Episode #36: We Need To Talk

Why is communication in the ICU so important? When we live in a world of comatose patients all we hear is beeping alarms. What is happening to patients in a world of solitude on the inside? What would communication mean to them?

During a research study done by Lance Patak, MD at UCLA medical center, former patients reported the following:

“When I most needed to communicate I couldn’t speak, and I couldn’t really make myself understood. Nor did I feel like I was being given the opportunity to perform as an individual. I felt like I was being judged by a set of criteria for other patients. And, you know, that’s natural. I am not an ordinary patient. I’m sure no one’s an ordinary patient.”

“They don’t even consider giving you a piece of something as simple as a piece of paper.”

“I kept trying to tell them I had pain in the back and uh they didn’t understand what I was saying. Finally I just came to the point where I stopped.”

“It would allow me to indicate things without having to draw them. The idea of pointing at a figure and then completing the sentence with the catch phrases is a good idea.”

“It would create an interface between the patient and the staff that would in a way formalize the requirement that they pay attention to what the patient is trying to say. It would be like a passport. The person, even if they didn’t use it, could wave it, say ‘I matter. I can be heard. I have a stake in this. It’s not just about you acting on me. It’s about my being able to tell you what I want, what I’m doing’. I believe the concept itself is very strong, because it would both obligate the staff to stop and listen with a fresh ear, instead of saying, ‘Oh well, they’re intubed. They can’t talk. Let’s just write them off.” It could inspire, that is to say instill hope and empower those who are not as strong willed as I am.”

“This is really good because it addresses the emotion and the needs…and like I said when you’re intubated, emotion is the most important thing I think…and to explain what’s going on.”

“Maybe it could be part of the preoperative package. It’s a lot of information, but if they had a photocopy on paper of this and said, ‘this is your message board, familiarize yourself with it’. That could be very helpful, so that somebody isn’t trying to cope with discomfort and trying to interpolate.”

“How can you talk to somebody with just yes and no’s? It’s almost too, it’s almost impossible.”

“Everybody is so different… You know, that’s, that’s the biggest problem. Uh, you know, people communicate differently.”

“If I was disappointed, it was the degree of frustration of trying to get someone to understand me.”

“I asked, I was told the I might be wake up intubated. And I told everyone that I was very frightened about that and I wanted to avoid that. So avoiding waking up was the most important thing. I didn’t want that to happen to me. When I woke up, I was intubated. I was completely aware of it. So, avoiding that was the most important to me. Unfortunately, I was unable to do it.”

Patak L, Gawlinski A, Fung NI, Doering L, Berg J. (2004). Patient’s reports of health care practitioner interventions related to communication during mechanical ventilation. Heart & Lung — The Journal of Acute and Critical Care 33(5), 308–320.

More resources about communication in the ICU:

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