December 9th, 2011

To the Moon and Back in the ICU: It’s Not a Solo Trip

I stepped into Bill’s room in the intensive-care unit (ICU) and caught sight of him lying in bed. I asked him how he was today. In a nervous voice, he told me that he was fine. Monitors flashing lights and pumps chiming in chorus filled the room. With machines ablaze, it was like witnessing a space shuttle launch at NASA’s mission control room. I turned to him and said, “You’ve been through some pretty tough times. You came to us after your heart stopped and we had to restart it. We did a catheterization to look at your arteries and found a lot of blockage. Unfortunately, we ran into problems with bleeding after the procedure but now the bleeding has stabilized. It’s time to go ahead with open heart surgery for your blocked arteries. Tell me your thoughts on this?”

With his melancholy palpable, he said, “I don’t want to have this operation. I have no one to live for. I have a son who is an orthopedist but he doesn’t have time to visit and an ex-wife who doesn’t want to see me either.”

I reflected on his statement. I had recently had an experience after the birth of my child that opened me to the importance of personal connections in health outcomes. While still in the hospital my two-day-old son, Arjun, developed labored breathing. The pediatrician, with a worried look, suggested that we transfer him to the neonatal ICU. There, he was placed into an incubator. Like an astronaut space suit, it provided a special environment designed to protect against infections and noise.

Over the next four days my wife and I planned shifts to be there with him for support during the stay. We spent time feeding him and offering comfort. We witnessed daily improvements and noticed signs that his breathing was growing stronger. Through my time there, I could see numerous other babies in similar situations. However, it was a rare sight to see other families involved in their baby’s care. Curious, I asked one of the nurses the reason for this. She said, “Well, the parents just come by to pick up their baby when the baby is better.” I was surprised to hear that other parents were not as involved in the care of their baby. After several days, Arjun left the ICU and came home well before the other babies.

I knew Bill’s decision whether to undergo the operation was a difficult one for him and I could not make it on his behalf. I turned to him and said, “Well, I think before you make up your mind not to proceed you should ask your son if he can come visit and we can discuss the options you have.”  Eventually Bill did agree to the operation after talking with his son and he did well for the remainder of his hospitalization.

In the cases of Arjun and Bill, family support was a powerful form of medicine. As health care providers, physicians should encourage family involvement in the care of patients. Advanced medical illnesses need to be approached with a holistic perspective, which includes patients reaching out to friends and family. Without their support, taking our patients to the moon and back by the use of advanced medical therapies alone to improve health care outcomes is hard won.

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