ICU From Both Sides of the Bed "If you could not speak,what would you want us to know?"

We, we can't hear you, Dr. B. I think your microphone is muted. Well, thank you. I have been talking all this time. No, no, no. Well, thank you for that. I'm glad you were here. Now, the reason for today's session is to explore whether you're going to be in the ICU as a patient, whether you're going to be in the ICU as a doctor, a clinician, a nurse, a caregiver, Or you're going to be in the ICU as the family of someone who is in the intensive care unit. And that is daunting for everyone. Luckily or unluckily, I have been there as 3 roles. I was there as a patient first. I had a near-deadly accident that landed me in the ICU with head trauma, with surgery. And I had to watch my colleagues come to my bedside. I have to watch how they were hesitating, choosing their words, trying to tell me it's going to be okay, hiding from me that tomorrow I was going to go to the operating room until the right time, or maybe somebody else would take that uncomfortable conversation and not them. Everybody was nourished with intentions, but unfortunately, it translated to a vulnerable person who relied on these relationships and the trust that was built before coming to the ICU to suddenly realize I wasn't getting the same relationship with them as I was. Now I'm a patient. They feel the need to protect me. I was also there as a family member. And just yesterday a colleague called me and said to me his loved one is in the ICU, and he was trying to not step on any toes and not to be that guy because he's also a doctor. But now it's his loved one in the ICU, and I just said, I'm giving you permission to be that guy. Because the communication changed. without anybody checking with you. So you need to change your communication style as a result of that. And then the last one is as a doctor, as the ICU person overwhelmed managing my own emotions. So nobody is ready for the ICU because frankly, these are 3 doors to the ICU and I walked through all 3 of them. The worst time to learn how to be in the ICU is when Someone you love is already there, or you are already there. So today I'm going to help you enter the room a little bit more prepared. So when we go through those 3 doors, questions to ask today is the patient, what is happening to me? The family, what should I do? And the clinician, what can I change? And so which door have you entered today? I want you to let me know in the comments section. This is going to live on YouTube, so you can go in and just send me comments. Have you been the patient? Have you waited for someone that you loved, or have you cared for a stranger in crisis? As a patient, that's the number one door. My body arrived before my story. I remember I was lying on the ground and thinking about calling the people that I cared for. In that moment, it didn't matter what my credentials are. It didn't matter, did I have problems with people or not? Did they call me on my birthday or not? It didn't matter whether there was a difference or we haven't spoken. If there is any intelligence, none of that defined a life. What did was kindness. Kindness is what really translated to the most visceral part of me as a patient. I eventually woke up enough to return to medicine, and I started to ask questions. But quite frankly, I thought I was going to die no matter what. I was moving to the operating room and to get surgery. I was convinced. Even though it didn't make any rational sense that the general anesthesia was going to kill me, and it didn't. But I was convinced of that. So fear is irrational, and it was not real. When someone tells me that there is a fear, I don't judge them for it, because fear is human. So towards the end of my medical school was that motor vehicle accident. And then I had a traumatic brain injury, which meant my thoughts were not my own. My memories were gone. People were talking to me whispering, and I thought they were screaming. And then when you felt that you were getting better, there came the next one. You had to have surgery. And so going back to the ICU, being on a ventilator, the tube in your mouth and not being able to speak, convey your message. It was just hard on me. So afterwards, I just became a different kind of doctor. The chart recorded what happened to me, but my life recorded the meaning of what happened to me. And so from there, I couldn't remember all of the accidents, but my body remembered that something had happened. I literally had post-ICU syndrome. I remember whispers and talks like, hey, why are you screaming? Look at that guy. He's probably not gonna make it. You only have a broken hand. And I realized that that guy was me. They were talking about me, thinking I wasn't listening, and I was. And I was frightened with that. For example, I woke up and I tried to talk, but the tube was in my mouth. And the nurse came to me to say, what's happening? What do you want to say? Oh, you're probably thirsty. And I had