Podcast 885: Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU with Dr. Wes Ely

“Every person is priceless, no matter how much disease they’ve got.”  This is what my guest  in this podcast, Dr. Wes Ely left our listeners with during the interview.  Dr. Wes Ely is is an internist, pulmonologist, and critical care physician and the author of a new book entitled “Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU.”

In this interview, we speak about COVID and other critical illness, ICU care and  his safety program called the A2F Bundle which is now being implemented, studied and adopted by ICU teams around the world.  A2F Bundle has the following components:

A  – Assess, Prevent and Manage Pain, B – Both Spontaneous Awakening Trials & Spontaneous Breathing Trials, C – Choice of Analgesia and Sedation, D – Delirium: Assess, Prevent and Manage Pain, E – Early Mobility and Exercise, F – Family Engagement and Empowerment

I invite you to listen to this great podcast with Dr. Wes Ely while we explore questions for the listeners about great path towards getting your life back even after profound COVID and ICU stays  If you would like to learn more about Dr. Ely and his book, please click here to be directed to his website.

You may also refer to the transcripts below for the full transciption (not edited) of the interview.

ABOUT THE AUTHOR

E. Wesley Ely, MD, MPH, is an internist, pulmonologist, and critical care physician. Dr. Ely earned his MD at Tulane University School of Medicine, in conjunction with a Masters in Public Health. He serves as the Grant W. Liddle endowed chair in medicine and is a physician-scientist and tenured professor at Vanderbilt University Medical Center. He is also the associate director of aging research for the Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC). He is the founder and codirector of the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, an organization devoted to research and ongoing care for patients and families affected by critical illness. Dr. Ely has had numerous studies published in The New England Journal, JAMA, and The Lancet, and his writing has appeared in The Wall Street JournalThe Washington PostUSA TODAY, and numerous other publications. He lives in Nashville.

DR. WES ELY INTERVIEW

Greg Voisen
Welcome back to Inside Personal Growth. This is Greg Voisen, the host of Inside Personal Growth. And we have Dr. West Ely on the line with us. And that beautiful plant in the corner, he just put back up there so we could have something wonderful to look at and he's got a new book out that actually came out September 7, called Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU Intensive Care Unit. Well, Dr. Ely, thanks for being on Inside Personal Growth and spending a few minutes with my listeners, many of them in the health care profession, and many of them will probably wanting to learn more about what you have to say, your nonprofit as well. So I want to let them know a little bit about you, an internist pulmonologist and critical care physician. Dr. Ely earned his MD at Tulare University School of Medicine in conjunction with a Master of Public Health. He serves on the grant w a little Endowed Chair in medicine and is a physician scientist and tenured professor at Vanderbilt University Medical Center. He's also the Associate Director of aging research for the Tennessee Valley Veterans Affairs, generic, generic research, education and Clinical Center. He is the founder and co-director of the critical illness, brain dysfunction and survivorship center. And we will put a link to that Dr. Ely for everyone to go to because there's some wonderful videos up there, I was just watching a few of them. And the organization is dedicated to research and ongoing care for patients and families affected by critical illness. He also has numerous studies published in the New England Journal of Medicine, the Lancet, and right his writings have appeared in The Wall Street Journal, The Washington Post USA today and numerous other publications. And he lives in Nashville. Well, quite a bio, and quite something to speak about here. Because many of the listeners may not know about this issue. But obviously COVID has been something that has exacerbated the challenges associated with the numbers of people and ICU. And you right in the beginning of your book, that you mentioned that as a young Icon, you doctor, you went to extreme lengths, and your sole focus was on saving lives. You then state that in so doing you sometimes sacrifice the patient's dignity and caused harm. What is it that has happened? I was watching some of the videos since about, it looked about like 2007 2008 in that range. That changed ice us because it was listening to some of the patients, a young man who was shot in the stomach that came into ICU and was in there. A little boy, another woman with kidney failure actually listened to all of those very carefully. And the reality is things have changed over time. So what have you learned about patients inside ICU and what happens to them when they survive? And they come back out again?

