RickInOz

Those of you who also work in a critical care environment will confirm that it can be a thankless job. You are asked to take the sickest patients in the hospital and defy the disease or injuries that are killing them. It is not unreasonable for an intensive care unit to have a mortality rate as high as 40% - in other words 2 out of every 5 patients die before discharge.

It is not surprising, therefore, that intensivists often become disillusioned and burnt out. Dealing with the impossible and failing despite considerable investment can leave even the most optimistic clinician with a sense of depression. One coping mechanism is to become hardened and cynical; the other is simply to get out.

However, as the post title suggests, not all is bad. Every now and again we get to see nature defy the odds, and the patient we expected to die get better. As an example the RAH ICU currently has two such patients. For obvious reasons I can’t provide in-depth clinical details, but here is a snippet. The first is a young woman who was involved in a MVA (abbreviating: Motor Vehicle Accident). She was admitted to us with severe injuries and we told her family to expect the worst. After a month of aggressive treatment we were gratified to see her walk for the first time since the accident. The second patient is an elderly lady who was admitted with pneumonia and a poorly performing heart. The odds were very much stacked against her and, as with the previous patient, we warned her family that she would likely die. Yesterday we extubated her (i.e.: took her off the ventilator and the tube out of her trachea) and today she greeted me with a big smile.

It’s days like today that remind me why I chose intensive care. We wage a constant battle between modern medicine and the vulnerabilities of human physiology. Much of the time we lose, but once in a while we get to put two fingers up to fate!