Today I cared for a patient in an ICU I had never practiced in before.
I was at home, comfortable and content. The nurses were superb and we were in full banter within 10 minutes — they essentially telling me to get out of the way and let them do their work but joking with me at the same time. Familiar innuendoes, knowing glances and shared experiences. Oh, it was a grand time!
I began to think about HOW MANY intensive care units I have been in during the last 40 years. Yes, 40 years. I began working in ICUs as a 17 year old orderly. I have done just about everything there is to do in a critical care unit. How many units? I cannot count them all — general ICU, medical ICU, surgical ICU, trauma ICU, neurological ICU, pediatric ICU, neonatal ICU, cardiac ICU, cardiac surgical ICU on and on and on . . .
And I loved them all.
I loved the docs, the nurses, the support staffs. I loved the patients. I loved the not knowing when everything was going to hit the fan. Crisis, thinking on your feet, making it up as you go, doing something you had never done before, saving lives, reducing discomfort, helping someone die with dignity and not alone — all of it thrilling and experiences beyond compare. My heart beats fast just writing this.
With the excitement, however, came a price. You would “burn out” every 3 or 4 years. I submit that one cannot do this type of work without becoming emotionally numb after a while. If you ignore the fact that you are becoming hardened, desensitized and unfeeling, you will personally deteriorate and begin to rot inside. You need to have a good inner warning system, good friends and protective loved ones to realize when it is time to go. Sometimes you need to leave forever — your days in critical care are done and you hope you have taught the next generation well. Often, though, you just need a break. You go do another job somewhere else, using a new skill set in a much more relaxed setting. You might join the Air Force and practice in the outpatient setting! Ah yes, but then you will again find yourself in a new ICU — maybe in Iraq — and once again filled with purpose, sharing gut wrenching experiences, taking care of the sick and maimed, and filled with expectation of the coming day.
Today, I saw just one patient in my ICU. Yet it felt like I had never left it and was about to see 20 more. How I love it. It just seems to fit me like a hand in a perfectly fitting glove.