In the complex world of critical care, patients can sometimes fall into a vicious cycle of complications despite the best efforts of an experienced medical team. At times, it takes a fresh perspective from someone outside the primary team to make all the difference. This is the story of a patient who, after a cardiac surgery, faced this issue.
A woman underwent heart valve surgery. The postoperative course was complicated by significant bleeding , heart failure, infection and required prolonged mechanical ventilation. As time passed, her condition deteriorated further. She could not be weaned off the ventilator, developed muscle wasting despite full nutritional support, and eventually required a tracheostomy.
Four months passed and despite the efforts of qualified and experienced intensivists, surgeons and specialists there were no signs of improvement. Relatives got tired and disappointed while the doctors and nursing staff -to some extent- accepted that she could not get out of this situation but kept trying nonetheless.
Then, a new intensivist joined the department.
He was young and enthusiastic and had an aggressive approach towards patient management. As he took over the case, he made some major changes in management and within a few days the patient started to show gross improvement. Muscle tone improved. Ventilator settings were weaned down. Although due to the prolonged illness and complications involving multiple organs, the improvement was not enough for a full recovery. Still, hope had returned.
This situation raises an important question
Although some very senior and experienced intensivists and specialists from different departments were trying their best with not much progress , how come this new intensivist was able to make a difference?
Sometimes, when a patient stays in the ICU for a long time, the team becomes too used to seeing the same condition every day and becomes less aggressive in their approach and may stop trying new things. Treatment continues without making much difference. As a result, the day to day care can become routine, and opportunities for breakthrough may be missed.
While experience is invaluable, it’s equally important to recognize when a case needs new thinking. Sometimes, a new doctor or someone from outside, unbiased by the assumptions and with no burden or fatigue that builds up over a long course, can look into matters from the beginning and catch the mistakes or missed observations by the primary team.
This event is not meant to discredit the experience or the efforts put by the primary team. It’s about the importance of perspective. In long stay ICU patients, it is not uncommon for even excellent teams to miss opportunities for recovery simply because the situation has become too familiar and tiresome.
It’s always advisable to get an external opinion that might make all the difference between maintaining a status quo or saving a life.