Critical care

306 articles · Since 2011

Articles, page 15

A reminder of life’s pale blue dots

December 28, 2015Dec 28, 2015

February 14th, 1990 was not any extraordinary Valentine’s Day here on Earth. Couples dined, candles flickered, hands were held. On a day characterized by love, companionship, and joy, an enormous marvel of human ingenuity named Voyager One was embarking on a solitary trip into the cosmos. Initially launched 13 years previous by NASA to explore the universe, this spacecraft stood alone in the silent void of deep space, six billion …

Read more…

A reminder of life’s pale blue dots

Conditions and diseases

A nurse by herself. At the end of a life.

Amanda Anderson, RN

October 13, 2015Oct 13, 201513

I softly scrub blood from the teeth of a man who died moments ago. From the chair where I sat quietly writing nursing notes while he quietly ended, my patient's sallow skin and sunken cheeks looked so peaceful. But the…

I softly scrub blood from the teeth of a man who died moments ago. From the chair where I sat quietly writing nursing notes while he quietly ended, my patient’s sallow skin and sunken cheeks looked so peaceful. But the weeks of stagnant residue on his teeth bothered me.

To brush the teeth of someone who was in the process of dying would have contradicted my orders to provide comfort care, …

Conditions and diseases

Patient autonomy is held to be sacrosanct. A doctor reconsiders this view.

Anonymous

September 26, 2015Sep 26, 201585

The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Physician voices

Finding compassion for the choice a patient made

Suzanne Minor, MD

September 8, 2015Sep 8, 20152

Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He'd been admitted the previous night with seizures and cardiac arrhythmia. Joined by my husband, we made our…

Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He’d been admitted the previous night with seizures and cardiac arrhythmia.

Joined by my husband, we made our way to the ICU. When she saw Guillermo lying immobile, swollen and unresponsive, with a breathing tube in his mouth and other tubes snaking into his chest from IV poles, Sophie …

Physician voices

Avoiding a senseless, costly coda to a mother’s life

Benjamin Schnapp, MD

September 7, 2015Sep 7, 2015

“Tell me about your mother.” That is always how it begins. There was never quite enough time the last few years, time to put her affairs in order, time to talk about the unpleasantness that comes at the end of…

“Tell me about your mother.”

That is always how it begins. There was never quite enough time the last few years, time to put her affairs in order, time to talk about the unpleasantness that comes at the end of life. Now here we were, standing watch beside her stretcher in the emergency room. Upstairs was the grim certainty of the intensive care unit, the ceaseless beep-beep-beep of the life-support machines, …

Physician voices

When doctors pass the buck: The ugly side of a shift-work mentality

Tracey Delaplain, MD

September 1, 2015Sep 1, 201522

"I'm just the night doc," you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was "just the patient," who lay suffering hours…

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to …

Physician voices

Medical treatment has its limits. Empathy does not.

Caroline Tredway, MD

August 29, 2015Aug 29, 20152

“This is our sickest patient,” my co-intern began as she told me about one of her patients I would care for overnight. It was my first week of intern year, and I was assigned the overnight cross-cover shift for a busy cardiology service. Introducing myself as “Dr. Tredway” still rolled awkwardly off my tongue, but I had grown more comfortable throughout the week in my new role as a physician. …

Physician voices

The price of certainty in the ICU

Tom Peteet, MD, MPH, MEd

August 19, 2015Aug 19, 20153

Mr. J was as close to a typical sixty-year-old patient as possible, wary of doctors and selective in when he took his blood pressure medications. On a sunny Thursday, he woke up nauseated and called an ambulance. During evaluation in the emergency room, his blood pressures reached atmospheric levels (nearly 300 systolic). He began seizing, which soon stopped and was transferred to the ICU. As the admitting resident, I dutifully …

Read more…

The price of certainty in the ICU

Physician voices

Despite the problems in health care, most of us still care

Rob Lamberts, MD

August 2, 2015Aug 2, 20153

I got a call from a patient who had a family member sick and in the ICU. She wondered if I could come over "to offer support." Even though the family member wasn't a patient, I thought it would be…

I got a call from a patient who had a family member sick and in the ICU. She wondered if I could come over “to offer support.” Even though the family member wasn’t a patient, I thought it would be good to go.

