Friday, September 28, 2018

Saving a death when we cannot save a life in the intensive care unit

There are several situations and/or elective interventions in medicine where the patient is made unconscious, given anesthesia, surgery or sedation especially in terminally ill patients. In these situations, there is a chance that the patient may not wake up. Even though the intervention may have been necessary, it deprives them of their chance to share few last words with their families.

In the June 2018 issue of JAMA International Medicine, Michael E. Wilson - a critical care doctor - has written an account of a woman in intensive care in “Saving a death when we cannot save a life in the intensive care unit”, who was electively intubated for a procedure and then died, without ever having had the opportunity for her loved ones to say goodbye.

This can be somewhat likened to soldiers being sent off to war by their families with a puja and tika or families sending off their loved one on a pilgrimage or tirth yatra with a tika in ancient times as they may not come back alive.

This gives them an opportunity to talk to their families and express their wishes that they want to be fulfilled, knowing that this might be their last chance to hold this conversation.

When I was in Malaysia for the CMAAO general assembly, we went to the Port. There were three temples where fishermen prayed before going out to the sea and also when they returned.

The ritual of performing Shradh is to satisfy the unfulfilled, known or unknown, wishes and desires of the deceased person by the eldest son in the family. Shradhs are also for the unknown unfulfilled desires of our ancestors; unknown to the present family but maybe were known to the past family. These unknown wishes come back as dreams to their descendents through qualia or tanmatras. A mahashradha is performed when all the wishes of the ancestors are fulfilled. Once a mahashradha is performed, then there is no need to perform Shradh rituals thereafter.

 According to the Vedas, every individual has three debts to be paid off, firstly, the Devtas (Dev Rin), secondly of Guru and teachers (Rishi Rin) and, thirdly, of Ancestors (Pitra Rin). Devtas represent people with Daivik qualities; teachers the ones who have taught us and Pitra represent the three generations of our ancestors.
Therefore, it is always better to allow patients some time alone with their families and express their wishes, before any such intervention, or say goodbye in the worst case scenario.

 “My intubation checklist now includes this step…It’s a way to avoid stealing last words from a person”, as Michael E Wilson writes.

Always write down your wishes for your family…

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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