By: Dr. George Jacob.
Ever since I’ve been rendered a ‘non-operating surgeon’ thanks to a stroke, I’ve been working as an ‘ICU Doctor’, managing post-operative patients in the Surgical ICU of the hospital I work in. Over ten years down the line, my life as a doctor in the ICU has never been a sunset swim on a balmy beach. It’s been a coast on a tempestuous sea. Life has never been easy. It’s never meant to be when you are dealing with life grittily fighting for survival, while eager and anxious families wait outside with high hopes, often misplaced and unrealistic, for which they cannot be blamed. They pay through their noses for their dear ones’ treatment, which is prohibitively expensive today. They sell property, house and jewellery to raise money. When things go beyond them monetarily, neighbours, relatives, townsfolk and places of worship turn good Samaritans, hoping for the patient’s return to a life of reasonable quality. It need not be a happy ending always.
Often sick patients, up against many odds caused by the disease itself and many preexisting diseases adversely standing in the way to recovery do not improve. They linger in the ICU for days, while the families shell out nonexistent money. Hope turns to despair, frustration and anger against the treating team and the hospital. As an ‘ICU Doctor’, briefing the dear and near daily about their patients’ health status has been one of my most important responsibilities, if not the most sacrosanct, and demanding. The patients’ dear and near rightfully deserve to be briefed and updated on the patients’ clinical course, not only because they are paying for it, but more because the patient belongs to them dearly.
Briefing demands diplomacy, restraint, patience, understanding and empathy. Often patients in the ICU have abused, cursed and sworn at me using choicest vocabulary. This is usually indulged in by patients who, languishing in the ICU for many days, develop what is called ‘ICU psychoses’, where their offensive behaviour is beyond their control. Dusting it off my back, I brief their embarrassed dear ones with a smile, and also reassure them, concurrently.
I have had an instance when I needed to accompany a young girl who had undergone major abdominal surgery for cancer and later developed bleeding, to another hospital for an investigation called visceral angiography. This investigation was unavailable at that time in the hospital I worked in. The investigation, as is not uncommon, failed to locate the source of bleed. While transporting the patient back from the angiography suite to the ambulance to take her back, her father, irate, upset and anxious over the failed investigation, pushed me against the wall of a long and empty corridor within a completely strange place, with his forearm placed across my throat. ‘Now what, doctor?’ he snarled. I held on to my nerves with nobody to come to my aid. ‘Let’s see’ I stammered. Luckily, he let me off! I had to meet him too and his extended family the next morning for the briefing session, with a smile!
Sometimes, relatives of patients who have had to spend long days in the ICU without progress, later to deteriorate and eventually die, during the briefing sessions would record briefing sessions using mobile phones, meant to intimidate and to arm-twist, as part of their efforts to resort to legal means, with the recorded conversation to be used in the case. While some others, on losing their loved ones would descend on the treating personnel menacingly to ‘let off emotions’ physically.
Everything that is done for the patient as part of treatment is done so, with the best of intensions. But often, things go out of hand when money, at a premium, seems to be ‘wasted on a lost cause’ and ‘tired horses are flogged needlessly’. As long as medical science call upon doctors and hospitals to needlessly ‘waste’ money on seemingly lost causes, and flog tired horses beyond endurance, in their efforts to save lives ‘by going all out’, the doctors in the ICU need to learn: to listen patiently to the patients’ dear and near ones, irrespective of their state of mind, never to talk back with the same kind of emotion, Never to talk ill of other doctors and members of the treating team, and other hospitals, especially the one which would have referred the patient ,Never to get into arguments with them, to be sympathetic to their financial and other logistical difficulties, To be willing to liaise between them and the hospital management and powers-that-be to ease things out, if need be; never to blame them for having agreed to treatment options such as surgery, as it amounts to ‘washing off responsibility’, to smile even on being slighted most nastily, to be honest with them, and be unhesitant to say ‘I don’t know’, if need be, to explain to them in detail the treatment modalities being planned and their confidence gained.
(Dr. George Jacob is a consultant in Surgical gastroenterology, Lake shore Hospital,Kochi, Kerala)