Sep 9, 2011

Hanging by a Thread

I spent my previous two weeks at the SICU caring for one single patient. One. I never got the chance to talk to him, ask him how he felt, or personally wish him happy mid-autumn. Every day I looked at his vital signs, check his labs, listen to his heart and lungs, and dress his wounds. I had never spoken a word to my patient who is "intubated, sedated, in no acute distress."
This is something of a norm in the SICU. Patients usually arrive at their most critical state, requiring decisive actions delivered promptly. This is where things we take for granted become life and death. Too much water, for example, will flood the lungs and suffocate the patient. Every calorie matters to a patient who is critically ill. Even the bed angle affects breathing and intra-abdominal pressure - my patient got his too high and ruptured his surgical wound requiring an extra visit to the OR.
Most patients come and go. The average SICU stay at our hospital is 5.4 days. Mine is approaching his first full calendar month next week. As the clock ticks, his chances of leaving the SICU diminishes. This is a place plagued with superbugs and virulent hospital germs. And what's a better medium for growth than a stationary, defenseless, paralyzed patient on a bed surrounded by bodily fluids?
When we have employed the strongest antibiotics and the strictest regiments, life or death is back to God. An emotional place to be in - talking to families about DNR (do not resuscitate) orders, end of life care, and singing happy birthday to a 61-year old not expected to live through his birthday. Even though most never respond, I talk to my patient, sing to him, and wished him happy mid-autumn while attending to him every day. If he manages to pull through, I hope he can vaguely remember some medical student who swabbed his wounds, electrified his hands for the train-of-four test, and taps his brows every day.