Does the wife have the right to go to intensive care? Why aren’t even close relatives allowed into the intensive care unit? About sending a letter “On the rules for visiting relatives of patients in intensive care units (ICU)” and the form of a memo for visitors.

The intensive care unit is one of the most mysterious departments in the hospital. You can drive across the whole city and end up in front of a closed door, and even if you insist, they won’t let you into the department. “The condition is stable. You can't go inside. We provide all the care ourselves. Goodbye". All. What's going on behind that door? Why might they not let you into the department, although they are obliged to? Here are some reasons (and life situations).

The patient has just arrived

The patient was admitted by ambulance, surrounded by two doctors, three nurses, and a nurse. You need to transfer him from the gurney to the bed, connect pulse, pressure, and saturation sensors. Arrange venous access, collect blood and urine for analysis. Someone collects IVs and prepares drugs for administration. Someone assists the doctor - tracheal intubation is performed because the patient cannot breathe on his own.

At this time the doorbell rings. The intensive care workers have the keys, which means this is a relative. It’s impossible to let him in now, the doctor can’t talk to him, because helping the patient is more important. But relatives may insist on a visit, besides, they immediately want to know the diagnosis, receive information about the condition and “how long he will lie here,” although the person, let me remind you, has just been delivered and nothing is really known yet.

New patients arrived

This is the most common reason. The fact is that intensive care is not just a department. There is no strict visiting schedule. Or rather, he is. But if in the interval, say, from twelve to one, when it is allowed to visit patients, a seriously ill patient is admitted, no one, alas, will allow you to enter the ward. During patient admission, manipulations, etc., outsiders are prohibited from being present in the room.

Other patients in the ward

Yes, you need to remember that besides yours loved one There may be other patients in the ward. Lie down as you should in intensive care, without clothes. And not everyone will be pleased if people walk past them strangers. In the USA - this country is often cited as an example when talking about organizing visits to intensive care units - there are separate rooms for patients, and there are even sleeping places for relatives. This is not the case in Russia - several people are in one room.

A patient is recovering from a planned operation

Moreover, some patients, being in an unpresentable state, do not even want to see their relatives. For example, after elective surgery The patient spends the first day in intensive care. Lying naked. His throat is sore after the tube artificial ventilation. I have a stomachache. The bed is stained with blood because the bandage is leaking a little. He is in pain, but now they have given him an injection and he is falling asleep. In two days he will be transferred to general department, soon he will cheerfully run along the corridor and discuss his health with his family, but now he only wants to sleep. And he doesn’t need any visits.

The patient’s relative is not ready to visit

Another situation. The man lies for a long time. The diagnosis is serious. A relative arrives and really wants to see you. They let him through. After talking, the relative leaves the room into the corridor, goes to the door, but before reaching it, he faints right into the arms of the nurse on duty. It’s good if he is not very tall and large, and there is a trestle bed nearby on which they can lay him down...

Unusual people are scared foreign objects sticking out of the patient: catheters, probes, drainages. The departments often smell bad and can make any visitor feel sick. Moreover, if doctors see a relative in a clearly unbalanced state, they are likely to be denied a visit.

If there are no objective reasons preventing the visit, the relative will be allowed into the ward. Sometimes relatives help a lot - wash, treat, rearrange. This is real and necessary help, because there is always not enough staff. They are always allowed to see patients. And such people always wait patiently outside the door if manipulation is being carried out in the hall and outsiders are not allowed to enter.

You need to be prepared to visit the intensive care unit. Do not be frightened by the sight of your relative or his roommates. Don't wrinkle your nose at unpleasant odor. Do not cry with pity - this can be done behind the door, but here, next to the patient, you should support him, not he you. Do not disturb the staff and leave the room upon request. If you are not allowed in, it is best to wait quietly outside the door until the doctor is free and you can ask him all the questions that interest you. Reanimation is a department emergency assistance, and in emergency situations there is not always time to talk.

Anastasia Larina

Photo istockphoto.com

On the website of the Ministry of Health of the Nizhny Novgorod Region.

From July 1, access to branches intensive care should be opened in all hospitals in the country. The circular sent to the regions also contains the recommended form of a memo for visitors, which they should read and sign before visiting their relative in the intensive care unit. Pravmir publishes the document in full.

