Abstract
Working in intensive care leads us all to develop considerable knowledge and expertise regarding the management of critical illness. As we progress through our career, we also accumulate experiences that shape the way we approach challenging situations. Not many of us, however, will have experienced critical illness from the perspective of a patient. Those of us who have spent time talking to patients, or our own relatives, after their recovery gain an insight that we may otherwise have missed from our command and control position at the foot of the bed. We are taught to relegate opinions and conjecture of this nature to the lowest rung of the illustrious pyramid of evidence-based medicine. Yet time spent talking to a single patient about his or her experience on an intensive care unit may provide us with an understanding that a decade of randomised controlled trials may fail to convey. Taking the time to sit with patients and listen to them speak may be the only way to learn about the true magnitude, complexity and persistence of problems that arise in the aftermath of a life saved.
This month we are privileged to publish an article written by a member of the public who endured a sojourn in intensive care, where he succumbed to the horror that is delirium. In his article, titled ‘Reflections on delirium – A patient's perspective’, Roger Garrett describes the first-person reality of delirium and explains the power of memories to disturb long after hospital discharge. His story provides a personal and graphic insight into the mind of a delirious patient and portrays the loneliness of this position, hidden amid the bustle of one of the busiest areas of the hospital. Roger’s story is a common one and I have heard many such sobering accounts of delirium. We owe it to these patients to listen to their experiences, and to use their stories to strive even harder to prevent delirium from happening on such an industrial scale. I urge you to read this unique article, and then take a moment to reflect on how we might reduce the dehumanisation of the patients under our care.