Dr. Wes Ely
Sure. Thanks, Greg, for having me on. And thanks to your listeners. That was it, to my mind too much about me. I am a widget. I am not I'm nothing special in this regard. But I do view myself as a widget to try and improve the care and reduce the suffering of other people. And I hope the listener will take home some thoughts about their own ability to advocate both for themselves and for other people by what they're about to hear on this podcast. And Greg, I want your listeners to know too that this book, Every Deep-Drawn Breath is two things one, it's not a memoir. This book is not about me. And secondly, it's not making a penny off this book. This book is not to make me any money it is air all of the net proceeds 100% are going back to patients and families. We want to its They're their stories in the book they have given of themselves, for me to tell their story as a tribute to lift them up, and to lift up medicine and get a re humanization of the way that we approach care of our patients. And so to me, the reader is going into this book, whether you're a medical or non-medical, I wrote it for non-medical audience, so that every person can come there and find their heart on these pages and just say, do I love other people? Yes, if I love them, how can I serve them when they get sick, and have unexpected things happen in their life? That's what Every Deep-Drawn Breath is really about? Does that make sense?

Greg Voisen
Yeah, and it's loaded with stories. I mean, every page has another story. And it's great because it kind of allows the reader to read this more like actually, even as a novel, right? It's kind of like, hey, I can get drawn into the story of what happened. But we learned from stories, let's face it, that is how people learn.

Dr. Wes Ely
Right? And the reason I wrote this book, actually, is because I realized that no manner of science, me publishing in the New England Journal, JAMA, or Lancet, was actually getting the job done enough to make change occur fast enough. So your original question to me was, what have I learned from these patients? Greg. And what we learned was that back in the 1990s, early 2000s, we had all these people deeply sedated, in the ICU and immobilized we made a ton of progress between 2002 1020 with all these studies I told you about which are unfolded in the in the book via story via human beings’ lives. But then when COVID hit, we went backwards, 20 years, I mean, just a crazy Reversal of Fortune, if you will, back into the 1990s. In that, in the COVID ICU, we had this horrendous amount of over sedation, immobilization. And the patient suffered, the family suffered. And we as healthcare professionals suffered such that tons of people are quitting their chosen vocation that were losing 20 nurses a month here at Vanderbilt, even going up in their salaries and everything. We can't keep them because there's so burnt because this depersonalization occurred. And what every deep drawn breath is calling us to is how do we, as people come together to make eye contact, hold hands and see one another, even in the midst of severe critical illness in a modern day technologically driven ICU. So situation?

Greg Voisen
Well, you know, you I think, partially and I have another question, but this is a question before the question. You know, you kind of fight the battle of administration. You know, I work with Quint Studer, the Studer group, and also he does a lot of work with hospital administration. And, you know, obviously, on the outside of this, there's the professionals, nurses, doctors, who wants to have been of great care. Now they're on their hands, there's these all these administrators worried about liability. And you know, when you look at liability, it's the whole thing around the fear of, of what could happen, you know, am I going to be sued? Is this going to happen? And I get that, but they haven't found or seem to have found and the reason I say this, and I speak from personal experience, I lost two brothers, not from COVID. Last year. So sorry, Greg. And there were only four of us, there's only two left. So the reality is, you know, getting into the hospital even to see them or seeing them on a ventilator or doing the things that we'd like to do was just such a challenge. I mean, what comment would you make about this balance between how administration runs a hospital? And how the health care workers with inside the hospital would maybe like to see it differently?

Dr. Wes Ely
Sure, well, let me use story. So I remember in COVID, that I was caring for because you said your brothers died before COVID. Right?

Greg Voisen
No, no, during but the reality is they were not from COVID.

