in the middle of ICU

It’s hard to know where to begin writing about experiences in the ICU, and it’s easy to not try because it’s so hard. It’s difficult to describe what it feels like, and so I thought I could just describe concretely what happens, but that’s also difficult. But I think it’s important to try. In the mornings we go from room to room, learning the details and mechanics of each person’s breathing and blood flow through their vessels. There is a ton of science and linking of every organ system. I like that breadth a lot, and I also like the detail more than I expected.

Then we enter the rooms and a lot of the time there is still a lot of science, but many times it becomes human. Yesterday, we spoke to a family who decided to withdraw care from their mother, a woman that before her illness had been a feisty, vibrant woman who traveled to Vegas and smiled gently at us when she was awake. When we first met her we thought she might be improving, even leave the ICU. Then things progressively worsened to the point that we weren’t sure she would recover, and if she did, surely not to her baseline. As the decision was made to make her comfortable and remove her breathing tube, I thought, I can’t remember the last time an entire team of interns, residents, fellow and attending cried with a patient.

Then we saw another patient’s family in tears. This patient had also been healthy and active, and had collapsed suddenly the day before, and found to have had a large heart attack. The family told us that their husband, their father, had woken up, could show them two fingers when asked to. And we cried a little again, this time not for letting go but for remaining connected.

Then we visited a young patient whose medical course has been up and down since he’s been in the ICU. He will seem like he’s getting better, staying stable, and then he’ll crash. His partner, a naturally sweet woman who is always so grateful and kind, asks if he is likely to get better or worse, and none of us know. In him I can feel the entire spectrum of upswing s and downturns that embodies the ICU.