Heroes at the Heart of the ICU
It’s natural that people outside medicine should view intensive care units with a certain dread. After all, they are alien, mechanized realms whose mere existence signifies crisis and loss.
However, there’s another popular notion about people who work in ICUs. You know--cold, callous, cerebral. Men and women who no longer feel but simply float from one high-tech stall to the next, regulating bodies gone awry.
Does this ring true--even a little bit--for you? If it does, you might want to reconsider after hearing this story of a recent Friday night in one ICU.
But first, a warning: This Friday was not a good night in the ICU. By Saturday morning, two patients had died. Both were young, and both fought hard to live.
One of the patients we’ll call Ronald. We met when a serious infection brought him to the hospital barely a week following an organ transplant. Yes, he was sick. But with potent antibiotics, he perked up for a while. He told me about his “real life” working at an amusement park. He had worked there for years. He liked being around children.
Six weeks later, with failing lungs, liver, kidney and heart, Ronald could no longer talk, and his real life was worlds away.
Ronald spent his final week in the ICU. From the many specialists who gathered at his bedside, to the nurses who kept watch for 12 hours at a stretch, to the dialysis technician who filtered his blood, to the respiratory therapist who ran his ventilator, a small army worked around the clock to coax him back to the world he once knew. A world beyond the endless, electronic day of the ICU.
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Without a doubt, these were seasoned pros with cool heads and steady hands. Repeating maneuvers performed daily in ICUs across the country, they inserted needles, hung drips, suctioned tubes, inspected X-rays, and analyzed lab values, sometimes making life-saving decisions on a minute-by-minute basis.
But they also had hearts. Hearts that hoped for a miracle. They had seen miracles before. In truth, the technical wizardry was just a stopgap to allow a miracle to happen.
One person who wanted a miracle badly was Ronald’s intern. This was his first time working in the ICU as a full-fledged doctor. He and I conferred often about Ronald’s antibiotics. At final count, six antibiotics were on board. And still, the lungs wouldn’t heal.
Saturday morning, the intern found me. With a sad, almost apologetic look, he asked if I knew what had happened to Ronald.
Yes, I replied, I knew. For a second, our eyes met. Exactly what he felt I don’t know. But for me, it was regret and failure: emotions I now accept--after years of doctoring--as part of life.
Then the intern volunteered something else. Another patient, Sam, had also died on his shift that Friday night. Sam (also not his real name) was an artist with leukemia. Although I never met him, I knew of Sam. Two nights earlier I had approved a special treatment for him--a last-ditch elixir for fungal pneumonia.
Sam’s immune system had been warring against his body for weeks following a bone marrow transplant. This complication is called graft versus host disease. It scars organs and makes them vulnerable to infection, especially the lungs. Like Ronald, Sam had died in respiratory failure, attended by the same ICU crew. It made for a long night.
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The intern had probably had a couple hours of sleep, if that. Being bone tired while mourning the loss of a patient is a recipe for despair for any young doctor.
I touched his shoulder. Look, I said, you have to think of it this way: It was their time.
The intern’s eyes widened. You know, he answered, Sam’s mom said the same thing.
In medicine today, there are many happy endings, including heroic rescues from diseases that were once uniform killers.
Along with happy outcomes, there are tragedies.
But even tragedies as profound as death should leave some sweet memories. Some people think, when you die in an ICU, you die among strangers. I disagree. When the machines go silent, the monitors turn dark, and a patient’s eyes are finally and respectfully closed, there are no strangers in the ICU--only sad people sharing grief.
Claire Panosian Dunavan is an internist and infectious diseases specialist in Los Angeles. Readers’ comments are welcome at drclairep@aol.com. The Doctor Files runs the fourth Monday of the month in Health.
