Not for TV

I have not had time to write recently, so I am posting one of my earlier essays. I hope to get back to my regular posting in a week or so.


Not for TV

When I get to work in the morning I swipe my badge to enter the unit I am working on. I am greeted by the SNAP!...SNAP! of locks unlatching on the entrance doors. This reminds me that I work in a private place. In one sense there is no privacy for an ICU patient. There are glass doors on all of the rooms and curtains are generally kept open. The patient’s vital signs are displayed on various monitors strategically placed around the unit. The patient is meant to be under observation, or at least observable, at all times. Everything is very public in this way, but at the same time the ICU environment is emphatically not open to the general public. In three years my wife came twice to see where I was working. She would walk quickly around the unit casting a glance or two at the patient’s rooms as she passed. It is not a place where a visitor feels comfortable to sit and observe. My brother is something of a technology buff and amateur inventor. He expressed an interest in observing medical devices in action, but this is not possible. My brother is not allowed to watch me work.
There will never be any unsupervised TV cameras in an ICU. It would be a huge violation of privacy. Even regular cameras are forbidden. I have seen few things agitate nurse managers more than patient family members taking pictures of their relatives. Even talking on cell phones is against the rules and is strongly discouraged. The rationale for this is that the patient’s monitors can be affected by the phone signals, but those who know technology will tell you that this idea is false. Nurses themselves often use their own phones in empty rooms or hallways, but they are more likely to ask a family member to turn off a cell phone than to tell them to wear gloves in an isolation room. This is not limited to one hospital. As far as I am aware it is a standard policy in all hospitals. The ICU environment simply resists the outflow of information.
I am not a watcher of hospital TV shows, but I am often struck by the incongruity between the reality of the ICU environment and its public portrayal. It is not that the patient’s situations or the devices and machines are outside of the public consciousness, it is that the flow of patient care and the mood in which that care is delivered is entirely different.
An example illustrates: Shortly after I first started working in the MICU I was sitting in group report. The charge nurse from the night shift was going through the routine of giving brief updates on the patients in the unit and their conditions. She came to a particular patient and paused in the middle of the summary. She smiled slightly, relishing the moment and what was to come. “And,” she said, “A maggot crawled out of his nose.” I suddenly felt as if I were in 6th grade. Ten nurses sitting around the table let out a chorus of moans and giggles. Tongues stuck out, lips curled, everyone laughed. It was a joyful moment and not at all at the patient’s expense. Something interesting had happened on the unit and though there was no question of shrinking from it neither was there any bashfulness in feeling grossed out. It was a happy honest moment which made me feel good about my choice of workplace. It also made me aware that I was experiencing something very private. Any outside observer would have made the honesty of this moment totally impossible. I wondered how such an occurrence would have been depicted in a TV show. I imagined appall and outrage, “Oh my God! How could this have happened in Our hospital?” How far from the truth such a depiction would be!