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Wednesday, June 13, 2007
(4:31 PM) | Stephen:
It's Easy To Not Care

I don't swim. I don't like getting in water that reaches up to or above my chest, because it reminds me too much of the beginning stages of an asthma attack. In fact, the type of evenly distributed pressure upon the chest that one feels while submerged is probably the closest that a non-asthma sufferer can get to feeling like an asthmatic.

When you have an asthma attack, the muscles lining the bronchial tubes in your lungs rapidly constrict, reducing your ability to take in air. At the same time, inflammatory cells accumulate on the inside of the tubes, further shrinking the available space for air. Asthma is an evolutionary legacy from the distant past, when our only defenses against illness were the methods that our own bodies developed; it's a sign of a hyperactive immune system.

An asthma attack is suffocation from the inside out. When one occurs, your body starts to ramp things up in order to get more air inside the lungs and keep the oxygen flowing throughout your system. But as you take more and faster breaths, whatever it was in the air that triggered the response in the first place is just being brought into your system in greater and greater amounts, resulting in your body's attempts to save itself actually causing greater distress and danger.

Sooner or later your body will produce mucus in order to protect your lungs from the irritant. As you aspirate the mucus, you are forced to cough, often uncontrollably. Your heart is thrown from its normal rhythm, your diaphragm is worked past exhaustion. Sweat breaks out along your forehead, and your eyes become extremely bloodshot. The more you cough to remove the mucus in order to breathe clearly, the more your body senses the need to produce mucus. The vicious cycle becomes worse with each quasi-breath, each cough, each wheeze.

When you are able to take in a breath without causing a coughing fit, it's impossible to inflate your lungs, no matter how hard you try. The air feels cold coming into your system, your chest aches with the effort of drawing in a breath that might be 1/5 of normal. As the attack progresses, your ability to breath diminishes, your body starts to ache, you start to lose your physical strength as your body, now fully in a panic, pulls resources away from your limbs in order to preserve your heart, your chaotic lungs, ultimately your brain. If the attack is severe enough, then your body will just continue to shut systems down, one by one, as the amount of oxygen you're capable of taking in declines. Ultimately you will reach the point that your oxygen intake is insufficient for keeping your key systems alive, and you will die, squeezed to death by your own body.

There's treatments, of course, for asthma. When I was a child, the best treatment available was, I kid you not, to eat 2 teaspoons of local honey each day. I did also start to get antihistamine injections, done at home by my sainted mother, to the tune of 3 each week. Finally, cromolyn sodium came on the market, a horrible, horrible capsule full of dry, gritty powder. This capsule was placed inside a device that resembles modern inhalers, except that it contained two needles that were used to pierce the capsule when it was cocked, and a fan on the end that would help to distribute the air and therefore the dry powder evenly when you inhaled it into your lungs. It's not as fun as it sounds, trust me.

And then there was albuterol, which has saved my life on more than one occasion. Take a puff, hold it in as long as you can, exhale and do it again. Your bronchial tubes open up, your lungs stop producing mucus, all is well. Except that your heart starts racing, but that's a small price to pay.

If things get really bad, then a hospital or paramedics can inject you with straight adrenaline. From my personal experience, at least, once that happens it's over and everything will be fine.

Albuterol is fairly cheap, less than $20 for a good supply of it without insurance. Depending on the severity of one's asthma, an inhaler or nebulizer can last for a month or a couple of years. Adrenaline, especially since it has uses outside asthma attacks, is standard-issue for paramedics and of course emergency rooms. These in particular are well-known, tried and tested medicines, mass produced and available in a myriad of places.

Which is all the more reason to be outraged at the death of Lavonda Kimble, a 30-year-old St. Louis resident who was jailed for failure to appear over 2 traffic tickets. While in jail she had a severe asthma attack, and someone did call 911. But when paramedics arrived, no one was around to take them to Ms. Kimble. It took them 8 minutes after arriving to get back to her, 8 minutes during which her body finally lost its ability to survive under its own relentless attack.

This is not a new problem with the jail. The responding paramedic wrote in her report that
Every time I’ve been to the justice center it takes 10 to 15 minutes to even get to the patient. There is never anyone to guide us and never any sense of urgency.
I'd like to know what moron thought it would be a good idea to not have some basic medical supplies and people with a bare minimum of emergency training on hand for situations just like this. What's probably more likely, though, is that there was some moron who sold the outsourcing of inmates' medical care as a way to "shrink government" while lining the pockets of various business associates.

So because of a lack of an inhaler or at most an individual dose of adrenaline, an innocent woman died. But wait, you say. She wasn't innocent! She was in jail. Except that most people in jail are innocent, because that is where they wait until they have their trial, unless of course they can come up with their bond money. And while providing for the detention of suspects considered a flight risk or a danger, the law says that anyone who has not had a trial is innocent.

That's the deeper issue here, the real cause of stories like these. Americans have forgotten that the people who are arrested are not guilty of anything, at least not yet. Their fellow citizens sitting in jail cells have not been found guilty of any crime. And if they are convicted, once their sentence is done, once their "debt is paid to society," then they are supposed to be citizens again. But that has become not good enough for this society. Those convicted of crimes must pay for the rest of their lives, by forcing them to report convictions on applications, by permanently taking away their right to vote, by not caring enough about our prisoners to make sure that when they do get out they've had opportunities in prison to improve more than their ability to do violence and their sense that society will never have a place for them to make a living honestly.

We dismiss the casual sadism of jailers who don't care enough about their charges to make sure that paramedics can reach them in time to save their lives. We joke about the violence that takes place in prisons, and always, we always clamor for more penalties, more activities to be made into crimes, more felonies, more jails, more prisons, more violence, more sadism, more Lavonda Kimbles lying on the cold tile floor of the St. Louis Justice Center struggling to take in even one God damned breath as their bodies slowly and inexorably squeeze themselves to death.

Some day you're going to breathe your last breath, and when you do you'd better hope with all your might that St. Peter standing at the Pearly Gates has a more lenient attitude toward your crimes than you did toward Lavonda Kimble.

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