Friday night shift. As a usual thing, patients ‘ lesson for this doctor.
This time: the dilemma was on untied hands. I can use a lot of words: tied, fastened, immobilized. Anyway, science has already given us the evidence that patients feel anxious with their hands tied when they are lying on a bed in the ICU. And when you think about it, it seems obvious. But what was a custom is not a bad idea. In this case, we did it for prevention removing anything, especially probes and tubes to breathe or feed.
Fortunately, doctors from time to time manage to break paradigms. We have already learned that if we explain them -and we also learned that patients can understand us- they will not retire anything when they understand that those uncomfortable elements are needed to stay alive. That day by day, they will probably be gaining independence, but for now, they need to be still patient, in every sense of the word. So a short intervention on what things should avoid touching or grabbing, how each of these things help, that are now so uncomfortable, is enough and we have again a “free” human being with their hands loose, so be able to scratch their noses when they want.
I decide then to start my task; I have a patient just starting to wake up in the ICU, but still she is very delicate, connected to the respirator. Probes, tubes: it must be terrifying to wake up suddenly. I explain that she required a large surgery, she is still weak and that through that tube in her mouth a respirator is helping; there is a screen that shows me how she is, but for that she has all those cables connected, and I am seeing how I manage with that an alarm not to sound so much.
I ask her if she understands me, to answer with her head, to move her hands and her feet quiet, but otherwise, do not try to move so much. She understands, and makes signs she wants to write. She asks the usual questions about what happened, what surgery was, what day it is, what is happening and what we expect to happen, who have visited her, etc. One by one, some easier than others, I respond. In the end I remind that I will leave her hands loose, but she must try to be aware of not withdrawing anything, even if it´s inlike, to be patient. She looks at me with her eyes wide open and shakes her head from one side to the other, saying no.
– Don’t worry, you’re going to have your hands loose. She shakes her head again. She says no.
Confused, I ask her:
– Don´t you want to have loose hands?. She says yes. We looked at each other strangely.
Why would anyone want to be tied up?
Suddenly, someone asks:
– Do you talk or do things asleep? She smiles and nods.
– And you remove things that hinder you? She nods again.
Mystery solved. My patient feels more relaxed knowing that nothing is going to be removed while asleep. She doesn’t want to run the risk of having her hands loose. It was impossible to convince her. She didn’t accept that we could fix better the tube or that we cover her hands. But obviously, she knows herself.
11:30 pm. I have just visit my patient again: She is placidly asleep, with the tube in her mouth and her hands gently tied to the sides of the bed.