Annals Graphic Medicine - Caring for Dying Patients: Visual Narratives From the Intensive Care Unit
Authors: Ginny Bao
Journal: Annals of Internal Medicine (2018)

Web Exclusives1 January 2019Annals Graphic Medicine - Caring for Dying Patients: Visual Narratives From the Intensive Care UnitFREEGinny Bao, MDGinny Bao, MDCalifornia Pacific Medical Center, Internal Medicine Residency, San Francisco, California (G.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G18-0016 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I started this series of drawings from my desire to illustrate my experiences as a medical student in treating intensive care patients through art. Although I felt comfortable discussing all aspects of my patients' clinical care, I struggled to verbalize the unspoken ethical dilemmas permeating through every patient interaction. These thoughts lingered in my head for months until I decided to express them through color, line, and form. Creating these visual images helped me to reflect and better understand how our daily medical interventions truly impact patient care. For viewers, I hope these images facilitate more mindful ways to care for patients and their families as they face illness and death. Each drawing represents a composite of patients I have encountered, and I used donated cadavers from the New York University Anatomy Lab to help accurately depict the anatomy in my illustrations.Numbers Download figure Download PowerPoint Hunger Download figure Download PowerPoint Code Blue Download figure Download PowerPoint Suffocation Download figure Download PowerPoint Decomposition Download figure Download PowerPoint Waiting Download figure Download PowerPoint References1. Blum FE, Lund ET, Hall HA, Tachauer AD, Chedrawy EG, Zilberstein J. Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: effects on patient safety and patient outcome. J Crit Care. 2015;30:438. [PMID: 25475075] doi:10.1016/j.jcrc.2014.10.025 CrossrefMedlineGoogle Scholar2. Martínez-Balzano CD, Oliveira P, O'Rourke M, Hills L, Sosa AF; Critical Care Operations Committee of the UMass Memorial Healthcare Center. An educational intervention optimizes the use of arterial blood gas determinations across ICUs from different specialties: A quality-improvement study. Chest. 2017;151:579-585. [PMID: 27818327] doi:10.1016/j.chest.2016.10.035 CrossrefMedlineGoogle Scholar3. Merkeley HL, Hemmett J, Cessford TA, Amiri N, Geller GS, Baradaran N, et al. Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients. J Crit Care. 2016;31:212-6. [PMID: 26476580] doi:10.1016/j.jcrc.2015.09.013 CrossrefMedlineGoogle Scholar4. Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med. 1997;157:327-32. [PMID: 9040301] CrossrefMedlineGoogle Scholar5. Mitchell SL, Kiely DK, Lipsitz LA. Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems? J Gerontol A Biol Sci Med Sci. 1998;53:M207-13. [PMID: 9597053] CrossrefMedlineGoogle Scholar6. Murphy DJ, Burrows D, Santilli S, Kemp AW, Tenner S, Kreling B, et al. The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330:545-9. [PMID: 8302322] CrossrefMedlineGoogle Scholar7. Gerstel E, Engelberg RA, Koepsell T, Curtis JR. Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. Am J Respir Crit Care Med. 2008;178:798-804. [PMID: 18703787] doi:10.1164/rccm.200711-1617OC CrossrefMedlineGoogle Scholar8. Gries CJ, Curtis JR, Wall RJ, Engelberg RA. Family member satisfaction with end-of-life decision making in the ICU. Chest. 2008;133:704-12. [PMID: 18198256] doi:10.1378/chest.07-1773 CrossrefMedlineGoogle Scholar9. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: a report on the medical, legal and ethical issues in the determination of death. Washington, DC: 1981. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: California Pacific Medical Center, Internal Medicine Residency, San Francisco, California (G.B.)Acknowledgment: The author thanks Dr. Barron Lerner for his guidance and editing, Laura Ferguson for her artistic input and guidance in the Anatomy Lab. and the people who donated their bodies to the NYU School of Medicine Anatomy Lab.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G18-0016.Author/Illustrator Information: Ginny Bao, MD, is an Internal Medicine Resident at California Pacific Medical Center. She recently completed her medical training at New York University School of Medicine, where she became interested in using visual art to capture alternative perspectives on the practice of medicine. You can view her other works at www.instagram.com/imaging.by.bao/ and contact her at ginny.[email protected]com.Author Contributions: Conception and design: G.W. Bao.Drafting of the article: G.W. Bao.Critical revision for important intellectual content: G.W. Bao.Final approval of the article: G.W. Bao.Provision of study materials or patients: G.W. Bao.Administrative, technical, or logistic support: G.W. Bao. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 2019Volume 170, Issue 1Page: W34-W40KeywordsAnxietyAsphyxiaConflicts of interestDisclosureEmotionsIntensive care unitsLungsPatientsResuscitation ePublished: 1 January 2019 Issue Published: 1 January 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...