been trying to talk to my family for a while, and I couldn't get my point across. So finally somebody understood, and I vigorously shook my head yes. And she's like, I can't give you anything to drink. The way that that was spoken to me. was just so heartless. It was not meant to be that. But the communication was, I was squeezed between 2 things because the nurse was busy. So she's like, is that what you want? You're not going to have it. Instead of saying, I can't give you what you probably want because here's why. And now I say it to my patients, your stomach needs to be empty in case we needed to take you to surgery or to do something with general anesthesia. We don't want what's in your stomach. reflux back into your lungs and cause more trouble. So these are the small things that make a huge, huge difference. Now, once you survive, you have to go through something huge. And that is, unfortunately, you have to live with the fact that you survived and somebody else didn't. So I lived with the fact that someone was in my spot and died. I could have died. And it, it was heavy that those feelings are real. And when you listen to another intensivist describing being intubated from inside the bed, which is what I just did, it just hopefully will bring you closer to the human. Not the patient in that bed. So the next one that I would like to speak is the ICU language. The ICU speaks 2 languages at once. What we hear as a doctor, as a nurse, or as an RT is an alarm. The bed inflating and deflating, the ventilator, the medications, the trends. What the patient hears is danger. Am I dying? Why can't I speak? Why are they holding me? Is anyone there? They're speaking about me. Don't they know I'm listening? So that's the unfortunate thing is you have to know what your words translate to the patient. First, when I come in to speak to a patient, I say my name. I also say, today is— this is the time. This is what's happening outside. You're in this city. Recently, one of my family members was admitted to the ICU. I educated the family every time to come in not to do the insecure thing. Do you know who I am? Don't do that. That person is struggling as it is. They are looking at you to reassure them, not them to reassure you from your fear of losing them. And so when you first come to the ICU, just speak to the person, anchor them in the present. Before you touch them, say you're going to touch them. They are hypervigilant. Translate the alarms. to them and tell them what day it is, say what happened, and then speak to them. I know it feels weird to say, you're a great hero, look at how much you're a warrior, you're fighting. But that's the language they understand. And they are fighting, even if it means that they are laying in bed. That contrast between I'm laying in bed, yet I'm actively fighting, We have to actually understand it and then translate it to them. Translate the alarm. Many times I say to the wife, you can touch your husband, grab his hand. Don't worry about the alarms. We will handle them. And then give one short idea at a time. You have been doing well. You've been to surgery and back. You have a fracture. You have been— Too many things for a A brain that is on sedative. And then return the control. Offer them choices that are real. Would you like me to leave the light on, or would you like the light to be off? Would you like me to explain it now, or can I come back later? If there are glasses, look for them, put them on. Hearing aids. If there's any music— how many times I've had the joke of people coming into the ICU room where I'm doing a procedure and they hear music. And I say, if you as a person who just walked in, how it made you feel, imagine the person who vulnerable, what music makes them feel, how to dial down the light, and what is the position in which they are. Sometimes these are the only things they feel because the world shrunk to that. So if you can speak, start as a patient with 4 questions. Where am I? What happened? What is helping me today? And what is the next decision? Start there and stay there. If you can't speak, point, blink, write, use a communication tool. It was so important and relieving to my family when I told them about my loved one who is now in the ICU, take— go to the internet and download a bunch of images or even the alphabet and have them point and reconstruct the words. It was huge for the patient, huge for the family. Okay. The ordinary scene is not ordinary. This is as the family. Something happened to me which was striking. Many of you know that I lost my father about 4 months ago. He lost the battle to cancer. It was a year and a half, and about 8 months in, I wanted him to get a second opinion. And so I secured an appointment. He was bedridden in a hospital. I didn't want that to be a barrier, so I scheduled that, and I talked to the social worker to schedule an ambulance transport, and he was taken in that ambulance to the office of the other second opinion cancer doctor. I left work. I