Icu Quotes

Flickering lights anonymous doors my heart escaping in drips i'm still waking up but she's still sleeping this ICU is hotel for the dead

I was an angel in heaven for two days or at least I thought I was. Really I was whacked out on drugs and in ICU.

Augustus Waters died eight days after his prefuneral, at Memorial, in the ICU, when the cancer, which was made of him, finally stopped his heart, which was also made of him.

They remained imprisoned in the CICU, kept alive in physicality by mechanical devices and medicinal support, inexorably suffering. I revered their resiliency, though I struggled to understand whether they were truly resilient or if this was a descriptive term I used to assure myself that what we were doing was just. Could they merely represent physical beings at this point, molecular derivatives of carbon and water, void of souls that had moved on months prior once the universe had delivered their inevitable fate, simply kept alive by us physicians, who ourselves clutched desperately to the most favored of our prehistoric binary measures of success: life?

Van Houten, I’m a good person but a shitty writer. You’re a shitty person but a good writer. We’d make a good team. I don’t want to ask you any favors, but if you have time – and from what I saw, you have plenty – I was wondering if you could write a eulogy for Hazel. I’ve got notes and everything, but if you could just make it into a coherent whole or whatever? Or even just tell me what I should say differently. Here’s the thing about Hazel: Almost everyone is obsessed with leaving a mark upon the world. Bequeathing a legacy. Outlasting death. We all want to be remembered. I do, too. That’s what bothers me most, is being another unremembered casualty in the ancient and inglorious war against disease. I want to leave a mark. But Van Houten: The marks humans leave are too often scars. You build a hideous minimall or start a coup or try to become a rock star and you think, “They’ll remember me now,” but (a) they don’t remember you, and (b) all you leave behind are more scars. Your coup becomes a dictatorship. Your minimall becomes a lesion. (Okay, maybe I’m not such a shitty writer. But I can’t pull my ideas together, Van Houten. My thoughts are stars I can’t fathom into constellations.) We are like a bunch of dogs squirting on fire hydrants. We poison the groundwater with our toxic piss, marking everything MINE in a ridiculous attempt to survive our deaths. I can’t stop pissing on fire hydrants. I know it’s silly and useless – epically useless in my current state – but I am an animal like any other. Hazel is different. She walks lightly, old man. She walks lightly upon the earth. Hazel knows the truth: We’re as likely to hurt the universe as we are to help it, and we’re not likely to do either. People will say it’s sad that she leaves a lesser scar, that fewer remember her, that she was loved deeply but not widely. But it’s not sad, Van Houten. It’s triumphant. It’s heroic. Isn’t that the real heroism? Like the doctors say: First, do no harm. The real heroes anyway aren’t the people doing things; the real heroes are the people NOTICING things, paying attention. The guy who invented the smallpox vaccine didn’t actually invented anything. He just noticed that people with cowpox didn’t get smallpox. After my PET scan lit up, I snuck into the ICU and saw her while she was unconscious. I just walked in behind a nurse with a badge and I got to sit next to her for like ten minutes before I got caught. I really thought she was going to die, too. It was brutal: the incessant mechanized haranguing of intensive care. She had this dark cancer water dripping out of her chest. Eyes closed. Intubated. But her hand was still her hand, still warm and the nails painted this almost black dark blue and I just held her hand and tried to imagine the world without us and for about one second I was a good enough person to hope she died so she would never know that I was going, too. But then I wanted more time so we could fall in love. I got my wish, I suppose. I left my scar. A nurse guy came in and told me I had to leave, that visitors weren’t allowed, and I asked if she was doing okay, and the guy said, “She’s still taking on water.” A desert blessing, an ocean curse. What else? She is so beautiful. You don’t get tired of looking at her. You never worry if she is smarter than you: You know she is. She is funny without ever being mean. I love her. I am so lucky to love her, Van Houten. You don’t get to choose if you get hurt in this world, old man, but you do have some say in who hurts you. I like my choices. I hope she likes hers.

The entire belief was insulting to many of us, but nonetheless, the term “top trained,” which would come to be regurgitated with great regularity by hospital administration and by Dr. Kowatch, would eventually evolve to become what I would describe as an unhealthy infatuation, one that I now understand represented the developing disconnect between the majority of the Heart Center team and hospital administration, which would ultimately have detrimental effects on the program, which would become visible to all in the near future.

So how’s it going?” “Okay. Glad to be home, I guess. Gus told me you were in the ICU?” “Yeah,” I said. “Sucks,” he said. “I’m a lot better now,” I said. “I’m going to Amsterdam tomorrow with Gus.” “I know. I’m pretty well up-to-date on your life, because Gus never. Talks. About. Anything. Else.

Just before you went into the ICU, I started to feel this ache in my hip.” “No,” I said. Panic rolled in, pulled me under. He nodded. “So I went in for a PET scan.” He stopped. He yanked the cigarette out of his mouth and clenched his teeth. Much of my life had been devoted to trying not to cry in front of people who loved me, so I knew what Augustus was doing. You clench your teeth. You look up. You tell yourself that if they see you cry, it will hurt them, and you will be nothing but A Sadness in their lives, and you must not become a mere sadness, so you will not cry, and you say all of this to yourself while looking up at the ceiling, and then you swallow even though your throat does not want to close and you look at the person who loves you and smile. He flashed his crooked smile, then said, “I lit up like a Christmas tree, Hazel Grace. The lining of my chest, my left hip, my liver, everywhere.

The hospital will never be healthy for patients if it's not a healthy environment for nurses, where their voices are heard and where they can care for their patients and use the full extent of their knowledge, abilities, and skills. After all, hospitals today have become one big intensive care unit: all patients need intensive caring.

I've gotta something more important to offer, something I'm sure mom cares about more than anything. "Mommy, I am... so skinny right now. I'm finally down to 89 pounds." I'm in the ICU with my dying mother, and the thing that I'm sure will get her to wake up, is the fact that in the days since mom has been hospitalized, my fear and sadness have morphed into the perfect anorexia motivation cocktail, and finally I have achieved mom's current goal weight for me: 89 pounds.

As Christians, if sin were the reason for our afflictions, then we should all be in ICU" ~ R. Alan Woods [2012]

Go get your gun because God won't show. He sent a poet instead. The Don Quixote of the ICU. Quite impressive for a cripple. Munchhausen by proxy of a muse. Tempt not a desperate man. This split lip is for you. I traded it for an outdated tooth.

Many marriages would have been laid to rest a long time ago, if they were not on a life-support machine called other people’s opinions and/or expectations.

This book was started during the first wave of COVID pandemic, when pictures of bodies loaded into refrigerated trucks were coming out of New York. It came about because an ICU nurse emailed us and asked us to post something, anything, because reading our work on her short break between grueling shifts kept her sane.

We learn that hospitals have run out of ICU beds to treat gravely ill Covid-19 patients, but we do not learn of the decades-long series of choices that led to a U.S. healthcare system that privileged efficiency over capacity. This flood of information without context can so easily, and so quickly, transform into misinformation.

