At the End of the Day
As the saying goes, in the long run we're all dead.
I wonder then what is it I really do in the ICU? A carpenter finishes his job and has something to show for it. A house, a remodeled kitchen. A tile layer can go back and look at his work which will last until the next owner of the house decides to tear it up and start again. But in the mean time, the owners can walk on his work and admire its beauty.
In the ICU it seems like an endless battle that we are certain will eventually be lost. In the long run we're all dead.
I got called in after dinner last Friday night to see a 77 year old nursing home patient who was found by the nursing home staff unresponsive, with respiratory distress and an unmeasurably low blood pressure. He was in the nursing home because after years of heavy smoking he not only couldn't breath without supplemental oxygen, but the vessels to his feet were so clogged that ulcers were developing and spreading, not healing because of poor blood supply. He would never walk again, and would clearly never return to independent living at home.
And yet, the ER doc duly intubated him, put him on the ventilator and sent him up to the ICU. I wandered in and asked the HUC where the new patient was.
"Which one, Doctor? You have three new ones to see."
Great. In the fifteen minutes it had taken me to drive in there was an 87 year old woman who had just had part of her colon wacked out and was febrile, hypotensive and tachycardic. She would be in the ICU shortly.
There was also a 60ish year old woman in the ER who had recently had abdominal surgery with the discovery of a widely spread adenocarcinoma throughout the abdomen. Rather than close her up and tell her the truth- which would have been "Sorry, there's nothing we can do, and you should get your affairs in order." - The surgeon had done an aggressive surgical resection and the oncologists had given her the first course of chemotherapy. Predictably, now ten days later, she was in septic shock and being sent directly to the ICU.
I spent the next 6 hours going from room to room- physical exam, review the drips and vital signs, adjust the vent, write orders for iv fluids and antibiotics,.......
I basically wrote the same order set for all three patients and then after rechecking to see that things were pretty stable, I went home. I got to the house at about 1:30 am and was woken up about every half hour subsequently with questions and updates from the Unit nurses.
At the end of my work day, Saturday morning, what did I have to show for my work, other than exhaustion? There were three patients who were still alive, but not for long. The Angel was making rounds right behind me, taking notes and planning his schedule. What was it I had really accomplished? My job is to keep these patients alive, and I had done it to the best of my abilities. But, even in the short term these poor souls were dead.
I told myself it was the fatigue talking. Ours not to reason why and all that. I got dressed, went outside and spent a few hours in the August sun chopping brush, pruning trees and pulling weeds. Simple work, physical, without much need for conscious thought. A Zen experience. And when I was finished I could walk around the garden and see my accomplishments. Well, by evening I would be feeling philosophical and by Monday ready to start again.
I wonder then what is it I really do in the ICU? A carpenter finishes his job and has something to show for it. A house, a remodeled kitchen. A tile layer can go back and look at his work which will last until the next owner of the house decides to tear it up and start again. But in the mean time, the owners can walk on his work and admire its beauty.
In the ICU it seems like an endless battle that we are certain will eventually be lost. In the long run we're all dead.
I got called in after dinner last Friday night to see a 77 year old nursing home patient who was found by the nursing home staff unresponsive, with respiratory distress and an unmeasurably low blood pressure. He was in the nursing home because after years of heavy smoking he not only couldn't breath without supplemental oxygen, but the vessels to his feet were so clogged that ulcers were developing and spreading, not healing because of poor blood supply. He would never walk again, and would clearly never return to independent living at home.
And yet, the ER doc duly intubated him, put him on the ventilator and sent him up to the ICU. I wandered in and asked the HUC where the new patient was.
"Which one, Doctor? You have three new ones to see."
Great. In the fifteen minutes it had taken me to drive in there was an 87 year old woman who had just had part of her colon wacked out and was febrile, hypotensive and tachycardic. She would be in the ICU shortly.
There was also a 60ish year old woman in the ER who had recently had abdominal surgery with the discovery of a widely spread adenocarcinoma throughout the abdomen. Rather than close her up and tell her the truth- which would have been "Sorry, there's nothing we can do, and you should get your affairs in order." - The surgeon had done an aggressive surgical resection and the oncologists had given her the first course of chemotherapy. Predictably, now ten days later, she was in septic shock and being sent directly to the ICU.
I spent the next 6 hours going from room to room- physical exam, review the drips and vital signs, adjust the vent, write orders for iv fluids and antibiotics,.......
I basically wrote the same order set for all three patients and then after rechecking to see that things were pretty stable, I went home. I got to the house at about 1:30 am and was woken up about every half hour subsequently with questions and updates from the Unit nurses.
At the end of my work day, Saturday morning, what did I have to show for my work, other than exhaustion? There were three patients who were still alive, but not for long. The Angel was making rounds right behind me, taking notes and planning his schedule. What was it I had really accomplished? My job is to keep these patients alive, and I had done it to the best of my abilities. But, even in the short term these poor souls were dead.
I told myself it was the fatigue talking. Ours not to reason why and all that. I got dressed, went outside and spent a few hours in the August sun chopping brush, pruning trees and pulling weeds. Simple work, physical, without much need for conscious thought. A Zen experience. And when I was finished I could walk around the garden and see my accomplishments. Well, by evening I would be feeling philosophical and by Monday ready to start again.
posted by ICUDOC at 12:53 PM
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