ICU

It’s easy to assume that all medicine is interchangeable; that if you’ve worked your way up the chain of command, from intern, to resident, to fellow in a specialty, especially in the tentacled realm of internal medicine, that you would assuredly be good to go with knowing enough about everything. Some of the more prestigious specialties, like cardiology or pulmonary/critical care, assume their knowledge supersedes. And with taking care of critically ill patients, there is a corollary assumption that competent super-specialists automatically understand what comes next, mortality.

With this, there is often a simplification and gross misunderstanding of what mortality entails. It becomes simplistic, often the caricature of what it truly is. Yet it only takes stepping in to the world of hospice to understand that mortality and everything it touches is complex and far-reaching. It only takes taking care of dying patients in all forms to understand that mortality requires markedly more specialized knowledge than simplistic assumptions.

We recently had a case with an ICU clinician as a patient’s caregiver. Although this caregiver was very competent in their own domain, it was clear that dominant aspects of managing the mortality were completely foreign to them. The medications, the dosing, the regimens, and what was being seen over time were all poorly understood. This clinician required enormous rerouting to keep on track with sensible management for a good outcome.

I’ve said it many times, but it bears repeating. The management of mortality is not an afterthought, is not a short and fatuous blip at the end, but rather a lengthy, drawn-out process requiring specialty knowledge. If we understand this, that not everyone can know and manage everything, we are liable to have a much more successful dying experience.