went to that hospital, parked, crossed the street, and as I was running and all this stuff in my head, unfortunately. I was running to catch because I thought that I was late, and I opened the door because absent-mindedly I saw people coming in, and those people were emergency medical personnel with a stretcher. I just opened courteously the door politely to let the person in, and as the person was coming in, my subconscious— because my brain was busy just to get through the day, to get through where I'm going, registered that face was familiar. And I looked down and that was my father. I almost missed him because he became so familiar. A stretcher with emergency personnel walking or being wheeled down the street. It was an ordinary scene that I realized, oh my goodness, this is what a family must feel. They are afraid, they are stressed, they don't want to be here, but they have to be here and they have hope. And they're running the questions through their head. And so that was an extremely important moment that anchored me that this is what families must feel. So if you were a family, this is the second door. I was the family of the patient. This is my dad when he was young. I took one of his old pictures and I turned it with AI, with colors and everything, into what— how he must have been like when he was in his— I mean, I don't know, early 20s. And he was a teacher, and he was a leader in education, but he was my father. I was a doctor to people, but I was his son. And so this story wasn't carried by his medical chart. It was carried by him and me. And so when I showed up He would tell me one day, try with as best as he could to say the word muffin, and that was a muffin. He wanted a muffin. He wanted a cake to eat. So before he was a patient, and even as he was a patient, it was restoring the person inside the patient. So When he told me that, I jumped to my feet, ran downstairs, ordered one delivered, grabbed it, and went upstairs just to make sure. So as a family, don't be afraid to advocate for the things that restore the person behind the patient. Bring pictures that look at him or her or they living their life. I don't know, beating a piñata or driving or in the kitchen or laughing at a comedy because it brings the spirit of your loved one to that room. So anybody who treats them sees the human behind the patient. When you have to be in the ICU, some patients look at the ICU and say, Much of the ICU blurred together. For me, I barely remember that. And the family lives every single day. To you as a physician, as a nurse, as an RT, they are a name, a diagnosis. Your side of the chart is organized. It's clean. But for the family, it is completely jumbled. I woke up one day And then I was like, oh yes, oh my God, he's still in the hospital. Oh yeah, that's right. You emerge from sleep in the morning, and you know you have to blend in something stressful, traumatizing to something else, and you receive a call from the hospital, and then nobody leaves a voicemail. For the love of God, don't do that. Because we as the family, we imagine the worst, and the phone number that comes up is the general phone number of the hospital. You don't know if they called you from the OR, from the ER, from the radiology, from the lab, from the nursing station. You don't know where to call back. So that story has been incredibly important because we need to make sure to know that these patients are navigating through it minute by minute, second by second, and it's going to be etched in their memory. Forever. For my father, as a family, I literally went and said, what are your wishes? I didn't want to ask that. I didn't know when to ask that. I was clumsy when I asked that. So I just said, you were a teacher, teach me. What would you like me to do when it's time for you to leave? And he teared up and said to me, I wanted to talk about it, and I just didn't know how to bring it. So you ask yourself, have you— when was the last time you spoke to your loved one? Don't be afraid to bring up the questions about the values and about the end of life, because if you're uncomfortable and you're the one alive, imagine what they are going through. And they're as much as you afraid to talk about it, because we have this superstitious mentality of, what if I bring it up and jinx and tempt the fates? Trust me, you don't have that much power over human life. Just bringing it up in conversation doesn't make it happen. It doesn't manifest death, but it does bring something up, which is nobody speaks for your loved one but themselves. They are extremely grateful that you have brought back their agency to them. So what are their values? What would this patient accept, refuse? What are they hoping for? That's a beautiful question to ask. And what are they afraid of? Don't go into, should you have CPR? Should you not have CPR? No. Ask, what are you afraid of? I'm afraid to live like a vegetable in a hospital. Well, that tells you already way more than if you asked, do