BRINGING 'LIFE' INTO THE ICU

Dear Doctors, Medical Advisors, Govt Authorities,

It is hard to imagine why we humans follow rules which continue to exist for years and years without questions, without change, despite the serious damage it imposes on those who have to face those rules.

I am talking of The Intensive Care Unit or the ICU, where no family member of the patient is allowed to be with the patient during the day, but only come in as a visitor, once in the morning and then in the evening.

This rule, perhaps, was made to ward off infections that may arise from the entry and existence of family members during the day. But it makes no sense when we allow the whole clan of friends and relatives to visit during the evening visiting hours. And here again I am not talking of patients who have undergone some surgery.

Or then the rule was made to avoid hinderance or any disturbance to the treatment of the doctors and the nurses. But that is up for questioning as to whether the presence of a family member aids the treatment or causes disturbance. And steps to ensure that no disturbance happens is far easier than the complete ban of a family member.

I take my own family example. My mother was admitted to the ICU in 2018 for breathlessness.  She was a CO2 patient and on oxygen and her lungs had failed. The doctor told us to admit her to the ICU for 2 days. 2 days became two weeks with no sign of her being removed.

My mother pleaded to us, her children, to take her away from there. She felt all alone in the ICU. The ICU doctor too, after two weeks, advised us to take her home as she may get into what they call in medical term as ICU depression. But our consulting doctor advised that she continues to stay in the ICU. Can you believe that this kind of depression is documented and recorded and we do nothing about it?

So, we did DAMS – Discharge Against Medical Advice. And brought my mother home. We were given indirect indications that it could be her last days. And why should she spend her last days like this, in an ICU room, having terrible food and most importantly without seeing her children.

Later we admitted her to a special room in another hospital, where we were by her bedside all through her last month, chatting with her, laughing, feeding her and it was indeed a memorial goodbye to her.

Yes goodbye. As we have seen during the COVID times, the sad passing away of many without their family being able to see them. But it is no different at normal times too.

That is the request here. That it must be made possible. Many medical forums over the world are now debating over this inane ruling.

I had ventured out to write this plea many times before, then putting it away, with the feeling that nothing will happen out of this as the medical community may have their own valid reasons to continue with this rule. 

But yet again someone knocks at the door that it must be written. A friend came home two months back and recounted about her 65-year-old father passing away in the ICU from Covid. She said I think he died because the nurses had no time to look after him during these overcrowded times. From her phone conversations with her father, she was confident that he was sounding strong, full of life, getting better and the flu was far from serious.

She tells me that her father was told to take the prone positioning (lying on the stomach), common treatment for Covid patients. Through her many talks, she is of the opinion that the oxygen pipe could have lost its position and the staff is at times so busy that there is no one checking for hours. 

These are her assumptions. But then could it also be a possibility? That answer, the family and near and dear ones, will never get to know and live all their lives thinking, only, only if, they were there by his or her bedside. 

Which is a fact. Most hospitals and ICUs are short-staffed. Medical staff are sometimes so tired, they don’t have the energy to care beyond a point. Besides, there are young trainees doing their internship. Can you believe my mother’s two hands were black and blue because the nurses could not find a vein to remove blood!  Our own family doctor was shocked to see her hands. When we took her to the other  hospital, the nurses there too were shocked.

It is no rocket science to know that the young medical staff will not be able to have the patience, especially with elderly people with their increasing workload. Perhaps, it was possible in the earlier days. My friend's father, 90 plus years old, was admitted for malaria and put in the ICU.  His eyesight and hearing, both were very weak. The nurse would keep the tea or water and go away and he would never know and so never drink. Similar was the case many times for meals. And what is worse, my mother’s co-patients told us the hospital chapati was so hard, they could not eat it. Imagine that. Elderly sick patients not eating properly, no one to watch or coax them, and then taking heavy dose medicines. Is it difficult to fathom what all this can lead to?

I can’t for my life understand what is the risk of one family member being allowed to come in and see his or her patient during the day and sit at the side of the patient’s bed, if not the whole day, at least in intervals.

Yes, there are rooms outside the ICU where the patients' family are in COMPULSION to sit the whole day. That is more for the family member to be on call to buy the huge lists of medicines that crop up numerous times during the day. Well, that is another debate for another time. Sitting in that outside room no way helps the patient who would love to see their near and dear during the day, helping them with small things that are sure to be overlooked, yet so important for the patient. 

Hospitals should begin designing ICUs in such a way to allow this to happen. Besides, we can incorporate the use of masks at all times.

What a difference it makes for a patient to see his family member, knowing they are there if they want something desperately, to perhaps even help the medical staff in their duties, to give home food and most importantly say a better goodbye from this world, if that is to be.

Let’s begin to make ICUs the place to be cured and not to become more ill.