Some patients suffer from depression, anxiety and post-traumatic-stress disorder long after they have left. Being in the ICU usually means “a very slow, prolonged recovery period,” Dr. Cuthbertson said, “and indeed many patients will never get back to the quality of life that they had before they were critically unwell.”
That’s why, instead of keeping critical patients heavily sedated, they are now kept more awake, sat up in bed and exercised more, in hopes of offsetting those long-term effects.
It’s also part of why many people are asking which interventions are worth making, and which come at too great a cost.
“One of the great challenges of modern medicine,” Dr. Cuthbertson said, “is not saying, ‘Can we?’ but ‘Should we?’ “ The issue of how much treatment is too much is debated in medical journals, but it is also a pressing issue of national importance.
Intensive-care beds are extraordinarily expensive to operate, about $1-million a year in many hospitals. Such costs threaten the very sustainability of our health-care system if not kept in check.
Those who have not given written or explicit verbal directions to relatives may find themselves in critical-care units, unable to stop very aggressive treatments of marginal benefit, as families push for them simply because they feel it’s the safest default position.
Yet few of us expect that moment to come, except perhaps elderly people with complex chronic conditions.
Traumatic brain injuries are another common reason patients land here – car accidents, falls or other traumas. Physicians such as Damon Scales see in a day what many may not see in a lifetime, and the job has given his family new rules for living: “There’s no ladder climbing over age 50. At our cottage, everyone jumps in feet first,” not head first, he said. “There are no motorcycles, no drinking and driving.”
But for Ki-Don Kang, 54, it was the mere everyday act of going down the stairs to a restaurant-basement restroom, after a night of singing karaoke, that led to a fall and a brain injury that rapidly progressed to brain death.
Now his son, Jeffery, had a problem: His brother and mother were in Korea and he wanted them to see his father, even if he was only being kept biologically alive through the use of machines.
“How do I keep the body here one more day? That was the main thing,” Jeffery said. Then he figured out a way: organ donation. He signed his father up, not meaning actually to go through with it.
The following day, Aug. 21, Mr. Kang’s wife was able to see him, just as the son had wished, lying in bed amid monitors and machines flashing red numbers of vital signs.
But the organ-donation issue remained. The family talked for hours, and finally agreed that Jeffery’s loving, giving father would have wanted to donate. His heart, two kidneys and liver were removed to be transplanted into other patients.
Hours later, Mr. Kang’s youngest son, Justin, arrived from Korea: ”I just looked at him. He was really cold. I touched his hand, then I started to bawl my eyes out like crazy,” Justin said. “I really, really wanted to at least say my goodbyes.”
A superbug setback, but the will to go on remains A few weeks after her day in the sun, Bonnie Isacovics faced new trouble, in the form of a antibiotic-resistant superbug called NDM-1 that was making headlines around the world.
Andrew Simor, head of microbiology and infectious diseases at Sunnybrook, labelled it a “bad player” – in hospital patients, it can cause significant urinary-tract and other infections, as well as pneumonia and bloodstream and wound infections that are very difficult to treat.
Endemic in India, there are about two dozen cases across Canada; Ms. Isacovics is currently one of two patients at Sunnybrook who is carrying the organism, though she is not infected with it.
This meant further isolation: Every one who went into her room had to put on mask, gloves and gown, so as not to spread it to other patients.
By this point, Ms. Isacovics had accepted that she would need the ventilator long-term, but was hoping she would need it only at night.
Because of the long wait for the program at the other hospital, Sunnybrook began arranging its own training for her family and caregivers, to teach them to suction a tracheotomy (a surgical opening through the throat into the windpipe). They’d need a hospital bed, suction, home ventilator and supplemental oxygen. But she could be home by late December or early January.
At a meeting in late August, Dr. Fowler reminded her that if she gets sick again, with a bad pneumonia, she would return to the ICU. He wanted to make sure she dictated the kind of treatment they would provide.