On the rules for visiting relatives of patients in intensive care units and intensive care units

Visits by relatives of patients in intensive care units are permitted if the following conditions are met:

1. Relatives should not have signs of acute infectious diseases ( elevated temperature, manifestations respiratory infection, diarrhea). Medical certificates absence of diseases is not required.

2. Before visiting, medical personnel need to have a brief conversation with relatives to explain the need to inform the doctor about the presence of any infectious diseases, and to psychologically prepare for what the visitor will see in the department.

3. Before visiting the department, the visitor must take off his outer clothing, put on shoe covers, a robe, a mask, a cap, and wash his hands thoroughly. Mobile phones and other electronic devices must be turned off.

4. Visitors under the influence of alcohol (drugs) are not allowed into the department.

5. The visitor undertakes to maintain silence, not to interfere with the provision of medical care to other patients, and to follow instructions medical personnel, do not touch medical devices.

6. Children under the age of 14 are not allowed to visit patients.

7. No more than two visitors are allowed to be in the room at the same time.

8. Visits from relatives are not permitted during invasive procedures in the ward (tracheal intubation, vascular catheterization, dressings, etc.), cardiopulmonary resuscitation.

9. Relatives can assist medical staff in caring for the patient and maintaining cleanliness in the ward only at their own request and after detailed instructions.

10. In accordance with Federal Law No. 323 FZ, medical personnel should ensure the protection of the rights of all patients in the intensive care unit (protection of personal information, compliance with the protective regime, provision of timely assistance).

Dear visitor!

Your relative is in our department in in serious condition, we give him everything necessary help. Before visiting a relative, we ask you to carefully read this leaflet. All the requirements that we place on visitors to our department are dictated solely by concern for the safety and comfort of the patients in the department.

1. Your relative is sick, his body is now especially susceptible to infection. Therefore, if you have any signs of contagious diseases (runny nose, cough, sore throat, malaise, fever, rash, intestinal disorders) do not enter the department - this is extremely dangerous for your relative and other patients in the department. Tell the medical staff if you have any medical conditions so they can decide whether they pose a threat to your relative.

2. Before visiting the ICU, you must take off your outer clothing, put on shoe covers, a gown, a mask, a cap, and wash your hands thoroughly.

3. Visitors under the influence of alcohol (drugs) are not allowed into the ICU.

4. No more than 2 relatives can be in the ICU ward at the same time; children under 14 years old are not allowed to visit the ICU.

5. You should maintain silence in the department, do not take mobile and electronic devices with you (or turn them off), do not touch devices and medical equipment, communicate with your relative quietly, do not disturb protective regime department, do not approach or talk to other ICU patients, strictly follow the instructions of medical personnel, and do not impede the provision of medical care to other patients.

6. You should leave the ICU if invasive procedures need to be performed in the ward. Medical professionals will ask you about this.

7. Visitors who are not direct relatives of the patient are allowed into the ICU only if accompanied close relative(father, mother, wife, husband, adult children).

I have read the memo. I undertake to fulfill the requirements specified in it (surname, signature, date, degree of relationship with the patient, underline).

What happens to a person in the intensive care unit?

A person who is in intensive care may be conscious, or may be in a coma, including a medical one. For severe traumatic brain injuries and increased intracranial pressure the patient is usually given barbiturates (that is, put into a state of barbituric coma) so that the brain finds resources for recovery - it takes too much energy to remain conscious.

Typically, in the intensive care unit, patients lie naked. If a person is able to stand up, they may give him a shirt. “In the intensive care unit, life support systems and monitoring equipment (various monitors) are connected to patients,” explains Elena Aleshchenko, head of the intensive care unit at the European Medical Center. - For medications in one of the central blood vessels a catheter is installed. If the patient is not very severe, then the catheter is installed in a peripheral vein (for example, in a vein in the arm. - Note ed.). If artificial ventilation of the lungs is required, a tube is installed in the trachea, which is connected through a hose system to the device. For feeding, a thin tube - a probe - is inserted into the stomach. IN bladder a catheter is inserted to collect urine and record its quantity. The patient can be tied to the bed with special soft ties so that he does not remove catheters and sensors during agitation.

