If the Medical Intensive Care Unit has a scoreboard,
I don't want to see it. Some days it feels like the home team always loses. Patients
that look like they are about to recover take a nosedive. The real fighters
eventually give up. The most hopeful clinicians must face the grim inevitable.
But sometimes you just need one, good victory.
"The way I look at it, every patient who comes into
this ICU should die." My colleague's comment may have sounded harsh but I knew
exactly what he meant. You don't get a ticket into intensive care unless you
have a serious problem.
If people that sick were left on their own, none of
them would make it. Everyone we save is a bonus. That thought comforts us a
little when a patient arrives at the end of their long journey with disease.
But it brings a different feeling when we treat a 20-something-year-old in
His family shook their heads, wondered how he got
here, and looked at me for answers. Just last week, they said, he was outside
playing soccer. Then he was in the ICU with a tube down his throat, breathing
on a machine.
All of this from the flu? The flu? One doctor at a hospital hundreds of miles away had already
given them the "There's Nothing More We Can Do" speech. I've given it myself. It's
hard enough when the patient is an elderly woman with advanced cancer. But someone
my own age? I like to avoid that discussion.
The kid's one shot is to load all of that expensive
equipment onto a jet and fly him to my ICU. We are a magnet for the nation's
sickest patients. Tilt that scoreboard a little more against us.
But that also means, in our ICU, this guy stands
out. He is stronger and more resilient than any other patient. We pour
sedatives into his blood but he still fights against his ventilator with
rebellious breaths. We finally paralyze him to keep the air going in and out in
Two weeks pass and my patient's sister and mother spend
every day at his side. I rotate to a different team with different patients but
I still visit the young man every day. His sister says he makes friends everywhere
goes. I realize she's right. Soon, surgeons open a tracheostomy and pass the
ventilator's tube through the hole in his neck, just in case this goes on for
But one day I walk into his room and he turns his
head to look at me. I introduce myself and he raises one unsteady arm, trailing
IV lines, to shake my hand. I thank him for being so strong and he nods. Then
his lips move to form silent words.
"Where am I from?" He nods and I sit at his bedside.
"I'm from Florida, actually," I say. "It's really nice there this time of year.
Let me tell you all about it."
Finally, a victory.