Acute respiratory distress syndrome is not a good thing to have. However, also getting a pneumothorax along with your ARDS takes you from very bad to very worse. A reader shared with me these striking images. The young and healthy human body is an amazing regenerating machine capable of incredible recovery from incredible illness. The abused life of the chronically debilitated elderly is not. Chronically debilitated elderly folks do not recover from ARDS with pneumothorax. Young people might. For the debilitated elderly, this is a perfect chance for an ICU palliative care consult for no other reason than compassion and the alleviation of pain and suffering.
The question is, do you start the process at the end of their dying process or at the beginning. My experience, as a hospitalist, is that we commonly start the process at the end. We need to change that. Unfortunately, none of us have been trained to define the appropriate palliative care population. It really is a gut fealing consult. That's why I believe, all ICU patients should have a palliative care consult on admission.
Just like all of my patients with alcohol abuse get an intervention evaluation on my service, the same should apply to all ICU admissions. That way, the dying process is applied equally to all patients and physician consultants who don't understand what palliative care is don't feel like we, as hospitalists, are giving up on their patients as well by picking and choosing patients we think aren't going to make it. Right now, all I have is a gut feeling and a decade of experience. Palliative care offers me evidence, one way or another. My hope, eventually, is that we have a national standard for system wide screening for palliative care evaluation on admission. That way, limited resources are focused on patients that would benefit the most from having these important talks.