Personal Blog: How far should treatment go?
A few years ago I worked as a MICU driver. A MICU is a Mobile Intensive Care Unit, or a moving Intensive Care room. It has all the facilities, such as driver pumps for administering medication, a breathing machine and all kinds of medication.
When my shift started as a MICU driver, I always checked whether the vehicle was in good order. Is everything present that must be present, does everything work properly and very important is there sufficient fuel available, given that the MICU service was interregional.
If everything was been checked, I usually sat in the sitting room of the ambulance post, or sometimes in the room (of the MICU drivers) to work on my graduation project of my nursing school.
Then i waited for a call.
That one day we got a call. The assignment was to pick up an unstable patient in a peripheral hospital to take them to a higher echelon intensive care unit (an intensive care unit where they could offer a higher level of care).
This was a ride that had to be driven with light and sirens, some rides were from a higher echelon intensive care to a lower level, these were often stable (or stable enough) patients.
From the ambulance station I rushed to the hospital with the MICU (freight) car, here I picked up the intensivist (intensive care doctor) and the intensive care nurse.
From the hospital we rushed to the peripheral hospital, which happened to be in the neighborhood where I was living at the time. Fortunately, it was not very busy on the road and we were reasonably fast at our destination.
In the intensive care unit of the sending hospital we found a very sick patient, a young woman of less than 50 years, who had a severely low oxygen level in the blood and this for some time before we arrived.
Ventilation on the prone position
The woman was ventilated lying on her stomach, which was done to relieve the lungs and hopefully to be able to deliver more oxygen via the ventilator.
The prognosis was therefore already very bad.
The intensivists and nurses tried to do everything to improve her condition, only what was tried and whatever medication the woman received, the oxygen content was and stayed dramatically low. While I was a 4th year nursing student and knew a lot less than i know now, I understood that the mrs. was critically ill.
Given the fact that as a driver I could not mean much at the time, I tried as much as possible to support the woman's partner by hearing his story and answering the questions as good as possible. As I understood from him, Ms. became seriously ill in a very short time (hours) and her condition deteriorated at a rapid rate (this was also the reason that Ms. had to be brought to the highest level of an intensive care unit).
Given that she had become dangerously ill in a short period of time, her condition deteriorated very quickly and the fact that several organs were not functioning properly (MOF), the conclusion was that Ms. (Most likely) suffered a septic shock. , based on a bacteriological infection.
Given the fact that no intervention gave any change, at one point it was decided to have a special team rushed (from the hospital where we came from), to put Mrs on a special Hart-Long machine, a so-called ECMO Machine (Extra Corporal Membrane Oxygenation).
This means that the blood is diverted via the machine, the machine administering oxygen to the blood and then the blood (with more oxygen) is 'returned' to the patient.
ECMO
The team finally put Mw. On this machine, and we finally drove with police guidance to 'our' hospital, where Mw. Unfortunately passed away in the course of the evening.
It was an impressive case to experience, on the one hand the terrible case that such a young woman has become so seriously ill in such a short time, and the sorrow of the partner. But also the question of how far treatment should go. When do you say enough is enough?
Was the deployment of the ECMO team justifiable? Or was it 'better' to let the patient die in a the presents of her partner, so that the partner also had the chance to say goodbye to his wife?
Fortunately, I did not have to make that choice
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| Mobile Intensive Care Unit (in the Netherlands) |
When my shift started as a MICU driver, I always checked whether the vehicle was in good order. Is everything present that must be present, does everything work properly and very important is there sufficient fuel available, given that the MICU service was interregional.
If everything was been checked, I usually sat in the sitting room of the ambulance post, or sometimes in the room (of the MICU drivers) to work on my graduation project of my nursing school.
Then i waited for a call.
That one day we got a call. The assignment was to pick up an unstable patient in a peripheral hospital to take them to a higher echelon intensive care unit (an intensive care unit where they could offer a higher level of care).
This was a ride that had to be driven with light and sirens, some rides were from a higher echelon intensive care to a lower level, these were often stable (or stable enough) patients.
From the ambulance station I rushed to the hospital with the MICU (freight) car, here I picked up the intensivist (intensive care doctor) and the intensive care nurse.
From the hospital we rushed to the peripheral hospital, which happened to be in the neighborhood where I was living at the time. Fortunately, it was not very busy on the road and we were reasonably fast at our destination.
In the intensive care unit of the sending hospital we found a very sick patient, a young woman of less than 50 years, who had a severely low oxygen level in the blood and this for some time before we arrived.
Ventilation on the prone positionThe woman was ventilated lying on her stomach, which was done to relieve the lungs and hopefully to be able to deliver more oxygen via the ventilator.
The prognosis was therefore already very bad.
The intensivists and nurses tried to do everything to improve her condition, only what was tried and whatever medication the woman received, the oxygen content was and stayed dramatically low. While I was a 4th year nursing student and knew a lot less than i know now, I understood that the mrs. was critically ill.
Given the fact that as a driver I could not mean much at the time, I tried as much as possible to support the woman's partner by hearing his story and answering the questions as good as possible. As I understood from him, Ms. became seriously ill in a very short time (hours) and her condition deteriorated at a rapid rate (this was also the reason that Ms. had to be brought to the highest level of an intensive care unit).
Given that she had become dangerously ill in a short period of time, her condition deteriorated very quickly and the fact that several organs were not functioning properly (MOF), the conclusion was that Ms. (Most likely) suffered a septic shock. , based on a bacteriological infection.
Given the fact that no intervention gave any change, at one point it was decided to have a special team rushed (from the hospital where we came from), to put Mrs on a special Hart-Long machine, a so-called ECMO Machine (Extra Corporal Membrane Oxygenation).
This means that the blood is diverted via the machine, the machine administering oxygen to the blood and then the blood (with more oxygen) is 'returned' to the patient.
ECMO
The team finally put Mw. On this machine, and we finally drove with police guidance to 'our' hospital, where Mw. Unfortunately passed away in the course of the evening.
It was an impressive case to experience, on the one hand the terrible case that such a young woman has become so seriously ill in such a short time, and the sorrow of the partner. But also the question of how far treatment should go. When do you say enough is enough?
Was the deployment of the ECMO team justifiable? Or was it 'better' to let the patient die in a the presents of her partner, so that the partner also had the chance to say goodbye to his wife?
Fortunately, I did not have to make that choice
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