Watching a Parent Die on Facetime
She was breathing laboriously and had all but lost consciousness. In the subcutaneous tissues of her right arm, a syringe pump was delivering morphine and midazolam to help her breathe more easily and prevent the seizures she had been having earlier. Her right cheek still twitched periodically. She was in her daughter’s home surrounded by her grandsons and daughter. Just yesterday she had opened her eyes and smiled at her loved ones, tracking their movements. But she had stopped eating or drinking almost ten days earlier and stopped speaking too. Yet her breathing had been comfortable until tonight. Now, every breath seemed to be coming with tremendous effort. At her side was an iPad, which was reflecting her image 5,000 miles away on Facetime. Her two other daughters were watching from across the Atlantic.
I was one of them. She was my mother.
Various restrictions due to the pandemic had precluded me from being by her side. Virtually watching her slowly die with Hospice care was the best my younger sister—who was in New York—and I could do. Over the past 14 hours we had almost continuously watched her every breath, every twitch, every moan, and every anguished moment. I have almost 20 years of experience in critical care, have delivered terminal end-of-life care to hundreds of patients, and empathized with their families saying how I understood their anguish and suffering. I was wrong.
Just the week earlier I had helped manage three patients after being terminally extubated when further life-prolonging therapy was deemed non-beneficial. The families watched on Facetime as they breathed in distress, and we allowed an hour’s visit at the end to hold the patients’ hands as their loved ones passed on. We expressed our condolences and, even with the sincerest of intentions, we moved on to some the other humdrum activity of the ICU. I never imagined the enormity of the loneliness, desperation, and helplessness families must go through simply watching their parents or spouses or children die remotely via a device. Being able to hold and hug and kiss them brings closure that when denied can lead to unmeasurable pain. As three physicians, my sisters and I thought we would be strong watching our mother perish after comfort measures were instituted. But these measures are never just ‘comfort,’ and no matter how elegantly done, watching someone die on a device is simply cruel and a cause of insurmountable grief. Expressions of angst and sorrow are nature’s way of easing the pain of losing a loved one and also offer solace to the dying patient. It is a right for which families deserve to ask.
My mother’s death so far away has left a deep and lasting mark on me, and I will forever relive that moment with every patient that dies in the ICU. The ethical and moral distress that families feel at their loss of control in providing a loving passage for their family members at the time of death cannot be underestimated. The COVID-19 pandemic has produced myriad ethical entanglements, but not having families at a patient’s side during their difficult journey of dying is possibly the biggest ethical and morally problematic one with which healthcare will have to reckon. These decisions must be weighed against the benefit of protecting staff from potential exposures from family members in the ICU, however, these rules should be balanced in a way to provide a humane and dignified death to our patients and comfort to their loved ones so that they can go on in life.
Until then I get solace from this verse:
Do Not Stand at My Grave and Weep
by Mary Elizabeth Frye
Do not stand at my grave and weep
I am not there. I do not sleep.
I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.
When you awaken in the morning's hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.
Do not stand at my grave and cry;
I am not there. I did not die.
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ASA Monitor
ASA Monitor recently published “SOCCA: A Growing Community of Intensivists Embracing the Challenges of Modern Critical Care” by SOCCA members Shahla Siddiqui, MBBS, MS, FCCM and Ashish K. Khanna, MD, MS, FCCP, FCCM, FASA. Read the full article here.
2023 SOCCA Annual Meeting
SOCCA Reception at 2023 SCCM Critical Care Congress in San Francisco
Date: 1/23/2023
Time: 5:00 PM – 7:00 PM PT
Location: Hilton Union Square (333 O’Farrell Street)
Room: Franciscan A
When: February 2, 2023 | 6:00 PM ET
Where: Register online
Description: Join us for our first Early Career Intensivist Group Meet and Greet of the year on February 2 at 6pm ET. We will have SOCCA board member Dr. Ashish Khanna joining us for a lively discussion about navigating through life as an Early Career Intensivist. We look forward to seeing you soon!