The ICU brought on flashbacks to my residency years, in which I spent a lot of time in the ICU. …

Conditions and diseases

Doctors and nurses need to be better trained in palliative care

Anonymous

July 15, 2015Jul 15, 2015

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision-making in the ICU in a large survey published in JAMA Internal Medicine. About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life…

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision-making in the ICU in a large survey published in JAMA Internal Medicine.

About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1 to 7 scale. Doctors and nurses considered the largest barriers to end-of-life …

Physician voices

We all have the ability to touch other people’s lives every day

Hope Amantine, MD

June 1, 2015Jun 1, 2015

There was once a woman whom I met for the first time when she came to the ER, on death's door, metaphorically. I told her and her family just how seriously ill she was, and how slim the chances of…

There was once a woman whom I met for the first time when she came to the ER, on death’s door, metaphorically. I told her and her family just how seriously ill she was, and how slim the chances of survival. We all agreed on that day to take a shot at it — at survival, that is — despite lousy …

Physician voices

A powerful reminder of medicine’s humbling nature

Chiduzie Madubata, MD

May 27, 2015May 27, 2015

“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.” The coronary care…

“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.”

The coronary care unit (CCU) rotation is a unique place. Postoperative cardiothoracic surgery patients among many other pathologies from heart failure to heart transplant fill the unit, and it is the job of the …

Patient voices

What you say matters: An insensitive comment in the ICU

Lisa Goodman-Helfand

May 26, 2015May 26, 201530

Rarely are health care professionals given the opportunity to truly ponder a crucial aspect of patient care; the truth behind what it feels like to lie in a hospital bed, vulnerable, disoriented, and stripped of every basic human dignity. I have spent over 300 days as a patient in hospitals and more than three decades in and out of doctor’s offices and testing facilities. I have a profound respect for …

Patient voices

Fighting high health costs. Because I can.

Christen McCurdy

February 3, 2015Feb 3, 201512

Sometime while I was still in high school, my mom began to have trouble breathing. She had never had asthma before; an albuterol inhaler helped for a while. Still, cold season was a nightmare, and later, so was allergy season,…

After college, I moved back in with my parents. She fought her way through the cold season, dutifully driving 20 miles (and later 40, …

Medical education

A resident working in the ICU: What you cannot control scares you

Emilie Y. Prot, DO

January 19, 2015Jan 19, 20152

In respectful memories of Benson, Rose, and Sandy. I want to thank each one of them for helping me become a better physician. I stepped into the intensive care unit with a feeling of apprehension. I knew deep down, the…

In respectful memories of Benson, Rose, and Sandy. I want to thank each one of them for helping me become a better physician.

I stepped into the intensive care unit with a feeling of apprehension. I knew deep down, the patients I was going to care for were sick patients. Their status could change at any time. This was my first week on the ICU as a resident physician.

Benson needed emergent …

Physician voices

Witness to a patient, losing her life in front of us

PalMD

December 15, 2014Dec 15, 20144

She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding.

People …

Health policy

Nurses also have to confront to costs of care

Caroline Smith, RN

October 22, 2014Oct 22, 2014

As I finish my post-operative care routine for my 9-day-old patient, I notice that the cerebral oximetry machine is not picking up a strong signal. Despite troubleshooting, I am unable to figure out how to fix the problem, and I head to the Pixus to get a new sensor. Unfortunately, this one does not work either, and we must use a smaller sensor to pick up an adequate signal on …

Physician voices

Caring for the patient despite a vast difference in culture

Jim deMaine, MD

June 7, 2012Jun 7, 2012

I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, …

Physician voices

Reduce sedation in critically ill patients

a medical resident, MD

December 20, 2011Dec 20, 20112

I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking …

Critical care

Articles, page 15

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular