Intensive Care Unit Quotes

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.

We're not hunter-gatherers anymore. We're all living like patients in the intensive care unit of a hospital. What keeps us alive isn't bravery, or athleticism, or any of those other skills that were valuable in a caveman society. It's our ability to master complex technological skills. It is our ability to be nerds. We need to breed nerds.

When Will Graham could open his right eye, he saw the clock and knew where he was- an intensive-care unit. He knew to watch the clock. Its movement assured him that this was passing, would pass. That's what it was there for.

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.

SCBU (pronounced Scaboo) is the Special Care Baby Unit, NICU is Neonatal Intensive Care, PICU is Paediatric Intensive Care, PIKACHU is a type of Pokémon.

She was a woman who conquered herself so that she could serve others.

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. These days are spent in institutions—nursing homes and intensive-care units—where regimented, anonymous routines cut us off from all the things that matter to us in life.

yearning melodies help our bodies to achieve homeostasis—a state in which our emotions and physiologies function within optimal range. Studies even show that babies in intensive care units who listen to (often mournful) lullabies have stronger breathing, feeding patterns, and heart rates than infants hearing other kinds of music!

Two-thirds of the terminal cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did have discussions were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive care unit. Most of them enrolled in hospice. They suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In addition, six months after these patients died, their family members were markedly less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.

Impatience often makes us patients.

A cult is a group of people who share an obsessive devotion to a person or idea. The cults described in this book use violent tactics to recruit, indoctrinate, and keep members. Ritual abuse is defined as the emotionally, physically, and sexually abusive acts performed by violent cults. Most violent cults do not openly express their beliefs and practices, and they tend to live separately in noncommunal environments to avoid detection. Some victims of ritual abuse are children abused outside the home by nonfamily members, in public settings such as day care. Other victims are children and teenagers who are forced by their parents to witness and participate in violent rituals. Adult ritual abuse victims often include these grown children who were forced from childhood to be a member of the group. Other adult and teenage victims are people who unknowingly joined social groups or organizations that slowly manipulated and blackmailed them into becoming permanent members of the group. All cases of ritual abuse, no matter what the age of the victim, involve intense physical and emotional trauma. Violent cults may sacrifice humans and animals as part of religious rituals. They use torture to silence victims and other unwilling participants. Ritual abuse victims say they are degraded and humiliated and are often forced to torture, kill, and sexually violate other helpless victims. The purpose of the ritual abuse is usually indoctrination. The cults intend to destroy these victims' free will by undermining their sense of safety in the world and by forcing them to hurt others. In the last ten years, a number of people have been convicted on sexual abuse charges in cases where the abused children had reported elements of ritual child abuse. These children described being raped by groups of adults who wore costumes or masks and said they were forced to witness religious-type rituals in which animals and humans were tortured or killed. In one case, the defense introduced in court photographs of the children being abused by the defendants[.1] In another case, the police found tunnels etched with crosses and pentacles along with stone altars and candles in a cemetery where abuse had been reported. The defendants in this case pleaded guilty to charges of incest, cruelty, and indecent assault.[2] Ritual abuse allegations have been made in England, the United States, and Canada.[3] Many myths abound concerning the parents and children who report ritual abuse. Some people suggest that the tales of ritual abuse are "mass hysteria." They say the parents of these children who report ritual abuse are often overly zealous Christians on a "witch-hunt" to persecute satanists. These skeptics say the parents are fearful of satanism, and they use their knowledge of the Black Mass (a historically well-known, sexualized ritual in which animals and humans are sacrificed) to brainwash their children into saying they were abused by satanists.[4] In 1992 I conducted a study to separate fact from fiction in regard to the disclosures of children who report ritual abuse.[5] The study was conducted through Believe the Children, a national organization that provides support and educational sources for ritual abuse survivors and their families.

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.

A recent event in our family showed us even more how fleeting physical perfection is. Our oldest son had a brain aneurism rupture two days before his high-school graduation. For nineteen days, my son, who planned to attend the Naval Academy, clung to life in a neuro-intensive care unit. Thankfully, he recovered. During his recovery, after waking from a coma, we asked him if there was anything he wanted us to bring him from home. “Just bring Grace,” he said.

