I'm on staff in a 20-bed specialty intensive care unit for neurosurgery patients, but our census is low today and I was temporarily assigned ("floated") to the 20-bed medical intensive care unit (MICU) at our large urban teaching hospital.
Things are always busy in the MICU. There's always somethng interesting going on. Here's my day so far...
I can't provide any information that would make it possible to identify my patient without running afoul of the strenuous .privacy rule that is an essential part of HIPAA.
It's fair to say that my patient is very ill as a result of several severe traumas and health crises over the years, and like many patients in similar situations requires a variety of technological interventions to monitor and maintain essential life processes. My patient is much closer to death than (hopefully) we are.
Upon arriving in the MICU I was given a very thorough report by the nurse who has cared for the patient for the last three nights. We reviewed the pertinent events, the parameters we're measuring, and the team's near-term plans for the patient.
The patient's family met with members of the team last night, and they're facing the decision to redirect care. We've been using this term lately, rather than the terms withdrawing care or comfort measures only, since those two latter choices don't really express what happens when such a decision is made. They can also give the family the false impression that their loved one is somehow going to be abandoned.
The term redirect more accurately describes what the team does when treatment is not likely to improve the quality of life or lead to a positive outcome. We change our focus, and redirect our efforts.
Extraordinary measures are discontinued, like mechanical ventilation and drugs to fight infection or control heart rate, rhythm or blood pressure; and we move more explicitly towards focusing solely on the troubling symptoms that can accompany end of life, like pain, seizures, and difficulty breathing.
While the ICU is a high tech environment geared towards aggressive life-saving, the fact is that patients here are sicker, and as a result many of them don't survive.
The patient's immediate family needs to consult with several extended family members before making a final decision, for cultural reasons. They'll talk again with the team tonight, probably after I leave at 7pm.
Meanwhile, here we are - me and my patient.
When I first walked into the patient's room, the wall-mounted flat screen TV was loudly tuned to CNBC. It's a sad fact that the TV is on in a substantial number of the rooms in any hospital.
While a patient who's awake may need some distraction from long periods of boredom, I'm a zealot when it comes to turning off the TV when the patient's unconscious - and even when they're not. The scenes on the screen change and flash at a furious pace, and they're often frighteningly violent - not conducive to good health or recovery.
The cable system on my regular unit provides access to a couple of XM satellite radio channels, including traditional classical, so all of my unconscious and sedated patients, as well as some of the conscious ones, get at least a partial day's dose of Beethoven, Shostakovich, and the like.
I ran through the channels in the MICU. There was no XM, but I did find a radio station that I'd never heard before - it broadcasts a continuous stream of Islamic prayers and chanted recitations from the Koran. I've had it on all day.
My patient's not Muslim, and neither am I. I don't know any Arabic, but the sound of the chanting is comforting, and it's been filling the room with the presence of something from another part of the world:
The Sunnah recommended that a believer, whose waliyy, muslim relative, passed away should make du'aa, supplication and instirjaa saying the following, for his deceased relative:
Inna lillaahi wa innaa ilaihir
Allaahummah ajirnee fee
museebatee we akhlif lahuu
To Allah we belong, and to Him is our return.
O Allah reward me in my affiction and
let him be succeeded by the best.