It was a quiet day in the ICU, for me.
The morning started with an elderly man admitted with respiratory failure. He did not tolerate BiPAP. He was clearly uncomfortable and suffering.
The morning started with an elderly man admitted with respiratory failure. He did not tolerate BiPAP. He was clearly uncomfortable and suffering.
The family agreed: no more suffering. It is the end. Goals of care changed to prioritize comfort. He died naturally and comfortably surrounded by loving family.
Later, an extubation. I always go to the room for this, one of our most important decisions/procedures. It went smoothly, and the first words out of the patient's mouth: "thank you." and then, more importantly, a great cough!
On the floor, a woman coming to MICU for complications related to advanced malignancy was terrified. I gave the best reassurance I could: whatever else, you will not be alone. We are here for you.
Rounds. We spent hours weighing risks/benefits of intervening for a sick pt. Risks of intervention weighed against probability of alternative diagnoses. In the end, we were conservative... it paid off. All that discussion, analysis, debate: did it matter? I think so.
Finally, the evening. A number of patients were transferred out of the unit uneventfully and I spent a little time sending notes to PCPs and involved specialists. I referred a few patients to follow up with me in clinic after discharge.
Most days in the unit aren't quiet. They're full of codes, procedures, and everything else. It feels like everything is happening on those days. But sometimes, it is when it is the most quiet that the most important things happen.
