How do we close the gap?

By Aoife Abbey

Since publishing Seven Signs of Life a few weeks ago, I have had the opportunity to speak to a variety of different people in the media about intensive care. The immediate question that many ask me is why; why do you love it? How?

This isn’t a difficult question, and I am sure many members at the Intensive Care Society will identify with my answers. I answer that I know the sheer breadth of presentation in intensive care will always keep me engaged. I say that my speciality allows me to become engaged in the minute to minute demands of a resuscitation or trauma with a patient one moment, and then leaves me perfectly still, carefully contemplating the care of another patient, the next. I say that working in intensive care allows me to pay attention to minutia, to really care about a diagnosis, the physiology and the numbers, while at the same time exposing me to something that is very much the antithesis to this exactness. Intensive care is about holding sacred the whole person on front of you and caring about who they are and what they would want, even when they cannot contribute.  I tell them that I find the ethics of intensive care fascinating, because so much of what we deal with moves in the ‘grey areas’ of life, death and what is in between.

And then I tell them about the team-work. I have been asked often; ‘how do you get through the day when you know that you might do something wrong, or let a patient down?’ I say how lucky I am that intensive care is a truly a multidisciplinary specialty, that nobody in intensive care works in a silo and the team is made up of not just nurses, as well as doctors from different disciplines, but a rich collection of allied health care professionals and advanced practitioners. 

The other question that frequently crops up is ‘isn’t it hard, when so many people die?’. Usually this is followed by a statement that allies intensive care ‘as the place that is surely supposed to save lives?’. I answer by saying yes, intensive care exists to make the saves, to give those, often with small odds, a shot at survival –if it wasn’t for the prospect of these ‘saves’, would our speciality even exist? But also, I tell that that this isn’t the whole story, because intensive care is also about recognising inevitable death in our patients and intercepting with palliative care, with the same sense of urgency we had when we provided anything that we thought might have been life-saving. I tell them that to do my job well, you also have to want to provide good palliative care – and frequently, I find that they look surprised. 

I think this is what has stuck me the most, that people can align their expectations of critical care with a brand of heroism and life-saving and be surprised that I tell them intensive care is also about caring for those who are dying – and not just seeking to extend biological life, at all costs. There has also been surprise when I try and explain just how difficult a ‘recovery’ can be; when I explain that ‘waking up’ in intensive care is frequently just the beginning of a long process of rehabilitation. So perhaps as a community, we need to do better at making it clear what our speciality is about. 

I think that is entirely possible – because for all of the looks of surprise, I have also had encounters with people who know exactly what it is about. I have been taken aback, by the number of media personnel I have spoken to, who just happen to have had their own experiences of intensive care; either personal illness, or the critical illness, rehabilitation or death of a loved one. I am not of course surprised that these people exist, as a community we admit hundreds of thousands of patients to intensive care annually, and these admissions are linked to a network of friends and relatives that must extend to millions of people.  I think what I am surprised about is this – that the work we do affects so many people and yet so many seem unclear about the realities of what intensive care really is. 

How do we close that gap?