Over the years I have coincided with many intensivists in several ICU, and we have all seen needs for the system . Years after, we continue thinking the same things. And as in everything, there is a part that depends on the system and there is part that depends on what eyes look the reality.
36 hours ago I was on shift, and in the evening I got a call from the Emergencies Coordinator SUMMA 112 requesting bed for a patient. At the present time, the capacity in the ICU of Madrid is full as every winter, and they were longer than 1 hour trying to find an ICU bed for a patient, and six ICU had rejected the admittance. In my ICU were 2 free beds, and I had two patients pending for different procedures, so we also were near full occupancy.
I was told that the patient was intubated, so there was no much to talk about: he needed a bed so I told to bring the patient to my ICU, and we would see how we would manage. I was very surprised with the response: “Thank you Doctor, it has been too hard to find an ICU bed”.
I asked her more information of the patient, and told me that he had Amyotrophic Lateral Sclerosis Amyotrophic (ALS). Maybe at that time I could better understand why she had so much problems to find an ICU bed. “I know that he doesn’t have a “very good plate”, but he also need to be seen and to assess whether he is actually a patient for mechanical ventilation.” I know perfectly how people work in emergencies, and I know that it is very difficult to evaluate things on a global way at home and how a critical situation leads to do, so under that spotlight, any action is understood and respected.
In any case, the first reflection is obvious: we should evaluate people and their needs, not their background.
I grieved imagine the patient turning arround Madrid in an ambulance, waiting that “some castle” opened its doors. What would happend if the patient is your family?.
On the other hand, I would like to share some of those needs as a result of this story:
– Why don´t we have ICU in Madrid for patients who have a single organ failure?. Many patients prolong their ICU stay and we consume resources when really few intensive cares are needed. That ICU take care of patients requiring only mechanical ventilation and rehabilitation. Why do not create them if we already think that they are really useful?. They would be also a way to prevent the post-ICU syndrome, which perhaps has much less press than ebola but is much more democratic and affects many more people in our day by day.
– The intensivists are still focused on the result, not the process. When I spoke with the patient’s family, it was clear that the situation of the patient’s disease was terminal. They didn’t want him to receive interventionist measures and only wanted to be able to accompany him in the process of dying. We talked about directives and death, and with an admirable calm, one realizes that listening and speaking, people are very reasonable. We still need to be able to be closer to death, because we continue to believe that we save lives.
After talking everything with calm and tranquility, the patient was retired the mechanical ventilation yesterday. Gradually he stopped breathing and died. He was accompanied by his family at all times, that was his desire and what really could be done. Because dying in the best way matters.
It was really “a matter of plate”?
Pd: with all my respect and admiration for the Emergencies Coordinator SUMMA 112