A lot of people say the ICU is "fun." Maybe because they get to do a lot of procedures, or because they "like unstable patients" and feel more "doctorly" managing them. I think it's a grim place where many people only get worse.
There are a lot of people who get discharged from the ICU to a lower level of care, but those are mainly the "why does this person even have to be in the ICU?" types. Those types though are usually stable and just need closer monitoring that they won't get on the floor.
The ICU is a hard place because patients can "crash" at any moment. On a typical day, I've had patients go into respiratory failure in the middle of rounds so I'd run off to assess, treat, and get the stat intubation. Other times I'll be sitting at a computer working and I get called because the patient's sheets are soaked with blood and they end up needing going to the OR immediately after fluid resuscitation and stabilization.
Other times I'm taking care of patients with multiple organ failure who got tipped in the wrong direction because of an infection they couldn't fight off given their age and failing organs.
I've never had to try to "save" people from death who already have established end-stage irreversible organ damage prior to the ICU and who are full code. It's hard on me emotionally. It's harder on the families and the patient.
We have so many people who have end-stage illnesses and despite our best efforts, despite myself doing nursing duties like recording vitals and managing pumps, they get worse. The patients develop clots in bad places despite being on prophylaxis, they get a pneumonia despite me urging nurses to suction secretions and watching them like a hawk. They get a new fever, or this infection doesn't get better and it turns out it's resistant to this antibiotic, or the infection gets disseminated, or they got hypovolemic and we resuscitated them but bacteria translocated and how they have an infection running around their entire body.
Or the patients "Code," sometimes 2+ times and we have to do CPR and run the code and give them epinephrine, amiodarone, etc, and people line up to relieve the previous person doing chest compressions. Sometimes they die, sometimes we get spontaneous circulation back and they turn out okay but not the same as before..or they suffer massive brain damage because we couldn't get their pulse back for a long time and only their brainstem survived.
I don't know why the ICU is fun to people. Most of what I see are very sick patients who are suffering, lackluster nursing, crying families, and stressed out doctors.
That's not to say I didn't have a majority of patients get discharged from the ICU, but the bad stuff seems to overshadow the good. It's hard when you talk to patients and family and the patient is very sick with little chance of survival and they're still full code. There's nothing wrong with choosing full code, it's just hard on us and families.
Many people think comfort care is "giving up" or "pulling the plug." I don't think it's bad to pass away with your pain and dyspnea taken care of when medical intervention can't rescue you anymore. I want to pass away at home, comfortably, in my sleep, with my loved ones around, not in a hospital.
I encourage more families to have dialogues with their very ill loved ones about what their loved one really wants. CPR doesn't always bring everyone back every time. Coming in with multiple organ failure and ending up sicker in the ICU happens often.
I wish with my entire heart I could save everyone who came into my ICU. I wish I could see them transform from skin and bones, I wish I could see them smile and see them strong enough to stand up and shake my hand and walk out of the unit.
I just can't always save people who already have failing organs and come in with shock or respiratory failure. But I accept the challenge and put my entire heart and soul into it. I talk to those patients like they're family or friends when I have time during the day.
I hold their hand before I leave the room. I tell them I'm always around in the unit whenever they need me. I tell them I'm watching their vitals constantly on the monitor at the nurse's station. I explain procedures to them and personally tell them their new study/imaging findings. I try to comfort them, I ask if they're scared or worried and I do my best to help them.
Sometimes those patients don't make it. Sometimes it's me who calls time of death and says a few words to the family about how they're resting and with a God who loves them.
Losing patients crushes me.
It takes a special person to be an ICU physician. I just couldn't do it as a career.
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