The body is treated with a liquid to prevent bedsores daily. They treat their ears, wash their hair, cut their nails - everything is as in normal life, except that hygiene procedures does medical worker" But if the patient is conscious, he may be allowed to do it on his own.

To prevent bedsores, patients are regularly turned in bed. This is done once every two hours. According to the Ministry of Health, in public hospitals there should be two patients per nurse. However, this almost never happens: usually there are more patients and fewer nurses. “Most often nurses are overloaded,” says Olga Germanenko, director charitable foundation"SMA families" (spinal muscle atrophy), Alina's mother, who was diagnosed with this disease. - But even if they are not overloaded, there are still always not enough nursing hands. And if one of the patients becomes destabilized, he will receive more attention at the expense of another patient. This means that the other one will be turned later, fed later, etc.”

Why are relatives not allowed into intensive care?

According to the law, parents must also be allowed to visit their children (here it is generally allowed living together), and close to adults (Article 6 323-FZ). This possibility in pediatric ICUs (resuscitation and intensive care unit) is also mentioned in two letters from the Ministry of Health (dated 07/09/2014 and 06/21/2013), for some reason duplicating what is approved in federal law. But nevertheless there is classic set reasons why relatives are refused to be allowed into the intensive care unit: special sanitary conditions, lack of space, too much workload on the staff, fear that the relative will do harm, start “pulling out the tubes”, “the patient is unconscious - what will you do there?”, “ internal rules hospitals are prohibited.” It has long been clear that if the leadership wishes, none of these circumstances becomes an obstacle to the admission of relatives. All arguments and counterarguments were analyzed in detail in a study conducted by the Children's Palliative Foundation. For example, the story that you can bring terrible bacteria into the department does not look convincing, because the hospital flora has seen a lot of antibiotics, acquired resistance to them and has become much more more dangerous than that, what you can bring from the street. Can a doctor be fired for violating hospital rules? "No. Exists Labor Code. It is he, and not local hospital orders, that regulates the procedure for interaction between employer and employee,” explains Denis Protsenko, chief specialist in anesthesiology and resuscitation of the Moscow Department of Health.

“Doctors often say: you create for us normal conditions, build spacious premises, then we’ll let them in,” says Karina Vartanova, director of the Children’s Palliative Foundation. - But if you look at the departments where there is access, it turns out that this is not such a fundamental reason. If there is a management decision, then the conditions do not matter. The most important and difficult reason is mental attitudes, stereotypes, traditions. Neither doctors nor patients understand that the main people in the hospital are the patient and his environment, so everything should be built around them.”

All inconvenient moments that may actually interfere are removed by a clear formulation of the rules. “If we let everyone in at once, of course, it will be chaos,” says Denis Protsenko. - Therefore, in any case, it is necessary to regulate. At First Gradskaya we start things up one by one, introduce them and tell stories at the same time. If the relative is adequate, we leave him under the control of nursing staff and go for the next one. On the third or fourth day, you understand perfectly well what kind of person this is, and contact is established with him. Even then you can leave them with the patient, because you have already explained to them everything about the tubes and devices for connecting the life support system.”

“Abroad, conversations about admission to intensive care began about 60 years ago,” says Karina Vartanova. “So you shouldn’t count on the fact that our health care will be inspired and do everything tomorrow. A forceful decision or order can ruin a lot. The decisions that are made in each hospital about whether to admit or not to admit, as a rule, are a reflection of the attitudes of management. There is a law. But the fact that it is not carried out en masse is an indicator that both individual doctors and the system as a whole are not yet ready.”

Why is the presence of relatives 24 hours a day impossible even in the most democratic intensive care units? In the morning, various manipulations and hygiene procedures are actively carried out in the department. At this time, the presence of a stranger is extremely undesirable. Relatives should also not be present during rounds and when handing over shifts: this will at least violate medical confidentiality. During resuscitation efforts, relatives are asked to leave in any country in the world.

A resuscitator at one of the US university clinics, who did not want to give his name, says that their patient is left without visitors only in rare cases: “In exceptional cases anyone's access to the patient is limited - for example, if there is a danger to the patient's life from visitors (usually these are situations of a criminal nature), if the patient is a prisoner, and the state prohibits visitation (for seriously ill patients, an exception is often made at the request of a doctor or nurse), if the patient has a suspected/confirmed diagnosis of a particularly dangerous infectious disease(Ebola virus, for example) and, of course, if the patient himself asks, no one is allowed to see him.”

