“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories of clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher and Podchaser.
The intensive care unit can be a traumatic place for patients, who are often heavily sedated, rendered unable to speak through breathing tubes, isolated by limitations on family visits, and sometimes even physically restricted. In fact, a significant proportion of patients discharged from the intensive care unit later develop persistent cognitive impairment and physical disabilities.
For the past 2 decades, Wes Ely, MD, has worked to improve ICU patient care, conducting landmark studies leading to the development of delirium prevention protocols that are now adopted across ICUs. Today, Ely co-directs the CIBS (Critical Illness, Brain Dysfunction, and Survivorship) center at Vanderbilt University Medical Center in Nashville, Tennessee.
In this episode, Ely joins Henry Bair and Tyler Johnson, MD, to share his long-standing fight to reform critical care medicine and tells harrowing stories that illuminate and uplift the humanity of patients amid the chaos of critical care – and in the process discusses themes that rarely appear in contemporary medical discourse, such as love, beauty, and mercy.
In this episode you will hear about:
- 2:33 How Ely discovered medicine as a calling growing up in rural Louisiana
- 4:27 How a fascination with cardiopulmonary physiology, combined with an interest in patient relationships, led Ely to critical care medicine
- 6:31 A discussion of how patients in intensive care can often be “dehumanized”
- 10:40 A story from Ely’s early career that illustrates “malignant normalcy” – when standards of treatment harm the patient
- 13:27 A discussion of physician burnout and how patient dehumanization contributes to it
- 18:53 What Ely and his colleagues have learned from years of research into harmful standard practices in critical care
- 24:04 An explanation of the ABCDEF treatment set designed by Ely and collaborators to improve outcomes in critical care patients
- 29:37 How Ely deals with the guilt and shame he feels about the harm he inadvertently caused patients early in his career
- 36:03 Thoughts on how eye contact, physical touch and open heart are essential to good medicine
- 44:51 A discussion of how Ely’s spirituality influenced his approach to patient care
- 50:45 What it means to bring healing when patients face serious illness, even at the end of life
Here is a partial transcription (errors of note are possible):
bay: Wes, thank you so much for taking the time to join us today and welcome to the show.
Ely: It’s my privilege, Henry, I appreciate you coming with me. And you too, Tyler.
Johnson: Thanks to be here.
bay: You have had an incredible career revolutionizing critical care medicine. But before getting into all of this, can you take us back to the beginning and tell us how you discovered a vocation in medicine?
Ely: Thanks for asking. I’m so grateful to be on this podcast, because when it comes to the art of the doctor, I think I got into it for the right reasons — for me anyway, personally — it’s that my father left us when I was little. I was raised by my mother in the hot, dusty fields of Louisiana. I was, I had to be a farmer because we had no money. And I was trying to make money for our family. And I was around these amazing people in the fields. We had huge fields of 6,000 plants of tomatoes, purple peas, watermelons and all that. And all day, either we were planting in the spring, or we were harvesting these products. And I got to know these men and women that we chose with all day.
And at first I thought I belonged to them. But I realized over time that they wouldn’t really have a way out of that area. They were going to be migrant workers. And it was their, it was their choice. But they didn’t really have an option either. And they would, the little things in their life medically would become big things. You know, the cuts would turn into big abscesses and they would lose teeth. And so I said, you know, maybe if I had the chance to study science and medicine and I could be with these people while they were suffering and be present with them at the bedside , holding their hand, helping them through more difficult days. And that’s why I got into medicine. That was it. I wanted to serve these people and have a role in our relationship that I could serve.
Johnson: You know, it’s reminiscent of that kind of ideal of, I’m not saying you even knew what it was at the time or that you necessarily planned to get into it, but it’s reminiscent of that kind of ideal country family doctor, right? Who is there at every stage of life to care for the baby when he is born, and the old man or woman when he or she dies. And yet, you ended up heading into critical care medicine, which in some ways could be considered quite a far cry from the country family doctor kind of thing. So how did this change happen? How did you end up in intensive care?
Ely: Yeah, along the way, I was going to be a family doctor and I imagined myself carrying a leather bag to their house, etc. What happened was that I was working at UVA with this family doctor named Louis Barnard. It was actually the first endowed chair of family medicine in the country. And we would sit in his office at night and he would talk about his life in that area. And I kept telling him how fascinated I was with cardiopulmonary physiology. I just fell in love with Guyton’s textbook on heart and lung physiology, and it got me so excited about the science of how the body works.
And when I started going to the intensive care unit at Charity Hospital in New Orleans, I not only loved the physiology, but I saw that these people were extremely scared. They were about to die having this unexpected circumstance in their lives. And I thought, well, maybe if I both like the physiology of what we’re doing in ICU and I can relate to these people at this very, very vulnerable time in their lives , it could be a fusion of those two things .
And I’m going to just stop by saying that in the next 5 years what I learned was unexpected was that the field was going in a direction that would prevent me from doing what I loved, that’s that is, to prevent myself from looking people in the eye, talking to them, having a relationship with them, because the field was going in the direction of deep sedation, in a coma, immobilized on a ventilator. But I didn’t know that at first.
For the full transcript, visit The art of the doctor.
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