The death rate remains 100 per cent, and the pattern of the final days, and the way we actually die, are unchanged. What is different is that we have lost the familiarity we once had with that process, and we have lost the vocabulary and etiquette that served us so well in past times, when death was acknowledged to be inevitable. Instead of dying in a dear and familiar room with people we love around us, we now die in ambulances and emergency rooms and intensive care units, our loved ones separated from us by the machinery of life preservation.

I wanted peace and quiet, tranquillity, but was too much aboil inside. Somewhere beneath the load of the emotion-freezing ice which my life had conditioned my brain to produce, a spot of black anger glowed and threw off a hot red light of such intensity that had Lord Kelvin known of its existence, he would have had to revise his measurements. A remote explosion had occurred somewhere, perhaps back at Emerson's or that night in Bledsoe's office, and it had caused the ice cap to melt and shift the slightest bit. But that bit, that fraction, was irrevocable. Coming to New York had perhaps been an unconscious attempt to keep the old freezing unit going, but it hadn't worked; hot water had gotten into its coils. Only a drop, perhaps, but that drop was the first wave of the deluge. One moment I believed, I was dedicated, willing to lie on the blazing coals, do anything to attain a position on the campus -- then snap! It was done with, finished, through. Now there was only the problem of forgetting it. If only all the contradictory voices shouting inside my head would calm down and sing a song in unison, whatever it was I wouldn't care as long as they sang without dissonance; yes, and avoided the uncertain extremes of the scale. But there was no relief. I was wild with resentment but too much under "self-control," that frozen virtue, that freezing vice. And the more resentful I became, the more my old urge to make speeches returned. While walking along the streets words would spill from my lips in a mumble over which I had little control. I became afraid of what I might do. All things were indeed awash in my mind. I longed for home.

Klein studied nurses, intensive care units, firefighters, and other people who make decision under pressure, and one of his conclusions is that when experts make decisions, they don't logically and systematically compare all available options. That is the way people are taught to make decisions, but in real life it is much too slow. Klein's nurses and firefighters would size up a situation almost immediately and act, drawing on experience and intuition and a kind of rough mental simulation. To Van Riper, that seemed to describe much more accurately how people make decisions on the battlefield.

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

Columbus and his successors were not coming into an empty wilderness, but into a world which in some places was as densely populated as Europe itself, where the culture was complex, where human relations were more egalitarian than in Europe, and where the relations among men, women, children, and nature were more beautifully worked out than perhaps any place in the world. They were people without a written language, but with their own laws, their poetry, their history kept in memory and passed on, in an oral vocabulary more complex than Europe’s, accompanied by song, dance, and ceremonial drama. They paid careful attention to the development of personality, intensity of will, independence and flexibility, passion and potency, to their partnership with one another and with nature.

It was a fascinating hint that flu might have a heritable component, but other studies failed to replicate the finding. Then in January 2011, in the midst of the annual flu season in France, a two-year-old girl was admitted to the intensive care unit of the Necker Hospital for Sick Children in Paris, suffering from ARDS (acute respiratory distress syndrome). Doctors saved her life, and one of them, Jean-Laurent Casanova, sequenced her genome. He wanted to know if it held the key to why an otherwise healthy child had nearly died of a disease that most children shrug off. It turned out that the girl had inherited a genetic defect that meant she was unable to produce interferon, that all-important first-line defence against viruses. As a result, her besieged immune system went straight to plan B: a massive inflammatory response similar to the one pathologists saw in 1918.

The economy — and the need to keep it strong and growing — has somehow become the most important aspect of modern life. Nothing else is allowed to rank higher. The economy is suffering; the economy is improving; the economy is stable or unstable — you’d think it was a patient on life support in an intensive-care unit from the way we anxiously await the next pronouncement on its health. But what we call the economy is nothing more than people producing, consuming and exchanging things and services.

Consider this sobering statistic: Shortly before the 2009 H1N1 pandemic, CIDRAP undertook a national survey of hospital pharmacists and intensive care and emergency department doctors, as we detailed in chapter 18. The update of that survey identified more than 150 critical lifesaving drugs for all types of diseases frequently used in the United States, without which many patients would die within hours. All of them are generic and many, or their active pharmaceutical ingredients, are manufactured primarily in China or India. At the beginning of the COVID-19 outbreak, sixty-three were already unavailable to pharmacies on short notice or on shortage status under normal conditions—just one example of how vulnerable we are.

