Every ICU is different. All those who work or have any experience there (patients and families, health managers) know it.
And this difference not only concerns its size, architecture, benefits, type of patient attended, but also its organization, management, human resources … So, in our country, we have medical, post-surgical, coronary or trauma ICU, for example. Not all of them have individual boxes, or windows with daylight, or information rooms or waiting rooms. Some ICU of third-level hospitals have resources and benefits that other ICU of secondary or primary hospitals do not possess (cardiac care devices, extracorporeal oxygenation membranes, advanced cardiovascular monitoring systems, or even continuous renal replacement therapy or ultrasounds.
In Spain, the norm is the ICU are attended 24 hours by physicians specialized in intensive care medicine (intensivists) and nurses trained in the care of critical patients. However, it is not always so and in other countries the model is different; they are called “open”, in which the patients are assisted by the different specialists who indicated their income. The visiting policies, information or the engagement of families in the care of the patient admitted to the ICU can also be very variable
Two things for me are common. First, people attended there are going through one of the most difficult moments of their lives (here I include the binomial patient-family), who suffer a process that, in real or potential, puts at risk their life and that they need an attention , care and the most advanced technical devices and exquisite. Professionals who work in the ICU put all our efforts to bring forward these patients with the best quality of life. But sometimes this is not possible and we lose the game against death.
And here comes the second common denominator of all UCI in the world: in all ICU, patients die. In all. Death itself equals all human beings, as Jorge Manrique said in his famous verses: “… close are the same those who live by their hands and the rich ones.”
Although death affects all UCI greater or lesser, what is variable is the way we serve the process of dying in our units, and that is what we should reflect. We have often heard that the ICU is not the best place to die, but we must make it a good place to die. Professionals not only have to take death in our units, when it is inevitable, as something natural and not as a therapeutic failure, but we must learn to detect and diagnose it with more diligence and haste to help this process be the best possible for patients and their families. We must facilitate the accompaniment and mourning, adjusting to their times, meeting their physical, psychological and spiritual needs. We must learn to accompany in their pain, to comfort them, to be present and not to blur in the maelstrom of other stories and other lives. This is the most important moment for the one who is leaving and for those who stay. It’s “the moment.” And they need us.
I know we’re on it. I want to believe it. I believe it.
By Ángela Alonso.