It is inevitable that some people will die who get admitted to the ICU. It is always sad, and it makes us sad as critical care clinicians. It is reality, nonetheless. During the pandemic, it seemed that everyone who was admitted with COVID-19 ended up dying, and thank God, that was not the case at all.

Still, when it is clear that I will not win the battle against critical illness; when it is clear that my patient will die, then my fight changes to ensure that my patient does not die an ignoble death.

What is an ignoble death? It is one without dignity; it is a death not on the patient’s own terms; it is death of pain, distress, anguish, and suffering. No one deserves this kind of death.

None of us knows when we are going to die. None of us knows where we are going to die. None of us knows how we are going to die. Those things are, in fact, unknowable and beyond our control.

What we can control, however, are the terms of our own death. When we finally face death, how will we die? Will we die on machines? Will we die having the healthcare team pounding on our chests and shocking our hearts? Will we die having someone put a tube down my throat? Will my family be there?

We can choose the answers to those questions. We must choose the answers to those questions and make those answers known to our doctors and those taking care of us in the healthcare setting. It is absolutely essential – and dare I say it – critical that we make the answers to these questions known. Everyone deserves a death on their own terms.

And so, as a critical care specialist, I try my hardest to learn what the terms of my patients’ death are, and I fight my hardest – I battle to the fullest – to make sure that my patients die on their own terms. I battle to the fullest to make sure that my patients have a good death, one that is not ignoble: a death without pain, without suffering, without anguish, and on my patients’ terms.

During the COVID pandemic, it seemed that all we did for those afflicted with COVID was not curing the illness, but simply providing a good death. It did cause us a lot of anguish, because we are in the business of cure and healing. At the same time, there is nothing ignoble about providing a good death. If that’s all we can do for our patient, we have done our patient a tremendous amount of good.

Listen to the podcast episode about this topic here: https://healthcaremusings.substack.com/p/the-battle-against-an-ignoble-death

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When the time finally came, I came to the ICU thinking I knew all that there was to know about Critical Care Medicine. I came to the ICU fully confident in my abilities to crush critical illness and save every patient I saw. I came to the ICU roaring like a lion…until I met the ICU nurses.

They whipped me into shape real, real quick. They showed me, in short order, what I didn’t know, and they showed me how to be properly behave in the ICU. I came to the ICU roaring like a lion…and the ICU nurses left me meowing like a kitten. And that experience taught me very early on to NEVER cross an ICU nurse.

The nurses in the ICU are among the best nurses around. They are highly skilled, highly educated, highly motivated to do what is right for the patient, and they do not back down easily. They will keep fighting for the patient with all their might, all their passion, and all their soul. I am not saying that other nurses do not do this. I am saying that ICU nurses do this par excellence.

I was witness to their selfless care during the COVID-19 pandemic. They spent hours at the bedside of countless very, very sick people with COVID-19. They gave them everything they had, and if the patient was not going to make it, they made absolutely sure the patient did not die alone, holding their hand in the room while the family was mourning on an iPad or cell phone.

They are such an important component of the care of the patient in the ICU. I was – and continue to be – in awe of their excellent patient care, and I am grateful to be their partner in the ICU.

As I said before, when I first came to the ICU, they whipped me into shape real, real quick. I learned to NEVER cross an ICU nurse, and their tough love made me a much better critical care doctor. I am forever better because of those ICU nurses with whom I worked my very first month in the ICU as a doctor. And to them – along with every other ICU nurse – I am forever grateful.

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These were the words of my partner in the ICU, signing out a woman who was suffering from ongoing bleeding from her gastrointestinal tract. She came into the hospital for a routine endoscopy. Suddenly, she started bleeding. She not only “kept me busy,” but I did not leave her bedside for my entire shift – more than 7 hours.

Her bleeding was relentless. Despite everything I was doing for her, she kept bleeding. We gave blood transfusion after blood transfusion. She kept bleeding. I sent her to the Radiology suite to get an angiogram and have metal coils placed inside the blood vessels. I was there in the suite, and I watched the blood vessels get blocked. She kept bleeding.

I had the Gastroenterology specialist come back and look into her stomach again with a camera, to see if he can do anything to stop it. She kept bleeding. Finally, after virtually emptying the blood bank and trying everything else, I called the General Surgeon to come and take her to the operating room.

The only way he could stop the bleeding was to take out her entire stomach.

She was in terrible shock, and she required multiple medications to support her blood pressure. I had to keep her deeply sedated on a breathing machine. And yet, she survived. She was then transferred to the University for more advanced surgery to connect her intestines to her esophagus.

She survived, and I pray she will have a full recovery from this horrific illness.

With the relentless waves of COVID-19, it is so very easy to give up hope and say, “Why even bother?” It is so very easy to “just swim down” and succumb to hopelessness and despair. And yet, cases such as these remind me that, there is still joy in the ICU. It is not all death and despair. By the grace of God, I am still able to help someone survive critical illness and live another day to be with family and others whom they love.

With COVID clouding over all that we do in the ICU, I have to remind myself that I can still do good and help people. It is not all doom and gloom. Yes, I had a long shift taking care of this patient, and it was exhausting – both physically and mentally. At the same time, it is so thrilling to know that my patient – who I thought was going to bleed to death – survived and will hopefully do well after this terrible affliction. This case has helped me combat and resist the hopelessness that COVID can easily instill.

Even in the midst of another COVID winter, there is still joy in the ICU. I can still help people heal and not helplessly watch them die. I will always try to remember this case and not despair. There is still joy in the ICU.

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