In an earlier blog (“What are little boys made of?”), I highlighted the fact that “things aren’t always just what they seem” and linked this to a Jack Johnson song with a relevant title. The unearthing this week of the above bit of footage seemed to underline this very dramatically, if embarrassingly.
There’s no doubt that the perspective we choose (or happen) to view things from can profoundly alter our perception of what is going on. We can bring all sorts of assumptions, which may not be immediately obvious, to our considerations. When looking after a critically ill patient, one of the great dangers is the “inherited diagnosis." When extremely ill patients are admitted to Intensive Care Units, the clinicians working in those units need to respond rapidly with resuscitative measures and organ support technologies. Whilst treatment must take priority over diagnosis in this situation (ie the reverse order from usual medical practice), getting to the underlying cause of each patient’s organ failure must follow soon thereafter. The business/busyness of resuscitation and multi-organ support can sometimes distract from establishing the root cause of the problem, and it needs to be remembered that organ support/life support technologies are usually treating the symptoms rather than the underlying cause. They are only there to avoid imminent death and create a period of stability while the primary problem is dealt with, and organ failure is unlikely to recover unless the underlying cause is dealt with, and dealt with in a timely fashion. So diagnoses made by other clinicians prior to intensive care need to be reassessed and, if necessary, altered. Assumptions need to be identified and alternative possibilities considered. Sometimes a change of view is required to get the best result - the pizza needs to be turned the right way up...
This marks the difference between a Doctor merely skilled in resuscitation and life support technologies, and an Intensivist. That is not to say that Intensivists can deliver all of the wide range of treatments of the underlying disease which might be required. For example few Intensivists are surgeons, and many ICU patients have an underlying surgical problem, which only a suitably skilled surgeon can address. For the same reason, most surgeons are not based in an ICU as they are not expert in the range of medical and invasive technological therapies which critically ill patients also require. High quality specialist intensive care nursing is a further fundamental component of this teamwork, as it is often this highly motivated and courageous group that deliver the organ support technology and specialist treatments prescribed by Intensivists. It’s a big team, with lots of important disciplines not yet mentioned, including specialist physiotherapists, radiologists, pharmacists, dieticians, organ donor staff. (Slicer knows he’s going to get it in the neck for mentioning these last...! Last but by no means least...)
What is needed for success is an alignment of perspective, an agreement of what the priorities are, and good team work across lots of healthcare disciplines co-ordinated by an Intensivist. Alongside all of this, time must be found to communicate with empathy the medical findings, treatment plan and estimate of prognosis to the closest relatives of the patient. Finally, such aggressive therapy needs constantly to be reassessed regarding whether or not it continues to be in the best interest of each patient. Inevitably, the best interests of some are served by switching from aggressive therapy to palliative therapy aimed at comfort and dignity, rather than continuing to aim for survival when it becomes clear that survival is a fruitless pursuit.
Intensive efforts of an entirely different kind (another kind of unearthing) have grabbed the attention of the world in the last few weeks, and particularly in the last few days. However, Slicer is in no doubt that they have required entirely analogous teamwork, co-ordination and application of technology.
All together now: "Their future's so bright.... they gotta wear shades."
The bunch of miners who quite literally descended to the underworld, and spent more than 2 months there whilst things hung in the balance, before being raised to life on the surface have attracted much global sympathy and interest, as has the rescue mission. The outcome could have been very different.
Peggy Seeger’s song (covered by U2 on their Joshua Tree tour) recalls the Springhill Mining Disaster of 1958 in Nova Scotia, Canada:
“Down in the dark of the Cumberland mine
There’s blood on the coal, and the miners lie
In roads that never saw sun nor sky
Roads that never saw sun nor sky...
...Listen to the calls of the rescue team
We have no water, light or bread
So we’re living on songs and hope instead
We’re living on songs and hope instead.”
'OK,' I hear you say, 'Pity you could only find a song about coal miners. These guys were after gold.'
Try this for size then, from the gorgeous voice of Margo Timmins, of the Cowboy Junkies:
"We are miners, hard rock miners
To the shaft house we must go...
On the line boys, on the line boys
Drill your holes and stand in line...
...Two years and the silicosis takes hold
And I feel like I'm dying from mining for gold
Yes, I feel like I'm dying from mining for gold."
Slicer wishes Intensive Care achieved as high a survival rate as the Chilean rescue mission did, but then these guys did start out healthy. Naturally there was elation when they were winched up one at a time but the fact that they still had a sense of humour (eg enquiring how the dog was) after such protracted difficulty has been remarkable. Whether they would have found a prank funny or not is another thing, but Slicer did love the idea proposed by a friend: of rescuers greeting them in Planet of the Apes costumes. Perhaps it’s just as well that we’ll never know how that would have gone down...
It seems that there was a limit to the size of person who could be winched up through the drilled tunnel. The miners were expected to have lost weight and so it was hoped that they would be sufficiently thin that it wouldn’t be a problem.
Each will have their own perspective on their deliverance. Some will credit their endurance, some have already credited the providence of God, some will credit luck, others the drilling technology and the expertise of those operating it. (The analogy holds too for those who experience critical illness). Who knows what these resilient miners will say when they get home? Slicer considers the potential explanations listed are not all mutually exclusive. Those of us who were just observers may inherit a diagnosis or harbour an assumption that one agent of deliverance was the real explanation, and the others romantic illusions. But perhaps there is a viewpoint we can reach where several of these agents are acting in concert – but it may require us to question our assumptions and the analyses or dogmas we inherit from others before we can do so.
“You try so hard but you don’t understand
just what you will say when you get home
because something is happening here but you don’t know what it is
Do you, Mr Jones?”
Ballad of a Thin Man
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