I first saw them lying on the floor of the ambulance, having fallen due to the weight. The people who had come with them tried to lift them back into the seat but could not manage to do so. The entire staff on duty in the emergency department worked together to bring them from the ambulance to the emergency room.
Upon examination, there was no heartbeat or breathing. It could be said they were dead. If nothing was done in a few more moments, death would be certain. Although there was no hope, with the intense efforts of the junior doctors on duty in the emergency department, the heartbeat was restored. A tube was also inserted into the lungs to assist with breathing. After a few more minutes, their condition improved slightly. They were immediately placed on a ventilator in the intensive care unit.
For the next ten days, a team of doctors, including myself, along with the ICU staff, worked tirelessly. Today, we were able to remove them from the ventilator. During this time, I had to face many questions and concerns from the patient's relatives. When I told them that the situation was serious, the usual question was whether they should transfer to another hospital. I responded that all necessary treatment facilities were available here, and transferring them in this condition would be risky. However, the final decision about transfer was up to the relatives. If they decided to transfer, I assured them that we would arrange an ambulance with a ventilator.
Eventually, after talking to everyone and consulting repeatedly, they decided to continue treatment here. One thing I must especially mention: after deciding to continue treatment here, the relatives showed extraordinary patience. There were no unnecessary questions. When I said the condition was serious, they silently listened with a calm face. When I said there was improvement, they looked at me with shining eyes. Such support from the patient's family is the luck of any doctor.
During this time, I reminded them that if the situation worsened, they might need ventilator support for a longer time, and there might be a huge bill. If they were facing financial difficulties, I suggested considering transferring the patient to a medical college hospital. Their response was, "Money is not a problem; we only need treatment here."
Today, they are speaking to us with their hands, talking to their daughter and husband. She is a dance teacher and is even teaching the ICU staff some steps!
If we had written them off as dead and left them without any intervention, it would have been a normal occurrence for the hospital. But for the family, it would have been an irreparable loss. Would we have backed off fearing the shameful accusation that doctors "keep the dead on the ventilator for money"?
That’s not how we were taught as doctors. We can’t let the reputation of this noble profession be destroyed by those spreading false rumors due to established interests. Among a hundred patients placed on a ventilator, even if 99 die, one may survive. The memory of that one person is enough to keep us going.
We didn’t come into this world through our own abilities; I believe there is a God who controls it. Those without faith may call it the will of nature, but death is not something we can decide. Doctors are those who learn through experience that we must never write anyone off. We have seen patients who were certain to die make miraculous recoveries, and we have also seen others, who were certain to recover, succumb to death. It’s this uncertainty we experience through our own encounters that compels doctors to fight till the very last moment to save a life. You may try to depict it as a desperate money-driven act, but that won’t break our spirit. Even with broken hearts, we will continue doing this again and again because we don’t remember the faces of the patients who die, but the smiles and joy of those who survive, and the happiness of their families is our strength.
Why are there so many false campaigns about ventilator treatment? Why are there so many misconceptions?
It is the critically ill patients who cannot maintain their own breath who are admitted to the ventilator. Naturally, the mortality rate of such patients will be higher. The success of ventilator treatment largely depends on the cause of the patient’s condition that led to their need for the ventilator. For example, a person bitten by a cobra, who is unable to breathe and is turning blue, has a very high chance of survival if placed on a ventilator. Once the venom is neutralized, natural breathing can resume, and the patient can be removed from the ventilator immediately. However, if the ventilator is needed due to a severe illness affecting the brain or other vital organs, the chances of survival become lower. Similarly, in conditions like pneumonia, heart disease, certain poisoning cases, fluid buildup in the lungs, muscle weakness affecting breathing, and Myasthenia crises, patients who require ventilator support often recover with the help of this treatment, saving a precious life.
Brain death and the ventilator are the main factors causing misconceptions among the public. While brain death is not difficult to understand, legally confirming it requires certain formalities. A group of doctors, including a neurologist, must decide on the matter. Some tests must be conducted to confirm death. However, since the patient is likely to die completely within a few hours or, in rare cases, a few days, doctors often do not proceed with these formalities. Even if brain death occurs, other organs, including the heart, may continue functioning for some time. If a person’s heart is still beating, even if there is no hope of survival, it is not easy for anyone to simply disconnect the ventilator and allow the patient to die immediately. In such situations, I have often spoken with the patient’s relatives. When I tell them there is no hope, but the heart is still beating, I ask if we should turn off the ventilator and hasten death, or wait for a few hours or days and let natural death take its course. Every time, the answer I get is: "We will wait for natural death."
This was written two years ago. Some recent events have caused this to come up again. The patient I mentioned earlier, I have seen several times since. She speaks to me gently in familiar tones, and the love and respect she shows me is unmatched. Even a week after she left the hospital, I saw her.
Ventilator deaths and survivals are not new to doctors. That is why many of them eventually forget these events. But some people remain unforgettable. Let me tell you about two such people.
One of them is a neighbor of mine and my hospital. I had a close personal relationship with them. She was admitted with pneumonia. After completing rounds at night, I found her in a stable condition. I told her husband that she would likely be out of the ICU in a day or two. However, the next morning, when I went to see another patient in the ICU, I noticed something unusual in this patient. Her breathing had become labored. Warning signals were coming from the equipment attached to her body, and I saw some red lights blinking. Her blood oxygen level was dropping. Without a ventilator, her life would be at risk. I immediately woke up her husband and informed him. He was initially confused, as I had assured him the previous night that she was fine. Since the patient’s son and daughter-in-law were doctors, things were easier for me. I spoke to her son on the phone, who assured me that they would provide full support for any treatment. The patient was immediately moved to the ventilator. Within a few days, her condition improved, and she was able to go home. The day after her discharge, she came back to see me with a cake, and inside it, she wrote: "Thank you, Dr. Jamal. Thanks for everything." The cake I ate wasn't the most luxurious, but it was the most delicious. A doctor cannot put a price on the joy of receiving such a gesture.
