It is Wednesday evening. Eighty
days ago, Guillian Barre Syndrome (GBS) took away nearly all muscular functions
of our 81-year old patient. Having survived pneumonia, sepsis and GBS, all that
is left is a cognitively sound, tracheal cannula-dependent, tetraplegic
patient. Where there once was a sparkle in his eyes, now only sadness remains.
On that Wednesday evening I
sat down and talked to my patient and his wife. Was there anything I could do
to make life less miserable for them? In the end we concluded that there was
only one thing I could do: take him home for the last time. So, I called the
nurse and we started to search the internet. Within a few minutes we found the
website of the “make a wish” ambulance (http://www.wensambulancebrabant.nl ).
On Thursday morning, one of our ICU nurses and I were
accompanied by an ambulance nurse and a driver ready to take our 81 year-old
patient home. Never before had I seen anyone enjoy an ambulance ride as much as
Mr. GBS.
We spent 3 hrs in his house
and garden, with tears and laughter. This was his last visit home, nonetheless,
it seemed that these 3 hrs made up for the 80 days of misery. Not long
thereafter, Mr. GBS died.
In my 5-year ICU career, I
only went home to a patient on three occasions. This was the first time I
returned with my patient. On the other two occasions the patient stayed at home
and received palliative care. In the Netherlands transmural palliative care can
be realized within 24 hrs. In the Radboud University Medical Centre, an ICU
nurse created a protocol to transfer palliative care from the ICU towards the
patient’s home. Over the past 5 years approximately 5 patients a year have used
this possibility of dying at home (https://www.venticare.nl/kennisbank/artikelen/naar-huis-om-te-sterven-vanaf-de-intensive-care article in Dutch).
Why is taking your patient
home at any day during his or her ICU stay not standard of care? Is it related
to the costs? Unlikely, because the “make a wish” ambulance is supported by donations and the
nurses and doctors work for free. Is it fear that something might happen to the
patient? This is something that can be discussed with your patient (if
possible) and / or relatives. Furthermore, the doctors, hospital, and patient
are insured. Workload then maybe? Workload is and will always be high in our
profession. Nonetheless, witnessing Mr. GBS’s emotions upon his visit home gave
our complete ICU team extra energy and augmented their joy at work.
I hope that this subject will
get the attention it deserves throughout the world. In my opinion, offering our
patients and their loved ones the possibility to visit there homes, either
during their (long) ICU stay or at the end of their lives, should eventually become
standard of care.
Bart Ramakers
Bart Ramakers is an Intensivist at Bernhoven
Hospital in the Netherlands, he is also my dear college at the foundation
'Venticare 'professionals in acute care. I want to thank him for
his blog and hope he wants to write again in the future
for Humanizing Intensive Care !
Read his
previous blog here: https://www.blogger.com/blogger.g?blogID=4950057984322853031#editor/target=post;postID=2490644021030687224;onPublishedMenu=overview;onClosedMenu=overview;postNum=1;src=postname
Palliatie op
de ic of thuis Lees het protocol & checklist van het RadboudUMC
http://www.fcic.nl/onderzoek/icu-delirium-2-2/