They try not to allow children into adult intensive care units either here or abroad.

What to do to be admitted to intensive care

“The very first step is to ask if you can go to the intensive care unit,” says Olga Germanenko. - Many people simply don’t really ask. Most likely, it’s in their head that they can’t go to intensive care.” If you asked, and the doctor says that it’s impossible, that the department is closed, then it’s definitely not worth making a fuss. “Conflict is always useless,” explains Karina Vartanova. “If I immediately start stomping my feet and shouting that I will rot you all here, I will complain, there will be no result.” And money doesn't solve the problem. “No matter how much we interview relatives, money does not change the situation at all,” says Karina Vartanova.

“There is no point in talking to nurses or the doctor on duty about admission. If the attending physician takes the “not allowed” position, you need to behave calmly and confidently, try to come to an agreement, says Olga Germanenko. - There is no need to threaten to appeal to the Ministry of Health. You calmly explain your position: “It will be easier for the child if I am nearby.” I will help. Tubes don't scare me. You said what happened to the child - I can roughly imagine what I will see. I know the situation is difficult.' The doctor will not think that this is a mad mother in hysterics who can pull out tubes and yell at the nurses.”

If you are rejected at this level, where to go next? “If the department is closed to relatives, communication with the head will not yield anything,” says Denis Protsenko. - Therefore, you need to go to the deputy chief physician for medical work. If he does not give you the opportunity to visit, then go to the main doctor. Essentially, that’s where it all ends.” Olga Germanenko adds: “You need to ask the head physician for a written explanation of the reasons why they are not allowed in, and with this explanation go to the local health authorities, insurance companies, the prosecutor's office, supervisory authorities - anywhere. But just imagine how long it will take. This is bureaucracy."

However, Lida Moniava, so to speak, is encouraging: “When the child lies for a long time, the mother is already allowed in. Almost all intensive care units begin to admit them a couple of weeks after hospitalization, gradually increasing the duration of visits.”

Director of the Department of Public Health and Communications of the Ministry of Health Oleg Salagay contact your insurance company, which, in theory, is responsible for the quality of medical care and respect for patient rights. However, as it turned out, companies have no experience in dealing with such situations. Moreover, not everyone is ready to support their relatives (“Resuscitation is not created for dating, they are fighting for human life as long as there is at least some hope left. And no one should distract from this fight either doctors or patients who need to mobilize all their strength in order to survive,” one of the insurance companies told the Afisha Daily correspondent). The responses from some companies are full of confusion due to supposedly contradictory legislation, but nevertheless, someone is ready to “react quickly.”

When there is objective reasons not to let a relative into the ICU? If you are openly sick and can infect others, if you are under the influence of alcohol or drug intoxication- in these cases, you will rightly not be allowed into the department, no matter how hard you try.

“If there is a quarantine in the hospital, then no certificate will help you get into the department,” explains Denis Protsenko.

How to understand that everything is ok

“If you are not allowed into intensive care, you will never know whether everything is being done for your relative,” says Olga Germanenko. - The doctor may simply give little information, but in fact do everything that is needed. And someone, on the contrary, will describe the smallest details of your relative’s treatment - what they did, what they are going to do, but in fact the patient will receive less treatment. You can probably ask for a discharge summary. But they won’t just give it to you - you need to say that you want to show it to a specific doctor.”

It is generally accepted that allowing relatives into the intensive care unit will complicate the life of the staff. However, in reality, this reduces the number of conflicts precisely because of the quality of medical care. “Of course, parental presence is additional quality control,” says Karina Vartanova. - If we take a situation where a child had no chance to survive (for example, he fell from the 12th floor), the parents were not allowed in, and he died, then, of course, they will think that the doctors did not do something, overlooked something. If they had been allowed in, such thoughts would not have occurred; they would still have thanked the doctors for fighting to the end.”

“If you suspect that your relative is being treated poorly, invite a consultant,” suggests Denis Protsenko. “For a self-respecting, confident doctor, a second opinion is absolutely normal.”