I don't believe the sickest people that I meet throughout my day at work are in the business of having outlandish desires, either. I don't think they are staring at the square-tiled ceiling of the intensive-care unit and dreaming of being an astronaut or an explorer. I don't think they're holding the hand of their wife and thinking, "I hope we win the lottery and become rich." Perhaps I am wrong, but I think they are, for the most part, simply hoping they will get to be a part of life again. They are hoping for all the things we take for granted every day: the ability to breathe by yourself, to get out of bed, to sit on a toilet or lie in a bath. To swallow your food and choose what you want for breakfast. To walk out into the world and appreciate all its beauty, or complain about the weather - but to have that choice.

There are many reasons why the tech revolution will hit the emerging world much harder than it will hit Europe and the United States. In developed countries, children are more likely to grow up with digital technologies as toys and then to encounter them in school. Governments in these countries have money to invest in educational systems that prepare workers, both blue and white collar, for change. Their universities have much greater access to state-of-the-art technologies. Their companies produce the innovations that drive tech change in the first place. This creates a dynamic in which high-wage countries are more likely than low-wage ones to dominate the skill-intensive industries that will generate twenty-first-century growth, leaving behind large numbers of those billion-plus people who only recently emerged from age-old deprivation. The wealth in developed countries helps them maintain much stronger social safety nets than in poorer countries to help citizens who lose their jobs, fall ill, or need to care for sick children or aging parents. In short, wealthier countries are both more adaptable and more resilient than developing ones.

In what way can it act as master? Through scores of incarnations, the ‘self ’ we end up with is derived from the attributes with which we endow our God, the abstract Ego or conceptive principles. All conception is a denial of the Kiã, and hence we human beings are its opposition, our own evil. As we are the offspring of ourselves, we are the conflict between whatever we deny and assert of the Kiã. It would seem that we cannot be too careful in our choice, for it determines the body we inhabit. Thus forever from ‘self ’ do I fashion the Kiã, which may be without likeness, but which may be regarded as the truth. From this process is the bondage made, and not through intellect shall we be free from it. The law of Kiã is always its own original purpose, undetermined by anything else, and its emanations are unchanging. Through our own conceptive process things materialize, and take their nature from that duality. Human beings take their law from this refraction, and their ideas create their reality. With what do they balance their ecstasy? They pay measure for measure with intense pain, sorrow, and miseries. With what do they balance their rebellion? Of necessity, with slavery! Duality is the law, and realization by experience relates and opposes by units of time. Ecstasy for any length of time is difficult to obtain, and takes a lot of work. The conditions of consciousness and existence would seem to be various degrees of misery alternating with gusts of pleasure and some more subtle emotions. Consciousness of existence consists of duality in some form or other. From it are created the illusions of time, size, entity, etc.: the world’s limit. The dual principle is the quintessence of all experience, and no ramification has enlarged its primordial simplicity, but can only be its repetition, modification or complexity: its evolution can never be complete. It can never go further than the experience of self, so returns and unites again and again, ever an anti-climax. Its evolution consists of forever returning to its original simplicity by infinite complication. No man shall understand its ‘reason why’ by looking at its workings. Know it as the illusion that embraces the learning of all existence. It is the most aged one who grows no wiser, and is the mother of all things. Therefore believe all ‘experience’ to be an illusion, and the result of the law of duality. Just as space pervades an object both inside and outside it, similarly within and beyond this ever-changing cosmos, there is this single principle.

In order to avoid the deafening of conspecifics, some bats employ a jamming avoidance response, rapidly shifting frequencies or flying silent when foraging near conspecifics. Because jamming is a problem facing any active emission sensory system, it is perhaps not surprising (though no less amazing) that similar jamming avoidance responses are deployed by weakly electric fish. The speed of sound is so fast in water that it makes it difficult for echolocating whales to exploit similar Doppler effects. However, the fact that acoustic emissions propagate much farther and faster in the water medium means that there is less attenuation of ultrasound in water, and thus that echolocation can be used for broader-scale 'visual' sweeping of the undersea environment. These constraints and trade-offs must be resolved by all acoustic ISMs, on Earth and beyond. There are equally universal anatomical and metabolic constraints on the evolvability of echolocation that explain why it is 'harder' to evolve than vision. First, as noted earlier, a powerful sound-production capacity, such as the lungs of tetrapods, is required to produce high-frequency emissions capable of supporting high-resolution acoustic imaging. Second, the costs of echolocation are high, which may limit acoustic imaging to organisms with high-metabolisms, such as mammals and birds. The metabolic rates of bats during echolocation, for instance, are up to five times greater than they are at rest. These costs have been offset in bats through the evolutionarily ingenious coupling of sound emission to wing-beat cycle, which functions as a single unit of biomechanical and metabolic efficiency. Sound emission is coupled with the upstroke phase of the wing-beat cycle, coinciding with contraction of abdominal muscles and pressure on the diaphragm. This significantly reduces the price of high-intensity pulse emission, making it nearly costless. It is also why, as any careful crepuscular observer may have noticed, bats spend hardly any time gliding (which is otherwise a more efficient means of flight).

