I think it's hard for people to understand that, generally speaking, we do try to treat every patient like they are our family member w the treatments they get. We don't hold back the "best" medications or therapies. We rarely ration like that in the ICU... 1/

Instead, we are constantly deliberating about whether something will do more harm than good because when you're that sick the slightest bit of extra stress - even the extra fluids from medications - can add up and just make things worse...

Families always ask if we have stronger antibiotics or whatever. We don't. We could give you antibiotics that cover more bacteria at the risk of more side effects like intractable c diff diarrhea that could frankly be the last straw. Side effects can kill you.

If we have better, we give it. If there isn't access to something because it is experimental, I usually wouldn't want to give it to my loved ones. It is just too easy to hurt people trying to do more, do it faster, do it stronger.

The patient's voice is critical, but it isn't absolute. We work together. I'm not going to let you or your family pick your ventilator settings... but I will let you decide if being on life support is within your goals or not. You're the boss, but you can't micromanage.