A few weeks before leaving the village, I saw an elderly man who had ingested poison and was in a critical condition. By the time I rushed to the ICU from the OP, he was gasping for his last breath. He had ingested pesticide. He was a habitual alcoholic, completely enslaved by alcohol. This is a common problem among alcoholics. Sometimes, they get the thought of suicide for no particular reason. He had waited for a time when there was no one at home and consumed the poison.
There was no chance of survival without a ventilator. When I entered the ICU, I saw his son and other relatives standing outside, their faces showing signs of poverty. It was almost certain that they wouldn't be able to afford the treatment. But I knew if I waited and didn’t act, the patient would die. Usually, before using the ventilator, I talk in detail with the relatives and have them sign a consent form. But there was no time for that now. I quickly inserted a tube into the patient's lungs and connected him to the ventilator. Afterward, I spoke with his son.
There was no chance of survival without the ventilator. It would be expensive. If it’s okay, we can consider the medical college option, I told him. His response was heartbreaking: “Sir, I’ve spent half of the money I earned on alcohol. My father has never given me peace in life. He is my own father; I can’t let him die like this." He looked at me with despair.
Some people live lives that are of no use to their families. Not only are they of no use, but they also create trouble for others. The conditions in the homes of most alcoholics are similar.
“How many days will he need the ventilator, Sir?” his son asked with exhaustion in his voice.
I couldn’t give an exact answer. Sometimes, it could be one or two days; other times, longer.
Anyway, for now, I had borrowed some money and arranged for the treatment. It would be enough to treat him here.
Two days later, there was significant improvement in the patient’s condition. However, when we started thinking of removing the ventilator, a new problem arose. A rare condition known as "Intermediate Syndrome" can occur when someone ingests pesticide. The condition causes muscle weakness from the neck down to the feet, making it impossible for the patient to move. This condition can last for weeks. Since the muscles needed for breathing are weakened, the patient cannot breathe. If the ventilator is removed, the patient will suffocate and die in moments. This is what made me anxious. I recalled a similar case at Kozhikode
Medical College where a patient had spent a month on a ventilator. He was discharged on the thirtieth day without anyone informing the family, as it was government treatment.
When I spoke about this to the son, he collapsed in despair, sitting on the floor. How do I console him? It’s all about money.
I told him, “Go and check at the medical college. If the ventilator is free, I can arrange for the transfer immediately.” As per my suggestion, the relatives went to Thrissur Medical College to inquire. But there was no luck. All the ventilators were occupied with other patients.
What a tragic situation it is... Without a ventilator, it is impossible to save a life, but the family cannot afford the cost. The man, who had destroyed all of his son's earnings through alcoholism, now had to be treated again. It is indeed heartbreaking.
Apart from the difficulty in breathing, the patient seemed quite normal—he was conscious, opening his eyes, aware of what was happening around him, and listening to everything. A person in such a state cannot simply be taken off the ventilator. The thought of keeping him on the ventilator for weeks started giving me a lot of stress.
However, by some stroke of luck, after a week, the patient's muscle strength gradually started improving. After about 10 days, he started breathing on his own without the ventilator. That moment was one of the few instances of relief I had recently. Although the financial burden of the large debt still weighed on the patient's son, there was a smile on his face, which brought me great joy.
On the day of discharge, I called the patient alone and had a conversation with him. I reminded him of his responsibilities to himself and society. He lowered his head in guilt and promised not to drink anymore. Sometimes such promises last, but often they are nothing more than empty words, just like many other alcoholics' vows. After that, I never saw him again.
The point I am making is this: the stories that people hear about ventilators are mostly filled with despair and financial loss, focusing on those who died while on ventilators. However, those who survive due to ventilator support rarely share their stories on social media. As a result, the true stories remain unknown, and only those with negative experiences are widely shared, often sensationalized.
The ventilator, however, is undoubtedly one of the best life-saving tools for patients who cannot breathe on their own. It is a device that gives breath to someone who is unable to breathe, without any miraculous powers. After death, placing a patient on a ventilator will only result in air entering the lungs unnecessarily, and the body will still undergo the natural process of decay. It’s common sense to understand that no matter how long a patient has been on a ventilator after death, it doesn't change the inevitable outcome.
Unnecessary misconceptions can prevent patients from receiving proper treatment. The bridge between the medical professionals and the patient's family is crucial in saving a life in critical condition. If there is a breakdown in that relationship, it may be necessary to transfer the patient to a different hospital. However, it is essential that the support from the doctor and the hospital is strong, as this will greatly boost the confidence and sincerity of the medical team. Otherwise, the focus of the doctor’s attention may shift from the patient’s care to dealing with post-death complications. This can result in unnecessary consent forms being signed, and sometimes, unnecessary tests being carried out to cover the doctor’s tracks. Ultimately, it is the patient who suffers.
One thing must be emphasized: stories of patients who recover after being on a ventilator for long periods are often mere fantasies. For a doctor, having a patient on a ventilator is far from a comfortable situation. Ventilator treatment is not as simple as it seems. Once the patient is attached to the machine, it is not just a matter of leaving them there. The ventilator settings must be monitored constantly. One must assess how the patient is responding and adjust the settings accordingly. It's a challenging task that requires constant vigilance.
Every doctor strives to wean a patient off the ventilator as soon as possible. The situation I described earlier—where a patient is left on a ventilator after death—is something that should be avoided.
So, let’s try to understand the facts. Let’s discard the misconceptions, take a step back, and return to the times when doctors and patients shared mutual understanding, respect, and care for one another... the way it was in the past.