“You are the ICU consultant today after a 2-week break. Your Intensivist colleague yesterday arranged this family meeting with the daughter of your patient Mrs Pearson. Mrs Pearson is a 78 year old lady who has been in ICU for 2 weeks. She has had three bowel resections for recurrent GI bleeding (angio-dysplasia). Her ileostomy continues to bleed and she requires 2-3 units of blood each day, every day. She has a tracheostomy, is ventilated, and occasionally obeys commands. Her blood lactate is 7 mmol/L suggesting ischaemic gut.The Surgeon has decided that another operation is pointless, that angiography has failed, that transfusions should cease and therapy be withdrawn. You have assessed the patient and you and your colleagues agree, but no one has yet spoken with her daughter, Dianne Pearson. The Blood Bank director advised today that no more blood would be provided.”
Candidates were expected to discuss these issues with the daughter in a compassionate manner.
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.