you want to be on a breathing machine? No one knows the answer to that, but everyone knows I don't want to end up in the hospital. If I can, I want to be home. But what if you can't, loved one? And they'll answer you, if you cannot, I won't hold it against you. That alleviates your guilt as well. And it did for me. I said, I will do my best, but if I can't, he says to me, well, then in that case, I won't hold it against you, and I will accept that that was my fate. What was normal before the illness? What changed? Talk to them about it. Say you won't be able to walk anymore. You're going to need a walker. You're going to need to be in a supervised place so your medications are not duplicated or missed. And then ask them for their voice. What would they say if they could join this conversation? If they're not there and you are speaking for them. That way you feel that the decision is built together. Remove yourself from that conversation. Say, if it's not me, I want to be absolutely truthful about them, not what you wish you could do for them. Them. If they never like doctors, well, you have your answer. If they fought you to go to the hospital, you have your answer. Don't impart on them Your choices. 5 questions that families can ask every day. What changed since yesterday? What are we most worried about today? What are we doing and how will we know if it works? What decision may be coming next? Who will update us and when? Write these answers down because fatigue changes memory. These answers are simple to remember, and they anchor what it is that you ask every day. You can even write them down. When the doctor comes in, ask the nurse, can you take those answers down for if I'm not here? At least I'll find them there. And you can contact the nurses. I usually got a lot of answers from the nurse, from the nutritionist, from the respiratory therapist, the physical therapist. I wasn't always, even as a doctor, able to connect with doctors. And as a doctor, even if I try to reach families, some days are just not— they're just not enough hours in the day. So these questions, you write them down, they become your answers. Family presence is part of the care. And I usually ask, why are we removing family from the team. Ask whether a family member can listen or participate. Most of the time, yes. Sometimes I took more time from the doctor than I anticipated, but it wasn't always. Sometimes I said, I'm good. I don't need that much time. If you are a physician, when appropriate, invite safe and meaningful participation. Ask your social worker to stage a family communication. If you do it often enough, then it will be less and less time spent with them. Not all families will take a lot of time from you. And some of them, they don't need everyday calls. Sometimes as physicians or as nurses, we feel like, oh, it's going to take away from the day that I already have to— I'm busy and my actions are timed. There are medications I need to deliver to the patient, procedures. Unfortunately, that's just not the truth. The truth is only a few patients need lengthy conversation, and that lengthy conversation can be planned. And if you don't plan it, it'll catch up with you and it'll be longer. Record what happened when the patient couldn't, and then offer mental health, bereavement, spiritual care. I always ask, Do you have a faith leader that can be invited to this? And then set predictable communications and follow-up if you can. What I've learned is what goes unsaid harms much more than what can be said. And that patients and families forgive when you say something in a clumsy way. And when you are aware to tell them, hey, I didn't mean it that way. We're all human. There is a study about AI that showed that AI can answer better than a doctor. In fact, patients, when they were blinded to who answered, preferred the AI answer. But when it was revealed who answered, the patients did not like that AI answered them. They wanted the clumsy, imperfect doctor answers. And so for that, I wanted you to know before you go to the hospital, Eat. Sleep before you are collapsing. Your patient, your loved one is going to need that. Leave the room without apologizing. As a doctor, you— people understand we're busy. We will tell them, I'm leaving the room, but it's okay. We don't need to feel bad about leaving the room because they know we're busy. And as families, please ask the same question twice. It's okay. I'm giving you permission to do that. So as a family, I need you to know you need to call your primary care and ask what kind of sleep aid I can use in the next few days that my loved one is in the hospital. I did. I called my primary care and asked them. And then I asked everyone around me, including at work, if you see me tired, I may take a little bit of time and log off and take a nap and come back so I can give you all of me. So I need you to know, if you're not at the bedside, please, medical teams, don't judge families. They're doing the best they can. This is