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.

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.

We all look for the crack of dawn that signals the passage of responsibility to a fresh crew. We all know the system sucks, that the long hours make for fuzzy thinking and that they generate pure blind hate at facing that next ridiculous admission. We all feel the frustration of doing too much for too few, and the insecurity of not knowing how much is too much or if it was really too little. We don’t like admitting how little we know, and none of us wants to look like fools. We don’t like criticism and yet we need it. We flog and flog, and rarely have the opportunity to see the veritable forest for the trees. We hate the patients for making more work for us. We especially hate the grossly self-destructive ones who don’t deserve our sweat and society’s money.

The next morning, while everyone else sat in the waiting area, Mia and I met with the doctor. “Well, I have good news and bad news,” Dr. Genecov said. “The bad news is that she needs this surgery, and we need to get it on the books right now. The good news is that I’ve worked with a company to invent a new device. Instead of using the halo, I can now do everything internally.” What? Did I just hear what I think I heard? He continued talking, but I honestly didn’t hear anything for the next few seconds while I tried to process this new information. Seriously? I can’t believe this! I thought. Where did this come from? I knew he was working on a better bone graft procedure before we needed it, but this just came out of nowhere! I tried my best to hold myself together. All I wanted to do was call Jase and tell him this news. Actually, I wanted to climb the nearest mountain (if there were mountains in Dallas) and shout it from the top of my lungs! After thanking him profusely, Mia and I walked down the hall for our appointment with Dr. Sperry. “Do you know what you just avoided?” Dr. Sperry asked, grinning from ear to ear. “A shaved head, the intensive care unit for a week, and a much longer recovery period.” That was it. I couldn’t hold back any longer and let my tears flow. Mia looked at me in surprise. If I was embarrassing her, I didn’t care. It was for a good reason. “Dr. Genecov has been working hard to perfect this procedure, and he has done it one time so far.” She looked right at Mia and said, “And I’m convinced he did that one to get ready for you.” Mia smiled and said, “Cool.” Mia had enjoyed her honeymoon period. She felt no stress or anxiety about the future, which was a great blessing. I was thankful that I had not told her about the distraction surgery and glad that my eleven-year-old daughter didn’t understand all that she had been spared because of this development. When I filled in my mom, Bonny, and Tori on this unexpected and exhilarating news, they all gasped, then shouted and hugged me. All I could think of was how grateful I was to my Father in heaven. He had done this. Why? I don’t know. But I knew He had chosen this moment for Dr. Genecov to perfect a new invention that would spare my daughter, at this exact time in her life, the ordeal of a device that would have been surgically screwed into her skull. After getting to the parking lot, I immediately called Jase with this incredible news. Like me, he was having a hard time wrapping his head around it. “How many of these has he done?” I hesitated, then said, “One.” “One? He’s done one? I don’t know about this, Missy.” I quickly reminded him of Dr. Genecov’s success in the new bone graft surgery and said, “Babe, I think it’s worth the risk. He’s proven to us just how good he is.” Jase is not one to make a quick decision about anything, but before our phone call ended, he agreed that we should move forward with the surgery.

The goal of Look Ahead was to reduce heart disease, a common complication of diabetes. The study, conducted in sixteen clinical centers in the United States, assigned about five thousand adults with type 2 diabetes to either a low-fat diet with intensive lifestyle modification or to usual care. The study, published in the New England Journal of Medicine in 2013,33 was terminated prematurely for “futility.” Analysis by independent statisticians found no reduction of heart disease among participants assigned to the intensive low-fat diet, and no prospect of ever seeing such a benefit emerge.

