Abstract
“M
I called out to my next patient as I stepped into the waiting room. There was no response.
“Mr. Jackson!” I repeated, my voice a little louder. Again, no reply. Perhaps he went to the bathroom. Perhaps he simply got tired of waiting at this bustling university hospital continuity clinic.
Just as I was about to call out again, my eye caught a middle aged African American woman approaching me. Short and obese, she limped on her right leg, wearing a sagging brown cotton jersey skirt, a fuzzy white cardigan over top, and a red–blue–green scarf with a design of wild flowers draped around her neck. She had a lovely wide smile, bright dark eyes, and long eyelashes. Her short black hair was parted in the middle, with reading glasses up on top of her head. Huffing breaths, she came close to me.
“You are the one; I recognized your voice,” she said, “I have been asking about you. You were my doctor two years ago at the ICU. I remember you held my hand and sang for me.”
Stunned, I froze in my place. Could it be … Ms. Gardner? She had been very ill and assumedly dead.
Ms. Gardner. She had been my patient when I started my first ICU rotation. At that time I was six months into my internship at a large academic medical center.
Infected with HIV, she had been a 40-year-old woman admitted to the ICU for sepsis and embolic stroke. Unresponsive, she was intubated and connected to several intravenous poles. Tentacles from a Swan Ganz catheter explored and interrogated data from her right heart. Her impaired renal function required short-term dialysis. Numerous medications and twice daily laboratories became her paradigm. Her management vacillated between “wet” one day demanding large doses of diuretics to “dry” another day requiring volumes of IV fluids.
I remember at the time feeling overwhelmed by the ICU environment. It was a steeled mechanical engine. Everyone was programmed to perform a specific job and knew exactly what needed to be done. Most walked with masks and gloves on. And I was fuel to that engine—constantly hypervigilant, remembering every minute detail, terrified of missing something seemingly small, but genuinely critical, to my patients.
During my rotation, a few patients coded and died. There were a lot of intense activities around the patient during the code, but once called, the staff dispersed. An eerie silence would engulf the room while nurses left to remove lines and clean the body. We never talked about it. We just went on to our next task.
I remember my first code; I stopped eating and cried every night for a week.
Ms. Gardner and I shared a kinship while I attended her. She and I stayed off an environment that was dehumanizing to both of us. I wanted to protect her but felt powerless, even embarrassed about my uselessness. During morning rounds, I would stay behind while my team moved on to the next patient. Momentarily alone with my patient, I would take her hand and whisper a prayer, a simple murmur for perseverance and strength.
When my one month rotation finished, I felt relieved. I left the ICU for an elective in a different site and never had the chance to follow-up. I kept thinking about my patient, wondering if she lived.
“You are the one who prayed for me,” she beamed as I absorbed her joy.
Tears filled my eyes. I hugged her and told her how happy I was to see her. She survived seven weeks in ICU and was discharged to a rehabilitation unit where she successfully regained her strength and independence. The machine, this time fueled with human connection, again prevailed.
An ICU is a place of feverish energy, a place where illness is reversed and death is ferociously fought. Yes, it can be an engine steeled with efficiencies and accuracy, a contraption without reverence for the healing power of the simplicity and the profoundness of quiet reflective moments. Perhaps such tameness would not be congruent with the almost heroic function of such a unit. Regardless, we must train our students to never suppress their humanity. My seemingly unresponsive patient reinforced in me the power of universal love, empathy, and kindness even in the midst of the unrelenting forces around us; in this way the ICU is only a microcosm of the energies of life itself.