A very happy Bertrand, only days ago. Photo by Phil Toledano.
Bertrand had a rough night, but I think it was largely because he wasn't allowed to eat. The concern was that he was still at risk from aspiration during intubation.
During rounds in the morning, I explained that much of his current distress was now due to hunger. (Bertrand's hunger cry is distinct from his pain cry. And, I pointed out that he kept trying to eat the tubes near his mouth.)
I convinced them to start him on a little Pediasure through his nasal-gastric tube, and he stopped crying in minutes. He's now on a continuous feed and has been relatively peaceful.
In fact, he's slept most of the day, after about 36 hours of being too uncomfortable to rest.
He's awakened every two hours to vacuum out his lungs. It sounds about like throwing a wetvac in a swamp, and while it's uncomfortable, he clearly feels (and breathes) much better afterward.
The mechanical respirator hums in the background, giving Bertrand's breathing a Vader-like quality.