I liked it all, but most of all I liked the fact that although the play was entirely focused on Quintana there were, five evenings and two afternoons a week, these ninety full minutes, the run time of the play, during which she did not need to be dead. During which the question remained open. During which the denouement had yet to play out. During which the last scene played did not necessarily need to be played in the ICU overlooking the East River. During which the bells would not necessarily sound and the doors would not necessarily be locked at six. During which the last dialogue heard did not necessarily need to concern the vent. Like when someone dies, don't dwell on it.

ICU is a hard place for me since it’s often the last stop for our sickest patients.

Hospitals strip a lot from you—your independence, your confidence, sometimes your will to live. But pettiness too. Pettiness is the first casualty of the ICU waiting room. No one has the energy for it.

I can now afford to think about her. I no longer cry when I hear her name. I no longer imagine the transporter being called to take her to the morgue after we left the ICU. Yet I still need her with me.

I knew why he hadn’t said anything, of course: the same reason I hadn’t wanted him to see me in the ICU. I couldn’t be mad at him for even a moment, and only now that I loved a grenade did I understand the foolishness of trying to save others from my own impending fragmentation: I couldn’t unlove Augustus Waters. And I didn’t want to.

How can a health service so stripped of spare capacity cope with the demands of a once-ina-lifetime global pandemic? I bite my lip and think longingly of Germany’s twenty-nine intensive care beds per 100,000 people – four times the number of ICU beds in Britain

Gate C22 At gate C22 in the Portland airport a man in a broad-band leather hat kissed a woman arriving from Orange County. They kissed and kissed and kissed. Long after the other passengers clicked the handles of their carry-ons and wheeled briskly toward short-term parking, the couple stood there, arms wrapped around each other like he’d just staggered off the boat at Ellis Island, like she’d been released at last from ICU, snapped out of a coma, survived bone cancer, made it down from Annapurna in only the clothes she was wearing. Neither of them was young. His beard was gray. She carried a few extra pounds you could imagine her saying she had to lose. But they kissed lavish kisses like the ocean in the early morning, the way it gathers and swells, sucking each rock under, swallowing it again and again. We were all watching– passengers waiting for the delayed flight to San Jose, the stewardesses, the pilots, the aproned woman icing Cinnabons, the man selling sunglasses. We couldn’t look away. We could taste the kisses crushed in our mouths. But the best part was his face. When he drew back and looked at her, his smile soft with wonder, almost as though he were a mother still open from giving birth, as your mother must have looked at you, no matter what happened after–if she beat you or left you or you’re lonely now–you once lay there, the vernix not yet wiped off, and someone gazed at you as if you were the first sunrise seen from the Earth. The whole wing of the airport hushed, all of us trying to slip into that woman’s middle-aged body, her plaid Bermuda shorts, sleeveless blouse, glasses, little gold hoop earrings, tilting our heads up.

Jesse stirs again. This time his fingers twitch. As much as I want to see him open his eyes, I can’t be here for that. It’ll make leaving him too hard. I turn toward the doorway and I’m outside in the main room of the ICU when I hear his weakened voice say, “Winter?” I hurry back to the waiting area. Hopefully he’ll think he dreamed me. Maybe he did. Sometimes I feel like I’m not even real anymore

God is too wise to be mistaken, God is too good to be unkind. So when you don’t understand When you don’t see His plan, When you can’t trace His hand, Trust His heart.

steps from the ICU, so she could check on me at night. She and my father also lent their voices.

bleak news breaks in the Health Service Journal that Northwick Park Hospital in Harrow has been forced to declare a critical incident after running out of ICU beds.

ICU seems to be staffed by good, smart young docs who think they know everything, and wise RN’s who really do.

The surgical ICU had its surgeons and anesthesiologists, doctors who wrote the shortest and most indecipherable notes. The notes reminded me of haikus, and because I wasn’t a literary person, I called my time in this unit difficult poetry.

If internal pain showed on the outside I'd be in ICU for the rest of my life. No amount of stitches could staunch the bleeding of my broken heart. The sadness dilutes my blood. I'd never scab, I'd bleed to death. Then, finally, the pain would end. I'm

Mom once snuck me into a casino. We were going on vacation to Crater Lake and we stopped at a resort on an Indian reservation for the buffet lunch. Mom decided to do a bit of gambling, and I went with her while Dad stayed with Teddy, who was napping in his stroller. Mom sat down at the dollar blackjack tables. The dealer looked at me, then at Mom, who returned his mildly suspicious glance with a look sharp enough to cut diamonds followed by a smile more brilliant that any gem. The dealer sheepishly smiled back and didn’t say a word. I watched Mom play, mesmerized. It seemed like we were in there for fifteen minutes but then Dad and Teddy came in search of us, both of them grumpy. It turned out we’d been there for over an hour. The ICU is like that.

She’d replied with something she’s never said aloud before: “There’s nothing in the world I want more than a child.” The words had felt exposing. There’d been no hiding the desperation in her voice. But she’d wanted Whitney to know that she’d still choose to be a mother, even if she knew it would end this way, in an ICU bed.

You’re safe, I remembered whispering to Quintana when I first saw her in the ICU at UCLA. I’m here. You’re going to be all right. Half of her skull had been shaved for surgery. I could see the long cut and the metal staples that held it closed. She was again breathing only through an endotracheal tube. I’m here. Everything’s fine . . . I would take care of her. It would be all right. It also occurred to me that this was a promise I could not keep. I could not always take care of her. I could not never leave her. She was no longer a child. She was an adult. Things happened in life that mothers could not prevent or fix. —JOAN DIDION, The Year of Magical Thinking

The ICU was not the thrill ride I had expected. Turns out, they never called the high school student in from the reception desk to assist the doctors in lifesaving procedures. Instead, the job entailed hours of watching incredibly worried families wander in and out of the waiting room to use the restroom and retrieve cups of coffee.

We don’t die well in America. Ask people where do you want to die, and they will tell you, at home with their loved ones. But most of us die in an ICU. The biggest taboo in America is the conversation about death. Sure, it’s gotten better; now we have hospices, which didn’t exist not so long ago. But to a doctor, it’s still an insult to let a patient go.

The relentless malpractice of deliberately withholding early effective COVID treatments, of forcing the use of toxic remdesivir, may have unnecessarily killed up to 500,000 Americans in hospitals. Dr. Kory says so plainly: “Dr. Fauci’s suppression of early treatments will go down in history as having caused the death of a half a million Americans in the ICU.

Impatience often makes us patients.

malignant normality.

No one chooses to be a patient, but everyone can choose to keep sight of the person in the hospital gown.

Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or “It’s okay” or “I’m sorry” or “I love you.

Its's not enough to keep people from dying. We have to save the life that they want to return to, the one they had before they came to us." This was critical care nurse Mary Ann Barnes-Daly's mantra...

Nearly everyone who is asked where they want to spend their final days says at home, surrounded by people they love and who love them. That's the consistent finding of surveys and, in my experience as a doctor, remains true when people become patients. Unfortunately, it's not the way things turn out. At present, just over one-fifth of Americans are at home when they die. Over 30 percent die in nursing homes, where, according to polls, virtually no one says they want to be. Hospitals remain the site of over 50 percent of deaths in most parts of the country, and nearly 40 percent of people who die in a hospital spend their last days in ICU, where they will likely be sedated or have their arms tied down so they will not pull out breathing tubes, intravenous lines, or catheters. Dying is hard, but it doesn't have to be this hard.