Dr. Wes Ely
Okay, that's why that's what it is. So in the exact same scenario, I remember during COVID, I had a patient who had an autoimmune disease, not COVID. And she desperately needed her family. She needed her mother and her father, she was, she was a young woman. And she became, to my knowledge, the first person at Vanderbilt University, who had a visitor after the initial phases of COVID when we were afraid and shut down hospital visitation to everyone so that everybody was suffering, even if you didn't have COVID. You were affected by the pandemic. Of course. The reason I tell the story and answer to your question is that it took a lot of mental wrangling and voice and arguments to get me on the same page with the administration to say, this is not an option for this woman, her actual medical care requires her mother at the bedside. In other words, the family is not a luxury, they're part of the treatment plan. Right?

Greg Voisen
Right. Well, I like how you put that. And you did that very diplomatically. And fortunately, we were able to go in and see one of my brothers during the process. So it really did help a lot. It helped him make his transition easier. And I think, you know, in our finitude, you know, when you think about our finitude, whether it was from court COVID, or whatever, the reality is, is hundreds of 1000s of families died not being next to the people by their bedside. And those bodies, as you know, ended up then going to the morgue, and then basically, because of COVID, not having the kind of closure they needed. So there's a lot of people out there, without closure, I speak to them all the time. I do a lot of interviews around books like this. But you know, you tell a lot of interesting patient stories in the book and one of it set the stage for what happens to patients that were admitted to the ICU and survived. And we're talking about…

Dr. Wes Ely
Before you tell that story before you ask about this particular story. There are two things happening in my head, you know, go ahead. One is that you talked about people dying, and the body's going to the morgue. One thing I want the listeners to know, is that through an NIH funded investigation, we are now actually getting volunteers who donate their brains to us. And we're studying the brains of COVID and non-COVID survivors to understand differences between what happens to the brains in critical illness versus critical illness plus COVID. And the reason we're doing that is that one of the downsides of critical illness is that people get an acquired dementia. This is part of the pix syndrome, post intensive care syndrome, which I'm sure we'll get to in a minute. But long COVID, which everybody is on everybody's mind, because this suffering that goes on months after COVID infection, picks plus long COVID is the worst form of this pandemic induced nightmare that people incur. And so we're studying that, and I just want the listeners to know. Secondly, I want them to know that that one way that we're combating this immense loneliness that makes people you know, suffer even greater both the families and the patients when they're not together is that we have a safety program called the A to F bundle. And I know we're come back to that as well. But this safety bundle called the abcdef bundle, F in this A to F bundle is family. And so we are fighting to have the family there at the bedside and have them have us not break that important connection between the two. And this is critical during the dying process as well as during the living process. So I just want to put that out there.

Greg Voisen
I think. I think it's important that you say that, I mean, it's a very important factor that you're studying the brain, you're studying these long-term effects of COVID. You know, if you look in history, how people died, and you go back because I did an interview with a physician from New York about her book finitude, and like you been studying a lot of patients for a long period of time, and an ICU doctor as well. And, you know, she said in this book, that if you go back to the 1500 1600s, when people would die at home, which is where most people want to die. Today, 97% of the people die in a hospital. That's not really where they want to die, because they're really sitting in ICU. Right? Right. It's a lot of this happens in your territory. And you are very well aware of this. And I think it was really a telltale sign that about what she said, you know, with the families being around them, obviously medicine wasn't an advanced as it was, but the reality is that the process was so much more humane, seemed humane, much more humane. So let me get to this story about Richard Longford or language or minister You know, he was admitted he survived would you just mind relaying the story to the audience and endeavored to articulate what can happen to a patient who survives from a stay in the ICU? I mean, I, you know, I've seen I have friends who had delirium dementia, one of my friends just died, he fell jogging and hit his head and, you know, same thing. He was having some delirium. So, I'd like for you to address this because it's a big thing. And there's also another factor, Dr. Steve Berman was on here healing beyond pills and potions. He talked about what happens when the brain swells with the water. You get that edema, hydrocephalus hydro right There's was a New England Journal of Medicine study done. And many of these patients who have dementia, actually they found when they put the stent in, they literally they relieved that condition. And they saved their lives. And I thought that was pretty fascinating. Because of that, I'm hope I'm saying it's right hydrocephalus. But the point is, is that I didn't know the correlation. I had no correlation. But Steve was reading a Jama article that somebody did. And literally, they started checking these patients. And they were like, wow, there's a direct correlation between what's going on we just thought they had dementia. We just thought that they were, you know, had Alzheimer's, but in reality, their gait had changed. This is I'm getting off the subject here. But because I think it's important to my listeners, somebody's gait changes, they're not walking, right. They're doing something and they're not thinking properly and you think they have Alzheimer's? You might want to think about checking that.

