Before Tennessee attempted to execute Christa Gail Pike on September 30, 2026, she wrote something that captured an important distinction between death and dying. Pike, who was sentenced to death for the 1995 murder of nineteen-year-old Colleen Slemmer, wrote, "I…
Before Tennessee attempted to execute Christa Gail Pike on September 30, 2026, she wrote something that captured an important distinction between death and dying. Pike, who was sentenced to death for the 1995 murder of nineteen-year-old Colleen Slemmer, wrote, “I am not afraid to die. I am only nervous about the process.” What made her nervous was not the fact of death itself, but what she might consciously experience …
A young mother arrived in the intensive care unit sick but improving. Overnight, her care was handed to a telemedicine physician on a video screen. By morning she was beyond saving. Keith Corl is an emergency and critical care medicine…
A young mother arrived in the intensive care unit sick but improving. Overnight, her care was handed to a telemedicine physician on a video screen. By morning she was beyond saving. Keith Corl is an emergency and critical care medicine physician who has worked in more than 40 community …
A patient in intensive care gets worse at 2 a.m., and the hospital has no critical care doctor in the building. Chris Gallagher, a cardiologist and founder of Access TeleCare, has spent 15 years building virtual care programs inside hospitals,…
A patient in intensive care gets worse at 2 a.m., and the hospital has no critical care doctor in the building. Chris Gallagher, a cardiologist and founder of Access TeleCare, has spent 15 years building virtual care programs inside hospitals, and he explains why that gap is so hard …
History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those…
History has taught medicine some brutal lessons. Nearly two centuries ago, Ignaz Semmelweis noted a disturbing pattern in the maternity wards of Vienna, Austria. Women cared for by physicians were dying of puerperal fever at dramatically higher rates than those cared for by midwives. The hospital still looked functional, the wards remained open, physicians continued working, and the institution carried on. But something inside the system was profoundly wrong. Semmelweis …
An excerpt from Self-Awareness and Trust: Leading Healthcare Teams from the Inside Out. "Knowing yourself is the beginning of all wisdom." - Widely attributed to Aristotle I had been away from the intensive care unit (ICU) for a couple of…
“Knowing yourself is the beginning of all wisdom.”
– Widely attributed to Aristotle
I had been away from the intensive care unit (ICU) for a couple of weeks. When I came back for a scheduled week of service, I put on my black fleece jacket (the same one I had worn hundreds of times before). As I slid my …
In an early 2026 piece, I criticized the growing practice of outsourcing bedside ICU care to tele-critical care programs. I argued that replacing the in-person work of physicians, nurse practitioners (NPs), and physician assistants (PAs) with remote physicians leads to…
In an early 2026 piece, I criticized the growing practice of outsourcing bedside ICU care to tele-critical care programs. I argued that replacing the in-person work of physicians, nurse practitioners (NPs), and physician assistants (PAs) with remote physicians leads to the lack of a bedside leader, shoddy exams, breaks in the continuity of care, the depersonalization of the doctor-patient relationship, and an overall degradation in the quality of …
An excerpt from Blood Poison: The Untold Story of Sepsis. Eduardo's blood pressure failed to respond to one fluid bolus, then another, and another. We instructed his nurse, Jenny, to start a vasopressor called dopamine while Alex and I prepared…
Eduardo’s blood pressure failed to respond to one fluid bolus, then another, and another. We instructed his nurse, Jenny, to start a vasopressor called dopamine while Alex and I prepared to place a central venous catheter in Eduardo’s internal jugular vein. (Dopamine also increases heart rate and cardiac muscle contractility. Although doctors classify drugs as vasopressors and inotropes, many of …
I did not expect the red-carpet treatment. My illness came on abruptly, without a prodrome and without the courtesy of localizing symptoms, no cough, dysuria, or obvious source of infection. One weekday morning, after stepping out of a hot shower,…
I did not expect the red-carpet treatment. My illness came on abruptly, without a prodrome and without the courtesy of localizing symptoms, no cough, dysuria, or obvious source of infection.
One weekday morning, after stepping out of a hot shower, I collapsed onto the bathroom tile like a heap of wet seaweed. I attributed it to overwork, dehydration, and the predictable consequences of caring for everyone except myself. By the time …
The narrative in a recent essay on tele-critical care is wrenching, and the case it describes deserves the somber consideration that any preventable death in the intensive care unit (ICU) demands. Its indictment of tele-critical care, however, conflates a single…
The narrative in a recent essay on tele-critical care is wrenching, and the case it describes deserves the somber consideration that any preventable death in the intensive care unit (ICU) demands. Its indictment of tele-critical care, however, conflates a single tragic outcome with the totality of an evidence base that, taken as a whole, supports the careful expansion of ICU telemedicine, not its retreat. To frame tele-critical care as …
After working close to 20 years in this medical-surgical ICU, I thought I was an expert. Infallible. I could do it all. I left my ICU comfort zone, my lifelong nurse friends, and ventured out. Nothing could stop me. For…
After working close to 20 years in this medical-surgical ICU, I thought I was an expert. Infallible. I could do it all.