The nurse smiled and gestured to two cameras pointing at each patient—one to monitor the patient himself, the other to observe the charts. The nurse told us that these were fed by Skype directly into the intensive care unit in one of the hospitals in Washington, DC, where there was a Syrian-American ICU specialist looking at the monitors twenty-four hours a day, and adjusting the patient’s medication and ventilation based on the clinical parameters.

So anyway. If I let Corey take me out again, he’s got this buddy – Kyle maybe? Dunno – anyway, he’s single. Maybe you could come along and we could go doubles.” Lisa thought being involved in a shop class accident sounded more fun, but she managed a somewhat pleasant expression, or so she hoped. “Isn’t Kyle the one who spent a week in ICU after he tried to jump over a UPS truck with his bike?” “I think so. Why?” Lisa sighed. “If I have to explain it…

He eased the door open, scanned right and left, then slid into the corridor and into the room across it. Machines beeped and hummed, monitoring whatever poor bastard lay in the bed. Staying out of the range of the camera, he slithered against the wall until he could aim the jammer he carried. Even as the alarm sounded he was out and into the next room before the ICU team came running. He repeated the process, grinning as the medicals ran by. He hit a third for good measure, then made the dash to 8-C. By the time they determined it was an electronic glitch, rebooted, did whatever they did for the poor bastards in beds, he’d have done what he’d come to do and be gone. He moved into 8-C. They kept the lights dim, he noted. Rest and quiet was the order of the day. Well, she’d get plenty of both where he was sending her. He moved to the bed, pulled out the vial in his pocket. “Should’ve kept your nose out of our business, stupid bitch.

Back in the ICU waiting room old Opal-eye blinks, turns her head, fixes her gaze on me, like she knows what I did, what’s hiding in my pocket, and a cruel thought violates the folds of my mind, residue left over from the evil impulse: I got the ring anyway, Laura, it’s mine now, isn’t it, now that you’re dead. I press my pocket, feel the ring’s undeniable there-ness. I need to close myself off to mischievous impulses and bad thoughts. But it’s hard because no one ever taught me how.

Trong một góc lặng của ICU, tôi bắt đầu nghiêm túc suy ngẫm về những điều đau khổ mà tôi đã cố lờ đi trong suốt ngày hôm nay. Sẽ như thế nào nếu tôi ở lại? Sẽ như thế nào nếu tỉnh dậy và mồ côi? Sẽ không bao giờ ngửi thấy mùi tẩu thuốc của bố? Không bao giờ đứng bên mẹ thủ thỉ tâm sự mỗi khi rửa bát? Không bao giờ đọc cho Teddy một chương mới của Harry Potter? Sống mà không có họ? Tôi không chắc đây còn là thế giới mà tôi thuộc về nữa hay không. Tôi không chắc mình có muốn tỉnh lại hay không.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.” People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

Perhaps both mechanisms – the lack of recall at the moment of trauma as well as the ability to witness our surroundings and our injured body from outside of it – are natural phenomena that evolved to protect us from the vivid impact of trauma and also help us cope.

Most victims went looking for exactly what they got … If you try to sell smack on some other scumbag’s turf, or if you go ahead and marry Prince Charming after he puts you in the ICU four times running, or if you stab some guy because his brother stabbed your friend for stabbing his cousin, then ... you’re just begging for exactly what you’re eventually going to get. ... you would be amazed at how seldom murder has to break into people’s lives. Ninety-nine times out of a hundred, it gets there because they open the door and invite it in.

Just before the Miracle, when I was in the ICU and it looked like I was going to die and Mom was telling me it was okay to let go, and I was trying to let go but my lungs kept searching for air, Mom sobbed something into Dad’s chest that I wish I hadn’t heard, and that I hope she never finds out that I did hear. She said, “I won’t be a mom anymore.” It gutted me pretty badly. I couldn’t stop thinking about that during the whole Cancer Team Meeting. I couldn’t get it out of my head, how she sounded when she said that, like she would never be okay again, which probably she wouldn’t.

Okay, let me get this straight.” Annette stood in the doorway staring at us. “First, you al meet Roxie, now that’s after Indy got kidnapped a couple times, shot at and car bombs were exploding. And after Jet got shot at, kidnapped a couple of times and almost raped. Then came Roxie and I was around when Roxie was assaulted at a haunted house and held hostage at a society party after, of course, she got kidnapped. I leave and new girl Jules starts a vigilante war against drug dealers and ends up in ICU with two bul et holes in her. Then new, new girl Ava survives a drive-by, gets kidnapped repeatedly and ends up on a wild ride, exiting a wrecked car right before it explodes. Now all of you are getting shot at… at the same time?

A group of grandmothers is a tapestry. A group of toddlers, a jubilance (see also: a bewailing). A group of librarians is an enlightenment. A group of visual artists is a bioluminescence. A group of short story writers is a Flannery. A group of musicians is--a band. A resplendence of poets. A beacon of scientists. A raft of social workers. A group of first responders is a valiance. A group of peaceful protestors is a dream. A group of special education teachers is a transcendence. A group of neonatal ICU nurses is a divinity. A group of hospice workers, a grace. Humans in the wild, gathered and feeling good, previously an exhilaration, now: a target. A target of concert-goers. A target of movie-goers. A target of dancers. A group of schoolchildren is a target.

Because there is always new news to report, we rarely get the kind of background information that allows us to understand why the news is happening. We learn that hospitals have run out of ICU beds to treat gravely ill Covid-19 patients, but we do not learn of the decades-long series of choices that led to a U.S. healthcare system that privileged efficiency over capacity. This flood of information without context can so easily, and so quickly, transform into misinformation. Over one hundred and fifty years ago, the American humorist Josh Billings wrote, “I honestly believe it is better to know nothing than to know what ain’t so.” And that seems to me the underlying problem—not just with CNN and other cable news networks, but with contemporary information flow in general. So often, I end up knowing what just ain’t so.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or “It’s okay” or “I’m sorry” or “I love you.

operative risk, it was the best kind of tumor to have, and the best place to have it; surgery would almost certainly eliminate her seizures. The alternative was a lifetime on toxic antiseizure medications. But I could see that the idea of brain surgery terrified her, more than most. She was lonesome and in a strange place, having been swept out of the familiar hubbub of a shopping mall and into the alien beeps and alarms and antiseptic smells of an ICU. She would likely refuse surgery if I launched into a detached spiel detailing all the risks and possible complications. I could do so, document her refusal in the chart, consider my duty discharged, and move on to the next task. Instead, with her permission, I gathered her family with her, and together we calmly talked through the options. As we talked, I could see the enormousness of the choice she faced dwindle into a difficult but understandable decision. I had met her in a space where she was a person, instead of a problem to be solved. She chose surgery.