Dr. Wes Ely
Sure. Well, let's go back to the beginning of your story. Your question about Richard Langford. So yeah, listen, survived. This guy is a has a fascinating story. He's featured in Every Deep-Drawn Breath, one of the many patients and he was a fairly young man in his 50s, who was a minister, had memorized 1000s and 1000s of Bible quotes, etc. He could recite them that will, he became a missionary in Africa, he worked with the World Health Organization, and he needed an elective knee repair because his tennis game was off. Unfortunately, after the very routine procedure, he aspirated developed sepsis and ended up on the ventilator for 10 days. And afterwards, he was completely changed, his life never did get back to its previous circumstance, he ended up having to retire early. He ends up living with his mother for the next 20 years. And he comes to our support groups every week, at the CIBS center, C I-B-S, critical illness, brain dysfunction survivorship center, you can find our work at ICU, delirium.org. ICU delirium.org. Richard, let

Greg Voisen
Let me put a plug in this book is worth the resources in the back of it, even if you didn't read anything else, and all you got was the resources Plus, I just want to say this, the books that inspired you to write this book, I was reading the list, and I'm looking at, you know, Rene Brown, and all the people that you were reading, and I see all the books stacked up on your desk like mine. This one is fake behind me that I live, I literally have 1500 something books, but I'm just going to put a plug in. When you buy this book

Dr. Wes Ely
Thank you. There's a whole resources section back there, which is a basically a how-to manual for patients and families.

Greg Voisen
Yeah, anyway, go on with Dr. Langford.

Dr. Wes Ely
Richards, IQ drops dramatically by a couple of standard deviations. And the way his daughter describes it is, and this is after the 10-day ICU step. So he never had a stroke. He never coded. He just had sepsis and was on a ventilator and got a lot of sedation. That was it. And we see this in 1000s and 1000s of people, his daughter says, and this is in the book. It's like a master chess player, looking at a chess set, who knows the pieces and knows that he knows how to play, but can't even remember the name of the game. And that's the mind jumble that many 1000s of people find themselves in after critical illness. And in contrast, Greg to the story you told a moment ago about the person with hydrocephalus who got the drain, that's a focal physical thing that can be treated. And I'm glad you use that example. These patients instead have a global injury over their whole brain, which is millions and millions of neuron neurons dying during their critical illness dying from what dying from blood micro blood clots, dying from overuse of sedatives which have neurotoxicity like benzodiazepines specifically, or overuse of propofol even, which is the Michael Jackson drug. And also dropping oxygen counts, and then just, you know, the brain bone is connected to the body bone. So immobilizing the body, for days on end actually affects the brain. These things are all connected. And so that's what happened to Richard Langford. It was it's super sad, but it is not rare. It's extremely common. And that is part of what I want the audience to know about. So that they can do what they can advocate their level of being awake, mobilize getting out of the bed as soon as possible and what I call getting back to the land of the living.

Greg Voisen
I you know, I saw that in the videos and I saw the people that actually were having trouble went that way and the differences that it made versus the ones you compare and contrast to in the olden days didn't do that, right. And you tell this really compelling story about responding to a code blue with one of your patients. You proceed to explain that Dr. Chen was already in their fierce attempts to insert, insert the ventilator, couldn't find the airway. It was blocked, but they head back. I mean, I was reading the story with much interest, can you tell the story and what you believe is wrong with critical care medicine, and what needs to change about the culture of critical care?