The psychiatrist R. D. Laing, at one of the first conferences on Buddhism and psychotherapy that I attended, declared that we are all afraid of three things: other people, our own minds, and death. His statement was all the more powerful because it came shortly before his own death. If bare attention is to be of any real use, it must be applied in exactly these spheres. Physical illness usually provides us with such an opportunity. When my father-in-law, an observant Jew with little overt interest in Eastern philosophy, was facing radical surgery not so long ago, he sought my counsel because he knew of some work I was engaged in about stress reduction. He wanted to know how he could manage his thoughts while going into the surgery, and what he could do while lying awake at night? I taught him bare attention to a simple Jewish prayer; he was gradually able to expand the mental state that developed around the prayer to encompass his thoughts, anxieties, and fears. Even in the intensive care unit after surgery, when he could not tell day from night, move, swallow, or talk, he was able to use bare attention to rest in the moment, dissolving his fears in the meditative space of his own mind. Several years later, after attending Yom Kippur services, he showed me a particular passage in the prayer book that reminded him of what he had learned through his ordeal. A more Buddhist verse he could not have uncovered: A man’s origin is from dust and his destiny is back to dust, at risk of his life he earns his bread; he is likened to a broken shard, withering grass, a fading flower, a passing shade, a dissipating cloud, a blowing wind, flying dust, and a fleeting dream. The fearlessness of bare attention is necessary in the psychological venue as well, where the practice of psychotherapy has revealed just how ingenious and intransigent the ego’s defenses can be. Even when they are in therapy, people are afraid of discovering things about themselves that they do not wish to know.

An incident which meant a great deal to Diana took place in that same hospital away from the cameras, smiling dignitaries and the watchful public. The drama began uneventfully three days earlier in a back yard in Balderton, a village near Newark when housewife Freda Hickling collapsed with a brain haemorrhage. When Diana first saw her behind the screens in the intensive care unit she was on a life-support system. Her husband Peter sat with his wife, holding her hand. Diana, who was visiting patients in the hospital, had been already been told by the consultant that there was little hope of recovery. She quietly asked Peter if she should join him. For the next two hours she sat holding the hands of Peter and Freda Hickling before the specialist informed Peter that his wife was dead. Diana then joined Peter, his stepson Neil and Neil’s girlfriend Sue in a private room. Sue, who was so shocked at seeing Freda Hickling on a life-support machine, did not recognize Diana at first, vaguely thinking she was someone from television. “Just call me Diana,” said the Princess. She chatted about everyday matters; the size of the hospital, Prince Charles’s arm and asked about Neil’s forestry business. Eventually Diana decided that Peter could do with a large gin and asked her detective to find one. When he failed to reappear, the Princess successfully found one herself. Peter, a 53-year-old former council worker, recalls: “She was trying to keep our spirits up. For somebody who didn’t know anything about us she was a real professional at handling people and making quick decisions about them. Diana did a great job to keep Neil calm. By the time we left he was chatting to Diana as though he had known her all his life and gave her a kiss on the cheek as we walked down the steps.” His sentiments are endorsed by his stepson, Neil. He says: “She was a very caring, understanding person, somebody you can rely on. She understood about death and grief.

