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Authors: Tilda Shalof
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ICU , I couldn’t get any closer to the bedside. Besides, why would I leave when I haven’t mastered it? I’m still trying to get it right.
“You’re just here for the stories,” some nurses tease me.
I’ll admit it – I’m an adrenalin junkie, getting high on the drama and action and grappling with the various complicated ethicaldilemmas, but my real fix is stories. I never tire of being let into my patients’ lives. I’m insatiably curious about the multitude of challenges that people face and the infinite ways they respond to them.
As fascinating as it all is, I rarely let outsiders into my world. I don’t tell my friends or family much. When I do, they either don’t get it or it makes them worry about themselves – or me. Then I have to reassure them that I’m okay.
This is what I’ve chosen, what I love to do
. I have never nursed sick children, worked in disaster zones in the aftermath of earthquakes or floods. I’ve never taken care of trauma victims, women in labour, or babies, only critically ill adults. Violence, cruelty, trauma, abuse are harder for me to compute, but illness, disease, and existential suffering make more sense to me.
Our patients have complicated metabolic diseases, overwhelming infections, or rare auto-immune disorders; many have undergone major thoracic (chest) or abdominal surgeries or organ transplants. Some have multiple organ failure; few have only one thing wrong with them. Many, but by no means all, are elderly. In all cases, outcomes are uncertain. But there is one thing there’s no getting around: our patients suffer. We do our best to ameliorate their discomfort, but there’s no denying it. At times, it’s hard to tell the difference between the suffering caused by the illness and that caused by the treatments. More than anything, there are always more questions than answers, way more problems than solutions. “We’re like
CSI
detectives,” one nurse said, “always gathering evidence, building a case, trying to solve puzzles.”
After the mystery is “solved,” more or less, our patients move on to a step-down unit or a medical or surgical floor. When they eventually go home, they don’t usually stay in touch, but a few do. One grateful patient took the time to write to us recently:
You first met me as a very sick patient on the verge of death. Tomorrow I will be transferred to the rehab centre. You kept me alive to make this possible. I am so grateful for your skills and care. My two grandchildren will now see much more of grandma. Bill and I will continue to grow old together and enjoy ourselves. Thank you from the bottom of my heart …
It’s lovely to hear from them, but those aren’t the ones we get to know as we do the ones that end up with complications, whose paths are rocky and turbulent. They loom larger in our psyches. In other parts of the hospital there are faster turnarounds, even “miraculous” recoveries, but here, triumphs are hard-won and tenuous; progress more fragile, usually partial and imperfect. It’s more of a slogging away, a day at a time, two steps forward, one back, or one step forward and two back.
Down seven, up eight
.
And yes, over the years, I have seen many deaths. I once had an argument with an administrator who designed a poster to represent our ICU . She chose a photograph of a sunset and a tree, the light glinting through the leaves at sunset. It sends the wrong image, I insisted. People come here to fight. The pastoral beauty of nature is not what inspires them here; they want cutting-edge science and sophisticated technology. This is not a hospice or a place to die – at least not at first. We admit a patient to the ICU because we believe we can make them better – at least it starts off that way.
But not everything can be fixed and death can’t always be “cheated,” as we like to believe. Those of us who’ve worked here for any length of time have seen too much of the other side of things – or
“You’re just here for the stories,” some nurses tease me.
I’ll admit it – I’m an adrenalin junkie, getting high on the drama and action and grappling with the various complicated ethicaldilemmas, but my real fix is stories. I never tire of being let into my patients’ lives. I’m insatiably curious about the multitude of challenges that people face and the infinite ways they respond to them.
As fascinating as it all is, I rarely let outsiders into my world. I don’t tell my friends or family much. When I do, they either don’t get it or it makes them worry about themselves – or me. Then I have to reassure them that I’m okay.
This is what I’ve chosen, what I love to do
. I have never nursed sick children, worked in disaster zones in the aftermath of earthquakes or floods. I’ve never taken care of trauma victims, women in labour, or babies, only critically ill adults. Violence, cruelty, trauma, abuse are harder for me to compute, but illness, disease, and existential suffering make more sense to me.
Our patients have complicated metabolic diseases, overwhelming infections, or rare auto-immune disorders; many have undergone major thoracic (chest) or abdominal surgeries or organ transplants. Some have multiple organ failure; few have only one thing wrong with them. Many, but by no means all, are elderly. In all cases, outcomes are uncertain. But there is one thing there’s no getting around: our patients suffer. We do our best to ameliorate their discomfort, but there’s no denying it. At times, it’s hard to tell the difference between the suffering caused by the illness and that caused by the treatments. More than anything, there are always more questions than answers, way more problems than solutions. “We’re like
CSI
detectives,” one nurse said, “always gathering evidence, building a case, trying to solve puzzles.”
After the mystery is “solved,” more or less, our patients move on to a step-down unit or a medical or surgical floor. When they eventually go home, they don’t usually stay in touch, but a few do. One grateful patient took the time to write to us recently:
You first met me as a very sick patient on the verge of death. Tomorrow I will be transferred to the rehab centre. You kept me alive to make this possible. I am so grateful for your skills and care. My two grandchildren will now see much more of grandma. Bill and I will continue to grow old together and enjoy ourselves. Thank you from the bottom of my heart …
It’s lovely to hear from them, but those aren’t the ones we get to know as we do the ones that end up with complications, whose paths are rocky and turbulent. They loom larger in our psyches. In other parts of the hospital there are faster turnarounds, even “miraculous” recoveries, but here, triumphs are hard-won and tenuous; progress more fragile, usually partial and imperfect. It’s more of a slogging away, a day at a time, two steps forward, one back, or one step forward and two back.
Down seven, up eight
.
And yes, over the years, I have seen many deaths. I once had an argument with an administrator who designed a poster to represent our ICU . She chose a photograph of a sunset and a tree, the light glinting through the leaves at sunset. It sends the wrong image, I insisted. People come here to fight. The pastoral beauty of nature is not what inspires them here; they want cutting-edge science and sophisticated technology. This is not a hospice or a place to die – at least not at first. We admit a patient to the ICU because we believe we can make them better – at least it starts off that way.
But not everything can be fixed and death can’t always be “cheated,” as we like to believe. Those of us who’ve worked here for any length of time have seen too much of the other side of things – or
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