Every deep-drawn breath An intensive-care doctor's notes on healing

Review by Publisher's Weekly Review

Ely, a critical care doctor, debuts with a remarkable look at transformations in ICU care. He opens with a confession--that he'd "sacrificed patient dignity and caused harm" as a young physician by trading "the priceless gift of eye contact and conversation for medically induced unconsciousness and...deep sedation." For years, the standard practice was to keep patients on ventilators heavily sedated, but Ely began questioning the protocol after encountering numerous patients who suffered from "post-intensive care syndrome" and whose cognitive functioning had been dramatically impaired by the length of time spent unconscious. Ely discovered doctors in the U.S. and abroad who'd adopted different approaches, including reducing the duration and level of sedation, and active measures to keep patients mentally engaged, which he began to implement. Ely movingly recounts his efforts, notably when his vision of an improved ICU was put into place in 2014 with rooms that "were spacious, practical, and filled with light... and included a comfortable area for family members or friends." And the revised, reduced-sedation "return to humanity" program, he writes, saves lives. This humble--and humbling--look at the limits and potential of medicine will stick with readers. Agent: Susan Golomb, Writer's House. (Sept.)

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Review by Library Journal Review

Critical care physician Ely (Vanderbilt Univ. Medical Ctr.) draws on his own experience for this book about the role of humanity and compassion in the ICU. Looking back on his early career, Ely now finds that he focused on the methodology of keeping ICU patients alive, at the expense of trying to understand patients' experiences during and beyond their ICU stay; his path forward from that insight forms the backbone of the book. It includes sensitive analysis of the racialized history of critical care medicine and health care disparities that stem from gender, class, and disability. Ely discusses post-intensive care syndrome, which he believes is too-little discussed by patients and health-care professionals. The syndrome's sometimes permanent changes to a patient's health arise from the ICU stay itself rather than the original reason for admission; overuse of deep sedation and medical paralysis on ventilator patients is now recognized as a primary contributor to delirium on the unit and long-term mental and physical disabilities. Ely's book also supplies a number of resources for patients and their families, plus a list of further reading. VERDICT Heightened media attention to intensive care medicine during the pandemic should make this of interest to both lay and professional readers. Ely writes with passion, clarity, and authority.--Richard Maxwell, Porter Adventist Hosp. Lib., Denver

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Review by Kirkus Book Review

A physician reflects on the lessons learned throughout his career in intensive care. As a young medical student in 1985, Ely recognized that his drive to save lives sometimes came at the expense of patients' dignity. In this dynamic, often touching debut, the author chronicles a personal, passionate return to the ethical heart of the Hippocratic oath. In addition to a timeline of the ICU and its history of medical innovations, Ely details a succession of individual bedside narratives. They range from the heartbreakingly sad, like that of his first patient, whom he wasn't able to save who but spurred him toward more revolutionary lifesaving technologies; to more hopeful cases of patients with delirium who were aided by patient-centered care and a defining moment during his daughter's recovery from a skull fracture. The author effectively illuminates the daily pressures placed on caregivers, especially as they relate to one particularly harrowing condition, post-intensive care syndrome, when discharged ICU patients begin to suffer chronic new conditions brought on by their tenure in the ICU (this was especially prevalent among Covid-19 survivors). Ely also provides a thoughtful exploration of the ICU treatment culture of sedation and immobilization and analyzes how it can be recentered around a core value of "humanity in doctoring." Collectively, these anecdotes movingly exemplify the caregiver's role in assuaging patient suffering through compassionate efforts to not only deliver quality clinical care, but to focus on "finding the person in the patient, using touch first and technology second," and preparing and supporting patients back into life beyond the ICU setting. Ely promotes these protocols within the end-of-life spectrum, as well, where compassion, respect, and comfort are tantamount. A closing section offers practical tips and resources for further research on the care delivery process within an ICU setting, useful for both general readers and professionals. As Ely conveys through anecdotes and experience, physicians can maximize their knowledge by focusing on, listening to, and learning from their patients. Meaningful, thought-provoking insight into the world of critical care. Copyright (c) Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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