ICU Delirium and a call for humanity in healthcare
I recently listened to a talk on awake and walking ICU’s. With the first story shared by the ICU nurse who has worked in both these ICU’s and traditional ICU settings where patients are typically sedated, I was both horrified and intrigued.
Having had a rather intense ICU stay with my transplant, my instinct was absolutely not. I found that I’d held to the borrowed belief that the drugs I’d been given in the ICU had saved me and the horrors I’d endured would have been more traumatic in a fully conscious state. But by the end of this presentation, not only did I have a conviction that these awake and walking ICU’s sounded like a really good idea and if I were to end up in another situation similar to the one I’d been in for my transplant I would want this but I also had more questions about my own experience.
I was also introduced to the name ICU delirium. Which I’d heard the concept before but never knew it had a name, and without a doubt this is what I had. Listening to the stories of other patients, and hearing their own similarities to mine down to the alternate realities that existed, I felt like I wasn’t crazy. And not only was a name given to this concept of what happens in ICU’s but the why was broken down, the how these things affect the brain and nervous system.
Bold statement: without being educated on ICU delirium, the effects of prolonged sedation and these worst case scenarios that don’t happen to a lot of patients but did happen to me, I did not give informed consent.
What if there had been another option, one where I could have been part of my own care with agency and autonomy?
I’m not saying for sure this was possible in my case. There’s a lot of things we’ll never know. But the question was raised in the back of my head of what if the care I’d received, that I’d only ever been expected to be grateful for because at least I wasn’t dead, where my body was blamed as being the faulty piece of the puzzle, wasn’t all I’d thought it was?
What if the intent to help actually caused harm?
I’m not making any claims, or expecting any answers. I agree that these situations are far more complex than I or most people could ever understand, and I am grateful for the medical care I received. I do believe everyone in that hospital was doing their best.
And I believe if we are not critical of our systems, we do not get better. Part of the responsibility in belonging to this community is continually calling on individuals to do better. Patients deserve better. Simply not dying should not be the goal.
The main thing I took away from this talk, which is something I’ve stated in other arenas and have built my career on, is that medicine lacks humanity. Medicine, as a system, is not a trauma informed framework, and it strips patients of their autonomy more often than not.
Ideas were brought up in this talk on ways to improve this, including things like minimal sedation for these intense injuries and illnesses, a prioritization of family in care, nutrition and movement as pillars in recovery and not just afterthoughts and patients being treated as humans rather than an inconvenience or something to manage. I have ideas, too, on why these things happen and what patient centred care might look like, but those are stories for another time.
If better is possible, is what we have good enough? Is patients repeatedly being traumatized in masses by their medical care a baseline we are willing to accept?