not something they anticipated. As a clinician, the third door, you enter the room carrying medicine and weather. In fact, I ask people about, hey, do you remember your brother, your father, or your grandfather? What did they die of? They're 80, and they remember exactly the words the patient— the doctor told them about their loved one decades ago. So our words mean something. Your words, your pace, your face, the silence when you kind of look away when they ask you something, when your hand is on the door answering. Just trying to leave. Those are actually words that you are not saying. So what the clinician may carry home— I, as a doctor, spoke to people and then left and went somewhere just to cry. And then I learned it's okay to cry in front of the patient and the family. It's okay. I promise you. So there were so many nights where I lost a patient, and then I went and cried somewhere, or I came home and just jotted down that story just to get it out. Grief for clinicians is real. We take our patients home. And you know, we— I had as a patient, I was reading the face of my doctors who came in before I heard what they had to say. So Fast feet are sometimes necessary because, well, I have to go somewhere. Say it. I have to go somewhere because I need to save somebody's life. But if I have to go because I need to eat, I also say it. I said one time, you'll hear me being hurried. It's because I'm fasting and it's Ramadan. In about 30 minutes, I have to break fast and it takes me 20 to go home. And I usually like to be with my family. Would you mind if I'm short today and tomorrow I'll come in with more time to give you? I introduce myself all the time, not as the ologist. I usually call it the antibiotic doctor is coming. The kidney doctor spoke today. I went to the X-ray doctor, the heart doctor, the brain doctor. I'm your ICU doctor. If they don't understand, I tell them, you're in the ICU and I'm the ICU doctor. You're a guest at my house. And they laugh at that. So introduce yourself, sit when you can. If I have 5 minutes, I will use 2 of them to look for a chair and sit so I'm at the same level as my patient so they feel less hurried in getting their information. When you compare the same information, the same time, and they ask the patient to rate it, a doctor who was standing and a doctor who was sitting, The perception of time spent was more for those sitting. Narrate before you touch. I'm gonna give me your hand, and I grab their hand and say, trust me, you're gonna be okay. If I don't know, I'll tell them, hey, this is a crystal ball question, and I wish I had that crystal ball. But in the meantime, I can tell you what I know. End with the next step. Before I leave, I usually say, so we have a plan. That is sometimes reassuring. We have a plan. The next step is— when they ask me, so when I go home, I say to them, that's station number 10. We are at station 3. I will tell you about home when we come closer. I will come back tomorrow. I'm sorry, I do not know when, but I think it's gonna be between 10 and 12. And if it's not me, I tell them, Dr. So-and-so is going to come tomorrow. I promise you, they are as smart, if not smarter than me. Check what was understood. I usually say, tell me what you understood from what I said. And then I leave some room for the impact. And if they're silent, I don't necessarily fill the silence. I grew comfortable with the silence because some people need that silence. I function with a brain that functions at the speed that's normal. They are in the hospital with plenty of drugs and medications. They may take a little longer. How many times had I just to say to my father, hold on, I'll let the doctor go and I'll repeat everything to you. And then if you have questions, I will convey them to the doctor because they process things a lot slower than what we do. Every update has to have a four-part. I don't always just use the potassium, the EKG, the heart, the this, the that. I usually describe the person. He's sicker today. He had a rough day today. He did not sleep very well. The why? His lungs need more support. The breathing machine helps him do that. What's happening today? Today, our goal is to increase his nourishment. Today, our goal is to treat the infection. Today, the goal is to protect his organs. Then next, by this afternoon, we will know from the CAT scan what will happen. Or by tomorrow, we will see how 24 hours had an impact on him. So these are— this gives you a framework of how to speak. The headline, The why, today, and next. This allows the person to have something to convey to the rest of the family. Imagine that the family or the patient need to answer questions. How are you today? What did the doctor say? And as a doctor, please don't say we don't know what's wrong with you, because that's never true. What's true is Of all the possibilities of what's wrong with you, we are still doing the workup, and we don't know which one. That's more accurate, but that instills confidence in