Every anaesthetist and intensive care doctor will have wondered if they did the right thing by taking someone to the intensive care unit. It is often the “easier” thing to do when faced with someone critically ill who is not in a condition to make an informed decision, especially when their family is not aware of what their wishes would be in this situation, and is very determined for us to try “everything” for their loved one. We end up taking over their breathing, inserting tubes and lines, and embark on a treatment plan that we know they have a very slim chance of surviving at all, and no chance of getting back to a level that they would have been happy with if they had had the chance to have that conversation with their family.
In the last few weeks, the way we work has changed radically. We are in the middle of a pandemic, and we are seeing infected patients come in critically unwell, needing urgent care, but without the benefit of having their family around them due to the danger of infection. Family members are not allowed to come to the bedside where we are working to try to save their life, and it is extremely difficult for us to enter and leave due to the need for protective equipment to prevent us from catching the virus.
There comes a point where we are certain that our efforts will not save our patient’s life, and to continue treatment is simply adding to their pain and distress. We discuss this with their family who may not appreciate how unwell they are, as they cannot visit. This is a conversation we would never normally have over the phone—it requires so much tact, empathy, and care to do it well, and it is so much easier to convey the information required face to face.
It is nobody’s wish to die on an intensive care unit, and most of the patients we treat will have thought about what they would want and when they would want their treatment to stop. Most people will have shied away from having that conversation with their loved ones because they don’t want to be morbid, upset themselves, frighten their loved ones, or there’s never really been the right time. I want to ask you please, make now the right time. Have this conversation with your family and let them know how you feel. It is the greatest gesture of love you can give them, and will make their discussions with us so much gentler and easier.
Helgi Johannsson is a Consultant Anaesthetist, RCoA Member of Council
Competing interests: None declared