Dr. Wes Ely
Sure, you know, what happened that day was Dr. Chen, my attending physician was trying to place an endotracheal tube, a plastic tube down into the trachea so that we could then attach this patient on to the ventilator, which has become so common and COVID. And what happened was that he couldn't get that tube down into that airway. The patient was getting bluer and bluer, the oxygen levels were dropping, more and more CPR had been interrupted, just to get this done. So the patient is having no blood flow, because their heart's not beating during this time. And it's extremely harrowing to watch this occur, especially during COVID. Because the SATs drop even more precipitously. And it's just it's just very scary. Now, you asked, what about critical care needs to change? Well, that scenario I just described is always going to be there in critical care. What what's happening though, is that we tend to extend that emergency kind of depersonalization out into the following hours and days. And we take patients and imagine this, imagine 100 people coming in with critical illness, they all have, they're all in color. They all have their own loves their likes, their dislikes, they their favorite music, their favorite food, their pets, their pets’ names. Imagine if you took all that color and humanization and ran everybody through a depersonalization chamber. And the other side, it was just tones of gray, everybody looks the same. Everybody's on a ventilator. Everybody's quiet, unconscious in a coma, unable to speak, and I don't know who they are, and I can't find out who they are. That's what unfortunately, has occurred way too often in the ICU. And what I am advocating for here is for use of this A to F bundle, the A, B, C, D, E F, which is really, you know, a is an analgesia approach to pain control, B is both stopping the ventilator and stopping drugs every day C is choosing drugs other than benzodiazepines, which are so dangerous, D is paying attention to delirium. E is early mobilization and getting somebody out of the bed, and f is having family at the bedside. And what I'm saying is that this approach is A to F bundle. We've studied this now, in about three to 400 papers in over 30,000 patients. And we know that it reduces death, reduces length of stay, improves the likelihood of getting out of the ICU and hospital faster, with less likelihood of going to a nursing home, going home instead.

Greg Voisen
And how many hospitals have adopted your kind of your philosophy? I mean, if you go across the country, and you say, look, we have lots of ICUs, how many have the A to F bundle that you're talking about? Because your nonprofit, has done all this research and study and you personally right? Yeah, and you're advocating this approach? Can you say that this has been widely accepted now?

Dr. Wes Ely
Well, we've done we can do better than just the United States, we've done surveys across about 30 countries in the in the world, we've had this translated into about 3540 languages. And I would say that around 60 to 65% of hospitals have done this, to some degree. The question, Greg is how much have they done it? So if there's six steps, and by the way, this safety bundle is kind of like Think of your pilot, trying to get you from LA to New York? Well, there's no way that pilot is going to get on the airplane and get you across the country safely unless they go through their safety checklist. Correct. All this is at the bedside eyes, a doctor, the nurse and the family discuss these steps of making sure that everyday Betty and Bobby, get these safety steps so that they can have a higher chance of survival and survival more completely, if about two thirds of hospitals have done it. But if they only do it half the way that we don't get full implementation of the steps, you could just do half the steps. And what we've proven and this is really fascinating, you know, in all of science, the most consistent proof of truth is a dose response. Meaning that if something is done 20% 60% 90% and you see that the efficacy goes up as you step up If your game, then that's a dose response. Or if you give a drug and the drug is very good and two milligrams is improved, when you go to four and improve, you go to six, that's a very, very strong evidence to prove. Well, we have a dose response proof in in 21,000 patients that we studied in the Sutter Health System in California. And then the Society of Critical Care Medicine studied this. And at ICU is across the United States, including Puerto Rico. And we found beautiful dose response. That is, you go from 20, to 40, to 60, to 80% compliance with the bundle, you see increasing drops in death, increasing drops in length of stay, increasing reductions in delirium, coma, and also, as I said, a higher likelihood of going to home instead of a nursing home. So that really makes it convincing. And I think we've got some implementation, we've got some work to do. It's one of the reasons that I want families and patients to come into the hospital saying, wait a minute, we know about this new approach in the ICU, we want our loved one to get this approach rather than just days and days of heavy sedation and immobilization.

