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Critical care

306 articles · Since 2011

Articles, page 14

Physician voices

The decisions that changed this physician’s career

3

I knew the moment when my career in pediatrics was over. I was in the fourth year of my med-peds residency, taking overnight call in the pediatric ICU. Nights were busy, stressful and I was alone. A young boy came…

I knew the moment when my career in pediatrics was over.  I was in the fourth year of my med-peds residency, taking overnight call in the pediatric ICU.  Nights were busy, stressful and I was alone.  A young boy came in as an unrestrained MVA after his father hit another car. Dad was OK (although severely distraught), but the five-year-old towhead boy in front of me was not, with his head immobilized in …

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The decisions that changed this physician’s career

Physician voices

Doctors are not God. Even if some patients want them to be.

I am not God. Nor do I want to be, but I feel sometimes that my patients and their families do. When I entered the ICU early that overcast morning I knew judging from the throng of anxious people waiting…

I am not God.

Nor do I want to be, but I feel sometimes that my patients and their families do.

When I entered the ICU early that overcast morning I knew judging from the throng of anxious people waiting outside that things were not right. He came to me straight away, his eyes haunting and sunken as if he hadn’t slept for the whole night. His body barely able to support …

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Doctors are not God. Even if some patients want them to be.

Patient voices

8 survival tips for families with babies in the NICU

Bringing a child into the world is nothing short of a miracle. It’s not comforting to think about, but even if you do everything “right,” there can always be circumstances beyond your control. Whether you have been told to plan…

Bringing a child into the world is nothing short of a miracle. It’s not comforting to think about, but even if you do everything “right,” there can always be circumstances beyond your control. Whether you have been told to plan for a stay in the NICU or it’s unexpected, here are survival tips from nurses for orienting yourself to the NICU.

1. Try to see your baby as soon as possible. It …

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8 survival tips for families with babies in the NICU

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Conditions and diseases

An ode to a beloved ICU nurse manager

2

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and…

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.

Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.

She had every possible attribute as a …

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An ode to a beloved ICU nurse manager

Conditions and diseases

A startling end to nurse turf wars

2

We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse. We always thought we had the higher acuities.…

We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse.

We always thought we had the higher acuities. We had the critical patients. The multi-system failure patients. The hemodynamically unstable patients.

We had to figure out the lungs, the heart, the kidneys, the brain, the pancreas, the gallbladder, the liver.

And …

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A startling end to nurse turf wars

Medical education

A NICU case that will stay with this medical student forever

“C-section at OR 3,” said the clerk at the neonatal ICU (NICU). We then sped to the prep area to enter the OR as soon as we could. Once geared up, we entered the OR and waited for the new…

“C-section at OR 3,” said the clerk at the neonatal ICU (NICU). We then sped to the prep area to enter the OR as soon as we could.

Once geared up, we entered the OR and waited for the new addition to the NICU family. Mom had no prenatal care, but we knew she had used multiple illicit drugs throughout the pregnancy, she was young, had a history of psychiatric disease, …

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A NICU case that will stay with this medical student forever

Patient voices

A patient’s advice on how to improve the health care experience

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Every patient has a story and an experience, and my patient experience began on July 6, 2004. One month after graduating from high school, I was involved in a near-fatal car accident. My heart shifted across my chest, lungs collapsed,…

Every patient has a story and an experience, and my patient experience began on July 6, 2004.

One month after graduating from high school, I was involved in a near-fatal car accident. My heart shifted across my chest, lungs collapsed, major organs were either lacerated or failed completely, my pelvis was shattered, and I lost 60 percent of my blood. I was airlifted to shock trauma near death and underwent immediate …

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A patient’s advice on how to improve the health care experience

Physician voices

Every day in the hospital, I walk through someone’s personal hell on earth

We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room. “I think you know what I am about to say.”…

We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room.

“I think you know what I am about to say.”

His mother took in a deep sigh, her eyes already swollen from inconsolable tears.

“I think he is dead.”

The whole room sank. We were all punched in the gut by those words.

“Oh my …

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Every day in the hospital, I walk through someone’s personal hell on earth

Conditions and diseases

We have no answers to these unbearable algorithms in life

Jim Morrison of the Doors once sang, "Petition the Lord with prayer ... You cannot petition the Lord with prayer." But we did that. We petitioned. On one side of the ICU, we had an 18-year-old girl, upper middle-class family,…

Jim Morrison of the Doors once sang, “Petition the Lord with prayer … You cannot petition the Lord with prayer.”

But we did that. We petitioned.

On one side of the ICU, we had an 18-year-old girl, upper middle-class family, had everything. Beauty, brains, money, supportive parents, and she was off into this new bright world, choosing her college of choice. A simple surgery led to sepsis, severe sepsis that raged through …

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We have no answers to these unbearable algorithms in life

Health technology

It’s time to disrupt basic communications in hospitals. Here’s one idea.

