By Dr. George Jacob.
Kochi: An intensivist is a doctor who works exclusively in Intensive Care Units (ICUs). He or she tends to extremely sick patients, a lot of them at death’s doorstep hooked to life-supporting machines and drugs.
The intensivist’s job among disconcerting alarms and bleeps from machines that keep patients alive is also an emotional rollercoaster ride. Two patients in the ICU I work in proved quite a handful emotionally recently, that I dreaded to take rounds, to be honest.
The first one was a 22-year-old engineering student who had widely disseminated colon cancer and renal failure. He had to be operated for intestinal obstruction caused by advanced cancer. A surgical attempt to at least enable the patient eat something before sure death snatched him away proved futile.
During my rounds the next day, he pleaded to be discharged from the ICU to his room to be with his dear and near, which was a perfectly reasonable request, considering his diseases which he was aware of A-Z. Being ‘clinically unstable’ I attempted to reason with him the need for monitoring in the ICU.
Looking straight into my eyes, without batting an eyelid, with hopelessness writ on his famished face, he told me; ‘Doctor you know I’m not going to live long. Let me at least be with my parents before I die’. I hoped the Earth would open up below my feet and swallow me, as I stood there torn between a ‘clinically unstable’ patient who merited ICU care, and a young man dying from advanced cancer yearning to spend his numbered days with his parents.
Somehow managing to convince him, I discharged him to his room the next day. After a few more days in the hospital, he died.
The second one was also a young woman in her 20s, who met with a gory road traffic accident. She had sustained pelvic fracture and liver injury. She lost her sister, whose death she witnessed in the car that had somersaulted, due to a burst tire. She also lost her daughter, a tiny tot, who she remembers sleeping on her lap at the time of the accident. The child later succumbed to head injury in another hospital.
The ICU was drowned in her loud wailing, as the two dead bodies were brought in, as per her request, ‘for a last look’. There wasn’t a staff without teary eyes. It was hard to work in the ICU that day. Extreme Emotional upheaval had the entire staff including me lose our composure. Having recovered from her injuries, she was discharged subsequently from the ICU to a room to be with her family.
Caught between a profession that runs on well-laid out ethics to work toward ‘clinical stability’ of patients and situations where circumspection may have to be sidestepped in the interest of humanity for emotionally and physically unwell fellow human beings, whose requests must be met, ensuring caution is not thrown to the winds at the same time, an intensivist’s job is evidently no Sunday afternoon stroll in the park.