Max’s unflinching gaze never left that house. “What do you think’s going to happen?” Jules asked him quietly, “if you let yourself peel that giant S off your shirt and take a nap? If you let yourself spend an hour, an evening, screw it, a whole weekend doing nothing more than breaking and taking enjoyment from living in the moment? What’s going to happen, Max, if—after this is over—you give yourself permission to actually enjoy Gina’s company? To sit with her arms around you and let yourself be happy. You don’t have to be happy forever—just for that short amount of time.” Max didn’t say anything. So Jules went on. “And then maybe you could let yourself be happy again the next weekend. Not too happy,” he added quickly. “We wouldn’t want that. But just happy in a small way, because this amazing woman is part of your life, because she makes you smile and probably fucks like a dream and yeah—see? You are listening. Don’t kill me, I was just making sure you hadn’t checked out.” Max was giving him that look. “Are you done?” “Oh, sweetie, we have nowhere to go and hours til dawn. I’m just getting started.” Shit, Max said with his body language. But he didn’t stand up and walk away. He just sat there. Across the street, nothing moved. And then it still didn’t move. But once again, Max was back to watching it not move. Jules let the silence go for an entire minute and a half. “Just in case I didn’t make myself clear,” he said, “I believe with all my heart that you deserve—completely—whatever happiness you can grab. I don’t know what damage your father did to you but—” “I don’t know if I can do that,” Max interrupted. “You know, what you said. Just go home from work and . . .” Holy shit, Max was actually talking. About this. Or at least he had been talking. Jules waited for more, but Max just shook his head. “You know what happens when you work your ass off?” Jules finally asked, and then answered the question for him. “There’s no ass there the next time. So then you have to work off some other vital body part. You have to give yourself time to regrow, recharge. When was the last time you took a vacation? Was it nineteen ninety-one or ninety-two?” “You know damn well that I took a really long vacation just—” “No, sir, you did not. Hospitalization and recovery from a near-fatal gunshot wound is not a vacation,” Jules blasted him. “Didn’t you spend any of that time in ICU considering exactly why you made that stupid mistake that resulted in a bullet in your chest? Might it have been severe fatigue caused by asslessness, caused by working said ass off too many 24-7’s in a row?” Max sighed. Then nodded. “I know I fucked up. No doubt about that.” He was silent for a moment. “I’ve been doing that a lot lately.” He glanced over to where Jones was pretending to sleep, arm up and over his eyes. “I’ve been playing God too often, too. I don’t know, maybe I’m starting to believe my own spin, and it’s coming back to bite me.” “Not in the ass,” Jules said.

She walked slowly towards him, taking in how he looked so eerily still. “Okay you,” she said, her voice choked. “We have to have a talk. I know you’re a Dardano, but a wedding reception in the ICU? Not so classy.” She lowered her head, her attempt at levity falling flat under the weight of her heartbreak. She blinked back her tears and cupped his face. “You listen to me, okay? You are not leaving me. You’re not allowed. You’re going to fight, understand? Alessandro, I will not bury another husband. Do you hear me? I refuse to grieve for you. That is not even an option because you are my life.” She kissed his forehead, the beeping of the heart monitor and the respirators the only sounds in the room. “Funny huh? I spent so much time pushing you away and here I am begging you to stay. Not just for me, but for our boys. Will’s already lost one father, don’t you leave him too. And Gianni…don’t you dare leave him nothing but stories about some man in a picture frame.” Bree took his hand, rubbing his ring finger. “Please, Alessandro. Fight. I won’t survive without you. I won’t.” She kissed his palm. “We’ve fought too hard for you to just give up when we’re finally going to be happy. Dammit Alessandro, you owe me! You owe me a life, a happy life together. So don’t you dare die on me. Don’t you leave me to deal with that son of a bitch father of yours by myself.” She covered her mouth with her free hand to stifle her sobs. She leaned down and kissed his still mouth. “I love you…I love you so much…” Her tears fell on his face as she rested her forehead against his.

I lost my first patient on a Tuesday. She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight P.M. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest. Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45 A.M., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive. When I finally left the hospital, at five P.M. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven P.M., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case. At eight P.M., my phone rang: Mrs. Harvey had died. I went home to sleep.

the tenuous edge between life and death – directly in the flight path of mystery.

It’s humbling, especially for those of us firmly rooted in scientific training, to realize that there are things in this universe that are important and true whether or not we have a good explanation for them.

No one should be so afraid of something they don’t understand that it limits their choices.

Then when the event would happen, they would become angry with her as if she had caused it.

When choosing is not an act of escape but an act of completion, then you will stay.

The stereotype of Italians said that they were chaotic; the hospital in Bastia said otherwise. There was still a sense of sorrow all around, but greater calm. The reception was staffed again. I asked them if I could see Matilde, and because I was a blood relation I was allowed to do so, with a nurse by my side. The day before I’d been able to walk into the ICU by myself, but only a few hours later the normal protocols had been reinstated. Almost normal, because I still had to zigzag between the beds set up in corridors, to get to Matilde.

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal. Line infections are so common that they are considered a routine complication. ICUs put five million lines into patients each year, and national statistics show that after ten days 4 percent of those lines become infected. Line infections occur in eighty thousand people a year in the United States and are fatal between 5 and 28 percent of the time, depending on how sick one is at the start. Those who survive line infections spend on average a week longer in intensive care. And this is just one of many risks. After ten days with a urinary catheter, 4 percent of American ICU patients develop a bladder infection. After ten days on a ventilator, 6 percent develop bacterial pneumonia, resulting in death 40 to 45 percent of the time. All in all, about half of ICU patients end up experiencing a serious complication, and once that occurs the chances of survival drop sharply.

On any given day in the United States alone, some ninety thousand people are admitted to intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an ICU from the inside. Wide swaths of medicine now depend on the life support systems that ICUs provide: care for premature infants; for victims of trauma, strokes, and heart attacks; for patients who have had surgery on their brains, hearts, lungs, or major blood vessels. Critical care has become an increasingly large portion of what hospitals do. Fifty years ago, ICUs barely existed. Now, to take a recent random day in my hospital, 155 of our almost 700 patients are in intensive care. The average stay of an ICU patient is four days, and the survival rate is 86 percent. Going into an ICU, being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life.

Often we expect God to do it all on His own. Sometimes He does and, of course, He is perfectly able to do that. Most times, however, He chooses to partner with us. The greatest way that He partners with us is in prayer.