Greg Voisen
You know, as this country ages, and this is a question around aging, because you know, many of your patients and end up in the ICU. And the biggest medical care costs, for the most part are as people are aging out, their 70s, their 80s, their 90s they're coming in the ICU, something happens. And, you know, you talked about here the basic principles of human caring, that was part something you mentioned in the book, which includes that less sedation. What do you find about this particular population, because if this population is, according to the US government, it's the largest percentage of Medicare bills, it's the largest percentage of anything, you know, when you have medical insurance, and you get to those ages, that's when stuff starts to happen, right? But it doesn't have to happen. And you have some tips in the book too. And I want you to mention those about things to keeping your brain active. You know, I've had Dr. Daniel Amen. on here talking about the brain is always listening. There's all kinds of research out there. And I want you to talk about both, you know, this aging population, how you can care for them better how they can care for themselves better, and these basic principles of human care.

Dr. Wes Ely
Well, I, it's great that you're talking about aging, I was trained by one of the fathers of geriatrics, his name was Bill hazard. He was at Hopkins and then trained me years later. And we shared a wall for a year as I was his assistant chief of medicine. And Bill always said to me, was to put on a lens on your camera, to look at the aging of our population, and how they might require different care. And what I want to tell you, Greg in the listeners is that older people have the same risks. They're just nearer to disaster from them. And what I mean by that is that they are more likely to develop the delirium more likely than to suffer the consequences of a dementia after the delirium. And for the listener delirium is that acute mind cloudiness during illness, and the dementia is the long insidious, usually slow onset things like Alzheimer's disease, but which gets zipped up in even a matter of 10 to 20 days after a profound ICU stay. So if they're near to disaster, how do we handle that? Well, two things. One, we are very, very diligent about attending to their need to get out of the bed every day to be working with them to clear their brain. We actually have a mnemonic called the Dr. Dre, and Dr. Dre is a famous rapper who has the beats here, but yeah, so Dr. Dre means that when we're at the bedside of an old or young person, but again, it's more problematic for the elderly. And they're delirious or confused. We say, well, let's run the Dr. Dre and it stands for diseases, drug removal, and environment D dare. So we asked ourselves what diseases are creating this, this delirium? What drugs should be removed? Like benzodiazepines, better drill, certain antibiotics, other sedatives, etc. And then what about the environmental things and environmental things for the elderly are very important. sensory deprivation leads to delirium. So if you can't see clearly, if you can't hear well, you need your eyeglasses. You need your hearing aids. I'll tell you a story. I had a patient named John. He was in the ICU, we're still very close friends. And he usually reads presidential biographies. He was reading a book about FDR. And every day I was in there with him. He wasn't reading the book. And I kept asking him, john, why aren't you reading your biography? He was recovering from a heart attack. And he said, well, my glasses are broken. But don't worry, my wife's going to bring them in. And on the third day, he started getting delirious, profoundly delirious. And I thought, wow, he's getting septic. He's getting sick again. So I did the Dr. Dre and I thought diseases maybe he's getting infected and septic felted his drug list, and then environment I thought, Oh my gosh, he's still going to have his glasses. So just he just reminding myself to run the Dr. Dre. I picked up my own readers out of my pocket gave us the John, use these glasses today. He was delirious. He wasn't making sense. So I didn't even think he followed that. The next morning, I kid you not I walked in the room. And John had on my readers, reading the FDR biography. He said, Dr. Ely, let me tell you what FDR did when he was threatened by your thought yada, yada World War Two chapter and verse, his brain was clear as a bell, it was only that is to add sensory deprivation. So these are the things we can do acutely. And I'll leave the reader with one more thing long term, when they incur a dip in cognitive function that lasts weeks and months after critical illness. Remember, Sudoku and Scrabble. Numbers, math words. So we if you put your arm in a crossword puzzle, you're already cast and you take the arm out of the cast six weeks later, it's atrophy. It's smaller, right? Then you have to exercise that arm to build it back up again. Well, that's what we have to do with the brain, we have to give it exercises. And after it's incurred, a delirious episode is now and now having some deficits, memory, executive function, etc. We can get that back again. And we use brain games to do it. It could be computer games, but it could just be words and what word jumbles or Sudoku and Scrabble?

