If you are working in an intensive care unit, your patients will frequently be intubated and/ or sedated. The ICU can be very dehumanizing, and it is easy to forget that patients are human beings with family and friends that love them. Adherence to critical care guidelines and following protocols is important. But while we are providing the highest level of care based on evidence, we must not ignore the humanity of our patients. There is a missing link that isn’t routinely taught in school or nurtured in training and isn’t encouraged when it is performed. The human connection, treating a patient like a person. Treat your patients as if they were your family member.

     Basic human decency supports the practice of avoiding derogatory conversations in the presence of patients. I have witnessed more than a handful of incidents of medical personnel discussing other patient scenarios in the presence of other patients. HIPAA laws aside, generic simple conversations are likely unavoidable (“hey the patient next door needs his pain medication…”, “is room 7 ready for radiology…”, etc). However, I have witnessed providers speaking about a brain dead patient who was being evaluated for organ donation in the presence of another patient. Speaking about death and organ donation in the room of a critically ill patient is unacceptable. Mentioning derogatory things about patients in the operating room is unacceptable. My personal opinion is that negative things should be avoided in general. I don’t mean that real problems should be swept under the rug. But in my opinion, extraneous negative remarks have no place in a patient's room.

A few thoughts.

1. Don’t lose your humanity. Treat all patients as if they were your loved one (family, friend, whatever fits that category for you). If you catch yourself slipping into a routine of just seeing the procedures and diagnoses, I urge you to engage in intentional self-reflection.

2.  Treat all patients as if they can hear and sense everything. I am not a proponent of the occult or the metaphysical, and I don’t believe in jinxes- I don’t believe that mentioning bad prognoses makes them more likely to occur. However, I believe that most patients who are intubated and sedated are aware, on some level, of their surroundings. There are plenty of reports of patients recalling stressful experiences from their time in the ICU. I don’t think we will ever know what they can hear or sense, or how it impacts their emotional and physical well-being. Therefore, I strongly advocate for treating all patients as if they can hear and sense everything.

3.  Try to imagine what you would want if you were in the patient's position. Imagine you can’t talk, you’re in pain, you have an itch you can’t scratch, your eyes are stuck shut from eye crust that you can’t wipe away, your mouth and throat feel like sandpaper, you don’t have your glasses or your hearing aids, you have no idea where you are or what day it is, etc etc. Now imagine you are slowly waking up as your sedation medicine wears off. You have people pinching you and yelling at you to open your eyes. Compare that to hearing a calm steady voice in your ear, speaking encouraging words, explaining that you are in an ICU, you have a breathing tube in place, you’re safe, your medical team is waking you up to see if you can breathe on your own and get the tube out. I’m not suggesting that this practice will eliminate agitation when a spontaneous awakening trial is performed. But just imagine the difference of being reoriented when you have no control instead of being shouted at and told to open your eyes. Imagine someone taking a wet washcloth to your eyes to remove the crust, allowing you to open your eyes for the first time in days. It’s not something you’ll learn in medical school. And it shouldn’t be revolutionary…but just imagine the difference in the patient's perspective and understanding of their situation.