I kept thinking how grateful I felt to have been part of this magnificent team. For five months we had been one unit, all specialists and all tackling the same problem together. The staff at the pediatric ICU and the consultants in the children's center reacted spectacularly. They rallied behind us and spent countless hours without charge, working to make this operation successful. As pessimistic as I was about the eventual outcome of the surgery, I still felt a glow of pride in being able to work side by side with the best men and women in the medical field. And the end of the surgery wasn't the end of our teamwork. The postoperative care was as spectacular as the surgery. Everything in the weeks following the surgery confirmed again our togetherness. It seemed as if everyone from ward clerks to orderlies to nurses had become personally involved in this historic event. We were a team--a wonderful, marvelous team.

is

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for Falasteen the boy i adored at sixteen gifted me his keffiyeh feeling guilty for living when others were killed simply for existing i haven’t seen him in sixteen years but think of him often these days his grandmother’s purse still carrying keys to their home believing they’d return in weeks can it even be called a key if what it unlocked is no longer there? we’d sneak onto mall rooftops & pretend shooting only happened with stars! 'we have a duty of memory,' he said, 'so they’ll kill us all until only the soil is witness' how could i reply? i sat in my liquid silence today there are nurseries of martyrs they bomb babies for they fear enemies hiding between pacifiers & tiny wrists bomb hospitals because enemies hide in ICU bedpans bomb schools because enemies hide in children’s bags bomb the oldest mosques & churches because enemies hide in rosary beads & votive candles they bomb journalists because enemies are hiding under their PRESS vests & helmets bomb poets because enemies hide in pages of peace poems the elderly are bombed because enemies hide under their canes the disabled are bombed because they harbour enemies in their artificial limbs they raze & burn all the ancient trees because enemies make bombs from olives they bomb water treatment plants because enemies are now water & so it goes: justification provided exoneration granted business as usual & the boy I adored has green-grey eyes the colour of fig leaves we don’t speak but i wish to tell him 'i’m sorry the world is a blade i’m sorry home is blood & bones i’m sorry music is sirens & wails i’m sorry night is infinite' but the boy I adored has grey-green eyes the colour of forgotten ash

Those first days his daughter, Sally, and I took twelve-hour shifts at the hospital, sitting in a chair next to his bed, listening to the beeping of monitors in the ICU. We were afraid to leave him. It was as if we were trying to hatch an egg, keeping him warm with our presence, and we didn’t want him to wake without a familiar face nearby.

Dr. Fauci’s suppression of early treatments will go down in history as having caused the death of a half a million Americans in the ICU.

When people start screaming, direct them into two places, ICU in hospital, to policemen who deal with criminals.

In 1983, I moved to San Francisco for my pediatric endocrine fellowship. I had no idea what awaited me in the pediatric ICU: three toddlers, eighteen months old, all on ventilators in congestive heart failure because their parents had placed them on a macrobiotic diet. These ostensibly well-meaning parents were trying to prevent their children from succumbing to the “toxins” associated with meats, oils, and dairy products, so instead they fed their tots grains, cereals, vegetables, and, of course, tater tots. As a result, their hearts ballooned and couldn’t pump from the lack of iron, vitamin D, and calcium.

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I also worried that the linguistic contortions embraced by highly educated liberals antagonized the 62 percent majority of the country that lacked a college degree and that resented being told to change their nomenclature. When The Lancet medical journal tried to avoid dehumanizing trans people by referring to "bodies with vaginas", many women felt dehumanized. I heard from an ICU nurse in Idaho who was told to ask each patient for their identity: male, female, both or neither. Some patients were bewildered, others offended or hurt. The nurse told of the unintended effect on one patient: "One woman, post hysterectomy with complications, burst into tears and said, "I hope I'm still a woman." The concern about stigmatizing trans people is legitimate, but overreach seems to me a fit to hard-right Republicans who campaign against wokeness; it's a self-inflicted error by Democrats.

Nora Ephron wrote that none of us should wait to have our “last meal.” Have it now, have it all the time, or you may end up in the ICU and your last meal will be institutional porridge.

On the basis of a recent meta-analysis,25,26 continuous peripheral analgesic techniques provide superior analgesia, reduce opioid consumption, and reduce opioid-related side effects (nausea and vomiting, sedation, pruritus). This technique is not commonly used in the ICU setting, but it opens a wide range of possibilities for the future treatment of acute pain in critically ill

Management essentials in the ICU: FASTHUG F=feeding. A=analgesia. S=sedation. T=thrombo-embolism prophylaxis. H=head of the bed elevated (30–45°). U=ulcer prophylaxis (PPI or H2 antagonists). G=glucose control.

Her brain was acutely damaged in the accident. When the doctor was coming out of the ICU, he feared. He made an evil prayer. “I am fine to live with her memories, I will settle myself with the very thought that she isn't anymore, happily and gently. But dear God, don’t make her lose her conscious, like a dead yet, living body. Coldness in the eyes, which I have seen filled with love and surprise will kill me every day. I don’t want to die a new death every minute. Take her away, Or give her back in whole.

That’s how I met Griffin, you know.” “What, at the racetrack?” She gazed at him again for several long moments. “You must be really bored.” “I’m . . . interested in . . .” He took a deep breath. “The truth is, you’ve been handling all this shit really well, and I’m, well, curious about you. You’re tougher than I thought—smarter, too. Frankly, I just don’t get how someone like you got hooked up with Lamont and Trotta in the first place.” “Ah,” she said. “There’s that refreshing honesty again. It’s very appealing, Harry, the way you put all the cards out on the table for everyone to see.” Her voice hardened. “Except the last time you did that, you had an entire deck still up your sleeve. You can’t blame me for wondering what you’re hiding from me this time.” Alessandra was staring out the window again, her chin held self-righteously high. But it was just an act. She was working hard to hide her hurt. He could see it trembling in the corner of her mouth. It was there, too, lurking in her eyes. I thought you were special. “Jesus,” Harry said, hating the guilt that pressed down on him. “You want complete honesty? Sweetheart, I’m more than happy to give it to you. No secrets, no tactful white lies, just the hard truth—is that really what you want?” “Yes.” “Great,” he said. “Let’s see. We can start with the fact that I’m scared shitless about seeing my kids again. I don’t know if Emily’s going to recognize me—or worse, if I’m going to recognize her. I’m dreading talking to Marge, and I’m still worried about George. I knew a cop who was recovering nicely from a gunshot wound. One day he seemed fine. The next day he was back in the ICU with an infection. Day after, we were sitting shivah at his house. But I digress. When you sit that way, you look kind of like a beach ball with a head,” he continued. “Your haircut is really, really bad, I’m probably going to lose my job for helping you this way, and I’m dying to fuck you.” He glanced at her. “Honest enough for you?

The purposes of Jesus Christ are not finished when one of this precious ones is forgiven. Not at all. Would a good father feel satisfied when his daughter is rescued from a car accident, but left in the ICU? Doesn't he want her to be healed as well?... Now the Son of God has come to ransom you, and to heal your broken, wounded heart, and to set you free from bondage.

But Ethiopia and America were nervous of an Islamic government and the US and other nations sponsored Ethiopia to invade Somalia and dispatch the ICU. This they did in 2006 with astonishing speed, force and cruelty, pounding Mogadishu to rubble and blazing a trail of looted homes, massacred civilians and raped women across the country, while those who had paid for the invasion looked away. With

Good things happen slowly,” said a doctor in the ICU months ago, “and bad things happen fast.

It is correct to love even at the wrong time. On rounds, the newborns eyed me, each one like Orpheus in his dark hallway, saying: I knew I would find you, I knew I would lose you. " -ICU The Road to Emmaus

it makes no sense to scoop people out of the river when we could go upstream and prevent them from falling in in the first place. The ICU is not the place for these conversations to begin, and yet that is where they are often happening, if they do at all.