Greg Voisen
Well, Wes that is a great story, which leads me to this, Ray, is it Fugay, right? If you feel good, and COVID patient that was showing signs of delirium, because you were speaking about delirium just now, as a result of low oxygen levels. Now, you know, a lot of people went out and bought oxygen meetings meters during COVID. Stick on your fingers, see what your pulse is? See how much oxygen you're taking in? Because there was obviously a serious issue going on? and still is? What are you talking about these long-term effects of COVID? I don't think we got into it. But what are some of the lingering effects in particular with this patient? And having contracted COVID?

Dr. Wes Ely
Yeah, great. So Ray, was in the ICU with COVID. And he was very delirious. We think that this is from, in this case, again, diseases like COVID, also blood clotting and COVID. Dropping oxygen levels, and COVID actually have a mnemonic called F COVID. Like we hate COVID. So F COVID are the causes of delirium. And it's family absence and isolation. And then COVID itself because it causes the virus itself. And then oxygenation, that's FC O V. These the virus I said, and then drugs. So he had all those causes. And when he developed days on end of the delirium, his wife even though is why we got his wife there, she was at the bedside, we addressed all the Dr. Dre stuff. But weeks later, Ray was having tremendous problems with his thinking. And he was a high school principal, and needed to get back to you know, his job. And the way that we did it was that that Shelley, his wife worked with him day in day out, and I've permission to use their names by the way, they're in the book. I'm working with them day in day out, exercising his brain, and putting him on a program basically of an hour to hour and a half a day of brain exercises broken up into three parts. And he got all the way back to where he wanted to be. He's living a very full and fruitful life. It took months, and I asked people to put their patients cap on because it's going to be, you know, it's they don't, they don't get sick in a day, they're not going to get better in a day. It's a long process. But we have hope. And we want to leave the reader, the listener here with a lot of hope, for their recovery and for getting their life back after critical illness. That's the main thing is don't lose hope. Because there is a great path towards getting your life back even after profound COVID and ICU stays.

Greg Voisen
Well, you do a great job in this book of telling him and I there's a personal story in here and want to make sure I get in before we end. And that's about your daughter Taylor. And you know, you're out by the pool. She does a flip and she hits her head. And obviously this is a very personal story and I think it's a good story for the listener to hear. What did the accident that Taylor had teach you about being a more masterful ICU physician because you have such a passion for this? And I'm not certain if this wasn't the impetus for your desire to want to drive you to do this, I'm just I'm just guessing. But I have a son who has chronic Myelogenous Leukemia. So I get to deal with his constant ongoing medications and what's happening with him as well. So any correlation there?

Dr. Wes Ely
Sure. You know, there's a reason why Taylor's story is chapter six in the book, it's right at the turning point of a 12-chapter book. And it was a turning point for me, I sat on the left side of that bed, normally, doctors stand on the right of the bed, if you ever thought about that before. But that's by convention, we do that, we stand on the right, and we examined from the right. In this case, I was on the left side waiting for the neurosurgeons to come in. And I realized that, in a sense, they weren't coming in regularly, they weren't teaching me what was going on, there was a form, I was kind of silenced as her father, and Taylor was silenced. And in a way we call this is a form of testimonial, injustice. And I sat there in the bed thinking, Oh, my gosh, I have done this to so many other people. You know, it's kind of like that, that Pogo thing, we have seen the enemy, and he is us. You know, I'm guilty here. And so I had to work through my own shame and, and guilt over the fact that I had committed a form of testimonial injustice and silencing other patients and their families. And I became, I vowed that I would not do that anymore to people. And that is what led me to develop the A to F bundle, sir, you're right. It was the pivot point for me in my life. And I realized that, I have a covenant with my patients and families that I don't want to break, it's a promise to uplift them, and to magnify their dignity. And this is important, every human being is priceless. And no amount of disease reduces the value of a person by an iota. Every person is priceless, no matter how much disease they've got. And it's my job to make sure that they know that to make sure they feel priceless, and to lift them up through their illness, whether they're going to survive or not. And that's what Taylorsville has helped me to get committed to. And that's the purpose of Every Deep Drawn Breath.

