"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of PICKWICKIAN.

I knew Gloria Fallows for about two years before she was admitted to Intensive Care. I first saw her as an outpatient in 1992 when she was 63. Even then she was enormous 275 pounds, five feet two inches and had trouble breathing. Her chief complaint was "shortness of my breath."

"Oh Dr. Martin!" she exclaimed back then. "I can't walk from here to there without struggling." She pointed to a wall of my office about ten feet away.

"How long Mrs. Fallows? How long's it been this bad?"

"Only the past few months. But it seems to get worse each day."

Weight was her problem. Imagine carrying a hundred-pound sack of potatoes packed around your abdomen and rib cage. Just like movement itself, your breathing would be restricted. Gloria breathed this way all the time. Each of her breaths was limited, too shallow to do a proper job of gas exchange.

We normally take in about half a quart of air with each breath. Gloria could only manage one-fourth of a quart. She needed more air than her chest cage, overburdened with largess, could oblige; as a result, her blood carbon dioxide level was too high and oxygen level too low. Gloria was comfortable at rest but exhausted - "I'm wiped out, Dr. Martin" - on walking any distance or climbing stairs.

Breathing problems also interrupted her sleep. She awoke each morning exhausted from incomplete slumber. To compensate, she frequently napped during the day, and at the worst times. She'd been in two car accidents after falling asleep at the wheel. No one was seriously hurt, including Gloria, but at age 62 she had to quit driving.

After that first visit I diagnosed Gloria's problem as typical of Pickwickian syndrome. Like all syndromes, Pickwickian is not a specific disease as much as a collection of abnormal findings. To most physicians the appellation 'Pickwickian' connotes a fat, sleepy patient who has some difficulty breathing. A more precise definition is any patient with obesity, excessive daytime sleepiness and elevated blood carbon dioxide pressure (PCO2). A high PCO2 in the blood signifies inadequate breathing or, in medical parlance, "hypoventilation."