Wes Ely, MD.
Photo by Heidi Ross
When entering the clinical wards in my third year of medical school, my mentors offered me the sage advice to spend as much time with my patients as possible. With only a nascent sense of medical knowledge and empathy in abundance, compassion and communication would be my main therapeutic tools.
As I progressed through to residency, the balance would flip. My medical knowledge would outpace my time, and woefully and too often, much of my empathy as well. Finding balance between humanism and science in medicine is not new, but with the accelerating pace of technological advancements, the scale for modern practice seems to bend towards technology. Master clinicians balance both. They employ the latest advances in medical knowledge and technology, while staying grounded in their patients’ stories, values and desires. Dr. Wes Ely is one such clinician, and he details the remarkable aspects of his career in his powerful new book Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU.
Every Deep-Drawn Breath chronicles Dr. Ely’s experience as a critical care doctor and in some ways, reads like a Hegelian dialectic, that is, an interpretative process using contradictory propositions to reach a firmer truth. His story begins with a thesis: A young critical care physician focuses on saving lives in the Wake Forest intensive care units. “My aim with my patients was to get their broken systems back to functioning as they should,” Dr. Ely writes, and he used the numbers on the monitors and ventilators to do so, as his sickest of patients were unable to communicate for themselves. Fundamental to this approach is a naturalist conception of disease—organs are dysfunctional and require restoration via a dedicated medical team. While admirable, this approach is inevitably reductionist. In narrowly treating a single organ, say, the lungs, heavy amounts of sedation bestowed collateral damage on other parts of the body like the brain. In working with patients after their ICU stay, Dr. Ely realized this damage to the brain, manifesting as delirium, was not benign.
The Hegelian antithesis in the story results from Dr. Ely’s perspicacity. He notices a pattern in the way many of his ICU patient survivors have difficulty returning to a sense of normalcy; they feel cognitively foggy, distressed from the hallucinations experienced while under heavy sedation, and they are left with severe motor deficits. His genius comes from taking these experiences seriously, or as he quotes Ann Patchett’s novel State of Wonder “[not being] so focused on what you are looking for that you overlook the thing you actually find.” He delves into this phenomenological approach to health, realizing ICU survivors did not feel at home in their lived bodies, despite apparent normal biological functioning. Despite being alive, their ICU stays stripped them of something fundamental.
Through patient narratives and Dr. Ely’s authoritative knowledge of critical care, Every Deep-Drawn Breath delivers a comprehensive understanding of how to best care for our critically ill patients. Witnessing his medical and research career, we see compelling evidence that more humanism in the ICU leads to improved patient outcomes and reduced rates of delirium. He details his A2F bundle, which in essence, humanizes critically-ill patients. The bundle consists of elements such as managing pain, preventing delirium via constant reorientation and keeping family involved in care, early mobilization and daily trials at minimizing sedation to liberate a patient from the ventilator. The fact such practices are commonplace in intensive care units today demonstrates how Dr. Ely has changed the conversation, and subsequently, the culture of critical care medicine.
Rather than remain abstract, Dr. Ely writes about such humanism in the form of personal anecdotes from his practice. In one instance, he offers a taste of honey on a spoon to his sickest patients who were unable to eat, as they cannot aspirate on it. He writes “It’s a simple gesture of care and affection from one human to another.” He also uses a version of 3 Wishes, a project created by Dr. Deborah Cook that aims to honor patients at the end of their lives with at least 3 wishes. These wishes have been as simple as offering a bite of vegetable samosa or a cold beer, reconnecting patients with old friends or putting on a beloved movie for a patient to see with a spouse. These acts of love are symbolic of the deep meaning residing in the patient-physician relationship.
In the end, we gain experience in empathy from Every Deep-Drawn Breath’s underlying message: As physicians go through their training, gaining medical acumen and technical skills, their compassion must remain central to patient-care. In so doing, Dr. Ely has been able to improve medical care and imbue each patient-physician interaction with the deep sense of meaning it deserves. His book provides true insight into what can be accomplished with humility, perseverance, dedication and above all else, love.—JP Mikhaiel
JP Mikhaiel is a neurology resident at Yale New Haven Hospital, who attended Georgetown University for both his undergraduate and medical degree. Mikhaiel is passionate about reading, writing and reviewing medical literature; his work has appeared in Intima, KevinMD and Scope, Georgetown’s literary journal. He hopes to pursue a career combining his love for neurology, writing and statistics.