Several sedation scales—the Richmond Agitation Sedation Scale (RASS), Adaptation to the Intensive Care Environment (ATICE) tool, and the Minnesota Sedation Assessment Tool (MSAT)—as well as tools for assessment of analgesia in the ICU, such as the visual analog scale, the numeric rating scale, behavioral pain scale,7,8 and critical care pain observation scale, have been developed (Figure 3-1).

Whoever invented the ICU should see some of the patients we have here. With reference to the atom bomb, Einstein said, “With the development of the bomb, everything has changed save our mode of thinking, and thus we drift perilously.” I propose with the invention of the ICU we also need to change our way of thinking. Just because we have the capacity to prolong life in elderly people doesn’t mean we have to and yet we do; every day in this place we prolong suffering at little benefit. Bring back the house call and a hold of the hand.

The ICU's life cycle for humans is as follows: a spurt of intense activity at birth; timeless adulthood, when one is afflicted with a range of woes that carry their own temporalities; and an inglorious, ill-defined end. The effect of this is, paradoxically, to make the individual an tin-defined, tabula rasa onto which various diseases are inscribed.

One study concluded that there were 1.7 errors per patient per day in America's ICUs. Of these errors, 29 percent could have caused clinically significant harm or death. Given that the average ICU length of stay is three days, this research suggests that nearly all patients hospitalized in the ICU sustain a potentially life-threatening mistake at some point during their stay.

7 Severe hemophagocytic syndrome with failure of one or more organs. The choice of cytoreductive regimen depends on the type of malignancy, which is not always precisely known on arrival of the patient in the ICU. For acute leukemias, efforts should be made to characterize the lineage (ALL or AML) before treatment is initiated, but if lineage cannot be determined, a non–lineage-specific

Some time way back in the latter half of my internship, I gave up the idea of saving lives and became more comfortable with the idea of managing illness to limit dis-ease. But in the ICU we really aren’t even able to do that very much since almost all the definitive maneuvers have already been made or are not any longer an option. As a result, what we do for ourselves and what we do for patients are really two distinct things. For ourselves we manage to learn a great deal about the mechanics of medical care for desperately sick people. For patients and, more importantly, for families, I’m beginning to think what we do is simply provide a dramatic, even gruesome ritual of dying.

Astronomer Carl Sagan was critical of scientists who couldn’t tolerate ambiguity, and he reminded them that the “absence of evidence is not evidence of absence.

Bree’s in the ICU at UPMC Altoona.

The glass walls of the ICU closed us in—an illusion of openness, of freedom, that only highlighted how trapped we really were.

He didn’t want anyone to perform CPR because he knew that even in the unlikely event that it restarted his heart, it would just mean that he would die in an ICU.

The blue eyes watched the Texan as his python skin boots took him into the dimness of the hall of doors and his escape from Corazon’s ICU was a clip clopping stride of broken confidence caught in the rebellious lighting of a cigarette.

So how to combine a liter of fluid with active agents, customized according to the patient’s weight and status, while keeping everything sterile? If this is for the ER or the ICU, we have about ten minutes to make it happen. Fortunately for the patient, there is a sleep-starved teenager apprenticed to a chain-smoking barmaid in the basement who is ready for action. ***

admitted,

absence of evidence is not evidence of absence.” I

I place my stethoscope onto their chest to listen for the lub-dub sound of the heart valves. Then I wait. I wait a long, silent, slow five minutes. I listen for silence and feel for the presence of absence. No sound is heard and no pulse is felt.

Life can only be understood backwards; but it must be lived forwards.

wish to experience a tranquil dying without whining about or withstanding death. “Like birth,” my treasured collaborator Sandra warns in Death’s Door, “death is surely by its nature undignified.” True, but with the help of hospice at home I wish to avoid being cut, drained, wired, monitored, intubated, and ventilated within the artificial life support systems of an ICU. “To die ‘naturally’ is to find a way to have a graceful death when the prognosis is terminal and further treatments are of questionable value. It is not a rejection of medical science, but rather an attempt to use the sophistication of modern medicine to treat—in a different, better way—those who are seriously ill or near death.” I

William Bennett Jr. He’s thirty-five years old. Admitted from a multi-trauma the same night the blue Dodge collided with that tree. He’s in bed twelve in the surgical ICU.

Alexander Fleming’s response when he returned to London from vacation in September of 1928 was not that his petri dishes cultivating Staphylococcus aureus – a common bacterial source of human infection – were contaminated and needed to be discarded, but that they were contaminated and needed to be investigated.

specially formulated liquid

There is no point in using the word ‘impossible’ to describe something that has clearly happened.” – Douglas Adams

PTSD – recurrent and uninvited memories that are distressing, all-too-real flashbacks to traumatic events, and severe emotional distress (or even physical reactions) when they are reminded of the event.

Apparently, neither did my colleagues, for they neatly sidestepped it – and I was encouraged to do the same.

Truth is stranger than fiction, but it is because fiction is obliged to stick to possibilities; truth isn’t.” – Mark Twain

Learning from the nurse that the patient was a chronic alcoholic, this made sense. Magnesium levels are frequently quite low in everyday, heavy drinkers.

One may be tempted to say that these experiences are simply a kind of dream,

In fact, she found that her new nonphysical reality didn’t seem new at all but that the longer she was in her now state, as she put it, she seemed to be more who she really was than when she was in her then state, when she was in the physical.

recalled a specific moment when she was no longer moving from but going toward.

radiographic images

antibacterial solution

To say, “It reminds me of something I’ve dismissed before, therefore I dismiss it,” is actually not scientific, but a dogmatic imposition of personal belief.

Perhaps because she had no doubts about the soul surviving beyond the physical, she didn’t need a transformative near-death experience – an experience that often flips a person’s conception about life and death

I’ve come to realize, though, that I don’t have to be able to explain something in order to acknowledge it and support the person reporting it.

I received the information neither from sensory information nor from rational deduction.

NDErs reported both wonderful and horrible disclosure experiences in each of the four categories of confidant, and no category was significantly better or worse.

the brain is not a producer but a receiver/transmitter of consciousness,

Perhaps you should tell Dr. X,” I told him. He began to laugh. “Don’t be absurd,” he said. That night I could not sleep. At two in the morning I dressed and returned to the hospital to look in on Immy. She was no better. Her parents had not left the ICU waiting room, and several other family members had joined them there. We sat together talking for awhile, but I had no news and could offer little comfort. My heart ached for them and for Immy. Back in the house staff residence, once again I undressed for bed, but I still could not sleep. I kept thinking of the lost medal and what Immy’s parents had told me. At last, I took some paper and wrote to Dr. X, telling him what had happened and how important the medal was to Immy’s family. Folding the note in half, I dressed once more and went back to

to her parents in relief, I asked if it was another one. “No,” her mother said, “it was the same one that was lost.” Dr. X had come that afternoon and brought it to them. I told them how glad I was that it had been found. “Yes,” her father said. “We are too.” Then he smiled. “She is safe now, no matter what happens,” he told me. The following morning, the surgery resident told me how the medal had been found. On the previous day, Dr. X had made his patient care rounds much as usual, followed by a dozen of the young surgeons he was training. But instead of ending the rounds in the ICU, he had taken them all to the laundry department in the subbasement of the hospital. There, he explained what had happened, and then he and all his residents and fellows had gone through the pediatric laundry from the day before

