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As and ICU physician, I’m often the first one to start a conversation about dying. It seems mad given the events that bring people into my unit, but I’m the one who addresses the elephant in the room. More often then not, that acknowledgement is a huge relief to family.
What guts me is the fragmentation of medicine. How topics of this magnitude are often not taken on in hopes of passing it down the line, to the next physician. It bothers me that family practice doesn’t exist in our hospital anymore.
I know that these topics require a relationship of trust and mutual respect to tackle. I also know that in our current system that is a difficult connection to foster. Isolation units, PPE and shorter rotations all limit our abilities to establish durable rapport.
So while I wait for the system to change, I take it upon myself to dive in, introduce myself, and make eye contact while asking them about their life, their expectations, and their fears. Because sometimes you don’t have a lot of time to be trustworthy.
