EVERY DEEP-DRAWN BREATH

A physician reflects on the lessons learned throughout his career in intensive care.

As a young medical student in 1985, Ely recognized that his drive to save lives sometimes came at the expense of patients’ dignity. In this dynamic, often touching debut, the author chronicles a personal, passionate return to the ethical heart of the Hippocratic oath. In addition to a timeline of the ICU and its history of medical innovations, Ely details a succession of individual bedside narratives. They range from the heartbreakingly sad, like that of his first patient, whom he wasn’t able to save who but spurred him toward more revolutionary lifesaving technologies; to more hopeful cases of patients with delirium who were aided by patient-centered care and a defining moment during his daughter’s recovery from a skull fracture. The author effectively illuminates the daily pressures placed on caregivers, especially as they relate to one particularly harrowing condition, post-intensive care syndrome, when discharged ICU patients begin to suffer chronic new conditions brought on by their tenure in the ICU (this was especially prevalent among Covid-19 survivors). Ely also provides a thoughtful exploration of the ICU treatment culture of sedation and immobilization and analyzes how it can be recentered around a core value of “humanity in doctoring.” Collectively, these anecdotes movingly exemplify the caregiver’s role in assuaging patient suffering through compassionate efforts to not only deliver quality clinical care, but to focus on “finding the person in the patient, using touch first and technology second,” and preparing and supporting patients back into life beyond the ICU setting. Ely promotes these protocols within the end-of-life spectrum, as well, where compassion, respect, and comfort are tantamount. A closing section offers practical tips and resources for further research on the care delivery process within an ICU setting, useful for both general readers and professionals. As Ely conveys through anecdotes and experience, physicians can maximize their knowledge by focusing on, listening to, and learning from their patients.

Meaningful, thought-provoking insight into the world of critical care.