During the pandemic, I couldn’t bring myself to leave the house, terrified I would find myself standing in the doorway of an ICU room, watching the doctors press their whole weight on the chest of my mother, my sisters, my children, terrified of the lurch of their feet, the lurch that accompanies each press that restarts the heart, the jerk of their pale, tender soles, terrified of the frantic prayer without intention that keens through the mind, the prayer for life that one says in the doorway, the prayer I never want to say again, the prayer that dissolves midair when the hush-click-hush-click of the ventilator drowns it, terrified of the terrible commitment at the heart of me that reasons that if the person I love has to endure this, then the least I can do is stand there, the least I can do is witness, the least I can do is tell them over and over again, aloud, I love you. We love you. We ain’t going nowhere.

No one chooses to be a patient, but everyone can choose to keep sight of the person in the hospital gown. Samuel Shem’s novel The House of God, about

Dr. Kory says so plainly: “Dr. Fauci’s suppression of early treatments will go down in history as having caused the death of a half a million Americans in the ICU.

recalled seeing it from a vantage point above his physical body – far above those of us who were working on him that day.

Reality is merely an illusion, albeit a very persistent one.” – Albert Einstein

The Universe is under no obligation to make sense to you.” – Neil deGrasse Tyson

experience they have during a medical crisis when their body is clinically dead or near-death should be ignored or dismissed as an entirely physical phenomenon?

How was he able to hear word-for-word every bit of the conversation as the lead physician supervised the surgery? How was it even possible that he seemed

we knew she had both streptococcal pneumonia and meningitis. She also had a raging sinusitis as well, which was the suspected source of all her troubles.

Do we always have help? I decided right then and there – and still I feel this way – that probably we do.

Finally, it was a hospice nurse, a gentle black woman, who broke the silence and said, “Now that is only the second or third time in all my years that I have heard that trumpet right after somebody died.

Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.” – Winston Churchill

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillator or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, caregivers were three times as likely to suffer major depression. Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place

a registered nurse in the Grudge ICU,

This could not have happened by accident; God was there.

journalism is on life support and democracy is in the next bed in the ICU.

doctors and nurses make decisions at a rapid clip, about 100 decisions a day per patient, according to research at Emory. Or more than 9.3 million decisions about care during a year in an ICU. So there is ample room for error.

Pain and loss were here in the dark place. He’d been here before—you didn’t do ministry for almost fifteen years without seeing it all—death, disease, heartbreak. But from the other side, the comforting side, the God’s-ways-are-not-our-ways side where you left the accident scene or the ICU waiting room or the graveside and went home to a house that smelled of pot roast and cherry pie and rang with the laughter of a healthy child.

John Maynard Keynes made the most audacious proposal that has ever reached the bargaining table of a major international conference: to create an International Currency Union (ICU), a single currency (which he even named – the bancor) for the whole capitalist world, with its own international central bank and matching institutions. Keynes’ proposal was not as impudent as it seemed. In fact, it has withstood the test of time quite well. In a recent BBC interview, Dominique Strauss-Kahn, the IMF’s then managing director, called for a return to Keynes’ original idea as the only solution to the troubles of the post-2008 world economy.

John Maynard Keynes made the most audacious proposal that has ever reached the bargaining table of a major international conference: to create an International Currency Union (ICU), a single currency (which he even named – the bancor) for the whole capitalist world, with its own international central bank and matching institutions.

lives. A physician I knew once cared

Dr. Spaceman enters from I.C.U. His lab coat is covered in blood. The women all gasp. DR. SPACEMAN What, this? No, no, I was at a costume party earlier this evening… and the hostess’s dog attacked me so I had to stab it.

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I spent my time between the hospital and Sloan’s house where I watered her plants and brought in packages. I washed whatever laundry she left when she did her momentary stops at home to shower and change before heading back to the ICU. I checked her mail. I’d made all the calls to her wedding vendors to cancel the wedding until further notice. At the hospital I brought books, magazines, coffee, and food for Sloan so she never had to leave her bedside vigil for anything trivial. Then I went home to my empty house. I cleaned for hours on end. I pulled out the contents of every cabinet in my kitchen and washed it all. I wiped out the drawers in the bathroom. I took apart my bed to vacuum underneath, and all the vacuum lines on the carpet had to be in just the right direction. I detailed the grout in my laundry room. I took a toothpick to the cracks in the stove, and I thirsted for relief from my own mind. My perfectionism was something I harnessed and cultivated for my own purposes. Something useful that made me focused so I could get things done. But now it was spiraling. None of the rituals made it better. Nothing shut off the urges or satisfied the feelings of incompleteness. Nothing gave me control again. I missed Josh. I missed him like I missed my sanity. It had become clear, almost immediately, that the burden of saving him from himself was going to fall on me.

It was for his own good. And the beast inside me roared. Every day it got louder. Nobody could tame it. Josh could calm me, but I wouldn’t let him close enough to try. Nurse Valerie buzzed me into the ICU. I slid the container of cupcakes across the counter of the nurses’ station. “Nadia Cakes.” She beamed at me. “You’re too good to us, girl.” She pulled the cupcakes down in front of her, looking over the assortment. Sloan had assigned me the job of bringing thank-yous to the nursing staff. Donuts, cookies, flowers. I tried to bring something every couple of days. The nurses had made all the difference in this situation. Valerie tapped her pen absently on top of the clear container and eyed me. “Can I ask you something?” I leaned over the counter, sorting her pens by color. “What?” I liked Valerie. She was my favorite nurse. She was no-nonsense. We’d hit it off immediately. “What did that boy do to you? ’Cause I can’t see any reason on my end why you’re not all over that man like white on rice.” Josh.Somehow in the last few weeks, the hospital staff had gotten wind of the Josh situation. “Valerie, we’ve talked about this.” She arched an eyebrow. “Have we? ’Cause you came off a little evasive if you ask me.” I shook my head at her. I wasn’t getting into it. She twisted her lips and gave me a knowing grin. “That man drives you crazy.” I snorted. “I don’t need him to drive me crazy. I’m close enough at this point to walk.

