I wage multiple battles in the ICU. Along with the primary battle against critical illness itself, one of the most important battles is the one against an ignoble death. This battle is so very important to me.
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
