After the ICU: What Does It Mean to Be 'Okay'?

[xchrom]

http://www.theatlantic.com/health/archive/2013/11/after-the-icu-what-does-it-mean-to-be-okay/281609/



On one of the most extraordinary nights of my first year as a doctor, I admitted a young woman to the intensive care unit who was coughing up blood and barely able to breathe. Just days before, she’d traveled to a hotel somewhere outside of New York City, where she’d received cosmetic injections of liquid silicone into her buttocks. She was 28 years old. Now, the silicone had traveled through her body, showering her lungs.


I’d never been so close to acuity, and there in those moments—as the bleeding in her lungs threatened to suffocate her, as her heart stopped and we started it again—I found myself terrified, but excited, too.

She didn't die that day, nor in the days and weeks that followed. Slowly, her lungs healed. We decreased the doses of the medications that kept her paralyzed and sedated; she started to wake up, nod, and squeeze our hands when we asked. It was awesome. She was going to be okay, I told her parents and husband. We’d saved her.

I've carried that victorious narrative with me for years. I told it again while interviewing for training to become a critical care specialist. But now, working as a physician in the medical intensive care unit myself, I've started to wonder if this is not only a story about the best of medicine today, but the worst of it, too.

[Nitram]

1. Excellent article!

Thanks for posting.

[xchrom]

2. ...

[Warpy]

3. One person I remember was a survivor of equine encephalitis

She'd been tied to a bed in our unit for weeks, her seizures so violent she'd blackened both her eyes and landed on the floor at least once. She told us she didn't remember any of it, but the sound of the alarms on some of the machines clearly spooked her. However, I'd have to say that in her case, it was worth it. She was back to her ranch and living her life, even if certain noises affected her on a subconscious level, even with residual mental fog.

ICU psychosis is more related to sleep deprivation than anything else because people are awakened so frequently by alarms, by the automatic inflation of a blood pressure cuff every 15 minutes, by various around the clock therapists doing treatments. Some of the craziest ones will clear as soon as they go home, surrounded by familiar things.

Some day we'll be able to treat people and have them walk out whole. We're not quite there, yet. There are just enough success stories to keep us trying.