When the pediatrician woke me at midnight to get a blood test from my three-month-old son, I knew things were serious. I should have known this already. Four weeks prior, my four-year-old daughter passed along a respiratory virus to my husband, me, and her brother. Her brother’s low oxygen level and inability to keep down milk brought him to the emergency room, where an oxygen mask was promptly fastened around his mouth, ...

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I fear that I’m not doing the right thing. You’re trusting me with your life. I hear you telling me that you don’t want me to do what I am about to do. I see it in your eyes, the resentment as you look toward your family. And hatred for me, your physician. You trust me to care for you as you enter the unit. I tell you I will. You ...

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The thing I think would surprise people the most is my relationship with death. I’m a critical care anesthesiologist. It’s an exciting, rewarding field – I tell my medical students and residents that it blends expertise in the human body with mastery over crisis. I started my career imagining every day in the ICU as another battle between the living and their eternal ...

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Medicine is an art. One can learn about symptoms, diagnostics, and treatment plans for various diseases, from textbooks and journal articles. It is harder to study empathy, compassion, and human connection from conventional academic resources. The art of medicine is discovered, acquired, and absorbed on the job by interacting and connecting with patients and their families, by partnering with them in their journey through sickness to health or even the ...

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"Being a neonatologist and a mother is living with the knowledge that the question 'What would you do?' could so easily become real, not hypothetical.  And so what would I do? I don’t know, heartbroken mama. Because I feel too much, but I don’t feel enough. Because I know too well, but ...

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"But if thought corrupts language, language can also corrupt thought." – George Orwell The “difficult” family At 2 a.m., on my first night shift as a pediatric resident, a patient, Casey, transferred from another hospital. She had a rare, progressive chronic illness, was medically complex, and was currently receiving treatment for an acute systemic infection. Shortly after she arrived, she became difficult to arouse. When I asked her mother questions, I was ...

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It was a cold winter morning in January 2021. Another day in the ICU, another day caring for critically ill patients with complex medical conditions, another day caring for patients on their death beds, another day interacting with patients’ families and their emotions, another day of putting on a strong face for my patients, their loved ones, my ICU family and my trainees, another day of giving bad news to ...

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General Douglas McArthur said: “However horrible the incidents of war may be, the soldier who is called upon to offer and give his life for his country, is the noblest development of mankind.” The soldier is trained to kill, and they learn to kill well, they have endured great physical and psychologic trauma and horror of such killing to give us freedom. They followed Washington, stood next to and shoulder to ...

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I was an assistant nurse manager (ANM) in a 24 bed ICU in my younger, energetic years. Before that, I was a manager in a very small emergency department. I must say, I loved it. I loved the thrill and the challenge. I was able to work with the Joint Commission; I ordered EKG monitors and defibrillators, any equipment needed for the emergency department. I worked with the health department ...

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Drip. Drip. Drip. It’s 8:00 p.m. I’m staring at the IV tubing. We forgot to stop the fluids. I’m standing in the resuscitation room alongside the naked, broken body of a teenage male. Unable to break my gaze on that dripping IV line, thinking, We’re going to flood him. But it doesn’t really matter. Somewhere in the background, muffled yelling comes through the doors. “Sounds like they found the family,” remarks a nurse. The tech is putting the young ...

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"Early in the pandemic, in thinking of and discussing possible solutions to help protect health care workers, two of my former colleagues and I recalled a device called the Surgical Smoke Evacuator (SSE), which we used extensively since the 1990s when we worked together at the University of Pittsburgh to collect and ...

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"I write this as a caregiver, patient educator, and clinical researcher. The coronavirus pandemic has shone a spotlight on intensive care units (ICUs).  Due to the rapid and continued increase in critical illness from COVID-19 infection, discussions about capacity and specialized equipment have become commonplace. Terms such as ventilators, ECMO, PPE, emergency use ...

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After 33 years as an ICU RN, I had finally decided I couldn’t do this anymore. It was my last nightshift. The last shift convinced me I had made the right decision. The CNA and I went door to door to turn each ICU patient that was not capable of turning themselves. ICU-06:  Mrs. Thelma was 86 years old. She laid in her bed, slightly restless. Restrained. On a ventilator. NG tube ...

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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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