The availability heuristic is all around us. We see a shark attack on the news, and we opt out of the surf. We neglect the fact that more people died from choking, having a bath or drinking alcohol than shark attacks in 2014 (1).
So we hang up the budgies, but will happily eat a steak in the tub while sipping on a red (just me?).
More emotionally laden events sit in the forefront of our mind, and it screws up our decision making.
At the start of the year, I was caring for a gentleman that had done everything right. A cyclist, triathlete and family man. He was still in his prime.
This was until he landed in the intensive care unit after a cardiac arrest from a big heart attack. A bystander, who happened to be an intensive care nurse, commenced CPR. He survived long enough to get a stent placed in the main artery to his heart to open up the blockage.
Unfortunately, during the period where his heart had stopped beating, his brain was robbed of oxygen. He sustained a hypoxic brain injury. He now struggled to communicate, and could barely feed himself.
How was this fair?
I thought of the lifetime of dependency. The strain on the family.
The nihilism sank in. Why bother staying fit if you can just get struck down like this anyway?
I then moved on from that cardiology block to the next rotation. I lost track of what happened to him.
I’m now working in intensive care. We see the devastating brain bleeds, the car crash victims, the patients with life threatening infections. We do our best to get them through their acute illness, and then they are discharged from the unit. Seeing them acutely unwell distorts thoughts. It seems almost impossible that they would recover to how they were before the illness.
I decided to look up the records of our chap who had had the cardiac arrest. “He is a new man” the letter read. I was overjoyed. After some intensive rehabilitation, he was back at work, back to cycling and thriving!
My biases were further shattered with a quick look at the science. In one retrospective study, 10% of patients suffering hypoxic brain damage were discharged home (2). While this isn’t a huge number, the fitness of patients’ prior to the injury was a key determinant in having a good outcome. So even if you are unlucky enough to have this happen to you, staying fit is your best shot at doing well after the incident.
The point of this story is that it’s not all doom and gloom in the acute care environment. What we do early on matters. We can make a difference.
You just need to make the effort to follow-up your patients to realise this.
(2) Heinz UE, Rollnik JD. Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation. BMC Research Notes. 2015;8:243. doi:10.1186/s13104-015-1175-z.