No one knows better than Paula how precious the ability to think really is. Every day, she gives thanks for waking up and still being able to think. She remembers when her ability to think was completely disrupted, leaving her unable to understand what was happening to her. Worst, even, without the ability to think and to hold on to those thoughts, she could not understand or tell anyone that her ability to think was impaired.
And what she realizes now is that when she is silently thinking she looks exactly the same as when she is silently thinking about not being able to think and not knowing why. I expect that her brain waves would be the same when her thinking is impaired as when it is fine; because the brain waves cannot pick up the content of her thought and cannot pick up if her thought lasts long enough for her to to remember.
As long as the person is silent or monosyllabic, no one can evaluate the quality of the thought or whether the quality has been degraded.
If someone had only looked at her carefully and asked…..are you able to think? …..I expect she would have said …no…something is very wrong…….or at the very least ….I don’t know….which also is a worrisome answer; no one does not know if they are able to think- unless their thinking has become impaired.
The quality of our thinking is something we take for granted, something which should be a “constant” and amazingly, it is usually stable. When thought is there but it has become impaired, then it is a sign that something is physically wrong because thinking is something that is a physical thing and takes physical energy to do, and I imagine heat, too.
We do not have to fully understand this to know it is so, and the paradox is that when thinking is impaired, we will no longer have the cognitive ability to say so, because we will not have the words to express the unimaginable. And we may not have the breathe to do so either. And so we will conserve energy by remaining silent, and vaguely worried and puzzled.
That is what Paula never wants to experience ever again.
Paula looks depressed when she is like this but she is not. She is in a quiet delirium, a recognizable state which looks exactly like a depression.
The difference between the two is the unmasking of Paula’s permanently broken ability to properly move air in and out of her lungs. This is not a lung issue, it is an autonomic nervous system issue. Paula does not know and cannot sense that her ventilatory system is broken and is damaged and that she will need help to regain her physical strength and health in order to be able to function well once again despite her permanent neural/ motor defect which makes maintaining PCO2 of the blood and tissues difficult when overcome by anything making moving air in and out of her body even more difficult than usual.
Paula does not know she has this defect. in fact her doctors are amazed that anyone with this defect can be alive. Because they have never seen such a defect. Because people do not know that they have this kind of mechanical damage. And doctors do not check respiratory rate and depth because it has never been part of their training.
So there are many Paula’s out there who are misdiagnosed with major depression or bipolar illness who actually have permanently damaged ventilatory systems, do not know it, and are not worked up for it because no one understands biology, phenotypes, mutations and without looking carefully at the pattern of vital signs [RR,BP,HR,Temperature] none of us can tell the difference between major depression and a quiet delirium. [and know that a quiet pattern of delirium can switch to a mixed or manic presentation as the ventilatory system tries to cope with rising acids in the blood. And due to mutations in the nervous systems, pulse oximetry may be normal as ca HCO3.
What is so hard about checking for broken breathing, now that you have discovered that it can be important during physical debilitating illness?
We have the tools to help patients in times of severe illness, even if we cannot fix their broken breathing. They can recover their previous physical health as it was before their severe illness, because when they were previously well-their breathing was still broken.
I hope I am being clear because I find that scientists and doctors are not understanding what uncoupling of the ventilatory system from metabolism and locomotor activity means.
Or what being alive and well despite this uncoupling means, never mind when ventilation becomes even harder-requiring supportive care.
to be continued……
Of Sound Mind 