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June 20, 2016

An ICU baptism: How a hospital granted the dying wish of a Vietnam veteran on a ventilator

Daily Briefing

A professor of medicine and critical care at the Nashville VA Medical Center and Vanderbilt University Medical Center writes for the Wall Street Journal about a dying patient's unusual request—and what it taught him about empathy in the ICU.

The patient, a Vietnam veteran named Bennie, was in bad shape when he was admitted to the VA hospital's ICU. His situation "had the makings of a fatal illness despite our best technology" recalls E. Wesley Ely, who worked as the attending physician. Bennie was suffering from delirium and pneumonia, and he had a massive stroke while in the ICU.

Although Bennie started to recover, his prognosis was grim. Clinicians asked him to share his goals for his final days.

One of Bennie's goals was clinical: stable vital signs.

But another goal was spiritual—and logistically complicated for a patient on a ventilator in the ICU: He wanted to be baptized.

"My next thought was that we'd have a chaplain anoint him with holy water in his bed," Ely writes, but Bennie's daughter, who had brought along a vinyl swimming pool, disagreed. "'Jesus wasn't sprinkled, Doc," she insisted. "He was dunked.'"

Hospital clinicians had their reservations. "There was no shortage of opinions about whether this was appropriate, safe, or even possible," Ely recalls.

Empathy: A common ingredient for happy patients, staff, and margins

But the staff ultimately set out to grant Bennie's dying wish. They cleared out an area next to Bennie's bed to make space for an inflatable pool, which they filled with water by rigging up dialysis tubing.

They raised Bennie into the air using a patient-transfer lift, unplugged the ventilator, and then lowered him into the water. As his son submerged Bennie's head, a hospital social worker sang "Amazing Grace."

Bennie died a week later, but "the ICU team's bold yet careful response to Bennie's unusual request taught me an enduring lesson regarding sympathy versus empathy," Ely writes. While sympathy is feeling sorry for someone, he says, "empathy is feeling 'with' someone ... being 'with' him in that pool, and rising with him out of it, we walked into others' lives better prepared to serve" (Ely, Wall Street Journal, 6/17).

The characteristics of effective palliative care programs

Despite mounting evidence of the broader benefits of palliative care, many administrators and physicians still think of palliative care as a way to provide a better experience for terminally ill patients.

What many don't realize, however, is the best palliative care programs also yield longer survival rates, lower costs, and improved quality. In profiling palliative care initiatives around the country, we identified five characteristics of the most effective programs.


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