Leave It There

[I originally wrote this as a medical student working in the ICU. It’s one of my most haunting memories and comes to mind every time I work in the intensive care unit.]

“I thought I could beat the ICU, you know?” My resident looked into the distance abstractly as he spoke, talking to himself more than to me. “Sometimes you think you won’t let it get you down, but you can’t. It always wins.”

I wondered what he meant by winning. Did he mean getting to leave on time? Did he mean keeping a positive attitude? How can you “win” in the ICU? I thought about all of the patients we were caring for. A comprehensive list of their names was scrawled on a big whiteboard, a canvas where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity. The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard: successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently to squeak out a new set of letters.

The resident’s pager went off. There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock. Of my sixteen hours on shift, there were two remaining. Then one. Five minutes. Finally my resident dismissed me. “Go get some rest,” he said kindly, scanning the computer screen and mechanically punching in orders. “All that’s left is paperwork. Nothing more for you.” As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU. I walked down a quiet hallway, paneled on both sides by glass. The view on the left faced out into the cold, dark, northeastern night. The right faced the surgical ICU waiting room, which remained lit with muted, tubular fluorescent bulbs. I glanced in and was surprised to see someone still waiting inside.

She was sitting alone. Her eyes were puffy and red, but dry. They looked as if they had been that way for a long time. A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward with a palpable heaviness. Her motionless presence made the room seem more static than if it had been empty. Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do, and that he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move. I got in my car and felt immensely grateful that I could simply drive away. I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room. I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she’s gone, ohmygod she’s really gone.

****

So tempting to take up a crown
of guilt around my head
and proudly wear another’s weight
of paralytic dread.
So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:

“Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.
Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:

There is a balm in Gilead
To make the wounded whole;
There is a balm in Gilead
To heal the sin-sick soul.

Some times I feel discouraged,
And think my work’s in vain,
But then the Holy Spirit
Revives my soul again.

If you can’t preach like Peter,
If you can’t pray like Paul,
Just tell the love of Jesus,
And say He died for all.”

Ventricular fibrillation (perhaps torsades de pointes?) and then SHOCK resulting in ROSC. The only successful shock on a long night of ICU call.
Rhythm monitor strip; can you guess what it is?
Leave It There

Leave It There

“I thought I could beat the ICU, you know?” My resident looked into the distance abstractly as he spoke, talking more to himself than to me. “Sometimes you think you won’t let it get you down, but you can’t. It always wins.”

I wondered what he meant by winning. Did he mean getting to leave on time? Did he mean keeping a positive attitude? How can you “win” in the ICU? I thought about all of the patients we were caring for. A comprehensive list of their names was scrawled all over a big whiteboard, where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity. The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard; successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently for a marker to squeak out a new set of letters.

The resident’s pager went off. There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock. Of my sixteen hour shift, there were two hours left. Then one hour. Five minutes. Finally my resident dismissed me. “Go get some rest,” he said kindly as he scanned the computer screen and mechanically punched in orders. “All that’s left is paperwork. Nothing more for you.” As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU. I walked down a quiet hallway paneled on both sides by glass. The view on the left side faced out into the cold, dark, northeastern night. The right side faced the surgical ICU waiting room, still lit with muted, tubular fluorescent bulbs. I glanced into it momentarily and was surprised to see someone still waiting inside.

She was sitting alone. Her eyes were puffy and red, but they were dry, and they looked as if they had been that way for a long time. A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward slightly as if carrying a palpable heaviness. Her motionless presence made the room seem more static than if it had been empty, as if Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do and he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move. I got in my car and felt immensely grateful that I could simply drive away. I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room. I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she’s gone, ohmygod she’s really gone.

*****

So tempting to take up a crown
of guilt around my head
and proudly wear another’s weight
of paralytic dread.So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:

“Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.

Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:

There is a balm in Gilead
To make the wounded whole;
There is a balm in Gilead
To heal the sin-sick soul.

Some times I feel discouraged,
And think my work’s in vain,
But then the Holy Spirit
Revives my soul again.

If you can’t preach like Peter,
If you can’t pray like Paul,
Just tell the love of Jesus,
And say He died for all.”

Leave It There