Comments on: Book Review: Through the Valley of Shadows

By: Samuel Brown

Samuel Brown — Wed, 03 Aug 2016 18:02:14 +0000

True Blue, there are pockets of excellence. Seattle and Vanderbilt and Intermountain do great work in this domain. UCSF has a solid history. BIDMC in Boston has done great work. It’s pretty spotty overall, though, and people are generally at the whim of call schedules (i.e., some clinicians are much better than others, and you get the clinician who is on call when you arrive). There’s a group in Madrid that is working on this, and pockets in various places in Europe. We should all be calling for better work from everyone involved.

Anon, the leading group for post-ICU followup is the Vanderbilt group, as I outline in the book. They have a nice website: http://www.icudelirium.org/recovery-center.html . It’s been my private hope that this book will actually be useful to survivors. I’ll be interested to hear what you think of it. If you feel comfortable, I’d be glad to hear your feedback (contact info is under Contact on http://samuelbrown.net ).

All best wishes.

By: Anon

Anon — Wed, 03 Aug 2016 06:31:11 +0000

Sam,

Thank you for addressing my comment (#3). I appreciate the caution regarding the PTSD trigger warning. Also, I appreciate the link to patient resources. I wish I had known how and where to get help following my trauma. Although I felt the follow-up cardiac support and care I received was excellent, I had to find my own therapist and navigate the landscape of emotional healing on my own. I wish I had understood what might happen following discharge and had been prepared with resources.

By: True Blue

True Blue — Wed, 03 Aug 2016 03:49:27 +0000

Samuel Brown, Are these practices the same throughout the first world, or are there places where it is handled better?

By: Samuel Brown

Samuel Brown — Tue, 02 Aug 2016 17:07:42 +0000

Anon, if you have PTSD from the ICU experience, be mindful that the book talks honestly about how painful the experience of the ICU is and how difficult recovery can be. In contemporary language, “trigger warning” for PTSD flashbacks related to pain, confusion, how alone you felt, the nightmarish memories of the ICU. I’ve hoped that this book will be helpful to ICU survivors and their families, if only to let them know that they are not alone. But, especially with PTSD, be mindful of the risk of triggers. For people with a therapist, I’d recommend discussing it with the therapist. For people with a trusted advisor, discuss it with them as you consider reading. It’s my fervent hope that this book will be helpful to all participants: clinicians, general public, and survivors, but it’s not written primarily as a guide book for ICU survivors.

I’m hopeful that the book and the related reform efforts will make ICUs less violent than they have been, while also helping clinicians to do a better job of providing personal and personalized care to people in the ICU.

On the general topic of ICU survivors, I recommend SCCM’s THRIVE initiative, which is doing wonderful work to support survivors and their families: http://www.myicucare.org/Pages/default.aspx .

You may also be interested in the WSJ piece today that talks about one relatively straightforward part of making ICUs better places: http://www.wsj.com/articles/icus-ease-restrictions-on-visitors-1470073304

All best wishes, Sam

By: Anon

Anon — Tue, 02 Aug 2016 02:19:28 +0000

Thank you for this review. I just bought a copy, hoping that reading this book can help me. I am not entirely sure what I hope for or need, but as a survivor of a wicked bout of viral myocarditis who experienced the post-ICU trauma your review referenced, I have avoided thinking about and discussing end-of-life care with my family. All I know is that I don’t want to go through such a severe and violent experience again. Thanks for the resource.

By: Clark Goble

Clark Goble — Mon, 01 Aug 2016 22:50:11 +0000

It’s an interesting point. I remember my dad saying that something like 20% of the kids he started school with were dead by the time he graduated high school. And that was in the period from the mid 40’s through the 60’s. Very recently. It was almost certainly worse in the decades before WWII.

Honestly while I’ve known people who’ve died, I can’t say I’ve had anyone I was in a close relationship at that time die. Even when my grandparents died I was either too young to really understand but also wasn’t with them daily such as to have a close relationship. My parents and siblings are still alive. All my friends are alive. Acquaintance who have died have done so typically after a few years from when I stopped hanging out with them. Effectively I’m cut off from a certain experience of death. Even most people I do know who died, like my grandmother, died well into their 90’s when death seems like a mercy for a worn out body to end the pain.

Like most Americans, I’m cut off from people I’m deeply close to like my children being taken away too early. That affects so much of how I think about these things.

The points about end of life care are also well made. The difference between legal “right to non-intervention” and a kind of respect for end of life is well made. So much that’s well intended in end of life care is invasive and unhelpful. I remember just a few years ago while in the hospital with very, very bad pneumonia how it really changed how I thought about things. (The doctor came in one night and noted that my oxygen was up as high as it could go that if I didn’t improve by morning I’d be taken to ICU and might die. Talk about a shock out of complacency.)

By: Samuel Brown

Samuel Brown — Mon, 01 Aug 2016 22:34:29 +0000

Thanks for the wise and kind review. I’m grateful for the careful thinking you display on this topic.