hile rotating through the ICU this summer, I had a patient who would beg me for water. He was intubated, so he couldn’t talk. Instead, he would scrawl “ice chips” on a notepad that we kept near his bed.
This patient had a feeding tube and an IV, so he wasn’t malnourished or dehydrated in a medical sense, but we couldn’t give him food or drink orally because if he choked, it might have infected his lungs.
I avoided him because I had a hard time looking into his eyes. As he gestured toward the notepad, I’d say, “I know, I’m sorry,” and leave the room as soon as I could.
As a budding psychiatrist, I try to recognize when and why I feel uneasy in my role as a doctor. Not quenching this patient’s thirst opened my eyes to how vital food and water are to feeling alive — and how we as medical providers can do better to give our patients that quality of life when they are with us.
When we finally removed the feeding tubes from this patient’s throat, the first thing he said was “I haven’t eaten anything in weeks!” The senior doctor reminded him of the role of that feeding tube.
Doctors and patients aren’t always on the same page.
The language we use helps create this divide. It’s much easier to make patients “NPO,” which means nothing by mouth, than reckon with the fact that we are denying them food and water. It’s much easier to give people what they need to survive, rather than what they need to feel “well.”
Some of our elderly patients have diets of pureed or thickened liquid to prevent choking. I’ve tried them. They are disgusting. Many patients think so, too.
In a recent JAMA study, people with dementia who were on thickened liquids often turned away from them, risking dehydration and other conditions. To better understand this diet and its ramifications, a group of health care providers at the University of California, San Francisco started the Thickened Liquid Challenge, drinking only this diet for a day. Their experiences, captured on video, are brutal in their honesty.
“It tastes like mucous,” said a young participant.
“It’s not that bad,” said a resident, even as her face, mouth puckered and grimacing, told a different story.
As a new physician, these experiences have encouraged me to think carefully about how food affects my patient’s quality of life. While we can’t always change the medical management of our patient’s problems, we may miss opportunities to see when we can.
During the summer, we had a patient who was rapidly declining. He was surviving on pureed foods, while a Milky Way candy bar sat on a table next to him.
Our senior doctor told the interns caring for this man to let him be.
“He can finally eat that Milky Way,” the doctor said. “He should make that his business before he exits this earth.”