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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On one of my first days of medical school, I shuffled into a lecture hall surrounded by professional looking individuals as we had done the days before. This similar routine persisted for a few days as we became oriented to our new school. Leadership had indoctrinated us with professionalism, administrative staff had terrified us to the point of avoiding any patient information for fear of being sent wherever they send ...

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Anyone who has worked in medicine for a long time well understands the power of the statement coming from an experienced person: “This kid looks sick.” That person could be a physician or nurse. Years of experience does tend to give one a sort of sixth sense for when to worry something serious is going on that just hasn’t shown itself fully yet. Seasoned parents can often provide the same ...

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He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. ...

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What if it is your parent? Your spouse? Your child? Imagine supporting a loved one through a journey of serious illness. You go to all the appointments, know all the medications, almost feel the aches and pains as if they were our own. You repeat the same thing over and over again to one doctor after another making sure nothing slips through the cracks. Did somebody write this down? Isn’t this ...

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It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry ...

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