The only sounds at the late hour were the faint jingle of a phone ringing in the nurses’ station, the ping of an elevator, the faraway sound of the wheels of a cart, and the gentle beep of Brandon’s vital signs monitor. They wouldn’t allow any flowers or personal items in the ICU, but Sloan had snuck in an engagement photo. It sat on the table next to the bed. Her and Brandon on the beach, the surf crashing around their feet, her tattooed arm over his shoulder, them looking at each other. Both of them laughing. I looked back at him and sighed. “You’re going to have some gnarly scars, buddy.” They’d started the skin grafts for the road rash on his arm. “But you’ll get to do everything you planned to do with your life. One of us is going to get the girl. I’ll help you any way I can. Even if I have to wheel your ass to the altar.” I could picture his smile. With any luck I’d see it in a few hours. A knock on the door frame turned me around in my chair. “Hey, cutie.” Valerie came into the room for her vitals check. She turned the lights up, and I stood and stretched. As if sleeping in a chair wasn’t hard enough, the activity every two hours was the final kicker. I wouldn’t call anything I did on these overnight shifts sleeping. Maybe napping, but not sleeping. Every two hours Brandon was moved. They checked his airways, changed out bags, looked at his vitals. I don’t know how Sloan was handling doing this almost nightly for the last three weeks. Sloan was a good woman. I’d always liked her, but now she’d earned my respect, and I was grateful Brandon and Kristen had her. “Did you decide what day you want to bring the kids to the station?” I asked Valerie, yawning. She cycled the blood pressure cuff on Brandon’s arm and smiled. “I’m thinking Tuesday. You on shift Tuesday?” “Yup.” She wrote down some notes on Brandon’s chart and then gave me a raised eyebrow. “Any updates with your lady friend?” I laughed a little. “No.” The whole nursing staff knew about my depressing love life. I’d gotten hit on a few too many times by some of the younger nurses. I couldn’t claim to have a girlfriend, and I wasn’t married, so it was either “I’m gay” or “I’m in love with that girl over there.” I’d gone with the latter, and now I wished I’d said I was gay. They didn’t know why Kristen wouldn’t date me, just that she wouldn’t. It had turned into the favorite topic of the ICU. A real-life episode of Grey’s Anatomy. I rarely got through a Brandon visit without it coming up. The drama escalated when Kristen had been hit on by the nurses’ favorite single orthopedic surgeon. According to the nurses’ gossip circuit, Kristen told him to go fuck himself. And apparently she’d actually said, “Go fuck yourself.” After that everyone was sure she was holding out for me. Only I knew better.

Good things happen slowly," said a doctor in the ICU months ago," and bad things happen fast." Those were comforting words, and they comfort me today. Recovery is a long, slow process. There are good days and bad days for both of us.

You are the Chief Experience Officer of you.

complete dataset it will be necessary to integrate the patient’s full set of lab values (including those not associated with the same MIMIC ICUSTAY identifier) with the record of that ICU admission without repeating or missing records. Using shared

intensive care units (ICUs) are physiologically fragile and unstable, generally have life-threatening conditions, and require close monitoring and rapid therapeutic interventions. They are connected to an array of equipment and monitors, and are carefully attended by the clinical staff. Staggering amounts of data are collected daily on each patient in an ICU: multi-channel waveform data sampled hundreds of times each second, vital sign time series updated each second or minute, alarms and alerts, lab results, imaging results, records of medication and fluid administration, staff notes and more.

It was also clear that although petabytes of data are captured daily during care delivery in the country’s ICUs, most of these data were not being used to generate evidence or to discover new knowledge. The challenge, therefore, was to employ existing technology to collect, archive and organize finely detailed ICU data, resulting in a research resource of enormous potential to create new clinical knowledge, new decision support tools, and new ICU technology. We proposed to develop and make public a “substantial and representative” database gathered from complex medical and surgical ICU patients.

A doctor might say, “There’s a chance your mother could recover from her pneumonia if we put her on the breathing tube and send her to the ICU.” A chance? That sounds great! A more accurate statement might be something like this: “We could put your mother in the ICU on a breathing tube. I don’t recommend that, because she will suffer, without likely benefit. The tube is so uncomfortable she will have to be sedated, so she can’t communicate with you. She may get restrained so she doesn’t pull out the tube. If she gets through this pneumonia, she will be weaker than before, and more likely to get sick again. This pneumonia signals she is in the final phase of dementia. I recommend that you consider hospice care and a do-not-hospitalize order, focusing on comfort care without the pain and trauma of repeated transfers as she grows weaker.” A family member will have a clearer picture of how this treatment fits into the larger scenario of old age, dementia, and frailty.

Golden Rules of ICU 1. Don't mess with the airway 2. Trust no one, check everything, give oxygen 3. There is no body cavity that cannot be penetrated with a 20G needle and a good strong arm 4. If your ICU is an exciting place to work, you're doing it wrong 5. Always look where a surgeon's been

Spending one’s final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or “It’s okay” or “I’m sorry” or “I love you.” People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.

Visitors stream in and out of the rooms and corridors. There are families to see, questions to answer, a new admission from the ED. It’s one thing after another—randomly, it seems—bouncing from one story to the next. Mr. Gunther, headed for the NIH, leaves with his wife. She gives me a long look as they head toward the elevator. I wish her well; living with Pascal’s wager can’t be easy. Mr. Kinney, a dapper corporate attorney, is also getting out of here after a rough two weeks. His pancreas is totally destroyed, replaced by puddles of necrotic fluid, yet he refuses to accept the fact that his fondness for single-malt scotch is the reason why. His wife gives me a long look, too, then they’re gone. Jim, the Cardiology fellow, shows me the echocardiogram he just did on Mr. Warner, our guy with HIV. Nothing there, Jim says, no vegetation, no sign of endocarditis. We consider what this means, make a plan. Up on 10 Central, Mr. Mukaj’s bladder irrigation backs up painfully again but there’s nowhere else we can put him, no empty beds in the ICU or Step-Down Unit, no place where he can have his own nurse with him all the time. We bounce this around, too, decide to try this, then that, we’ll see. Mr. Harris, our patient with Marfan syndrome, a plastic aorta, and a septic hip joint, spikes a fever again. Not good. We make a plan. And so it goes, on into the evening. On days like this, doctoring feels like pinball: nonstop random events—intercepted here, altered there, prolonged or postponed by this or that, the bells and boinks sounding all around—and sometimes you can’t be sure whether you’re the guy pushing the buttons, manipulating the levers, and bumping the machine, or whether you’re inside the machine, whether you’re the pinball itself.

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I would spend six days in the ICU in Reno, then six more in a Los Angeles hospital. And because I only do things I'm good at, pretty quickly I determined that I would be the worst patient ever.

Throughout my profession I have seen Him at work almost daily bringing courage to a patient facing a major procedure, replacing their fear with peace upon entering the operating room; smoothing the way during difficult surgery; encouraging His children with a sense of His presence or providing comfort for anxious parents.

She had been a mentor to so many of her high school students, inviting them over to our house on Mockingbird Lane, helping them learn lines from Shakespeare for the plays she directed. I was in grade school at the time and had loved to listen to their discussions. They seemed to know so much, and I hoped I would absorb their knowledge.

Five days later everything outside the sixth-floor ICU at Beth Israel North still seemed normal: this was the part neither of us (although only John admitted it) could get past, one more case of maintaining a fixed focus on the clear blue sky from which the plane fell.

More than one more day,” he had whispered to her before he walked her to the altar. “More than one more day,” he had whispered to her on the five days and nights he saw her in the Beth Israel North ICU. “More than one more day,” I had whispered to her in his absence on the days and nights that followed. As you used to say to me, she had said when she stood in her black dress at St. John the Divine on the day we committed his ashes.