I ran in to an acquaintance over the weekend that had been pursuing a degree in nursing. He had changed course after spending some time in a hospital. He said it was not the kind of environment he wanted to work in or be in. I think I understand. I also do not like the environment. It is not because of all the blood, mucous, vomit and stool that I have to manage and clean up on a regular basis – human bodies have only a limited repertoire of grossness and you acclimate to that in the first few weeks. It is the soul crushing machine that is the modern medical system which is truly opposed to any values or sense of aesthetic I may hold. Still, I like it. I feel alive and engaged at work. I have been thinking about why, and now my friend has me thinking more. In general, I think the ICU appeals to people because of the excitement. One gets to watch holes being drilled in skulls, abdomens being sliced open, emergencies responded to. Codes (when emergency resuscitation i.e. shocks compressions etc are carried out) are always somewhat thrilling because everyone is activated and working as a team. Never mind that the outcomes of codes are usually less than inspiring. Then there is the responsibility. As you work, lives depend on you in a very real sense and while this cuts both ways, it does give a feeling of importance. Some people (not me) are also enamored with the innumerable gadgets we learn to run. And then there are those who just want to help make people better.
While all of these apply to me to some degree I find that what I most value are the frequent opportunities to engage in righteous rebellion. Now, I am not talking about a rebellion against death. Often the problem is that someone who needs to die is not being allowed to die. Neither do I have any interest in killing people off. I have no desire to take that responsibility into my own hands. Rather, what I see and fight against is simple ignorance and lack of information. The representation of healthcare in mass media is so false that people often have no clue about what is really happening around them. They watch their loved ones waste away in agony and misery waiting in vain for some TV doctor to burst in and announce that he and no one else knows the answer and can return the doomed soul from the brink. For some reason these illusions are nourished by healthcare workers. Sometimes it is because no one wants to admit failure, error, or impotence. Sometimes it is the weight of false expectations – the family plans to have the patient home by the next holiday, who will tell them that this miserable life in the hospital bed is as good as it is ever going to get now? Patients and families often respond to bad news with anger. This also discourages the flow of information. Many healthcare workers see it as beyond their duties to expose themselves to these kinds of reactions. It is much easier just to give the pills, change the bandages and say “he sure is looking better today!”
As for me, I see the suffering it all causes and derive great satisfaction from dispelling these illusions. It is best when the patient and families are open and ready to hear. When they immediately recognize and appreciate that I am being straight with them. I know that most others will not be and this enlivens me and helps me to extend myself further. It is harder when there is resistance. Often the patient wants to die, but the family will not allow care to be withdrawn or limited (this is not assisted suicide). Often the patients are beyond being able to participate in their care, and there is disagreement among family members about which course to take. In these cases there is always a risk of becoming a target of family member anger. It is natural, after all, to look for someone to blame, especially when there are often so many mistakes, and no one ever steps forward to take responsibility. Still I will crush their illusions if I can, slowly and gently if I can. I am confident that I reduce my patient’s suffering in this way and that of their families as well. Medical feathers may be ruffled from time to time, but there has been no retaliation so far. Mostly there is appreciation from coworkers. I try to be careful also. I avoid exceeding my bounds. I am cautious not to expose myself uselessly. I am older and wiser than I used to be and I do have a family to support as well. Still, there is almost daily opportunity to fight against the black darkness of ignorance that enfolds this hellish modern society. There is more opportunity here in the ICU than anywhere else I have found. I love my job for this reason.