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Intensive Care: An Inside Story

In response to:

On Breaking One's Neck from the February 6, 2014 issue

To the Editors:

Dr. Arnold Relman’s beautiful and tough chronicle [“On Breaking One’s Neck,” NYR, February 6] is a reminder to everyone who has been lucky enough to survive beyond the eighth decade of how frail life can be. His observations on the care he received from doctors, nurses, hospital staff, and his wife and family are very acute and valuable.

He provides a list of factors that he feels allowed him to remain alive. He forgets a very important one. In the Massachusetts General Hospital emergency room someone is bound to have said that Dr. Relman had arrived. One does not rapidly forget the editor of The New England Journal of Medicine. I’m sure that helped a lot with his care. I wonder, without taking any merit away from all those who cared for him in the hospital (excluding his family, of course), what would have been the experience of John Doe.

Having learned from Dr. Relman and known him, I join all those who welcome his recovery. He may be more affectionate for the accident, but his intellectual toughness will not change. It is obviously at work in the piece.

Manuel Martínez-Maldonado, MD, MACP
Carolina, Puerto Rico

Arnold Relman replies:

I thank Dr. Martínez for his kind comments and for asking a good question: Would my medical care at the Massachusetts General Hospital (MGH) have been any different if I were not a well-known physician and medical editor?

I think it would have been pretty much the same in the emergency room, but probably not thereafter, in the intensive care unit. In the emergency room of a world-class hospital, like the Massachusetts General Hospital, the staff are trained to deal efficiently with every dire emergency. All resources are mobilized to save a life, regardless of the patient’s identity and usually with little or no need for personal communication between doctor and patient.

However, in the ICU, patient identity and communication with the patient could affect the medical care. Sometimes even the best ICU overmedicates patients in ways that may cause complications of which the patient might be unaware. In my case, the ICU staff followed my scribbled suggestions and caveats about drugs, even before I could speak. They also allowed members of my family (particularly the physicians in the family) to stay at my bedside after visiting hours. I don’t think this would have been the case if I had been “John Doe,” and I am quite convinced that this special treatment furthered my recovery. Helpless patients in an ICU would benefit if they had knowledgeable advocates other than the physicians directing their care. I could serve as my own intermediary, and this probably helped me survive.

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