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CMAJ • March 7, 2000; 162 (5)
© 2000 Canadian Medical Association or its licensors

Letters
Correspondance

The journey through the ICU

Michael Cusimano

Neurosurgeon; St. Michael's Hospital; University of Toronto; Toronto, Ont.

As a neurosurgeon who deals with critically ill patients every day, I read a recent article by Deborah Cook and colleagues with interest.1 Upon reflecting, I felt that understanding of the reasons why advanced life support is withheld, provided, continued or withdrawn in the ICU could be enhanced by using an alternative metaphor: that of the ICU stay and its attendant use of technology as a journey.

At times the journey is complete by the time the patient arrives in the ICU. At other times, however, the journey through the ICU becomes a trip through uncharted waters, and in these cases the ship has no power against the ravages of nature.

In this context, medical technology may be viewed as one means of taking the journey. The withdrawal of support may be viewed as halting one means of transportation, while its continuation may be considered a decision to carry the traveller - the patient - forward. When technology is withheld, it may be considered a means of travel that the traveller cannot or chooses not to use.

Other modes of transportation are possible for journeys. This might be the reason why some patients have positive outcomes in the course of their illness that cannot be explained by contemporary western medicine.

On the journey through the ICU, there are many travellers. They are all affected by the trip, whether they consciously realize it or not. In a journey, the travellers may make decisions on the means of passage they will take on the basis of their best intentions to reach a destination.

Reference

  1. Cook DJ, Giacomini M, Johnson N, Willms D, for the Canadian Critical Care Trials Group. Life support in the intensive care unit: a qualitative investigation of technological purposes. CMAJ 1999;161(9):1109-13.[Abstract/Free Full Text]




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