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Clinical Narrative Reflection

On ICU Rounds

Passing through the restricted entrance of the ICU is like stepping foot into another dimension.

A web of clear and blue plastic tubes makes it nearly impossible to determine which machine is wildly wailing as you enter this strange environment. Few patients are conscious. Some might argue that few are truly alive. Passing by rooms with no visitors is depressing but a crowd of family members in a doorway may just choke you up.

I knew I was in a fragile state, at the mercy of sharp memories of previous trips to the ICU, where my own family members shared the same lifeless gaze of each patient that was now before me.

Torn between my current emotional state and desire to learn all I could about the patient on whom our team was currently rounding, I stood between the IV stand and my preceptor as he discussed the course of action with the nurse and me. I was part of the team, part of the conversation, part of the solution. I was in the moment. It was exhilarating.

After discussing our treatment plan, my preceptor and the nurse left the room and I suddenly found myself alone with the patient. I was no longer part of a conversation. I was in a different moment. I was simply an observer that might as well have been family. This patient was no longer a forgettable name on a chart. He was a father, possibly a brother, certainly a son. The poor chances of survival that my preceptor had mentioned earlier echoed in my ears, as I watched the green peaks and troughs dance on his heart monitor. I wondered when he had last opened his eyes, and I wondered who he last saw with them. I no longer felt like the powerful problem-solving medical student that I was just minutes before.

As I stood silently next to the patient, I contemplated a recurrent source of anxiety: the desire to enter into a field of medicine with constant variety and endless excitement, and the potential for high levels of emotional stress. It was then that I realized the subtle yet poignant experience that had just occurred: in the moment, I thrived. I recognized the importance of logical discourse in the treatment of this man, and I was able to focus on the task of caring for our patient. As soon as the tethers of responsibility had been cut and I was free to feel, I felt. The ability to compartmentalize heavy emotions is a necessary skill in the practice of medicine and one that paves the way for balance between successfully caring for our fellow humans and remaining one ourselves.

I proceeded to meet my preceptor outside, bursting at the seams with questions regarding our patient’s condition. Back in the moment. Cool as a cucumber.

And I cried the whole way home.

Featured image:
to much food by wolfgangphoto