Worst Comes To Worst" (feat. Guru) [Babu mixing] "Worst come to worst my peoples come first" "Worst...come.....to worst" "Worst come to worst my peoples come first" "Worst come...to...worst" "Worst come to worst my peoples come first" [Evidence talking] Yeah It's goin down y'all That's Babu Yo, some people got good friends, at night I live my life right Intense, on the edge On the wild, I'm from the group where friction leads to fire Stack your bricks, the time is take your pick Do or don't, the track - Alchemist My life is good, I got my peeps in the mix, so... "Worst come to worst my people come first" [Iriscience] I got worldwide family all over the earth And I worry 'bout 'em all for whatever it's worth From the birth to the hearse, the streets, the guns burst Words I disperse are here to free minds And if mine are needy I need to feed mine "When worst come to worst..." [Evidence] Set up shop and write a verse Actually (what?), that's best come to best My lyrics take care of me, they therapy Get shit off my chest Extra stress, three-four over the score Different patterns of rhymin prepare me for war So next time you see us we'll be deadly on tour [Babu mixing] "Oh, when you need me" "Worst come to worst my peoples come first" [Guru talking] Word up, if worst comes to worst, I make whole crews disperse You know it's family first Gifted Unlimited with Dilated Peoples Babu, Evidence, Iriscience And a shout out to my man Alchemist on the trizzack "Oh, when you need me" "Worst come to worst my peoples come first" [Iriscience] I'm a glutton for the truth, even though truth hurts I've studied with my peoples on streets and in church We make it hard when we go on first Long road, honor of the samurai code These California streets ain't paved with gold Worst comes to worst "Worst come to worst my people come first" [Evidence] Uh, I got them back, at the end of the day We could go our seperate ways but the songs remains, it won't change Got my target locked at range I might switch gears but first I switch lanes Without my people I got nothin to gain That's why... "Worst come to worst my people come first" [Iriscience] Special victims unit, catalyst for movement Creates to devastate, since '84 show improvement Definitely Dilated Peoples comes first Cross-trainin spar, we raise the bar And we put it in your ear no matter who you are [Babu mixing] "Oh, when you need me" "Worst come to worst my peoples come first" "Worst....come...worst my peoples come first" "Worst...worst....worst....come to worst my peoples come first" "...my..my...my peoples come first "Oh, when you need me

In the book (Savvy Stories) you see some very real, very personal moments. The first week of Savvy’s life was the longest week of ours. We spent five days in the NICU (Neonatal Intensive Care Unit) worrying that our newborn daughter might die. It was touch and go for a while, and it was extremely difficult to write about. Chapter two gets a lot of people crying. But because we put that honesty out there, readers said “Okay, I can trust this guy.” Then they were better able to laugh with us, too.

She reacted to this with hostility and openly maintained a prayer vigil outside the intensive care unit, praying that her son would die because of the shame he had caused her.

Research and development conducted by private companies in the United States has grown enormously over the past four decades. We have substantially replaced the publicly funded science that drove our growth after World War II with private research efforts. Such private R&D has shown some impressive results, including high average returns for the corporate sector. However, despite their enormous impact, these private R&D investments are much too small from a broader perspective. This is not a criticism of any individuals; rather, it is simply a feature of the system. Private companies do not capture the spillovers that their R&D efforts create for other corporations, so private sector executives in established firms underinvest in invention. The venture capital industry, which provides admirable support to some start-ups, is focused on fast-impact industries, such as information technology, and not generally on longer-run and capital-intensive investments like clean energy or new cell and gene therapies. Leading entrepreneur-philanthropists get this. In recent years, there have been impressive investments in science funded by publicly minded individuals, including Eric Schmidt, Elon Musk, Paul Allen, Bill and Melinda Gates, Mark Zuckerberg, Michael Bloomberg, Jon Meade Huntsman Sr., Eli and Edythe Broad, David H. Koch, Laurene Powell Jobs, and others (including numerous private foundations). The good news is that these people, with a wide variety of political views on other matters, share the assessment that science—including basic research—is of fundamental importance for the future of the United States. The less good news is that even the wealthiest people on the planet can barely move the needle relative to what the United States previously invested in science. America is, roughly speaking, a $20 trillion economy; 2 percent of our GDP is nearly $400 billion per year. Even the richest person in the world has a total stock of wealth of only around $100 billion—a mark broken in early 2018 by Jeff Bezos of Amazon, with Bill Gates and Warren Buffett in close pursuit. If the richest Americans put much of their wealth immediately into science, it would have some impact for a few years, but over the longer run, this would hardly move the needle. Publicly funded investment in research and development is the only “approach that could potentially return us to the days when technology-led growth lifted all boats. However, we should be careful. Private failure is not enough to justify government intervention. Just because the private sector is underinvesting does not necessarily imply that the government will make the right investments.

And a severe influenza pandemic would hit like a tsunami, inundating intensive-care units even as doctors and nurses fall ill themselves and generally pushing the health care system to the point of collapse and possibly beyond it. Hospitals, like every other industry, have gotten more efficient by cutting costs, which means virtually no excess capacity—on a per capita basis the United States has far fewer hospital beds than a few decades ago.

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.

Medicine is becoming a business, and if people choose medicine as a way to make money, they should go to the States because there, health care is a commodity for sale and you can shop around for the best product. Patients are the customers and if you're rich you get better health care than if you're poor. In Canada, health care is a basic human right, a service that every human being deserves. Tell me, have any of you ever seen someone get preferential treatment? A Canadian over a non-resident? A white person over one of color? A VIP over an ordinary citizen?