the patients and their family instead of, we don't know what's wrong with you. Well, then send me somewhere where they know. When you have— how to create order from chaos. So When there is a code blue that happens, which is a cardiac arrest, I come in and I try to create order. I name a leader, I use names, I assign roles, and that brings everybody down because everyone knows how to do CPR. Then as a code leader, my job is not to tell them what to do. They know what to do. My job is to give them a common goal and to shepherd them in the right direction and to give them some order so that they feel useful. Keep the patient as a person. I want to speak about the patient. Before today, Mr. Smith was a friend, a father, a neighbor. Make space for goodbye. Don't stop a code blue or cardiac arrest and just say, Time of death is. When possible, have the family, whether on the phone or in person, say, I love you, thank you, I'm sorry, and goodbye. You need to help them find these words. They may not know that they matter at that time, but they'll remember them 10 years later. I did say I'm sorry, or I did say goodbye, or I did say I love you. Pause after death. Give 10 seconds. And the family, when they know that there was an honor, a moment of silence, they absolutely appreciate. Because people are realistic for the most part. What's non-realistic is they don't want their family member, their loved one, to not have mattered. They don't want people to have come to that. room just out of quickness and checking a box. And then check on your team later if you are the doctor. Check on the family. I tell my residents always, one of the last bastions of medical care that is not tainted by whether you're going to be paid for it or not, you're afraid to be sued, is giving condolences. So you call the next day and you tell the family, my condolences. I am Dr. So-and-so. I'm Nurse So-and-so. I'm calling with the rest of my team to give you my condolences, and I wish you peace. You don't wish them have a good day. You wish them peace. When people leave the hospital, it's not because they survived. It's not always as recovered. Did the body recover? Did the mind recover? And did the emotion recover? So 5 to 8 out of 10 people who received the ICU treatment develop a post-ICU care syndrome. Mm-hmm. So when you are having a rotation in the ICU, understand the things that you do may translate differently to those patients. Families develop anxiety, depression, grief, insomnia, and post-traumatic stress. Grief makes people do things that they never thought that they would do, and they grieve way before anything to grieve for happened. They grieve. the picture that they had of the person that they knew. You may have a discharge summary on the chart that closes a hospitalization, but it doesn't close the experience. And every time they go home or they go to the family and the patient always wonders, what if? What's going to happen? Will I have to come back? So leaving the ICU is not the end of the ICU experience because we have memory problems, we have weakness. I had patients tell me, I remember somebody with the spear stabbing me. And when I look at the chart, that's the day where they had an intubation, they were put on a ventilator, or they had an IV placed in them. So these things can be transformed by the brain into something huge, a nightmare of someone stabbing them with a spear. This is from a real story from a patient. So Before you enter your ICU, know your job. Different roles, but one goal: protect the person while treating the illness. Whether you are a patient, a family, or a clinician, we have a common goal: to protect that person. The first 24 hours, talk to them, create a map. You know, you Can tell them, I don't know how the person is going to— as long as the person is going to be here. But you can tell them somewhere within 10 days to 2 weeks because it's a septic shock or respiratory failure. This is never something of a day or 2. This is a full week. So the first 24 hours, build a shared map. Name the crisis. Why is ICU needed? What machine or medicines are doing? Name the decision maker. Who is the decision maker in here? Who speaks for the person when the patient cannot? Even if the person's speaking for themselves, I ask them, if you were asleep for some reason, is there someone you want us to contact? And don't take no for an answer because it might happen and you will find yourself making decisions for someone who could have done them themselves. Name the baseline. How was your life before? And what do you imagine? What do you hope for? What are you afraid of? And then when are you going to check with them? I usually tell them tomorrow I'm not going to be able to, but the next day I may. And I split the list of patients to call today and tomorrow and the next day so they're not always on the same day. And then name one contact. Frankly, I don't name one contact. I ask them for everybody who can be available, we can call them on the