Mar 31, 2013

Routines in the SICU

Medical care is surrounded by routines - fresh bloodwork every morning, nasogastric tube care, bed baths etc. Somehow in a forest of routine nursing work, our internal system, aided by whatever miracle drugs physicians prescribed, have the intrinsic ability to heal itself from all the chaos and assaults of disease.
On the other hand, family members of ICU patients have their own set of routines. They only get to visit from 10.30 to 11 am and 6 to 6.30 pm everyday. These precious 60 minutes become a treasured moment for families. Especially so when the patient's conditions are deteriorating and the end is imminent.
Every morning after ordering routine tests for my patient I would write the morning's progress note standing beside the bench on SICU-39. At 10.30 am sharp family members would be allowed in. All donning the pale yellow overalls as a feeble attempt of infection control, they would stand beside their beloved's bed and start their daily routine.
This wife of SICU-39 is there every morning, repeating the same words like a recorder - "it's me, Yun Ling is with me today. Can you hear me?" "We are waiting for you to come home. The grandchildren can't wait to see you again." "If you hear me, will you blink your eyes?"

After several minutes of unresponsive soliloquy, Mrs. SICU-39 will take out her expensive Samsung mobile phone and play recordings of her grandchildren's message. This is the most heartbreaking part of their visit.
"Granddad, I'm Xiao Xiao. Take care of yourself and come home to us soon!"
"Hey ah gong, I am Xiao Xiao's classmate who visited last week. Get well soon and jia-you jia-you jia-you! [translated: I give you my wholehearted support]"
My eyes will invariably swell with tears after several rounds of jia-you jia-you but I try to remain composed and refrain from leaving. Before they leave, I'd always nod and smile to Mrs. SICU-39 in recognition of her resilience. We became nodding acquaintances over the course of several days.
One day, after finding her husband in worse shape than previous days, she walked over to me.
"I think he's taking a turn for the worse."
I am not obliged to talk to families as I am not yet a licensed practitioner. However, there is no one with authority around.
"We started a new medication this morning. We'll continue to monitor him over the weekend for any changes. It will take about 2 to 3 days for the drugs to take effect."
She looked at me in the eye and said, with speckles of tears in her eyes, "it's ok if he doesn't wake up anymore, we all knew you (the medical team) did your best."
Her revelations broke my heart even worse than Xiao Xiao and her classmate's recitations. She loved him so much but had just realize things could never be the same again. It must take her a great amount of courage to utter "it's ok" - to let go of her routines, her struggles against the fragility of life.
Every person has the ability to love and be loved. To be given the knowledge to salvage love is certainly an honor. Yet at times like these, we could only do our best. At the end of the day, what matters most is whether you did your very best.
And I shall miss Xiao Xiao's voices soon.


Sleepless In KL said...

What's even more heart-breaking is when there is no one to visit and talk to the patient. I see how those patients cast longing glances at their wardmates/neighbours who have an endless stream of visitors while they lay alone on their beds, pretending to watch TV.

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