Mechanical Circulatory Support (MCS) / Extra Corporeal Membrane Oxygenation (ECMO) / Cardio Thoracic ICU (CTICU) Workgroup
Members who have a special interest in MCS are invited to join this workgroup. Our first meeting will be January 19, 2023, at 5PM CST. Please register in advance: SOCCA CTICU/ECMO Meetup Link.
This year, SOCCA is seeking committee volunteers for our communication, education, membership, and research committees—as well as the new clinical practice committee. To view committee descriptions and submit an application, visit https://socca.org/get-involved/.
You may submit an application for a SOCCA Committee between November 1, 2022 and December 31, 2022.
Learn more & review SOCCA’s Volunteer Selection Criteria.
This election cycle, SOCCA will be electing three members for the Board of Directors (3-year term). Further details about the governance structure of SOCCA are described in SOCCA’s Society Bylaws.
SOCCA members interested in serving in an elected positions on the SOCCA Board of Directors should submit a letter of interest, photograph, and curriculum vitae to Vivian Abalama, IOM, CAE ([email protected]) with subject line “2023 SOCCA Board of Directors Election.”
Review criteria by which Board of Directors and volunteer leaders are evaluated: Volunteer Selection Criteria.
You can apply via email only for a Board of Directors position between November 1, 2022 and December 5, 2022.
SOCCA Innovators Award: applications open 9/30/2022 – 12/31/2022.
Gender Equality in Critical Care
Major professional societies & organizations have the obligation to initiate & sustain strategies that support & enhance gender equality in critical care. WICC invites members of SOCCA to participate & discuss ways to advance these goals & values. Understanding & recognizing gender diversity challenges & carrying on the momentum gathered in recent years within SOCCA and outside it, will enable a positive environment for more women to enter & remain within ACCM.
SOCCA has a calendar/list of events. Visit it regularly & save essential dates.
The SOCCA Speakers Bureau has officially launched! As a SOCCA member, you may now:
- Upload your academic profile
- Search for collaborators and potential speakers
Have you made any changes in 2022? It’s time to update your SOCCA demographic profile and / or renew your membership. Keep your SOCCA experience seamless & don’t miss out on any updates & member benefits. Visit: buff.ly/3sPMG6j
SOCCA would like to acknowledge the invaluable contributions of our female intensivists during this month and year-round. Throughout September, four of our members will be sharing their experiences as a woman in critical care.
Read: Burnout: No Easy Answers in a Post-Pandemic World, by Sarah Alber, MD
Read: Belonging to an Organization: Professional Advancement & Personal Gains, by Nazish Hashmi, MD
Read: Mentors and Mentees: A Powerful Connection, by May Hua, MD, MS
Read: Women in Critical Care: Where We Are & Where We Want to Be, by Shahla Siddiqui, MD, MSc, FCCM
Shahla Siddiqui, MD, MSc, FCCM, and Co-Chair of SOCCA’s Women in Critical Care recently edited a special issue of Journal of Critical Care featuring women as first and senior authors. Read Dr. Siddiqui’s introduction in Volume 71 | October 2022 issue.
The SOCCA Early Career Intensivists working group provides new members and members who are early in their careers with the resources needed to ease the transition from trainee to practicing intensivist. Learn more.
ASA Monitor
Have you read “SOCCA, the Pandemic, and the Future” by SOCCA’s Miguel Cobas, MD, FCCM, in this month’s ASA Monitor? Visit: https://socca.org/wp-content/uploads/2022/04/Cobas_SOCCA.pdf
As a SOCCA member, you are eligible to receive a discount on an IARS membership. IARS membership benefits include a subscription to Anesthesia & Analgesia, SOCCA’s official journal, A&A Practice e-journal, free journal CME, access to a member community and discounted registration to the IARS Annual Meeting. Click here to view a list of membership options.
Anesthesiology Critical Care Fellowship Programs
Have you visited SOCCA’s Anesthesiology Critical Care Fellowship Programs page? If you would like your organization’s program added to our site, let us know here: https://socca.org/new-socca-fellowship-listing/.