phone. But then there is Various levels of degrees of comfort for physicians. So name one contact who gives and who receives the updates. Then those are the three doors. If you are a patient, I want you to tell the the team what I feel, what I understand. What I need, and I want one choice I still own. The family, what changed, what their loved one values. I knew everybody kept pushing my father for hospice, and I knew that while he accepted his fate, he still wanted to eat. He still wanted to do physical therapy. He still wanted things. There are some days where The team, which was new now, the new one bypassed me to go to talk to him, thinking that I was doing unreasonable. And then they were shocked by the time I walked in. I found them for 40 minutes trying to tell him, "You don't want this, do you? You want to go home, right?" That's not right. You need to ask and not impart your own values on the patient. They were shocked. He was. Pretty lucid and said, I understand what you're saying. I know what I have. I still want physical therapy. I don't know that we get to dictate how the end of life is for someone. I think they earned it. As a family, what are you worried about and what is your next question? So this is your note every day. And as a medical team, we always want to have what is today's headline? What's our treatment goal? What is the decision ahead? And when is the next update time? And that gives us one page that shares the and reduces the number of stories competing in the room. So what to say and what not to say? Some of the things that I teach my colleagues and my residents and medical students is say this, don't say that. Don't say everything will be okay. But do say, I'm here to support you throughout the process. You'll be surprised how it lands. These feel, when you are hearing them, when nothing is happening for you, as like, oh please, you roll your eyes. I cannot tell you how it landed for me. And I'm the doctor, and I'm the one who does these lectures. And as a family member, it landed for me in such a way that it felt that I wasn't alone. She has a poor prognosis. Don't say that, but you can say, I'm concerned that she probably may not make it home or she won't get better. Don't say the words withdrawing care. We never withdraw care. We always care, but we can shift our focus from saving her at any cost, including her suffering, to making her comfortable. The shift in the focus means that you don't stop caring. You just change the way it's delivered. And then the last one is, do you want us to do everything? My God, this is such an awful sentence. The sentence I wanted to hear is, make me feel empowered. Let's discuss the options if the situation gets worse. We will never stop fighting for you, but we want to know if your body gives up. What do you want us to do at that time? Here are your options. That makes so much more sense. My father, before the illness, was larger than life. He had impacted so many people, including the people in the hospital. Inside the illness, he remained anchored, but he was so vulnerable and so afraid. He needed to feel like he was being advocated for. So if he was asleep or he was delirious, that still his values were being upheld. And after the illness, he wanted to know how much of him was still there, that not everything was done, that if he was going to be bedridden, he would be accepting it. But tell me the truth. The work is to keep seeing them through the illness. So keep some of these resources that I put in here, and I'll Add the slide deck in the comments section after the YouTube video. The Society of Critical Care Medicine, I'm highly active in it, and the patient voice and the patient and family resources is rich there. ICU STEPPS, that's a guide to intensive care and recovery. Cleveland Clinic also has a large repository of resources about the PICU or the post-intensive care syndrome. And with that, I want to thank you for being here through this process of being in the ICU, either as a physician, as a patient, or as a family. So one question that you need to carry with you, if you could not speak, What would you want us to know? Speak it. Don't worry about putting it in a piece of paper or through a lawyer. Just speak it to people around you and speak it often enough that no one can hijack it and put their own values on it. So in the end, while 3 doors open to this, it's only one room. The patient needs orientation. The family needs partnership, and the clinician needs humanity. Today is a good day. Tomorrow we'll see, but today is a good day. Thank you. Thank you. I appreciate you. If you want, you can go to the YouTube video, leave me comments there, leave me ask questions or reactions, and find me on social media. I am a critical care physician. I also work in the clinical research and drug development field to try to bring new hopes for patients, and I'm also educating about the advent of AI in our days. There is a podcast if you want to watch it, the AI Ready Doctor.