Dying in the university ICU. Only the dying come into the ICU. No one wants to hear it, but it’s the truth.
40% of the patients who come into our ICU, die in our hospital. Maybe not right away, but in a few days or a few weeks later, their disease is relentless, irreversible and their organs continue to fail, beyond any repair.
Working a tertiary/ quaternary referral center means that the patients we get are usually sent in as transfers from outside hospital. They are sent to us with a need for resources beyond what these outside hospitals can offer. This ranges from special ventilator requirements, kidney dialysis, or need for liver transplant. Many of them have had complex surgeries from genetic disease or cancer, pre-existing liver disease, renal disease, or cardiopulmonary disease. Patients are then shipped by helicopter or ambulance to our university hospital, where they come with all their failing organs, along with their families who bring with them rising hopes and elevated expectations. They expect healing, they expect miracles, they expect us to make their family member whole again. Most of these patients have problems that are not easily cured or reversed since their bodies have been ravaged by their chronic disease. No one wants to say they are dying, because the expectation is that the patient will live. It is always THE hope, my hope, our hope. But it is not always a easy delivery.
I watch myself and my residents work tirelessly to help these patients, hourly watching their vitals, meticulously trending labs, ordering studies and therapies to stop the patients’ disease. They take good care of these patients (along with an integral team of respiratory therapists, nutrition specialists, nurses, social workers, etc). At times our team of doctors don’t eat, drink or sit down for 8-10 hours at a time, just trying to stabilize patients, get procedures done, talk to consultants, and update and take care of their families too. It is tireless, superhuman, and it is no less than a miracle they come each day to work, without disease and burn out. I am grateful for this.
In the ICU, we can’t save everyone. This is more often the case than not. This is anxiety and anger provoking to grieving families who set their hopes and dreams on the transfer to the university ICU. Understandably so, since they are the ones whose loved ones are dying. We rarely get to meet these patients, or learn their pre-ventilator, pre-tubes and lines personalities. But doctors can become the brunt of the rage, hostility, and frustration coming from grieving families whose expectations and hopes fail. We are tasked with healing the body at its most disequilibrium. We are tasked with carrying their emotional burdens. This toll on us as doctors has been palpable in the past two weeks. I have found myself sometimes crying after work, sometimes crying on the way to work, sometimes crying while shopping on amazon or doing ordinary tasks because it reminds me of something in the ICU. The weight of emotional burden sits on top of me like a load of bricks, until I can be away again at the end of the day. This burden has been more challenging than any medicine I have ever learned to practice in the last 9 years of my life. No one talks about the stress and the anxiety in training much. We are not good at talking about it. It may seem weak or a sign of failure. Because we are supposed to be doctors, we are supposed to have some sort of immunity. We are supposed to just handle it. But I think that we have to.
Truth is, no one wants to say the patients are dying, but they all are. The work we do is always wholehearted, self-sacrificing, hopeful, and meticulous. But sometimes the saving cannot be done, because this human body fails, and some faster than others. We do our best, but the best is not enough sometimes. No one wants to say that doctors “burn out”, but we do, because we are human too. We are not immune to the deaths we experience in our patients, we are not superhuman. We too, have souls and burdens to carry, and we too, carry this emotional burden for our patients and families. We have to take breaks. We have to seek respite.
I write all of this to say that I am learning. I am learning about life, about medicine. In fellowship, I have learned as much about the human spirit and soul as I have learned pulmonary and critical care medicine. I thank God everyday for life, because it is precious and limited. I also thank God because he reminds me everyday that though we grasp and plan, we are never truly the ones in control. That thought, is actually truly liberating.