An ex-colleague of mine, NS, just lost her beloved father to Covid-19 last week. I worked with NS briefly at a district hospital many years ago in the emergency unit. She left the unit for a dream to become an independent private medical practitioner on top of family commitments. Years passed. She did very well and from what I witnessed from afar, she has come to a stage that she is renowned as a local celebrity. The one with alhamdulilah, positive influence.
The challenges of becoming this public figure however comes with a price. Everything about her life and actions were scrutinized by netizens. I was so saddened to see how some of these people, who were not even there, were passing judgments on how she, a doctor, should manage her father’s condition. They screenshot her pictures and videos with her father and made it an ‘illustration’ to their own blog/ face book post about a topic that they want to talk about.
There was a comment on Habbatus Sauda (black seed), an alternative superfood that boasts a multitude of benefits. They were saying that because she is a doctor, this form of therapy was probably not put forth to her father causing him to succumb to his premature death. Then there were so called opinions that to put the father on a ventilator in ICU was a terrible idea because he looked fine! And that it was the ventilator that sped up his death. All these were said at the time when NS and her family was grieving. Some may say, just ignore it. However, in Malaysia, this is a big deal as social media is a heavily ingrained neo-culture in our everyday lives. I think we are like the top 5 users of social media in the world? Having someone posting on social media bad things about you is like having that person standing right next to you during the funeral. You could literally trigger someone to respond with just a few words on social media.
I have nothing against Habbatus Sauda. It has its benefits but like any form of food, it does have it’s limitations and you don’t treat something that needs a quick fix by consuming Habbatus Sauda while hoping that everything will be alright in a few minutes. We have to be realistic. What I am really bugged about is how people perceive the use of ICU care.
Who gets to go to Intensive Care Unit
ICU care is not for patients who, from the anaesthetists assessments are candidates heading towards imminent death. That is palliative care.
ICU is for those who are very ill but having the chance to pull it through and survive. We do have patients who are not ventilated in ICU because we anticipate a problem that could happen if the patient is managed in a normal ward and not monitored by the hour. For example, a patient with a long bone fracture. He may be alert and sitting up but he is at risk of a fat embolism from his injury. If his vitals are not monitored regularly, the early symptoms may be missed. Being on a ventilator per se is not an automatic ticket for a place in ICU. A patient could be ventilated in the wards for the comfort of the patient, to help the patient breath but they are not indicated for ICU care. The decision to intubate a patient is never an easy task. This is because it comes with its own risk and complication. But once a decision is made, they are always in the patients best of interest. Tak adalah orang suka2 nak masuk tube dan menyusahkan pesakit . Intubation requires preparation and a lot of planning regarding the patients care , the moment the team makes the step. It looks macam senang to the public when in fact, it is because the team are experienced and have been doing it for a long time.
How is ICU different from managements in the ward?
An ideal ICU set up is when you have 1 nurse caring for 1 patient. We are stretching these skilled nurses to a point of having 1 nurse caring for probably 3 patients. This nurse will be responsible to check on the patient from head to toe. From simple hygiene to matters as heavy as flow of inotropes and fluid. Every single input and output of the patient is measured. Apart from carrying out the doctor’s order, they are the eyes and ears that identify the turning point of the patient of whether they are getting better or worse. Every beep from the machines carry a different meaning and if a skilled person has worked in ICU for a long time, even the slight change in the beep tone was enough to warrant a concern from the nursing side. The problem will be highlighted to the intensivists for review and managed accordingly.
When I was a medical officer in the surgical department, one of the surgeons was very keen to learn the trick of the trade in managing pancreatitis. He wanted to lessen the burden on ICU by trying to manage his these patients in the general ward. He wanted to know what is ICU doing differently there so that he could emulate and bring on the practice in his ward. I never knew what was the final answer but I guess the strength of ICU lies in paying attention to the most meticulous detail in patient management. The drips per hour, the difference in pulse pressure, body temperature etc.
NS’s father was a suitable candidate for ICU. I cannot see it as otherwise. He had a chance to survive but the impact of Covid-19 was greater. I could only pray that NS and her family forgive those who perceived his care pathway as detrimental to his condition. That they could grieve in peace and move forward as a family.