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I had just taken over three other residents' phones and pagers when 2-year-old “Bryce” jumped off the couch in our oncology unit, landed on his chin, and bit completely through his lower lip. I quickly reviewed his platelet level from…

I had just taken over three other residents’ phones and pagers when 2-year-old “Bryce” jumped off the couch in our oncology unit, landed on his chin, and bit completely through his lower lip. I quickly reviewed his platelet level from that morning, examined him, and began calling plastic surgery and anesthesia for sutures. While I was on one phone, a second one started ringing. I declined the call and tried …

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It’s time to disrupt basic communications in hospitals. Here’s one idea.

Physician voices

We were promised death panels

15

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there's free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma…

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there’s free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We’re prepared to handle them.

“Where is the patient?” I inquired.

“On the way down from ICU. The surgeon’s on his way in,” I was told.

Hmm … …

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We were promised death panels

Health policy

For hospitals to thrive, they need to value nurses

15

Three weeks ago, I changed jobs. I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital. Why? I needed a less stressful position,…

Three weeks ago, I changed jobs.  I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital.  Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting.

I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I …

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For hospitals to thrive, they need to value nurses

Physician voices

The death of a child is an abomination

When, aged thirteen, my best friend died of complications from sickle cell disease, her parents could not attend her funeral or find out where she was buried. My mom explained to me that in the Yoruba culture because parents are…

When, aged thirteen, my best friend died of complications from sickle cell disease, her parents could not attend her funeral or find out where she was buried. My mom explained to me that in the Yoruba culture because parents are not expected to survive their children, it is considered an abomination for a parent to know where their child is buried. So, the young adults in the extended family attended …

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The death of a child is an abomination

Physician voices

I will make a concerted effort every day to do my job with love

Since beginning my medical education, I had been on one side of the curtain; the side where the doctors confer and discuss before telling the patient his or her fate, going from room to room giving updates and prognoses. I…

Since beginning my medical education, I had been on one side of the curtain; the side where the doctors confer and discuss before telling the patient his or her fate, going from room to room giving updates and prognoses. I interacted with patients for the purpose of getting their histories and physical examinations, collecting all the data so that I could present the case to my attending. I was engrossed …

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I will make a concerted effort every day to do my job with love

Physician voices

The myth of critical care

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When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.” Granted, that unfiltered comment came at the…

When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.”  Granted, that unfiltered comment came at the end of a long and sleepless 28-hour shift, but the sentiment holds true.

As doctors, we have a number of tools to assess quality of life in research.  We use fancy …

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The myth of critical care

Physician voices

Working in the ICU, I now know what hell feels like

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I walk up to the ICU. Ecstatic. I just placed a subclavian line, a chest tube, and performed a bronchoscopy on my patient. Intern year is going well, and today is a great day. For me. I have been learning…

I walk up to the ICU. Ecstatic.

I just placed a subclavian line, a chest tube, and performed a bronchoscopy on my patient. Intern year is going well, and today is a great day.

For me.

I have been learning so much, been trusted to do even more, and been a part of gratifying experiences. Successes. Life-changing procedures. Things that still make me sit in awe that we can transform the human body, …

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Working in the ICU, I now know what hell feels like

Physician voices

No textbook can teach doctors the stages of grief

3

It's 2:00 a.m., and the fluorescent bulbs flicker gently overhead along the quiet hallways of the intensive-care unit. Tonight I'm the ICU resident on call, and the weight of that title sits heavily on my shoulders. My team is in…

It’s 2:00 a.m., and the fluorescent bulbs flicker gently overhead along the quiet hallways of the intensive-care unit.

Tonight I’m the ICU resident on call, and the weight of that title sits heavily on my shoulders. My team is in charge of keeping our critically ill patients safe from harm overnight. Although the supervising physician is only a phone call away, I’m the acting team lead for any codes called during …

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No textbook can teach doctors the stages of grief

Conditions and diseases

The end can be sudden in advanced cancer

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It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was…

It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor.

For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis?   The chest …

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The end can be sudden in advanced cancer

Conditions and diseases

The benefits of trauma-informed care in the NICU

When my twin sons were born prematurely at 26 weeks’ gestation, my family’s lives were thrust into the whirlwind of the NICU and living daily with the reality of the babies (William and Elliott) being on life support. Having had…

When my twin sons were born prematurely at 26 weeks’ gestation, my family’s lives were thrust into the whirlwind of the NICU and living daily with the reality of the babies (William and Elliott) being on life support. Having had no prior intense and prolonged experiences with the hospital, and watching helplessly and fretfully as my tiny two-pounders fought for their lives, it’s almost impossible to put into language what …

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The benefits of trauma-informed care in the NICU

Conditions and diseases

The story of how a NICU nurse became a NICU mom

My son Acton is truly a miracle baby because he was not even supposed to be here. I had gone through four years of infertility with three miscarriages and an ectopic pregnancy (pregnancy in my fallopian tube), causing my left…

My son Acton is truly a miracle baby because he was not even supposed to be here. I had gone through four years of infertility with three miscarriages and an ectopic pregnancy (pregnancy in my fallopian tube), causing my left tube to be removed. After my last miscarriage, I was told I was in perimenopause and had less than 1 percent chance of ever getting pregnant again, let alone carrying …

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The story of how a NICU nurse became a NICU mom

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