I enter the hospital to work again. I must work as I have three small children and a husband presently out of work because of COVID. He is “non-essential.” A violinist is playing at the employee entrance. I know they do this to lift our spirits. But it’s a slow, sad string that reminds me of the titanic. And yes, every day I clock in, I feel as if it’s a ...

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I am a critical care and emergency medicine physician, I have had COVID-19 infection twice, and I’m tired. My first infection was early on in the pandemic.  I had to place a Blakemore tube in a young man who was going to die from his massive bleeding from cirrhosis.  I didn’t know then that the patient was positive for COVID, as he didn’t have any “typical” symptoms. I placed the tube ...

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As I've written before, I have to confess I've never been a huge fan of pathways and protocols. They often struck me as rigid and insensitive to the nuances of differences between patients. There are also times when they are just absurd when physicians, especially mid-level providers, implement them when analysis of the clinical situation clearly shows them to be inappropriate. I suppose part of me ...

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I have a video visit in the pulmonary clinic with one of my favorite patients. I ask her how she’s doing and wave to her husband sitting in the background of the living room where she is set up. Deborah says, “We’re good. We’re healthy. We are staying home. We miss our grandchildren and have been doing a lot of Facetime. And we get our groceries delivered.” A wave of relief washes ...

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Cardiologists with national reputations were available at a hospital just an hour away. I had connections there and could get what I was sure would be better care for my mother than she would receive in the small hospital where she had been taken following a heart attack in her office. But what if she died on the way? At 67, she had a full life and enjoyed her work ...

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She was dead when we walked in the room. Lungs ventilated, kidneys dialyzed, on pressors to maintain enough tension within her blood vessels to keep blood traveling to her brain and with a tentatively beating heart, but dead, nonetheless. The microbes had done their damage. Necrotic fingertips and toes curling and black, contractures sharply flexing her wrists and ankles from edematous compartments, damage to organs both known and yet to ...

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Late one evening, an ICU physician calls a family to say Dad’s breathing rate had slowed to such an extent that he did not believe Dad would survive the night without life support. This seasoned doctor added that he had never seen patients come back from this condition on their own.  Although Dad had do not resuscitate orders and his children had agreed with his wishes to forego extraordinary measures ...

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I’d like to preface this story by saying that the majority of the intensivists I have worked with have been exceptional, caring, and professional. We had all established a good camaraderie, and we had mutual respect for each other. We worked well together. But there always seemed to be one that was the exception. And as I drive some long miles on a recent getaway to the mountains, the flashback came back ...

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I sat outside my patient’s ICU room, my eyes glancing from his chart to him and his wife.  The picture was grim.  My patient, Tom, was a 56-year-old man, severely ill from decompensated cirrhosis, was admitted for the third time in a month with hypothermia from sepsis.  Despite antibiotic therapy, he was not improving.  Now his kidneys were failing from hepato-renal syndrome with a combined liver-kidney transplant, the only hope ...

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It had been a long day. Our progress notes were done. The last scheduled case in the operating room was done, and it was time to wrap up loose ends and sign out my patients to the night team. But that's when Room 4 died. I walked onto the Burn Unit. The nurses were frantic. Can you page the Intensive Care Resident? He's bradying down. The patient's heart rate was steadily declining ...

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"Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered. Her family can’t talk to her as she phases ...

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It seems impossible that 2020 could have brought another existential challenge to life as a lung and ICU doctor. As COVID-19 broke out earlier this year, I found myself on phone calls with physicians practicing in far-flung areas, helping host regular calls and webinar to keep doctors in my state updated on the rapidly changing science, working on triage protocols for decisions nobody should ever have to make, ...

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I had to earn my “stripes” in ICU. After I graduated from nursing school, the “big” hospitals wouldn’t take me into the ICU, as I had no experience as an ICU nurse. Back in the early 1980s, there was no such thing as an internship program. I desperately wanted to become an ICU nurse. So a small-town county hospital took me in. It was a six-bed “ICU,” and I slowly learned ...

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She started crying. This tough, capable, juggernaut of an ICU nurse looked just a little broken for a second while she cried. "It's not fair. It's immoral—or unethical. I don't know—I know it's the right thing. We have to protect the patients and staff but ... if it were my dad! I just … I can't go tell them that she can't come see him when we know he's going ...

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Is it possible to have it all?  Can you have a job that you love, helping people and using your brain and hands all at the same time; plus, a family, with a spouse and children, that you are always there for?  Is it possible to have a balance between your work and your family live while working as a medical practitioner? I would argue, it depends.  About 15 years ago, ...

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"They needed the final story to let go of her body, yet retain her spirit. Looking back on it, that’s when I saw the greatest honor of all — the everyday honor of storytelling for our patients. Maybe that’s the only cure we have for death … translating what happens from the body into the world. Perhaps that is the last frontier ...

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We are tired, overwhelmed, very committed, missing our families, and carrying each patient with us as we try to deliver excellent care in a very disorienting time. We worry about the health of our families and friends and community as well as our own health, for we are no help if we become sick and cannot continue to care for our ...

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As a newly minted neonatal-cardiac intensivist, I was all ready to take on the world. I mean, caring for the babies with congenital heart disease (CHD), congenital diaphragmatic hernias (CDH) and all other congenital anomalies and premature birth. I was excited and ready for service. It was my 27th year of "being a student." I had gone through the grind of medical school, residency training, fellowship training, and an additional ...

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Barriers. Barriers of yellow tape and plastic mark our makeshift rooms. Red zippers define the “ENTER” and “EXIT.” In the middle is a window of still clearer plastic, partially obscured by taped ECGs. Barriers are put up to keep us safe, but they can do so much more, if we let them. A tap on the plastic window has become the universal command of attention from the nurses, residents, and respiratory ...

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I am an ICU nurse. I love what I do; It's not just a career: It's who I am. No other job could offer me the intimate opportunity to support and guide a total stranger through the worst (and occasionally best) days of their life. Nowhere else would I leave feeling humbled by what I do every day. Nothing compares to that. Simply put: You don't find that sense of ...

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