Every life is valuable and deserves highest respect and care. No stone should be left unturned in saving a human life and no one knows it better than a doctor what it takes to save a life.
An article (I See ICU) had appeared in a leading local daily some time ago. The author in that article had chosen to open the write-up when the patient was in CT scan suite probably because she assumed that patient convulsed because of intra venous contrast injection while odds go towards head trauma as more likely cause of convulsions in patients with head trauma. Author had clearly tried to give an impression that convulsions occurred due to medical intervention and also tried to highlight unpreparedness of providers. These assertions by author seem to be contrary to facts.
Author could have chosen to begin with the circumstances that led to the accident and highlighted the importance of carefulness and protective equipment even during trivial chores like climbing a wall, leave alone climbing walnut trees which cost many lives every year to the extent that authorities had to sound alerts and issue advisories.
Author had inadvertently highlighted an important issue of inadequate health care facilities and failure of successive governments to construct tertiary care hospitals across the UT. We should be thankful to the people who run that lone tertiary care hospital, they work beyond their schedules and across all circumstances risking their lives every day. When all other professionals were staying home saving their own lives they were the people who took the pandemic head on. I wish author had enough courage to point her pen to those who failed to build a hospital.
Author has chosen to write in disguise of a veterinarian probably to give an impression that argument is scientific. Patient had GCS 8 on arrival to emergency according to author. GCS 8 is not just a decreased level of consciousness but is classified as severe brain injury with poor outcomes. Furthermore, traumatic sub arachnoid haemorrhage (tSAH) has poorer outcome than other forms of traumatic brain injuries (TBI) like extra dural haemorrhage or sub dural haemorrhage. Mortality of more than 80% is documented in literature in patients with SAH and for such critically ill patients ICU is the last hope.
We are an unfortunate population we don’t have many options when it comes to healthcare. I agree with the author, severe TBI patients deserve dedicated care, protocolised approach, early interventions whenever indicated and intensive care. We should come forward together and press governments to invest more funds in healthcare and also facilitate investments from private operators. Airway should have been secured immediately as these patients are at risk of aspiration. However it seems patient had not aspirated as aspiration will not cause coma instead will increase oxygen requirement.
Author had highlighted another shocking issue that is the direct interference of secretariat in allotting ICU beds to critical patients. Tertiary care institutes are highest academic institutions and should be free from duress. Only experts in the field should be allowed to prioritize patient admissions to ICUs. I don’t have words to say more on this issue, I can only wish that those were allegations only.
Author had described ICU as any other ward although monitors and ventilators were available, probably she wanted to highlight staffing issues. We are lagging behind in achieving set norms for doctor: patient and nurse: patient ratios even in general wards leave alone achieving recommended 1:1 nurse: patient ratio in ICUs. Again we should appreciate the efforts of staff who work in such stressful circumstances in every shift. Unfortunately author has blamed medical fraternity for condition of the patient, she is factually wrong. The medical condition of patient was due to fall from height with severe brain injury and not iatrogenic. It is hard to understand whether author wanted to gain sympathies of general public or create hostility towards medical profession. Although surgery has a role in management of traumatic SAH, outcome doesn’t depend on surgery alone. Other factors are equally and sometimes more important.
ICU patients are at increased risk of acquiring infections, developing coagulation disorders, bed sores etc. irrespective of primary diagnosis, with mechanically ventilated patients being at even higher risk. These patients are resource intense and outcomes are directly influenced by resource availability be it equipment or manpower. Putting beds and ventilators in a ward does not make it an ICU. Adequate space around each bed to accommodate all necessary equipment is pivotal as is 1:1 staffing that makes an ICU an ICU. Author has rightly understood the need of infection control in this patient population yet should have chosen her words carefully, it’s the staffing and duty shift patterns which make a difference between equally equipped ICUs. Government and people in authority should prioritize healthcare to meet standard norms for staffing of ICU’s.
Author clearly seems to be unsatisfied with doctors and other staff, while she choose to close her eyes on long duty shifts and untiring efforts of residents who not only take care of patients in ICU but also attend dozens of urgent calls across the hospital in each shift. Author also choose not to speak about transfer outs during that period, the patients that were shifted to other wards after improvement in their condition. She left no stone unturned to create an impression that patient was mismanaged and referring to herself as veterinarian to make argument look scientific. ICU’s have antibiotic policies in place and are strictly followed. It is not possible for non-medical professionals to comprehend how antibiotics are used in medical practice. Hospital acquired infection is a known entity in both developed and developing countries, incidence being higher in ICUs and even more in patients with indwelling catheters, central lines, and on ventilators.
Highest mortality rates are recorded in ICU’s within any hospital, it is the place where most critical patients are treated. Risk of fatal events being much higher during transportation. It is a choice of a person to call it a fatal ICU. However there are ICU stories of happiness and smiles.
In the last paragraph author tried her best to turn all hostilities towards white coats and stethoscopes hiding the facts that doctors on duty are not the ones who can build hospitals, recruit staff or create ICU beds. They are the ones who run the show burning their own blood and helping hundreds of patients with their own money.
Author could have used her pen to educate people to knock at the right doors.
I have sincere sympathies with all those who lost their loved ones, who could not get a bed in ICU, who could not reach lone tertiary care hospital in time and many others. Life definitely deserves a better treatment.
This piece is dedicated to all those doctors and para medics on duty who fight tirelessly for saving lives and bringing smiles.
(The views expressed are authors own and does not represent views of the institution he works for)
(Author is Senior Resident, Department of Anaesthesiology SKIMS, Soura Kashmir. He can be mailed at email@example.com)