The Intensive Care Unit can feel like a foreign country. The language can be hard to understand, the culture is very different from your own; the surroundings don’t look familiar; it is usually busy with a lot of noise and you are often at the mercy of others for help. Here is some information that can help you acclimate to the ICU setting and advocate for yourself.
The ICU team is diverse with unique skills, knowledge and abilities. Each member of the team has a different role to play. Therefore, we ask many questions, specifically for that particular discipline. You will find, however, that we ask many of the same questions, over and over. Please bear with us.
Intensive care is for people who are seriously ill, have life-threatening illnesses, or who require frequent monitoring. Each ICU nurse has one to two patients at the most because each patient requires that much care. Each patient has a heart rhythm monitor, breathing with oxygen monitoring, and can have invasive monitoring for continuous blood pressure readings. Oxygen can be delivered through a cannula in the nose, a face mask or a ventilator. The heart can be assisted by IV medication drips adjusted every few minutes and possibly with sophisticated machines that support the work of the heart.
Because of the complexity of care, communication is essential between the healthcare team itself (“rounds”) and with the patient and family. Speaking with the patient and one or two key designated family members helps the flow of communication. Recently I walked in a patient’s room and their visitor said, “Hi. I’m John and I am Diane’s son and her power of attorney for healthcare. You have a copy of her advanced directives scanned in the chart. I am the person you need to talk to for updates and consent.” I had to pinch myself to make sure this was real. I was pleasantly surprised and wished all patients had this person with them.
Gone are the days of paternalistic medicine where you are told what the plan is; now we have patient-centered care that includes the patient in determining what is important to you for your health. If surgery or a special procedure is recommended, informed consent is required. Be sure you are aware of the risks and benefits of the procedure, the risks and benefits of any alternative procedures and the risks and benefits of not doing the procedure. Ask questions about the risks. Ask what recovery will look like, for example, will you go home or to a rehab center or a skilled nursing facility? What might you need once you do go home, how much time will it take to recover, should a caregiver or a family member stay with you at home?
If the situation is overwhelming or very complex with many specialists, ask for a family meeting to gather with the doctors, nurses, the social worker and a few family members. Getting the big picture is often a daunting task and we are there to help you.
We know the ICU can be overwhelming and disruptive. We hope to make it the best experience it can be. We do our best because we care about you and your family.
“The capacity to care is the thing which gives life its deepest significance.”
– Pablo Casals