As the COVID-19 pandemic marches on, I find that it is not enough for me to help people survive.
All too often in the ICU, we collect and analyze data, and see our patients as a set of organs to fix and a list of problems to solve.
The panicked fear that many of us felt throughout the first year of the pandemic, coupled with absence of family at the bedside, amplified the dehumanization.
I now realize that my success as a frontline critical care doctor is best gauged by my willingness to dive into the chaos of my patients’ lives. To see the person in the hospital gown.
This may come in predictable ways such as focusing on pain and anxiety during long days on mechanical ventilation or palliative care to usher in comfortable dying. Other times, it comes in unexpected approaches to suffering.
We were shackling a deeply ill man because the rules said so
Recently, I cared for Jimmie, a man in his 60s admitted from prison into our ICU with lung failure and shock. As our team dutifully discussed the best plan for his medications, fluids, and ventilator settings, I was bothered by something else.
Jimmie’s left leg bore a set of heavy, bright red, metal shackles. I had seen this many times before and never acted on it. This time I asked our team, “Why does a man this gravely ill, intubated on a breathing machine, clearly unable to do anyone harm, require shackles? When he develops ICU delirium, this is going to be terrifying for him. Can’t we get them off?”
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