That is what nursing has taught me above all: compassion is the greatest wisdom.

Mercy headed for the elevators. Instead of pressing the button for the first floor, however, she found herself punching the third-floor button to the intensive care unit.

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.

My experience as an Episcopal priest led me to believe that I would never want to suffer the way I saw so many people die: in isolation, abandoned and with great existential suffering. I would never want to be in an intensive care unit, hooked up to all kinds of machines.

So, Columbus and his successors were not coming into an empty wilderness, but into a world which in some places was as densely populated as Europe itself, where the culture was complex, where human relations were more egalitarian than in Europe, and where the relations among men, women, children, and nature were more beautifully worked out than perhaps any place in the world. They were people without a written language, but with their own laws, their poetry, their history kept in memory and passed on, in an oral vocabulary more complex than Europe’s, accompanied by song, dance, and ceremonial drama. They paid careful attention to the development of personality, intensity of will, independence and flexibility, passion and potency, to their partnership with one another and with nature.

This included taking unprecedented steps to keep large numbers of elderly and frail patients out of intensive care wards to avoid these being overwhelmed. It would mean many patients would die without receiving the life-saving care they needed. Downing Street was anxious that critical care units should not be visibly overrun as they had been in Italy, Spain and China, where patients in the city of Wuhan were photographed dying in corridors. So a veil of secrecy was now placed over Britain’s hospitals. The publication of critical care capacity figures was suspended, which meant nobody outside the corridors of power would be able to tell whether hospitals were being overrun, and a general ban was imposed on information being passed to the media without sign-off from central command.

1980s, when a study of Intensive Care Units revealed that “the most significant factor associated with excessive mortality was the degree of nurse-physician communication

The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a silver’s chance of benefit. They are spent in institutions-nursing homes and intensive care units-where regimented, anonymous routines cut us off from all the things that matter in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.

Additionally, after a thirty-hour shift without sleep, residents make 460 percent more diagnostic mistakes in the intensive care unit than when well rested after enough sleep. Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant, liable harm to a patient.

In a written lament then words cannot simply be dumped or gushed or mushed as in initial grief. Here one cannot simply vomit out feelings but must choose words. Not that the lament is cold, objective, and detached. Rather the intensity of one's emotions unite with the discipline of one's mind to produce structured sorrow, a sort of authorized version of distress, a kind of coherent agony. In a lament, therefore, words are carefully selected, crafted, honed, to express loss as closely yet fully as possible.

I often struggle to breathe but resist thinking of the lost faith in the judicial system, incompetent politicians, and military dictators who worked hard to wheel me off into the intensive care unit (ICU) by placing my future on a ventilator. Now, my life support is a drip feed of foreign loans and emergency cash injections from lenders and friends. Have I told you my name? My name is Pakistan.

We established an investigative team at each hospital and selected 11 nursing units for the study at the 2 hospitals: 5 intensive care units and 6 general, non-obstetric care units. David Bates was the leader of the Brigham team and David Cullen led the MGH team.

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.

During a belated New Year’s cleaning, I come across my grad-school coursework on the Austrian psychiatrist Viktor Frankl. Scanning my notes, I begin to remember his story. Frankl was born in 1905, and as a boy, he became intensely interested in psychology. By high school, he began an active correspondence with Freud. He went on to study medicine and lecture on the intersection of psychology and philosophy, or what he called logotherapy, from the Greek word logos, or “meaning.” Whereas Freud believed that people are driven to seek pleasure and avoid pain (his famous pleasure principle), Frankl maintained that people’s primary drive isn’t toward pleasure but toward finding meaning in their lives. He was in his thirties when World War II broke out, putting him, a Jew, in jeopardy. Offered immigration to the United States, he turned it down so as not to abandon his parents, and a year later, the Nazis forced Frankl and his wife to have her pregnancy terminated. In a matter of months, he and other family members were deported to concentration camps, and when Frankl was finally freed, three years later, he learned that the Nazis had killed his wife, his brother, and both of his parents. Freedom under these circumstances might have led to despair. After all, the hope of what awaited Frankl and his fellow prisoners upon their release was now gone—the people they cared about were dead, their families and friends wiped out. But Frankl wrote what became an extraordinary treatise on resilience and spiritual salvation, known in English as Man’s Search for Meaning. In it, he shares his theory of logotherapy as it relates not just to the horrors of concentration camps but also to more mundane struggles. He wrote, “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.” Indeed, Frankl remarried, had a daughter, published prolifically, and spoke around the world until his death at age ninety-two. Rereading these notes, I thought of my conversations with Wendell. Scribbled in my grad-school spiral were the words Reacting vs. responding = reflexive vs. chosen. We can choose our response, Frankl was saying, even under the specter of death. The same was true of John’s loss of his mother and son, Julie’s illness, Rita’s regrettable past, and Charlotte’s upbringing. I couldn’t think of a single patient to whom Frankl’s ideas didn’t apply, whether it was about extreme trauma or an interaction with a difficult family member. More than sixty years later, Wendell was saying I could choose too—that the jail cell was open on both sides. I particularly liked this line from Frankl’s book: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

