In the wall of the box 6, opposite the bed, there is a photo of a Little girl, about three or four years old dressed with the typicall clothes of Madrid, with her dress, her shawl, her headscarf and a carnation. She looks funny in the camera, half side, with hands on hips. She looks at each one who comes into the box and we can only say: “Who is this cute girl?”.
She is my granddaughter!, responds JM, and his look changes. With the smile on the face, he tells us that she is her only granddaughter, the girl of his dreams, the most beautiful thing in the world. He only want to see and kiss her again.
JM is dying, he knows it, his family knows and his doctors and nurses too. We can not avoid it. Respiratory failure is irreversible and terminal. Do not intubate decision is taken and consensual. Only relieve, accompany and comfort.
In each episode of fierce breathlessness and extreme desaturation, JM´s eyes are focused in her small treasure. The force of that mischievous look seems to be the only wire that keeps him attached to life and the hope to see her again. Only charitable morphine makes that connection is numb.
JM died without apparently suffering. I say apparently because there was a suffering inner, spiritual, not physical, that we didn´t alleviate. He died without seeing fulfilled his last wish, to see and embrace for the last time to her granddaughter.
It´s true that we are opening the ICU doors, we are changing visiting policies, and we encourage the participation of the families in the care of patients, but we are leaving out of these advances to children (“Children under…not admitted”). We do, of course, thinking about them: we must move them and protect from suffering, pain, death… They will take longer time to suffer in this life!.
But as natural as life is death and suffering, and we can´t hide it. We have the task of explaining it to children as something natural, inherent in the existence, without occult or drama. Children can be short people, but they are not fools.
Why not a child may visit their parents, grandparents or brother if they are admitted to an ICU? Whenever we explain well what is what is happening, and how they will find his patient and how they should behave, we can lift that last barrier in our ICU.
This requires planning and consensus, both among healthcare providers, the families and the patient. The evaluation of each case must be individualized and thorough. It probably should not be something routine yet but exceptional, not forbidden.
The question is in the air: when would we let the children come into our ICU?.