Director, Emergency Services, Bikur Cholim Hospital
I recently had to play the other side. My father, he should
live and be well, was rushed to the hospital last week and
put in the ICU. ICUs are pressure atmospheres, and my family
now met this stressing atmosphere.
I would like to go over some rules that will make your lives
easier — and the staff's — as well as to maximize
the chances for recovery of your loved one.
1) ICUs are scary places and there are lots of beeps and
tubes. You have a right to be with your loved one, but you
do not have a right to be in the way. If you cannot stomach
procedures or have a tendency to faint or sigh loudly, then
please step outside.
2) Be educated about what disease your loved one has, and
this will help you better understand what is going on.
Questions like, "What are his chances?" and "What is his
condition?" are questions that are not very useful. USA ICU
regulations now require a point person from the family to ask
the questions and get answers and distribute them to the rest
of the family. Having the staff repeat the answers to the
same questions to multiple family members can waste precious
time.
3) Abide by ICU rules. While there is plenty of literature
saying that cellular phones do not affect ICU machines from
normal distances, ICU rules often say that they are forbidden
and you will cause consternation by not heeding. ICUs have
rules for visiting hours and how many people can see the
patient at once. Bargaining with the staff and begging takes
the nurses and doctors away from their primary concern: your
loved one.
4) Never use what is not yours. Do not "borrow" a band-aid
or a gauze pad or use the staff's bathroom or microwave.
5) Be thankful for their hard work. Gifts and letters are
always appreciated. They know you will complain if something
is not right, so be sure to complement if something is
right.
6) Never threaten staff. They work hard, under frustrating
conditions. Everyone has bad days, and while your loved one
is the most important in your eyes, they have ten loved ones
to take care of.
7) Understand priorities. You may want a blanket for your
patient, but if they are in the middle of a resuscitation, it
is not the time to be stubborn. Try to ask the most junior
person for information not regarding medicine. That is, if
you need a blanket, or want to know when the patient will be
going for a test, ask the secretary or the volunteer. Often
the doctor is too busy to check these details out.
8) Help out where you can. If your loved one is not eating
well ask if you can help feed him or bring food he likes.
Help them steer his bed if they need it.
9) People in ICUs need to be strengthened and have their
dignity preserved. Be a source of strength.
These are some rules for physicians in the ICU.
1) You work in the ICU every day. The patient you are taking
care of is here for the first time. Understand that for you
it is routine, but for others, it is very scary.
2) Preserve dignity. Give people realistic hope. Be
accessible. It is better to give the answer "I can not talk
to you at length right now, but will be happy to sit with you
later and answer all your questions" than to give a short
terse answer.
3) Recognize family dynamics, and respect them.
4) Families are under pressure and may scream or cry. Keep
your mouth shut. Get help from other members of the team.
5) If you have the time, do help with the little things that
may be below you.
6) Better to take a time out and chill than to be cranky.
Find a spot where no one can bother you.
7) Families that do not listen, are demanding or do not trust
you are always a problem. Set the ground rules early, and
recognize that there is only so much you can do. Do not take
it personally.
8) Be communicative. Better to give a pamphlet to educate
your patient, and say, "If you have any questions after
reading this, let me know."
9) Take a course on how to break bad news. I do not believe
in ever lying to a patient. If the family does not want the
patient to know what they have, take one aside, tell him the
truth, and ask him how he wants you to speak to Grandma. I
still would not lie.
10) Families are not doctors. Forget the jargon, and speak
simply.
11) Go the extra mile. And people will do the same for you.
These are my experiences and what I would suggest. Would you
like to add something?
One unrelated note: Both the USA and Europe are sweltering in
a very hot summer. Make sure that your elderly parents, and
young children, have functioning air conditioners and drink
well. Many elderly — due to thyroid misfunction or
medications — do not feel the heat.
For a refuah shleimoh of Ovi Mori Shmuel Ben Yosef.
Write me in care of the Yated.
