New book probes better ways to protect humanity of patients and families during ICU care

April 22, 2016

About four million critically-ill or injured patients are admitted to intensive care units (ICUs) in American hospitals every year. The care they receive is not only intensive, but intense -- the emphasis is on speed, applying the latest clinical interventions and medical technologies, and saving lives -- which is appropriate, given that mortality in an ICU can average between eight and 30 percent.

ICU care, in short, is more like the medical care George Clooney used to deliver on TV. But in the midst of all that drama, ICU physician Samuel Brown, MD, who has long practiced in the Shock/Trauma Intensive Care Unit at Intermountain Medical Center in Salt Lake City, a Level I Trauma Center, saw that the human touch should be more central to the healing process -- and he set out to find innovative ways to improve the way intensive care is delivered.

Dr. Brown, founder and director of the Center for Humanizing Critical Care at Intermountain Medical Center, shares his research and experience relating to how to protect the humanity of patients and families in intensive care units in a new book, titled Through the Valley of Shadows.

Using insights from cognitive psychology, the book discusses new approaches to reduce suffering for patients and their families when they need high levels of care, including concrete strategies to apply before, during, and after a serious illness.

Brown's work addresses the needs of both those who survive such illnesses, as well as those who die. He uses experiences from his own clinical practice to illustrate the current problems and possible solutions for dealing with serious illness.

He shows that the old model of "Doctor Knows Best" paternalism failed, but so have many of the proposed solutions that have placed too many burdens on patients. Between those extremes, Dr. Brown points out ways for physicians and patients to work together through the frightening trauma of life-threatening illness.

Collaboration is necessary because fear of death can create blind spots for patients, families, and physicians. A poignant experience described in the book deals with a man named Bruce and his three daughters. Bruce, who experienced overwhelming shock, finally died after exhausting two hospitals' worth of adrenalin in a desperate attempt to save his life.

"Because of our nation's relentless commitment to invasive, uncomfortable treatments, neither Bruce, nor his daughters were able to say goodbye or reflect on the meaning of his life before he died," Dr. Brown writes.

Dr. Brown's book also examines how clinicians' focus on medical care can blind them to the spiritual needs of their patients.

An example: One patient, a devout Catholic, received his last rites from a priest in his hospital bed hours before he passed away. But he struggled to create the sign of the cross in response to the priest's gentle ministration because his restraints, intended to keep him from dislodging any medical equipment, obstructed his ability to participate in the meaningful deathbed ritual -- and his clinicians never thought to release the restraints.

The book also addresses steps to prevent clinicians from accidentally dehumanizing their patients, such as making the effort to learn about his patients' lives and working to understand their goals, and establishing relationships with their family members. Although this effort takes extra time in a busy ICU, it means the patients and their families feel understood -- and helps them better understand what's happening to them.

"We are deeply committed to protecting the humanity of our seriously ill patients," he writes.

Through the Valley of Shadows was published by Oxford University Press and is available on

Intermountain Medical Center

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