Common Childhood Illnesses that may require PICU Care – Motherhood Chaitanya Hospital As parents, we’re no strangers to the occasional bumps, bruises, and sniffles that come with childhood. But there are times when more serious health concerns arise, requiring specialized care and attention. The Pediatric Intensive Care Unit (PICU) becomes a haven for children facing critical illnesses. With expertise from the best PICU hospital in Chandigarh like Motherhood Chaitanya Hospital, let’s delve into some common childhood illnesses that may require PICU care, understanding the challenges and the avenues of support available.

back to standing and listened. I needed to hear the truth. She gave me sound advice and recommended going to an appropriate emergency room if I felt anything suspicious with the baby. She said that our local hospital wouldn’t staff the neurosurgeons necessary to perform life-saving surgery, so we would need to travel to a larger city. Since we became more restless and hopeless every moment, Adam and I decided to drive the four hours south and crash the ER at an L.A. hospital. We went to Cedars-Sinai Medical Center because our midwife found great reviews about their Neonatal Intensive Care Unit

Now survival is commonplace, and a substantial part of the credit goes to the abilities intensive care units have developed to take artificial control of failing bodies.

I also praise the cooperative efforts in our pediatric intensive care unit. In fact, this togetherness permeates every aspect of our program here, including our office staff. We're friends, we work well together, we're dedicated to alleviating pain, and we're interested in each other's problems, too. We're a team, and Ben Carson is only part of that team.

Candice and her fellow custodians were all hired to do the same job, but some of them ended up rethinking their roles. One cleaner on a long-term intensive care unit took it upon herself to regularly rearrange the paintings on the walls, hoping that a change of scenery might spark some awareness among patients in comas. When asked about it, she said, “No, it’s not part of my job, but it’s part of me.

team working on two children who had been thrown from the back of their father’s pickup truck onto the roadway. By the time I reached the floor, Immy had been taken upstairs to surgery. The surgery had lasted almost twelve hours, and things had not gone well. The bypass pump, a relatively new technology, had malfunctioned for several minutes and Immy had lost a great deal of blood. She was on a respirator, unconscious and unresponsive, in the Intensive Care Unit. On the day after surgery, Immy’s mother told me in a shaking voice that Immy’s gown had been removed in the operating room and thrown into the hospital laundry. The medal was gone. Concerned, I called the surgery resident and told him what had happened. “Why are you telling me this?” he asked me.

the hospital to tape it to the closed door of Dr. X’s office. I had signed it and on the way back to my bed I began to worry. What if I had done something really foolish? If the surgical resident didn’t care about such things, why should Dr. X? I was off call the next day and, exhausted, I spent most of the time asleep. When I returned to the hospital for the evening shift, the pediatric day resident told me that Immy was no better. For the next few hours I took care of whatever was most urgently needed on the service, but later in the evening I stopped by the Intensive Care Unit to examine Immy and speak with her family. I found her parents in the waiting room. Together we went to see Immy. She was still unconscious. Leaning over to listen to her chest, I suddenly noticed a medal pinned to her hospital gown. Turning 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.

A typical twenty-bed intensive care unit generates an estimated 160,000 data points a second.

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.

Dad and I follow the quick-footed nurse across the car park to the Garrett Anderson Centre and upstairs to the intensive care unit.

Judiciary, politicians and establishment have worked hard to wheel off my spirit into the intensive care unit by placing me future on ventilator. My name is Pakistan.