In my first few days, I was completely overwhelmed and terrified. It was
instantly obvious to my fellow interns and myself that we were unqualified
and inexpert at keeping the SICU patients alive; in fact, we were all
petrified of killing a patient who was clinging to life with one small
misstep. The SICU nurses were right in doubting us: despite our newly
conferred medical doctor degrees, we held no practical knowledge. Query
us about reciprocal translocation of genetic material in chronic
myelogenous leukemia and we’ll wax lyrical about switched-on tyrosine
kinase; but ask us about a simple ventilator setting and you will be greeted
with awkward blank stares. In time, however, we all improved. As the
month wore on, the mechanical ventilator (the “vent”), IV drips, lines and
tubes, lotions and potions, and bed settings became intelligible and
powerfully manageable.
Now in my last week in the SICU rotation, I have spent many hours at
the bedside of Travis, a sixteen-year-old Pennsylvania boy whose car full
of high school teammates was blindsided by a cement truck after football
practice two weeks ago. Three young men were instantly killed, and Travis
arrived in the trauma bay in cardiac arrest. My fellow residents
resuscitated him right there in the emergency room, making the “trauma
zipper” incision from his throat to the pubic bone, clamping his aorta to
prevent it from completely rupturing and to barely avert death. In the two
weeks since that accident, Travis has undergone multiple operations,
coding three different times and facing multisystem organ failure.
There is a stunning level of control over a patient’s body in the SICU.
Before residency, I had not fully comprehended how powerful our
machines and medicines are in controlling the concentration of gases in
the body, the blood pressure, the heart rate, and the degree of wakefulness.
The physiology I learned in medical school, the revelations about the
organ and cellular functions, is now becoming muscularly effective. But
not entirely. Travis was dead on arrival, brought back to life with valiant
swiftness by the trauma surgeons, and has endured several operations
since then, all while battling failing kidneys, Clostridium difficile (C. diff)
bowel infections, alarming edema and bloating of his arms and legs, and
little evidence of brain wave activity. He has started to smell like death. I
initially doubted the claim of the ICU nurses that they could smell death,
but now I get it, the pungent smell of C. diff. mixed with the mildewy
essence of pseudomonas pneumonia so common in ventilated patients.
marcin
(Marcin)
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