"At rare diseases only narrow specialists know that some drugs cannot be prescribed, some can be prescribed, but certain indicators need to be monitored, so sometimes resuscitators themselves actually need consultants,” explains Olga Germanenko. - True, you need to approach the choice of a specialist carefully so that he does not talk down to local doctors and does not intimidate you: “You will be killed here.” There are such incompetents here.

“When you tell your doctor that you want a second opinion, it often sounds something like this: you are treating incorrectly, we see that the condition is getting worse, so we want to bring a consultant who will teach you how to treat you correctly,” says the psychiatrist, head of the Clinic of Psychiatry and psychotherapy of the European Medical Center Natalya Rivkina. - It’s better to convey this idea: it is very important for us to understand all the possibilities that exist. We are ready to use all our resources to help. We would like to ask you to get a second opinion. We know that you are our primary doctor, we have no plan to go elsewhere. But it is important for us to understand that we are doing everything that is necessary. We have an idea who we would like to contact. Maybe you have other suggestions. This kind of conversation may be more comfortable for the doctor. You just need to rehearse and write down the wording. There is no need to go in fear that you are breaking some rules. Getting a second opinion is your right’.

How to help

“Doctors are prohibited from saying that they don’t have some medications or consumables,” explains Lida Moniava, deputy director of the House with a Lighthouse children’s hospice. - And out of fear, they can convince you that they have everything, although in reality this will not be the case. If a doctor voices needs, thank him very much. Relatives are not required to bring everything, but thanks to those doctors who are not afraid to speak.” The problem is that it is believed that if the hospital does not have something, then the management does not know how to allocate resources. And relatives do not always understand the doctor’s situation, so they can complain to the Department of Health or the Ministry of Health: “Our medicine is free, but they force me to buy medicine, return the money, here are the receipts.” Fearing such consequences, ICU staff may even use their own money to buy good drugs and consumables. Therefore, try to convince the doctor that you are ready to purchase everything you need, and you have no complaints about this.

Spinal surgeon Alexey Kashcheev also find out from your attending physician whether it will be useful for current state the patient to hire an individual nurse.

How to behave in intensive care

If you are admitted to intensive care, it is important to remember that there are rules (in in writing or spoken by a physician) and are designed to enable physicians to do their jobs.

Even in those intensive care units where you can come at least in outerwear, there is a rule: treat your hands with an antiseptic before visiting the patient. In other hospitals (including in the West), you may be asked to wear shoe covers, a robe, not wear woolen clothes, and not walk around with your hair down. By the way, remember that by visiting the intensive care unit, you expose yourself to certain risks. First of all, there is a risk of infection by local bacteria that are resistant to many antibiotics.

You must imagine where you are going and what you will see.

If you become hysterical, faint, or start vomiting, you will attract the attention of the emergency room staff, which is potentially dangerous. There are other subtle points that Denis Protsenko talks about: “I know cases when a guy came to his girlfriend, saw her disfigured face and never returned. It also happened the other way around: the girls couldn’t cope with such a spectacle. In my experience, often relatives who volunteer to help quickly disappear. Just imagine: you turn your husband on his side, and he passes gas or has a bowel movement. Patients experience vomiting and involuntary urination - are you sure you will react normally to this?”

You can't cry in the ICU

“Usually the most difficult are the first visits to the department by relatives,” says Elena Aleshchenko. “It’s very difficult to prepare and not cry,” says Karina Vartanova. - For some it helps to breathe deeply, for others it’s better to cry on the sidelines, for others you need to talk, for others you shouldn’t even touch them. You can learn to be calm in the intensive care unit if you remember that the patient’s condition largely depends on your calmness.” Some hospitals have clinical psychologists who can help you cope with your emotions.

Ask how you can help, and don’t do it on your own.

“Mom can change the diaper, turn it over, wash it, give a massage - all this is especially necessary for heavy children,” says Olga Germanenko. “It is clear that nurses, given the current workload, cannot do all this to the extent that is needed.”

