46 - Deborah Cook - The compassionate and world-leading Canadian granting wishes at end of life

What do you do for your patients around their dying experience?

Do you celebrate their lives and support those left behind in grief?

Could you bring more humanity to your ICU?

Whilst you and your ICU colleagues likely act with kindness much of the time, I suspect listening to this podcast will have you wondering whether you could do better, especially when your patients are receiving end of life care.

This episode's guest, Professor Deborah Cook, from Hamilton in Canada, is striving to do this through the 3 Wishes Project she and her colleagues initiated several years ago. They encourage specific wishes unique to their dying patients, thereby dignifying the person, giving greater voice to the family and evoking clinician compassion. In this podcast you will hear all about this profound and important work, the sort of acts of kindness that have occurred in her ICU, the way you could approach this in your ICU, the benefits to clinical staff and institutional leaders, some of the logistical challenges they've faced, and some thoughts on spiritual care in the ICU.

Deborah Cook is a Distinguished Professor at McMaster University in the Departments of Medicine, Clinical Epidemiology and Biostatistics. As a life long clinician-scientist, she holds the first Canada Research Chair in Intensive Care Medicine and is the Academic Chair in Critical Care Medicine at McMaster. She is a founding member and 2-term Chair of the Canadian Critical Care Trials Group. Deborah is an active practitioner in critical care medicine at St. Joseph's Hospital where she supervises junior and senior clinical trainees. She is devoted to mentoring Masters and PhD graduate students in McMaster's Health Research Methodology Program, and junior faculty around the world, resulting in the creation of the Deborah J Cook Mentorship Award by the Canadian Critical Care Trials Group.

Deborah has published over 700 peer-review articles with an associated H index of 168. Her multi-method multi-disciplinary research interests include life support technology, prevention of ICU-acquired complications, end-of-life care, and research ethics. She has received numerous national and international awards for her practice, teaching, mentoring and research. She is a pre-eminent critical care scholar. Dr. Cook was inducted as a Fellow of the Royal Society of Canada (2009), a Fellow of the Canadian Academy of Health Sciences (2010), and received the inaugural Distinguished Lecturer Award in Critical Care Sciences from CIHR's Institute of Circulatory and Respiratory Health (2017). Her work on microbiome modification in critical illness using probiotics resulted in a prestigious Killam Fellowship in Health Sciences from the Canadian Council of the Arts (2017). Deborah received the Gold Leaf Award from CIHR for her enduring contributions to health care (2019).

For life long scientific contributions to the improvement of global intensive care and her foundational leadership in the first national ICU research network in the world, Dr. Cook was appointed an Officer of the Order of Canada (2016).

In this conversation Deborah also talks about:

• How she was drawn to intensive care from internal medicine
• How she discovered several gold mines to conduct research on
• Her belief that following your passion is the key to research success
• How humanity has fallen by the wayside as intensive care has developed
• How she was dissuaded from doing end of life research early in her career
• The growing interest in ethics and end of life care
• How she approaches ward rounds
• Dealing with our fixation on computer screens
• Being present and avoiding note-writing on ward rounds
• Her high expectations as a clinical mentor (including of herself)
• The importance of presence and engagement as the attending consultant
• The irrelevance of many of the words spoken on ward rounds
• The importance of keeping things fresh by releasing dying passions
• Her thoughts about how she cares for herself
• Which exercise and which books she prefers
• Her mindfulness practice
• Her love for family
• Some invaluable career tips

Deborah is passionate about patients receiving the very best care, about clinicians delivering this in an organised and cohesive fashion, and about researchers providing the highest quality evidence to guide this. She has been a kind friend and advisor to me over many years and I can't think of anyone with a better mix of acumen, experience and personality as the ideal Mastering Intensive Care podcast guest.

She is a personal favourite so please enjoy listening to the wonderful Deborah Cook.

Andrew Davies

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About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. I hope you'll glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient's lives.

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Links to people, organisations and other resources mentioned:

Deborah Cook (McMaster University)

Article about Deborah Cook

Article 2 about Deborah Cook

Video of Deborah Cook

Canadian Critical Care Trials Group

PROTECT study comparing dalteparin and heparin

The 3 Wishes Project

Publication from 3 Wishes Project

Other publications from 3 Wishes Project

ANZICS Clinical Trials Group

David Sackett

Book "Essentialism – The Disciplined Pursuit of Less" (by Greg McKeown)

Mastering Intensive Care podcast - Episode 45 with Scott Weingart

EMCrit podcast

2019 World Congress of Intensive Care Medicine

New Normal Project podcast

Plantfit Summit

Mastering Intensive Care podcast

Mastering Intensive Care page on Facebook

Mastering Intensive Care at Life In The Fast Lane

Andrew Davies on Twitter: @andrewdavies66

Andrew Davies on Instagram: @andrewdavies66

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