While 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.”
About the Author Reprints
I was with my husband in the hospital when they”the speak therapist” put him on this thick substance. I was awefull! I this was after open heart surgery. And being intubated for 5 days. He wanted and needed water.
I was at his bedside,. I gave him ice hips he tolerated . Them well. He would not tak the thick stuff ever,
So took time and let him sip a little juice at a time. He is fine today 6 months later. He received an L VAD. Please get me more advanced info for LVAD patients, and care givers.
He was no
The operation was a success but the patient died.
I hope I am never in a hospital where you work.
I’m left feeling angry after reading this article.
This is not just about this writer but there are specific references to her.
I am surprised, over and over again, how so many *educated* medical practitioners choose to ignore very basic needs and requests of their clients, also known as “patients.” What an oxymoron that word is! Is it a result of that toughening up and conscious dissociation all medical students are encouraged to learn while going through training to protect them from getting too involved, to protect their emotional well-being, to allow them to properly treat the people who are their clients/patients?
What really made me angry is the writer’s account of her behavior — running away, instead of spending a few minutes to comfort, explain, reassure the man. Seriously? As a ‘budding psychiatrist’ she is more interested in understanding and managing her own feelings than in holding that patient’s hand, looking him the eye, and explaining, perhaps once again, his situation and reassuring him that the tubes would be coming out.
Are we supposed to give her a trophy for having that epiphany? We can only hope that all this “think(ing) carefully about how food affects my patient’s quality of life” will lead her to actually take action when she sees opportunities to alter a patient’s medical management, instead of just running away.
What kind of medical management is it when it is not truly in that patient’s best interests? A “budding psychiatrist” surely understands that the *whole person* needs to be treated and not just the meat suit that is lying in the hospital bed.
I appreciate being treated as a person, with needs, wants, and common sense. I know what it is to have no food or water because of upcoming medical treatment. I kept asking for ice chips also, pleading actually. Surviving isn’t living. Who dictates what makes someone well? When treatment causes a person to be sicker than before treatment, I say stop. Enough.
I wonder if Italian doctors as equally oblivious to food and drink of their patients as Americans are. I travel to Italy often and most of the conversations Italians have (apart from sports) is about food, understood to be one of the most important parts of a good life. No good food=no life worth living.
“Mouth care” can better quench thirst than IV fluids or parenteral feeding, in the ICU or EOL setting:
http://www.ncbi.nlm.nih.gov/pubmed/24894026
http://www.ncbi.nlm.nih.gov/pubmed/16903584
http://www.ncbi.nlm.nih.gov/pubmed/7525778
http://www.ncbi.nlm.nih.gov/pubmed/9447811
Great perspective.