Staying in the intensive care unit around the clock is not only pointless, but also harmful

“You can visit us at any time, you can be with the patient for 24 hours straight,” says Elena Aleshchenko. Whether it is necessary is another matter. People then realize that this is of no use, that they are doing it more for themselves. When a person is in intensive care, he is sick, he also needs to rest.” Olga Germanenko confirms this idea: “There is no particular point in sleeping in the intensive care unit. In fact, no one will sit for more than four hours in a row (unless, of course, we are talking about a dying child). At the end of the day, everyone has their own thing to do.” A day in intensive care is hard not only physically, but also mentally: “What will happen to a relative after 24 hours in the intensive care unit? - says Denis Protsenko. - Corpses will be wheeled past him several times, he will witness cardiopulmonary resuscitation, and the sudden development of psychosis in another patient. I’m not sure that the relative will calmly survive this.”

Negotiate with other relatives

“In one of the intensive care units, where I ended up with my daughter, the children were lying in boxes for two,” says Olga Germanenko. - That is, if a nurse comes, and there are two more parents there, you won’t be able to turn around. And her presence may be needed at any moment. Therefore, we agreed to come to different time. And the children were always supervised.”

Respect the patient's wishes

“When a person regains consciousness, the first question we ask him is: do you want to see your relatives? There are situations when the answer is “no,” says Denis Protsenko. “In many clinics around the world there are such natural dying programs, when the patient and his family discuss how he will die,” says Natalya Rivkina. - This happens a month and a half before his death. The goal is for a person to die with dignity and in the way he would like. There are parents who do not want their children to see the process of dying. There are wives who do not want their husbands to see the dying process. They may not look nice. There are those who want to be with loved ones at the moment of dying. We must respect all of these decisions. If a person wants to make the transition himself, this does not mean that he does not want to see loved ones. This means he wants to protect you. You shouldn't force your choice on him."

Respect other patients

“Talk to your child as quietly as possible, do not turn on loud music, don't use mobile phone in the department. If your child is conscious, he can watch cartoons or listen to music using a tablet and headphones so as not to disturb others. Do not use strong-smelling perfume,” writes Nadezhda Pashchenko in “Together with Mom,” published by the Children’s Palliative Foundation.

Don't conflict with doctors and nurses

“The work of ICU staff is quite hard, very intensive, and energy-consuming,” Yulia Logunova writes in the same brochure. - This must be understood. And under no circumstances should you conflict with someone, even if you see a negative attitude, it is better to remain silent, it is better to take a break from communicating with this person. And if the conversation turns to a raised tone, the following phrase always works: I thought that you and I had the same goal - to save my child, to help him, so let's act together. I haven’t had a single case when it didn’t work and didn’t take the conversation to another plane.”

How to talk to a doctor

Firstly, it is advisable to talk with the attending physician, and not with the doctor on duty, who changes every day. He will definitely have more information. That is why in those intensive care units where the time for visiting and communicating with a doctor is limited, it occurs at inconvenient hours - from 14.00 to 16.00: the attending physician’s shift ends at 15.45, and until 14.00 he will most likely be busy with patients. There is no point in discussing treatment and prognosis with nurses. “Nurses carry out doctor’s orders,” writes Nadezhda Pashchenko in the brochure “Together with Mom.” “It’s pointless to ask them about what exactly your child is being given, since the nurse cannot say anything about the child’s condition and the essence of medical prescriptions without the doctor’s permission.”

Abroad and in paid medical centers You will be able to obtain information by phone: when completing the paperwork, you will approve a code word for this. In public hospitals, in rare cases, doctors can give out their mobile phone.

“In a situation where someone close to you is in intensive care, especially when it is associated with a sudden onset of illness, relatives may be in a state of acute stress reaction. In these states people
experience confusion, difficulty concentrating, forgetfulness - it is difficult for them to gather, ask relevant question, explains Natalya Rivkina. “But doctors may simply not physically have the time to build a dialogue with relatives who have such difficulties. I encourage family members to write down questions throughout the day to prepare for their appointment with the doctor.

If you ask “How is he/she?”, the doctor can give two answers: “Everything is good” or “Everything is bad.” It's not productive. Therefore, it is necessary to formulate more clear questions: what is the patient’s condition at this moment, what symptoms does he have, what are his plans for treatment. Unfortunately, in Russia there is still a paternalistic approach to communication with patients and relatives. It is believed that they do not need to have information about treatment. “You are not a doctor,” “You still won’t understand anything.” Relatives should always be aware that by law they must be informed about the treatment being carried out. They have the right to insist on this.

