As an ICU Doctor, I’m very blessed to be fulfilled…even if I can’t save a patient despite trying my hardest
“Your job must suck…”
This is what a patient’s family member told me when we were discussing a difficult end of life situation regarding her father. I know she meant no malice, and she felt that my job must be hard seeing so many people die despite all that we do.
There is definitely some of that, and it is never pleasant to have to tell a family — terrified by their loved one’s critical illness — that their father, or mother, or son, or daughter, or sister, or brother, or wife, or husband, or — most tragically — son, or daughter will not make it. Seeing patients die on an almost daily basis can lead many physicians to burn out.
I have been blessed not to be one of them.
This is not because I don’t care when my patients die. I hate when they die. And many times, especially in the ICU, my patients come to me trying very hard to die.
And so, I spend countless hours — working extremely hard — trying to prevent that from happening. It consumes an enormous amount of my mental, emotional, and spiritual energy. I lose many hours of sleep doing so. I lose many precious hours of family time doing so.
And when my patients do survive — which is, thankfully, most of the time — it gives me a fulfillment that is truly beyond description. To see people come in at the brink of death and leave the ICU alive and well, smiling at me and the rest of the ICU team, who have worked so hard at trying to save their life, it gives me a happiness that is beyond words.
This is precisely why I became a doctor.
There are times, however, when — despite all that we have done — we can’t save a patient. There are times when, despite doing everything right, a patient is going to die anyway. It never makes me happy. At the same time, I understand that patients will die from time to time. It is part of the job as an ICU doctor.
These dark times also provide me an opportunity for fulfillment, as I can try to help mitigate the suffering of my patients who are going to die.
Death is an uncomfortable subject about which to think and talk. Even though I see death all the time in the ICU, when I faced it myself, I was terrified. Not many people think about their goals of care if or when they get sick…really sick. Not many people make their wishes known to their loved ones if or when they become sick and cannot speak for themselves. And so it falls to the families to make these decisions on behalf of their critically ill loved ones.
Many families can’t handle this type of enormous pressure. It is a huge burden to bear, and I see so many families struggle with tremendous guilt over making decisions to withdraw support when it is clear that their loved one will not make it out of the ICU alive.
Thus, the patient continues to suffer from the effects of aggressive medical therapies that will not bring about any cure and only cause more suffering and pain. At these moments, I sit down with patients’ families and talk: we talk about where their loved one is medically, where they are likely to go, and — most importantly — what their goals of care are.
Something I almost always ask them is: “If Dad was standing outside his ICU room and saw himself right now, what would he say?” A lot of times, this helps them make the right decision: not necessarily to withdraw care, but to make the decision that their loved one would have made if they could speak for themselves.
That’s all I want to do: I want to do what the patient would have wanted. If this means dying on a ventilator after doing CPR for 2 hours, then that’s fine. If, however, this means not dying on a ventilator; if this means not having their life prolonged by artificial means; if this means focusing on quality rather than quantity of life, then this is all I want to do.
And if I can help the family come to that decision, if I can help them tell me what Mom or Dad really wanted, this is also success for me as an ICU doctor.
What’s more, I counsel them not to have any guilt. I share with my patients’ families my own experience with losing my daughter to cancer. I tell them that I truly do know how they feel. And I tell them not to have any guilt. I tell them, “The burden of grief is enough. The burden of guilt is not fair.”
After I say this, many times families will make a decision to withdraw care, and I assure them that I will do whatever it takes to make sure their loved one does not suffer while dying.
Watching your loved one die is never easy (watching my own daughter die was terror); we are never ready for it. At the same time, if they can die with dignity and comfort, without pain, surrounded by family, that is the best case scenario in an otherwise horrible situation.
I became a doctor to help people live and breathe better. Relieving the burden of disease is a joy from which I have benefited every single day of the almost 20 years I have been a doctor. At the same time, if I can also help relieve the burden of suffering of someone who is dying, and help bring the family peace and comfort, this brings me almost as much joy. And not only does the patient win, which is most important, but I also win as well.