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Reviews | The intensive care patient and the family

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For the editor:

Regarding “Who Are We Caring for in the ICU?”, by Daniela J. Lamas (opinion guest essay, February 7):

It is difficult for me to read Dr. Lamas’ essay because his account of the realities of the struggle of end-of-life patients and families in intensive care mirrors exactly what we went through nearly 15 years ago.

My 85 year old father entered the hospital after a fall and ended up in intensive care with acute respiratory distress syndrome. We accepted aggressive treatment, in the vain hope of his recovery.

As unprepared as we were for the outcome, we begged our attending physician to keep him artificially ‘alive’ until the family could reunite. Fortunately, he accepted. But we came away wondering if doing everything we could would hurt our father.

We knew these treatments were really for us, to give us time to accept the inevitable (unimaginable). There are no right or right answers to the questions posed by Dr. Lamas, but she identified the issues.

I hope his observations will provide guidance for physicians and hospital staff to work sympathetically with patients and families to help facilitate the decisions that need to be made.

Alison Grabell
Los Angeles

For the editor:

As a physician involved in promoting advance care directives with Honoring Choices Virginia, I found Dr. Daniela Lamas’ article compelling. As physicians, we always seek to find a balance between ethics and the practice of practical, compassionate care.

The decision to put a family’s needs first often conflicts with logical medical care such as the futility of further treatment or the availability of limited resources. In certain circumstances, the needs of the family must be strongly taken into account. On the other hand, it is also important to follow the wishes of the patient as stated in an advance care directive.

I commend Dr. Lamas for her thoughtful and compassionate approach to end-of-life care.

Kenneth Olshansky
Richmond, Virginia.

For the editor:

As a former hospice nurse, I was there for many family members who struggled to keep their loved one alive, even as they knew death was near. They believed that offering more food and water, or perhaps more chemotherapy or radiation therapy, would prolong the patient’s life.

The families wanted to do something but, in their grief, they did not consider the physical, mental and emotional consequences for the dying person.

I saw their conflicts and their pain. A kind question I often asked family was, “What’s the thing to do with love?” My question gave them pause to reflect on their immediate desire to sustain life a little longer. Almost always, they chose to let their family member die without further suffering, in peace and comfort. For them, the decision then became much easier.

young peg
Boulder, Colorado.

For the editor:

Dr. Daniela Lamas appropriately addresses the suffering of the families of dying patients. But performing heroic, yet futile CPR to assure a family that “everything has been done” borders on medical theater and questionable ethics.

Staff in our intensive care unit would feel devastated by the sound of grunting and snapping ribs as well as the jolts of defibrillator shocks – naming the process “last medical rites” when they knew CPR was futile. An intensive care team must sometimes be more realistic, without even offering futile care. Many hospitals now have futility policies.

Would Dr. Lamas have offered neurosurgery if the patient’s family had demanded it? Of course not! Also, how much did it cost to transfer and care for a patient in the midst of a pandemic in which resources are already stretched?

Jim from Maine
Seattle
The author is a retired pulmonary and critical care physician, Clinical Professor Emeritus of Medicine at the University of Washington School of Medicine, and the author of “Facing Death: Finding Dignity, Hope and Healing at the End” .

For the editor:

I appreciate Dr. Daniela Lamas’ thoughtful question about whether some end-of-life care is perhaps more for the family than for the patient, but it’s certainly being asked in a hospital context.

When my wife was near death, we didn’t ask if we should prolong her life for a day or two, but how to make her last day or two as peaceful as possible. Although we’ve had to go to hundreds of doctor’s appointments during her nine-year battle with cancer, she hasn’t spent a single night in the hospital, even though some of the best ones just happen to be. on the other side of the river.

Not all terminal illnesses can be treated at home, but when they can, it’s often the best place for the dying and for those who will live on. The “critical care rituals” Dr. Lamas refers to aren’t always the ones that matter most.

David Eisen
Cambridge, Mass.

For the editor:

Re “English is a living language. Period.”, by John McWhorter (Opinion, February 10):

Mr. McWhorter is right that the language changes and the historical perspective warrants modesty. But here and now, grammar rules determine understanding. Ignoring them leads to confusion, misunderstanding and ridicule. Using quotes as exclamation points, for example, will confuse readers or invite misinterpretation.

It may be an amusing academic curiosity for a scholar like Mr. McWhorter, but for the person who made the mistake, the consequences are more immediate. Many people who see a sign that says “’Fresh Fish’” — full of quotation marks, to use Mr. McWhorter’s example — will keep walking.

I’m all for bending or breaking rules that have lost their usefulness. But quotes aren’t, and in my field, journalism, their use is sacred, a sort of ironclad guarantee that someone else said those words verbatim.

Unless we want total chaos with attribution, we should just teach people the right way to use them. It’s not that difficult, and the effort is worth it.

You can quote me on that.

Joe Hayden
Memphis
The writer, a journalism professor at the University of Memphis, is the author of “The Little Grammar Book: First Aid for Writers.”

For the editor:

I appreciate John McWhorter’s discussion of quotation marks and how they have evolved, especially signs, from marks indicating speech to marks that simply show greater emphasis. He compares this new feature as a possible substitute for “jazz hands”.

It really made me think of air quotes, which I know are usually used to express irony or sarcasm. Perhaps it’s time to expand the role of these hand gestures as well. I wonder how much time should pass before someone can say, for example, You’re my favourite,” Where I believe you, using air quotes and really saying it.

Nancy Lubarsky
Cranford, New Jersey
The writer is a retired English teacher.

For the editor:

The ever delightful John McWhorter recounts the use a generation ago of the period in situations where it is no longer used today. He cites a number of examples, but does not mention any that New York Times readers can relate to. It appeared every day, exactly this way, on the front page of the newspaper: “The New York Times”. — yes, including the period.

Barry Biederman
Palm Beach, Florida.

For the editor:

Regarding “Pedestrian Fatalities Soar as Reckless Driving Rises” (news article, February 15):

A major factor not mentioned in this article is the distraction we see in many vehicles that pass us by: using a phone in a car. Whether the driver has their hands free or not, the distraction of a conversation with someone not in the car can be deadly.

It’s been proven by science time and time again, and I’m amazed when I see drivers holding a phone – and worse, using both hands expressively while waving them in the air as they speak.

All phone use should be stopped while we are driving. We drive with our brains, not just our hands.

Norma Lee Chartoff
West Haven, Conn.