Doctors react very nervously when frightened relatives come and say: “What are you doing? We read on the Internet that this medicine kills.” It’s better to ask this question like this: “Please tell me what side effects from this medicine have you encountered?” If the doctor does not want to answer this question, ask: “What do you think about this side effect? This way you don't attack or criticize. Any criticism causes resistance in people.

A common question in intensive care, especially if we're talking about about cancer patients: “Is that all?” or “How long does he/she have to live?” This is a question that has no answer. A properly trained physician will answer it. A doctor who does not have time will say: “Only God knows.” Therefore, I always teach relatives to ask this question this way: “What is the worst and best prognosis?” or “What is the minimum and maximum life expectancy according to the statistics of such conditions?”

Sometimes I insist that people go away and rest. No matter how wild and cynical it may be. If it’s obvious that they can’t do anything for the patient right now, they won’t be allowed in one hundred percent, they can’t make any decisions or influence the process, then you can get distracted. Many people believe that at this moment they should grieve. Going out to drink tea with friends in a cafe is breaking the entire logic of the universe. They are so fixed on the mountain that they reject any resources that could support them. When it comes to a child, any mother will say: “How can I afford this?” or “I’ll sit there and think about the child.” Sit and think. At least you will do this in a cafe, and not in the intensive care corridor.

Very often, in situations where one of the relatives is in intensive care, people become isolated and stop sharing their experiences. They try so hard to protect each other that at some point they simply lose each other. People must speak openly. This is a very important foundation for the future. A special category is children. Unfortunately, very often they hide from children that one of their parents is in intensive care. This situation is very bad for their future. Proven fact: the later children learn the truth, the higher the risk of severe post-stress disorders. If we want to protect a child, we must talk to him. This should be done by loved ones, not by a psychologist. But it is better that they get professional support first. You need to report in a comfortable environment. We must understand that children 4–6 years old have a much more adequate attitude towards issues of death and dying than adults. At this time they have a fairly clear philosophy regarding what death and dying are. Later, many different stigmas and myths are superimposed on this, and we begin to treat it differently. There is another problem: adults try not to show their emotions, but children feel and experience this experience as rejection.

It is also important to understand that different family members different variants adaptation to stress and different needs for support. We react the way we react. This is a very individual thing. There is no one correct reaction to such an event. There are people who need to be stroked on the head, and there are people who gather and say: “Everything will be fine.” Now imagine that these are husband and wife. The wife understands that a catastrophe is happening, and the husband is sure that he needs to grit his teeth and not cry. As a result, when his wife starts crying, he says: “Stop crying.” And she is sure that he is soulless. We often see conflicts related to this in families. In this case, the woman withdraws, and the man thinks that she simply does not want to fight. Or vice versa. And it is very important to explain to family members that everyone needs different support in this situation, and to encourage them to give each other the support that everyone needs.

When people do not allow themselves to cry and seem to compress their emotions, this is called dissociation. Many relatives described this to me: in intensive care they seem to see themselves from the outside, and they are horrified by the fact that they do not experience any emotions - neither love, nor fear, nor tenderness. They are like robots, doing what needs to be done. And it scares them. It is important to explain to them that this is an absolutely normal reaction. But we must remember that these people have a higher risk of delayed reactions. Expect that after 3-4 weeks you will have disturbed sleep, anxiety attacks, maybe even panic.”

Where to look for information

“I always strongly advise relatives and patients to go to the official websites of clinics,” says Natalya Rivkina. - But if you speak English, it is much easier for you. For example, the Mayo Clinic website has large texts in all areas. There are very few such texts in Russian. I ask relatives not to go to Russian-language patient forums. Sometimes you can get misleading information there that is not always related to reality.”

Basic information in English about what happens in the intensive care unit can be found here:

What to expect

“Within a few days after the patient is admitted to intensive care, the doctor will tell you approximately how long the person will stay in the ICU,” says Denis Protsenko.