I left my ICU comfort zone, my lifelong nurse friends, and ventured out. Nothing could stop me.
For a different hospital system, I became a critical care resource nurse.
This very large hospital system would dictate what unit I would go to and for how long. I truly thought I could …
To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who…
To those who would speak too quickly, to those shaping narratives without knowing the weight of the work, and to those of us still standing, I write this as a physician, as a colleague in medicine, and as someone who understands, intimately, what it means to stand at the threshold between life and death. Not as an idea, not as rhetoric, but as responsibility.
Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing…
Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing in my practice: “pneumonia” cases that don’t behave like pneumonia, young lungs that look like ARDS, and hypoxic patients whose imaging and labs do not match the story, until someone …
School had just started for the new school year. It was hot and humid. I had just retired from ICU nursing and behavioral health, a 46-year career and never skipping a beat. After several months of retirement, I couldn't sit…
School had just started for the new school year. It was hot and humid. I had just retired from ICU nursing and behavioral health, a 46-year career and never skipping a beat. After several months of retirement, I couldn’t sit still. I was bored and had that nagging feeling that I wasn’t done yet with my career. Maybe that nagging feeling was guilt. Like you can’t quit. You can’t stop. …
We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally. I learned quickly that nursing was not all about holding hands with a sick…
We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally.
I learned quickly that nursing was not all about holding hands with a sick child in the emergency room or fluffing up a pillow for a dying grandma. My initiation into the dark side of nursing began in the emergency department. I was fresh out …
We ran as fast as we could. I glanced up occasionally at the nurse straddling my patient, her blonde waves obscuring her face as she furiously attempted to restart a non-beating heart. We pushed the hospital bed down hallways and…
We ran as fast as we could. I glanced up occasionally at the nurse straddling my patient, her blonde waves obscuring her face as she furiously attempted to restart a non-beating heart. We pushed the hospital bed down hallways and around corners, narrowly missing people-filled stretchers lining the Emergency Department. I stood in the back while the experts took over. If she was ready to leave this world, I wanted …
An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was…
An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was cheap and, even better, considered a “legal high” as it was not detectable in drug tests. Josh came to the emergency room psychotic, paranoid, and hallucinating, with hypertension and SVT. …
When my son was in the neonatal intensive care unit (NICU), it felt like the end of the world. But the world did not end. Instead, my whole self was born. And I knew that I would carry this experience…
When my son was in the neonatal intensive care unit (NICU), it felt like the end of the world. But the world did not end. Instead, my whole self was born. And I knew that I would carry this experience into the classroom.
I had been an award-winning professor for seven years before I found myself pacing the sterile aisle between cribettes on the many early morning hours when my newborn …
This story has been fictionalized. Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306745014-K. OK. Next. Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306928906-K. We finish checking the emergency release blood…
This story has been fictionalized.
Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306745014-K.
OK. Next.
Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306928906-K.
We finish checking the emergency release blood and wait. We know that whatever was coming up isn’t going to be pretty. A lung transplant gone bad, uncontrolled hemorrhaging, 14 hours on the table. So much blood transfused, an exploratory laparotomy was …
For a while, I enjoyed telling Dave's story. In the beginning, I found it therapeutic. It was just as unbelievable to me as it was to the person I was telling it to. Somewhere along the line, telling the story…
For a while, I enjoyed telling Dave’s story. In the beginning, I found it therapeutic. It was just as unbelievable to me as it was to the person I was telling it to. Somewhere along the line, telling the story of Dave’s accident and the health care nightmare that followed became more matter of fact. Then, it became heavy.
What I didn’t tell most is that Dave’s injury took more than …
Room 1, ICU — Love on life support This was a busy Saturday in 2022. 06:45 — I walk into the unit and spot a gray-haired man pacing outside Room 1. Clothes rumpled, air sharp with sweat. The moment he…
Room 1, ICU — Love on life support
This was a busy Saturday in 2022.
06:45 — I walk into the unit and spot a gray-haired man pacing outside Room 1. Clothes rumpled, air sharp with sweat. The moment he catches my white coat he stops.
“Doctor, any updates for me?”
Through the glass I glimpse his world: a woman in her
