ICU Blues

Today was a difficult day. I had three deaths in a span of a few hours. A day like today, just gets into me.

I like Critical Care Medicine. Among my subspecialties, this is the one I find most challenging and rewarding. But it can also be depressing. As Critical Care specialists, we are in charge of the ICU, which in our hospital has 25 beds. And I’m in charge of this ICU 2-3 months in a year.

It will be an understatement to say that we take care of sick people. They are the sickest of sick.

Our average ICU patient will have at least 2 to 4 tubes or catheter sticking out from their normal anatomic body opening, and another 2 to 4 tubes or catheters sticking out from surgically made opening in their body. They are hooked to at least 1 life support machine (sometimes up to 3: ventilator, dialysis machine, and heart balloon pump). They will have 3 to 10 (or more) different IV drips running simultaneously. And will have 2 to 6 (or more) subspecialists that have to coordinate like an orchestra, to care for the patient. These patients have one foot on the grave and are knocking on heaven’s door.

If they say that primary care physicians are your first line of defense, then critical care physicians will be like your last line of defense before you cross to the other side. I find it challenging and rewarding when we have a patient that have already  received a business card from the grim reaper, and still was able to get out of the ICU, alive. 

But the rewarding cases can be far in between. Sometimes it can be just downright depressing. Just like today. In the past 7 days that I’m in the ICU, I already have 10 deaths.

Not too long ago,  I took this personally. I believed that I became a physician to “save lives”. But when the death toll kept on rising, I began to doubt my capability to be in this profession. I know I’m doing my best, but my best is not enough. Maybe I’m in the wrong career (I should have been in the funeral home business!). This troubled me immensely.

Gladly, I finally realized that I cannot save lives nor can I extend life. Only God can save lives, and only He can heal. I’m just an instrument. My role is to provide comfort to the sick and suffering, yes, even to the dying.

People say that doctors are “cold” and “detached”. Well, it is not a trait that is taught in medical school. Maybe it is a defense mechanism that we develop to maintain sanity.

If you deal with the dying and grieving families every day, you learn to distance yourself, or else you’ll be mourning for the rest of your life. Something that I have not yet mastered.

I still cry inside every time a patient of mine takes his last breath. I still shed a tear every time I see a son or a daughter, or a wife or a husband, or a father or a mother clinging to their dying loved one.  It still breaks my heart every time I tell families there is nothing more we can do, and it is time to let go and end the suffering of their loved one. My voice still cracks and my eyes still wells up every time I announce to a distraught family that their loved one has passed on.

Maybe someday I’ll get numb…… but then again, maybe never.

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