Greg Voisen
I can tell that and I want to just acknowledge you for the work that you're doing, how you're helping the public, the book. And I always like to leave with one last question. And I'll leave you with this, that I would like for you to answer. You know, we've talked about a lot of stories, we've talked about COVID. We've talked about delirium, we've talked about many different things during this last 40 minutes. But what are you also at the end of this book, say, hey, there's things you can do to make yourself better? In other words, if I'm not in the ICU, what are some of the things that you would give our audience or leave a couple of tips, if they do happen to go into ICU, that they would tell their family or they would give some advice, so that the stay there is the kind of state you would like to see them have? Okay, number one, and number two, you talked about the crossword puzzles, and you talked about the Scrabble, and they're getting things that people should do some of the things they can do to keep their brains, you know, very, very active. And to kind of prevent from some of these things that could happen.

Dr. Wes Ely
Sure. Well, we've talked about some of the practical things like brain games and brain recovery. So I'm going to end on this note instead. Because it is the core piece of all of this. central to all of our humaneness, I think sits Love, Love of each other. And what I want the reader the listener to know about how they can do a better job for themselves or their loved ones is basically the human connection is Martin Buber talks about the I thou this relationship between the eye and the doubt. And between I and you. And what I think goes awry in critical illness is that we break down this relationship when the family is not present, or they don't speak up for their loved one or the patient themselves are kept sedated for too long and we don't see who they are. So how can you overcome that? Well, one way is to come in the room. Instead of saying what's the matter with the patient. Say what matters to the patient switch that preposition from with to what matters to this person. And if everybody does it, the family the doctor, the nurse, we all say what matters To john lying in that bed there, then we have to say, Well, okay, well, how can we organize our job today to lift this person up in accordance with what matters to john? And that to me becomes the core thing. So some days, that means that we have to be very selfless, and maybe not push what we want. We know the families might say, well, I want you to do all these procedures, all these therapies, because I've got to have them live. But sometimes, we actually need to shift our goals, over palliation of symptoms rather than cure. And there are times in critical illness where we need to usher in great palliative care to reduce suffering during a dying process, instead of pushing with that, that extra intervention, which, you know, might have a 1% chance of working, but it doesn't fit with what the patient really values and once Does that help?

Greg Voisen
That helps a lot. And I think the fact that you know, you, you can, that the families can get involved in that and advocate for a loved one is really important. I think many people are very passive. They think the doctors have all the answers, the nurses have all the answers, and they just kind of sit there with the patient. But I think the key is that they do have an option, and they can let their voice be heard. And I think if anything that's important, and they need to understand that if the physicians are at the point of palliative care, that it's really important that you do listen to what they have to say, because many people will fight that they're going to say no, no, I, you know, we got to save the patient at all costs. And I and I just want to say to you, and to my listeners, go pick this 336-page book. It's a great book. If you if, during that you don't get anything out of one of the stories, that's crazy, because there's so many stories in here. Also,

Dr. Wes Ely
I'm available on twitter @weselymd. And if people feel so motivated, they want to leave a review on Amazon to draw their people towards the story. I just want the word to get out to other people and that would be beautiful and helpful.

Greg Voisen
Oh, and you are also it's icudelirium.org and I want to take that everybody goes there. Make a donation because the work that you're doing through your nonprofit is really, really valuable and important work not just to COVID patients, all ICU patients in the study of the brain and what's going on. And Dr. Ely, blessings to you Namaste. Thank you for being on with me and spending some time with my listeners.

Dr. Wes Ely
Thank you so much. It's been my privilege.

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