Chapter 2: Where are you vulnerable?

When you go too far with life-saving interventions

Aiming for life at all costs is a problem because it sometimes leads to no quality of life. We must ask the question, ‘What is an acceptable way for the person to live?’ This is certainly true for the patient, but we also have to consider how the family will live when this is all over... and maybe how the ICU team will too”. - ICU Physician

When you go too far with life-saving interventions

Families often want you to do everything you can to save a patient, which can put a lot of pressure on the clinical team.  At some point it may become clear that further intervention compromises the patient’s quality of life to a significant degree. The question then becomes, “When is enough, enough”?

Maintaining your sense of realistic limits is important.  When death is certain, your team will recommend to the family that you adopt a plan of care focused on comfort. If you and your team don’t have a well-defined boundary of when to shift from curative care to comfort care or your team and the family is not in agreement with switching the goal of care, your vulnerability to vicarious trauma increases.

Just as families are more at risk if they are not prepared for the possibility of death, so too are you if you lose sight of the “big picture”. Research on death anxiety clearly suggests that not acknowledging our own fears of death can lead to more aggressive treatments and may ultimately put us at risk of more profound vicarious trauma.