After resuscitation, once intensive monitoring is no longer necessary and the patient can breathe on his own, he will most likely be transferred to a regular ward. If it is known for sure that a person needs artificial pulmonary ventilation (ALV) for life, but in general he does not require the help of resuscitators, he can be discharged home with a ventilator. You can buy it only at your own expense or at the expense of philanthropists (from the state

Illustration copyright Ria Novosti Image caption Doctors explain the ban on visiting children in intensive care due to the danger of infections

The Russian Ministry of Health had to Once again remind that the law obliges doctors to allow relatives to see patients in medical institutions, including in intensive care.

The department's press secretary, Oleg Salagay, recalled that the ministry sent a corresponding letter to the regions last year.

"If there are any violations, you need to contact insurance company, which issued the policy to you, regional health authorities, control authorities," - wrote press secretary on Facebook.

This is how he responded to the petition, which requires the Ministry of Health to publish not a “letter of request”, but a decree that does not allow free interpretations. To date, a petition demanding that hospitals not interfere with visits to loved ones in intensive care has collected more than 200 thousand signatures.

The petition notes that it is important for patients, especially sick children psychological support, which they are deprived of due to the rules of medical institutions. The most popular comments on the petition describe cases in which sick children were deprived of communication with their parents.

Article 51 of Law 323 states that one of the parents or legal representative has the right to be with the child “while providing him with medical care in inpatient conditions throughout the entire treatment period."

Patients and staff charitable organizations who help children say that in Russia it is really difficult to get to intensive care for a child, let alone an adult. At the same time, in the regions the situation is much worse than in Moscow.

Typically, doctors explain the ban by saying that parents can introduce an infection or become infected themselves, in some cases they interfere with treatment and distract medical staff.

There are not enough psychologists who could work with parents and children. Patients often refer to Western experience, where relatives are not prohibited from visiting patients - except in cases where the patient is receiving emergency care.

The BBC Russian service turned to experts and asked them to comment on how the law obliging parents to allow parents to see their children in intensive care is being implemented locally.

Nyuta Federmesser, President of the Vera Hospice Fund

Wherever parents are not allowed, there is a violation of federal law. The Law on Citizens' Health stipulates the right of a child to be with his parents in the hospital.

All internal regulations are fiction and the will of the local chief doctors. Sanitary standards are often violated by employees more than by parents, since employees, for example, go outside to smoke in the same shoes in which they work, and parents obediently bring a change.

It’s scary in hospital departments nosocomial infection borne by dirty cleaning rags, a lack of proper hand-washing culture, gowns that nurses wear from room to room, and disposable gloves that are no longer disposable after the nurse wears the same gloves to the next patient.

Many nurses say they wear gloves to protect themselves from hepatitis, not to protect the patient.

Parents are the people most interested in quality care. And they are the first aid to the staff when children cry when it is time for lunch, washing or changing clothes. Parents must strictly follow only one rule - to leave the intensive care ward at the first request of the staff in the event of resuscitation measures or serious manipulations requiring the participation of two or more doctors.

Inappropriate behavior of parents, which is often referred to by managers intensive care units, when the mother is not allowed to see the child, is the result of separation from the children.

Alexander Rabukhin, anesthesiologist with experience in the USA

In the USA there is no such profession as a resuscitator. Seriously ill patients are treated by a specialized doctor. If this is a surgical patient, then in surgery, if a therapeutic patient, then in therapy, and so on. That is, there is no separate specialty “resuscitation” there, there are only intensive care units - the so-called ICU.

At certain times, please, you can [visit]. Relatives come in, order pizza in unison, watch TV, eat the pizza, wave to the hardware patient and leave. There is no such problem [ban on visits], because they generally treat it more simply, and doctors go around without white coats. A sick person is also a person, and relatives are people, so the human attitude.

In Russia, a sick person is a person who has lost all rights. From the moment you are admitted to the hospital, the nurse decides everything.

As for the unsanitary conditions, to be honest, I have never seen any homeless people come to visit there.

And this applies not only to intensive care, just try going to the hospital. It is much easier to get to any defense facility. In our country, 50% of the working population works in security, in my opinion. They need to protect something.

Now, if I, a doctor, come to some other hospital on business, if a pass has not been ordered for me, I cannot go through. And in order to order a pass, you need to get inside, and so on, the circle is closed. It’s good that they even let you into the grocery store without a pass, but you say intensive care.