In an intensive care unit, every day is a life-and-death struggle. Some patients will revive, while others will face the inevitable demise despite all the treatment.
Although medical professionals deem it their duty to save their patients, a senior doctor working at a Hong Kong public hospital says he understands the choices made by patients and their families in some cases where there is little or no hope of recovery.
“It’s the patient and the families’ choice, there’s no right or wrong,” says Dr. Chan Wai-ming, the chief of adult intensive care unit (ICU) at Queen Mary Hospital.
According to Chan, one in three prolonged intensive care patients actually do not want further treatments to sustain their life.
Dr. Sin Wai-ching, an Associate Consultant of the unit, remembers two contrasting cases.
A year ago, a 90-year-old patient was sent to intensive care after he collapsed while eating an ice-cream with his grandson on a street.
A check revealed that the elderly citizen was suffering from the rupture of abdominal aortic aneurysm, a 90 percent fatality emergency.
Resuscitation only saved his life temporarily because of necrosis of the leg after the rupture.
He could choose either amputation, in which he could very possibly die in the operation theater because of his age. Do nothing, and the toxin from the necrosis can also cost his life.
In the end, he chose the latter. But before the toxins failed his kidney, he had had his last moment with his family.
On the same day, an elderly home resident was also sent to the unit.
She lost her conscientious and had only a slight chance of survival, but her daughter insisted the doctor save her. The patient died in a couple of days.
The two stories tell two different attitudes towards death.
“ICU is supposed to be able to help in such situations, but actually we are powerless,” Sin said.
Powerless as such, medical personnel are often regarded as outsiders in such cases. Still, some of them can understand how patients feel.
A nurse in the unit, who bear the nickname Kitty, had also been patient once, as she suffered from a congenital heart defect and had her third heart valve replacement done a year ago at the place where she worked.
The indifference from her colleagues and the fear of death in the ICU she experienced as a patient changed her attitude in her work.
“We should never judge the pain of the patients because every person feels different about pain,” she says.
Now the nurse can put herself in a patient’s shoes and comfort the person in a way that he or she can understand.
Chan and his colleagues collected 16 stories like these for a book which has been published with the sponsorship of the Board of Management of the Chinese Permanent Cemeteries.
The public can request for a copy for free by filling out an online form at bit.ly/getonecopy.