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Can't Know

Sometimes when we ask a question of our 2 year old, she says, "I can't know." We correct her, "you don't know?" But after spending the past month rotating in the medical intensive care unit (MICU) I think she's on to something. I CAN'T know everything about these patients. When picking up a new patient in the morning I have an hour and a half before rounds to learn everything about them. They may have been in the hospital for weeks or months, on a ventilator, tube feeds, dialysis... With a list of problems for each organ system. I can't know. After a few days of following a patient then I start to know them, and begin to understand their illness.

This rotation brought many new experiences. I called family members to tell them their loved ones are dead or dying. I watched a patient die for the first time, and I pronounced a death for the first time. The patient had come in the evening, and I stayed late that night to help perform a stabilizing procedure. The next morning as I was doing my pre-rounds his heart rate and blood pressure began to drop. His family had specified not to perform heroic resuscitation should he start to decline, so I watched. I watched the numbers tick down over the next 15 minutes. "Do your thing" the nurse told me. Right, my thing... I'm the doctor now, I should decide that he's dead. This is not something that's explicitly taught in medical school. I only know from peripheral conversations what I should do to confirm death. I placed my stethoscope on his chest. It was quiet. He wasn't breathing, his heart wasn't beating. "So what do you want to call it?" The nurse asked. "7:20" I said, looking at my watch. I walked from there to the bathroom to collect myself before calling his family. I'm not really sure why I even felt sad. It seemed so routine to everyone else, and I didn't even know this person. I've had other patients die before, but it's been overnight when I come back in the morning, or days after I was no longer caring for them.

Some people briefly pass through the ICU for a day. They've got bad influenza, bleeding in their brain or GI tract... But the ones who stay for days are different. They stay for days, weeks, or even months because they're not getting better. And these were the patients I spent the majority of my time with over the past month. Most of these people are not making their own decisions about their care. Their family members are the ones telling us to keep them alive at all costs. One of my attendings said that everyone has the same code status, which is "If I'm going to get better, do everything, if I'm not, don't." Of course everyone has different ways of expressing this, but I think he was largely correct. I wonder what these patients being kept alive on machines would want for themselves. But making a decision for your own life versus a loved one is very different, and I don't envy the families having to make those decisions.

Now that I'm done with my ICU rotation, I am finished with inpatient rotations for my internship! The rest of the year brings more reasonable hours and weekends off!

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