Opinion | The ICU Patient, and the Family

To the Editor:

Re “Who Are We Caring for in the ICU ?,” by Daniela J. Lamas (Opinion guest essay, Feb. 7):

It is difficult for me to read Dr. Lamas’ essay because her account of the realities of both the patients’ and the families’ struggle at end of life in the ICU mirror exactly what we experienced almost 15 years ago.

My 85-year-old father entered the hospital after a fall and ended up in the ICU with acute respiratory distress syndrome. We agreed to aggressive treatment, in the futile hope of his recovery.

As unprepared as we were for the outcome, we begged our primary physician to keep him artificially “alive” until the family could gather. Fortunately, he agreed. But we came away wondering if doing everything possible harmed our father.

We knew that these treatments were really for us, to give us time to come to terms with the (unimaginable) inevitable. There are no good or right answers to the questions Dr. Lamas asks, but she has identified the issues.

I hope that her observations provide some guidance for doctors and hospital staff to work sympathetically with patients and families to help ease the decisions that must be made.

Alison Grabell
Los Angeles

To the Editor:

As a physician involved with promoting advance care directives with Honoring Choices Virginia, I found Dr. Daniela Lamas’s article compelling. As physicians we are always balancing ethics as well as practicing practical and compassionate care.

The decision to prioritize a family’s need often conflicts with logical medical care such as the futility of further treatment or the availability of limited resources. In some circumstances, the family’s needs should be strongly considered. On the other hand, it is also important to follow the patient’s wishes as stated in an advance care directive.

I applaud Dr. Lamas for her thoughtful and compassionate approach to end-of-life care.

Kenneth Olshansky
Richmond, Va.

To the Editor:

As a former hospice nurse, I was present for many family members struggling with wanting to keep their loved one alive, even as they knew that death was near. They believed that offering more food and water, or possibly more chemotherapy or radiation, would prolong the patient’s life.

Families wanted to do something but, in their grieving, they did not consider the physical, mental and emotional consequences for the dying person.

I saw their conflicts and pain. A gentle question I often presented to the family was, “What’s the loving thing to do?” My query gave them a break to reflect on their immediate desire to maintain life for just a little longer. Nearly always they chose to let their family member die without further suffering, in peace and comfort. For them the decision then became much easier.

Peg Young
Boulder, Colo.

To the Editor:

Dr. Daniela Lamas appropriately addresses the suffering of families of dying patients. But performing heroic, but futile, CPR to assure a family that “everything was done” borders on medical theater and questionable ethics.

The staff in our ICU would feel devastated by the sound of grunts and snapping ribs along with the jolts of shocks from the defibrillator – naming the process “medical last rites” when they knew that CPR was futile. An ICU team needs at times to be more realistic, not even offering futile care. Many hospitals now have futility policies.

Would Dr. Lamas have offered neurosurgery if the patient’s family had demanded it? Of course not! Also, how costly were the transfer and care of a patient in the middle of a pandemic in which resources are already strained?

Jim deMaine
Seattle
The writer is a retired pulmonary and critical care physician, emeritus clinical professor of medicine at the University of Washington School of Medicine, and the author of “Facing Death: Finding Dignity, Hope and Healing at the End.”

To the Editor:

I appreciate Dr. Daniela Lamas’s thoughtful question about whether some end-of-life care may be more for the family than for the patient, but it is definitely being asked from within a hospital context.

When my wife was near death, we asked not whether to extend her life for a day or two, but how to make her last day or two as peaceful as possible. Although we must have gone to hundreds of doctors’ appointments during her nine-year battle with cancer, she did not spend a single night in the hospital – even though some of the very best are just across the river.

Not all terminal conditions can be addressed at home, but when they can, that is often the best place for the dying, and for those who will live on. The “rituals of intensive care” that Dr. Lamas refers to are not always the ones that matter most.

David Eisen
Cambridge, Mass.

To the Editor:

Re “English Is a Living Language. Period., ”By John McWhorter (Opinion, Feb. 10):

Mr. McWhorter is right that language changes and that historical perspective warrants modesty. But in the here and now, rules of grammar determine comprehension. Disregarding them leads to confusion, misunderstanding and ridicule. Using quotation marks as exclamation points, for example, will baffle readers or invite misinterpretation.

Perhaps that’s an amusing academic curiosity to a scholar like Mr. McWhorter, but to the person who made the mistake the consequences are more immediate. Many people who see a sign that says “’Fresh Fish’” – fully loaded with quotation marks, to use Mr. McWhorter’s example – will keep on walking.

I’m all for bending or breaking rules that have outlived their usefulness. But that is not the case for quotation marks, and in my field – journalism – their use is sacred, a sort of ironclad guarantee that someone else said those words verbatim.

Unless we want utter chaos with attribution, we should just teach people the right way to use them. It’s not that hard, and the effort is worth it.

You can quote me on that.

Joe Hayden
Memphis
The writer, a professor of journalism at the University of Memphis, is the author of “The Little Grammar Book: First Aid for Writers.”

To the Editor:

I appreciate John McWhorter’s discussion about quotation marks and how they have evolved, particularly on signs, from marks indicating speech to marks that simply show greater emphasis. He likens this new function as possibly a substitute for “jazz hands.”

This really got me thinking about air quotes, which I know are usually used to express irony or sarcasm. Perhaps it’s time to broaden the role of these hand gestures as well. I wonder how much time would need to pass before someone could say, for example, You’re my “favorite,” or I “believe” you, using air quotes and really mean it.

Nancy Lubarsky
Cranford, NJ
The writer is a retired English teacher.

To the Editor:

The always delightful John McWhorter discusses the use, a generation ago, of the period in situations where it’s no longer used today. He cites a number of examples, but does not mention one that readers of The New York Times can relate to. It used to appear every day, exactly this way, on the paper’s front page: “The New York Times.” – yes, including the period.

Barry Biederman
Palm Beach, Fla.

To the Editor:

Re “Pedestrian Deaths Hit Highs as Reckless Driving Surges” (news article, Feb. 15):

A major factor not mentioned in this article is the distraction that we see in many vehicles that drive past us: the use of a phone in a car. Whether the driver is hands-free or not, the distraction of a conversation with someone not in the car can be deadly.

This has been proved by science over and over, and I am amazed when I see drivers holding a phone – and worse, using both hands expressively while waving them around in the air talking.

All phone use must be stopped while we are driving. We drive with our brains, not just our hands.

Norma Lee Chartoff
West Haven, Conn.

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