or popping the lung like a balloon. We also manipulated her ventilator such that she spent more time inspiring instead of expiring (again, for the medically minded inverse-ratio ventilation). Despite this her oxygen levels refused to improve. Multiple times we had to take her off the ventilator completely and manually bag her. Even with this, her saturations never got higher than the low 70s. I did the last thing I could, I medically paralyzed her. This didn’t work either. I had used up my bag of tricks, the patient was dying, and there was absolutely nothing I could do. Then, at the point of my maximal despair, our stat flu titres came back—positive for H1N1 influenza. (It was here I wrote my question from before).
When this came back I did the only thing I could, I asked everybody if they’d gotten their flu shot. We had been in and out of the room—most wearing masks, but some not, and there was an EKG technician who was there when I asked her, her eyes went wide and said in a small voice, “no.” I said, “Go. Now.” She went.
Eventually we got her a little more stabilized by turning her on the side that was less affected. That had the effect of shunting blood to the “good” lung and away from the “bad” lung. This was the first thing that actually seemed to work, and her saturations climbed to the low 80s. Still, I was convinced she would die.
But she didn’t and is still alive, barely. She has a tracheostomy, meaning that we surgically put a hole in her trachea so we can more easily ventilate. She also will probably need a gastrostomy—a tube in the stomach so she can be fed chronically.
She received steroids and paralytics, which will mean that she is at a high risk for developing a neuropathy—meaning that she will be weak and unable to walk for weeks or even months, if at all. If she lives, she will need intensive rehabilitation.
All of this could have been prevented by a simple flu shot at the drug store. My question to the collective who do not get vaccinated is why not? I’m truly curious.
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