My-CU Misconceptions
Now that I’ve survived my month of ICU (and actually enjoyed it–love that high acuity stuff), I should clear up some misconceptions about the ICU that I definitely had coming in (and that likely most people have about ICUs).
You walk through an Intensive Care Unit and see almost everyone totally sedated and out of it: on a ventilator, with lines going in their arms, legs, necks, urethras, and rectums, and lines of plastic tubing entrapping them, and you think, My God, why are we keeping these poor people alive on a ventilator? They’re too sick to make it, just let them go already! Americans don’t know how to let their loved ones go!
So it turns out: while most people in the ICU at any one time are really sick and totally out of it, every day there’s at least a few people who are getting better, getting various tubes removed from them, and actually getting out of the ICU. I had this big impression that few people make it out of an ICU–that most people die, and the ICU is some sort of “last ditch” effort. While it’s true that we can’t save everyone, and some people are just too sick for us to save, the vast majority of our patients did really well after suffering some seriously major insults to their bodies. It’s truly miraculous what people’s bodies can deal with with some support during the really bad times from the ICU.
I’ve had two experiences in the ICU that were night and day. One was a 4 hour observer in which half the patients were with it and talking to me and 1 got transfered to a medsurg floor. The other was a 12 hour shift and everyone was really sick, and really out of it. One patient was very old, had multi-system organ failure to the extreme- dialysis, vent, severe CHF. He had had 3 major surgeries that week. His pulse was something like 15 and bp something like 30/10. And they were loading him up with dompamine and epi and fluids cause his family didn’t want to let him go. It was so sad. Oh, and we had 3 other codes that night too, 2 on the same guy. So yeah…I can definitely see where people get their misconceptions. I hope to get to spend more time in the ICU in the future. I would have really liked to have had a chance to see some of the people I saw that night improve.
Probably because of my 1st year Medical Ethics course, I had assumed that almost nobody made it off the vent neurologically intact. I thought it was a last-ditch effort on the level of chest compressions.
I was pleasantly surprised to see how much good intensive care can do. I still don’t like dealing with it though. Having a human become come a saline-fueled urine factory with knobs and buttons to control ever bodily function is not something I enjoy.
I can’t even imagine working in a place where *most* of the patients died.
Most of our patients actually make it out of the ICU alive and a good number of those make it out relatively unscathed.
I never thought of the ICU as a place people go to die. (The Western equivalent I suppose of the African conception of the hospital as a place people go to die.)
Perhaps because I was in a Western ICU with malaria when I was sixteen? I survived completely unscathed as far as I can tell.
Thank-you for your honesty. Yes, your patients are worse off and yes some will die, but think of the many who do make it.
Yes, it’s easy to look at all the tubes and devices and think…this is the end of all things! But in reality, most of the technology is an assist for what the patient cannot presently do for themselves. Patients are acutely ill in ICU, but usually not chronically.
Thanks for sharing your thoughts on the subject!