We recently had a patient who arrived on our service in the intensive care unit after a complicated surgery. The surgery left him close to dying, and he was immediately put on life support and given heavy sedatives. Ventilators breathed for him. Special drugs kept his heart beating. A continuous pump acted as his kidneys, filtering out his body’s toxins and infusing the cleaned blood back into his veins anew. He had ...

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I recently read an article entitled “The family said, ‘Do everything.’” It described the case of an elderly patient at the end-stage of life. The article concluded that “If your loved one has reached an end-stage of life, do the right thing. Let them die peacefully.” While I agree with this author’s intent, recent experience has altered my perspective on the “right thing.” My father died after complications ...

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The stethoscope. Nothings says “I’m a doctor” more than the stethoscope in a pocket or draped around the neck. Forty-five years ago when I got my first one, a gift from my physician-father, the former was more common. Then we were more likely to wear coats — white coats or suit coats — and pockets were available. I had suit coats in which the lining was worn out from the ...

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There are medical honors so rare you don’t even know they exist. When you’re trudging through the slog of PBK/AOA/other — ultimately meaningless — letters, these seem to be the definition of distinction. Just like every other lesson, a patient taught me what real prestige is. Well, it wasn’t entirely that Oslerian, it was the patient’s nephew.* Carl paged me on an ordinary day — a fellow physician, he once saved my ...

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Have you ever felt so cold? I mean bone-chilling cold. I don’t mean the same kind of cold that northern winters can leave you feeling. I am talking about working in a hospital that is climate-controlled, and you are undoubtedly shivering. I still remember my first day on the job as a neonatology fellow. I was anxiously walking to the operating room to attend the delivery of a 25-week infant. As ...

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I'm sitting in the ICU team room, staring at the computer, trying to look like I'm writing a note. But my head is pounding. As an internal-medicine resident doing my first month of residency, I've found the ICU of the bustling county hospital a jarring place to start my training. Although I'd anticipated the clinical challenge of caring for very ill ICU patients, I was unprepared for the emotional burden of ...

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“Where is my baby?” I awoke upset that my belly, which hours before was bulging through my doctor scrubs, had surprisingly been flattened. No one had asked for my permission to deliver my baby. They told me he was delivered emergently — at 32-weeks gestation — to save both our lives. I was a third-year pediatric resident, the senior for the pediatric ICU, on the night of my son’s birth. My ...

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Since intensive care units (ICU) were created in hospitals more than a half a century ago, there has been a steady decline in death rates for individuals who are critically ill and require life support. That’s significant and meaningful progress, and it’s thanks to the pioneering work of many doctors, nurses and researchers who have discovered better ways to liberate patients from life support so that they can ...

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Sepsis, the body’s self-destructive inflammatory response to severe infection, is the leading cause of death in U.S. hospitals, particularly among the elderly. It starts as mild sepsis, advances to severe sepsis, and all too frequently blossoms into septic shock. More than 1.5 million Americans get sepsis each year. More than 250,000 die of the illness. One in three patients who die in a hospital have sepsis. 62percent ...

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Burnout has been a descriptive term for years, but lately, psychologists and others have assigned it specific characteristics with a view toward being able actually to study and measure it. One common definition of burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, detachment, and feelings of ineffectiveness. The PICU environment is often one of high stress, so it’s a place where this ...

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