Saturday, January 3, 2009

"It's a very odd experience, how this is starting to feel normal"

Over the past few days, I spent some time with a friend's family in the ICU waiting room.

It was an interesting experience for me- it certainly useful every once in a while to remember how things feel from the perspective of patients and there family.

One of the things I gained from the experience is the perspective that overall, modern medicine is a wonderful thing. There are a lot of complaints with the flaws in medicine, and we have all experienced our shares of frustrations. But overall, modern medicine can do some amazing things. This is particularly true at the University of Pittsburgh- I have been thoroughly impressed since I have come here with the overall quality of care, both technically, and just the general sense of humanity. This was over a holiday week (New Years), and the number of people working at UPMC who tirelessly extended themselves to take care of the patients and their families impressed me. I was proud to be part of the organization.

I was also impressed by the love family can bring to a patient. In the waiting room of the ICU, a few families were camped out. Some had not left the side of their loved ones for weeks at a time. As a physician, I was vaguely aware that families stay at the hospital to be with their loved ones, but I had never actually seen it first hand.

One thing was striking is how disorienting the experience is in terms of sense of time. Staying bunkered in the waiting rooms completely removes you from those external cues that separate morning from night. One day just blends into the next.

Another thing that was evident to me was the toll the human body takes from the lack of movement. This is true of the patients, but you also see it in the family members who are staying with the patients. Between the lack of exercise and the ample amounts of caffeine most family members consume, plus the intense emotional toll of their loved ones being sick, nearly everyone in the ICU waiting room was shaking their legs vigorously while they sat.

One of the family members said to me "it's a very odd experience, how this is starting to feel normal." I know what he meant, and I agree it is odd.

I was fortunate enough to make it through medical school without any patients dying on me. I remember the first time a patient of mine died- I was an intern in Cooperstown, NY. I wasn't expecting it at all- of the hundreds of patients I had seen that year, the one who died was by no means the sickest. But all of a sudden, there she was- just moments earlier she had been breathing and had a pulse, and now she lay motionless.

I had worked closely with a medical student that month, and the two of us just went into a back room, and I cried. For a long time- probably an hour. I had seen dead people before, but I had never seen someone die- actually go through the process of dying to the point where they were dead. And having lived through it, the experience was definitely not normal.

I can't say that I am used to the experience now- my line of work does not lend itself to patients dying very often. But I don't know that I would cry for an hour anymore. I don't think I am particularly jaded, but the process of death is just, well, more normal for me. And as my friend said to me the other day in the ICU, when I reflect on it, is very odd when the process starts feeling normal.

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