Hola a tod@s, my dear friends.

A few days ago, Julio Mayol commented on social networks his illusion when the British Journal of Surgery published his first article, in 1995. He has just be elected as a member of its Board of Management and Director of the company. ” It is said that if you really want something it ends up being reality,” he wrote.

With the same enthusiasm I present you “An emotional awakening”, my first article in Intensive Care Medicine.

Here is a brief summary.

“My name is Gabriel. I have been an intensive care physician since 2007. A magical and unique adventure where I never know what is going to happen. In the last 10 years I have cried and laughed, I shared suffering and hope. I helped many people with technological and emotional support but I did not receive training on psychological management skills.

I have also witnessed death way too many times, much more than the rest of the population.

Emotional time is very different from physical time, and we do not usually feel the difference.

Since I started to work, it has not changed much the situation in which “there is nothing going on”. But yes. Not just me, many ICU professionals feel that much remains to be done.

For me and my team it is very difficult to deal with death. We blame ourselves, we think what we didn’t, or what we failed. Perhaps we have unrealistic expectations of what is humanly possible.

I think that we are wrong: we usually focus on the end result rather than understanding the whole process, and that makes us feel guilty if a patient dies. 

We need to face the fact that sometimes the disease just wins the battle. If we understand this, we will be able to give a scientific and human approach that will help us to accept that death is the end result of our lives.

In Spain, we don´t conceive death as something natural. I was born in a vibrant country and, in general, people prefer not to think about death.

When critical illness occurs, patients and families raise walls. They are in shock, confused and not prepared. If my family or myself were there, what would our reaction?. How we would like to die?. My answer is clear: no pain, surrounded by the people who loves me and at home.

No tubes or catheters, or action futile if the result is not an acceptable life quality.

For me it is really curious that we, as organized human beings, prepare our vacations to the last detail, plan our birthdays or weddings months in advance, yet we ignore death or how we want to die or be treated in our last hours on this earth!

I invite you to stand back and think. To help us understand what you want and how to make this moment calmer, kinder and more gentle. To accept death without tags, no matter who you are or what you have.
If we understand our own process, perhaps we can help the others. I have never seen anyone who does not benefit from sharing, from talking about their wants, their likes, or their fears. Human being can adapt to almost any situation no matter how desperate or dramatic it might be.

By providing relief from pain, by giving solace to the despairing, company to the lonely, and a comforting hand for the frightened, we will provide dignity in death. At times this is more effective than the miracles of modern science and technology.

As physicians, we were taught to preserve life. But we also have the responsibility to educate people in the hard reality of life’s end: death. We must take up this challenge to train staff and management alike in the how and the why of end-of-life situations: communication, empathy, bedside manners, and preparing for grief. Some might think that palliative care in intensive care is incongruous

However, we should try to bring together the best treatment available with the best multidisciplinary care to ease the patient’s dying process. Working with common sense: maintaining autonomy, physical and emotional comfort and ensuring communication among those involved. And to avoid surprises and negative reactions.

We need to standarize all these processes in the ICU. Think about deathc as we think about life.
To improve our ICU, we need an emotional awakening.
Looking and listening, embracing and understanding, and feeling compassion for those who are suffering means preparing patients, families, and friends for the inevitable.
By putting ourselves in their shoes, we can feel what they feel, and learn to respect their wishes.

That “Cure sometimes, relieve often, and comfort always’’” which remains as valid two centuries later. And transform today’s reality into a better journey down life’s ICU path.

Happy Wednesday,