Gas Exchange?

Embarrassment detours us away from knowledge. Assumptions interfere with understanding. Ignorance leads to poor decisions. And so, let’s exchange some thoughts about . . .


I thought about these three—embarrassment, assumptions, ignorance—when I finally spent a few moments learning about a health concern that has been frequently referenced during my hospice’s weekly patient care meetings.

While reviewing patients, all of them nearing death, we mention odd words like cachexia and ascites. I eventually learned what those meant. We have discussions with health care medicalese like POLST, PRN, and SOB. The meaning behind those acronyms became second nature to me. I also didn’t have to ask a nurse or do a web search for “anticipatory grief” or a Foley catheter. There were some things I already knew!

Years ago, while attending those initial weekly meetings (officially dubbed IDGs, or InterDisciplinary Groups), I recall hearing the term “gas exchange.”

Gas exchange?


I suppressed a smile at that phrase. However, no one else was smiling. After all, the room included a knowledgeable physician, compassionate nurses, experienced medical social workers, and thoughtful chaplains. All smart people. Compared to me, they were health care veterans. They probably didn’t smile at anything. As a guy who had mostly spent time serving churches, trying to get through a Sunday sermon, and who had luckily stumbled onto a job where I could help with bereavement support, I was clueless.

And still trying not to smile.

Gas exchange? How can that be a concern for hospice patients?

Embarrassed a little, I actually thought they were referring to flatulence. Since I was ignorant, and I have an overly active imagination, I quickly assumed it involved a patient . . .


There, I said it.

How could I not smile? Except that I also suspected my false farting assumptions as a possible health care “concern” had some legitimacy. As a minister, I have visited church members in hospitals. This was after major surgeries, or while they were healing from serious illnesses or accidents. They sometimes struggled with, well, okay, flatulence. Of course, kids and teens will joke about farts. They are smelly, noisy, gassy, and always embarrassing. But when visiting in a hospital, I sometimes realized how awkward some church members acted because they couldn’t fart. Or, because their minister was present, they tried to stop their endless farting. Their “gas” was uncomfortably caused, or uncomfortably prevented, by drugs, a recent procedure, food, and more.

Finally, I learned that “gas exchange” has nothing to do with the fancy “F” word (flatulence) or the silly one (fart).

How embarrassing to make such a wrong assumption!

The Kaiser Permanente website describes gas exchange:

Respiratory failure involves the breakdown of a process in the lungs called gas exchange. Normally, the air you breathe in through your nose and mouth travels down your windpipe and into air sacs in the lungs. Along the walls of these air sacs are tiny blood vessels called capillaries. The oxygen in the air then moves into the blood through the capillaries. Simultaneously, carbon dioxide moves from the capillaries into the air sacs, completing the gas exchange. It is then exhaled. Respiratory failure occurs when the lungs fail to sufficiently perform either or both of these jobs.

Gas exchange is about precious, precious breath. Inhaling . . . exhaling.

During most dull, average, or thrilling days, I rarely think about breathing. Sure, as a kid playing sports, I had the “wind knocked out of me” a few times. When backpacking in the Sierra Nevada wilderness, I could get short of breath at the higher elevations. Once I had pneumonia, and that compromised my breathing—until I got better and (mostly) forgot about it.

Breathe-in. Breathe-out.

But there are hospice patients (such as those with amyotrophic lateral sclerosis or chronic obstructive pulmonary disease) confronted by a “gas exchange” that is no longer working like it once did. Of course this concern was part of what the hospice doctor and nurses were trying to help patients with on a daily basis. While there would be no healing or returning to “normal,” the hospice medical staff would try to do everything in their power to ease the patient’s suffering.

I no longer smile when a patient’s “gas exchange” issue is referenced. Serious people are trying to address a serious problem.

However, when “gas exchange” is cited in a patient care meeting, it does remind me of the mistakes I make in every part of my life.

Embarrassment about certain subjects will keep me ignorant about the facts.

It’s easy to hide my deep ignorance with surface assumptions. Those assumptions may cause me to wallow in guilt or to lash out and blame others, rather than to seek the best information.

I so often need to “take a breath” and stop assuming.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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