Thread by @WesElyMD

1/ When I play the #criticalcare movie 🎥 of me as an intern or resident back in my head, I see myself as much too robotic 🤖 with my patients, as if plugging in kitchen appliances.

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2/ The nurse would slip a Foley catheter up his urethra into his bladder. I’d go to the stockroom to get all the materials to slide a plastic endotracheal tube down his trachea to become command-central for his breathing on the ventilator.

3/ Next, I’d methodically place a Swan-Ganz catheter by serial insertion of a needle first, then a wire through the needle, next a dilator over the wire, and finally the catheter itself down into his great vessels and heart. And start the ‘pressors.

4/ “Fix the kidneys! Fix the lungs! Fix the heart!” These commands occupied all my thoughts & actions. Only many days into an ICU stay, when she was comfortably off the ventilator, free & clear of imminent death, would I even begin to consider what might happen next in her life.

5/fin
My concept of the “back-end” of critical illness was that I only had the luxury of caring about a pt’s thinking & walking once things were at a snail’s pace after life support was removed. I must remember that #PICS begins on day 1 in the ICU.

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