The Man in the MICU
HEART OF A DOCTOR
Pavitra Parimala Krishnamani, MD MS
A
fter graduating medical school, physicians embark on a new journey as they start a medical residency program, meant to give us three to seven years of specialty-specific experience. As medical residents, the wealth of knowledge we gain from our programs’ structured educational curricula and the 60-80 hour weeks we spend making critical medical decisions uniquely positions us to leave our programs as experts in our fields ready to independently practice in our specialties. Our journey through medical school and residency molds us not only as physicians, but also as people, and it is humbling to reflect on the beginning of my clinical experience as I get ready to graduate alongside my co-residents.
everything I could was obvious. And when I was sent to help with a Code Blue alongside my resident, my enthusiasm resounded with every light-footed step I took as we ran to the MICU.
This is a story for the almost 40,000 new medical residents who will be taking our places soon. It is a story of how the best of medical education happens under the most challenging of circumstances. It is a story of how we, as medical students and physicians, share in our patients’ vulnerability and how that empathy can feel like a double-edged sword. It’s the story of a man in the Medical Intensive Care Unit (MICU), who was the first patient to teach me about how it feels when the person whose life you are trying to save decides it’s their time to move on…
My resident watched me mirror him, putting away my white coat and grabbing a pair of gloves so that I could be of use if directed to help. He was clearly weighing my apparent lack of physical fitness against the adrenaline-driven enthusiasm reflected in my eyes.
Lights. Sirens. Action. In almost every Hollywood medical drama, there is a scene in which a patient crashes. Usually, it is an obvious event, with a nurse immediately calling a Code Blue and hordes of doctors quickly painting the room white. Suspenseful music keeps viewers holding their breath as medical personnel burst into action and give life-saving CPR. Thanks to their heroic actions, the patient’s eyes fly open as they take a deep, life-affirming breath once again.
“Medicine is a career I chose despite the sorrow of losing patients, because every life saved or positively impacted makes the challenges of training and practicing completely worth it.” Although almost three out of every four of these lucky Hollywood patients survive to discharge, real life is not so forgiving. A 2015 National Academy of Medicine-commissioned a report showed that barely a quarter of patients who undergo CPR while in the hospital survive to discharge, many of whom battle devastating neurological outcomes after resuscitation. Despite knowing that Hollywood’s portrayal was a far cry from the realities of medicine, there was no way before my clinical education that I could have been entirely prepared for my experience with a man I saw in my hospital’s MICU during my second week rotating in the wards. New to the clinical world, my fresh-faced excitement to see and learn about
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COMMON SENSE MAY/JUNE 2022
“Have you ever done CPR?” my resident asked. “Only on a dummy,” I responded, out of breath after running up the stairs.
“Okay then. This is different. Compressions on real people take more force,” he warned me, “Go ahead and stand in line.” He directed me to the line of blue scrubs waiting to do chest compressions on the rotund middle-aged gentleman lying on the bed in front of us. I understood the gravity of the situation. Yet, the exigent atmosphere around me clouded my ability to fully recognize what it meant that the human being in front of me no longer had a pulse. It was as I stood on a stool, leaning over the patient’s body, that it finally occurred to me that my compressions could keep this patient’s blood flowing to the rest of his body, or they could deprive him of the oxygenation he needed to even have a fighting chance at life. The moment of clarity that followed was paired with a laser focus I can neither describe nor recreate on command. The room disappeared around me, along with its people and its noises. I disappeared. My line of sight fixated on my hands, which were layered atop one another, sitting firmly on the chest in front of me. My elbows locked. “One,” I counted to myself, channeling what felt like my entire body’s weight through my palms and past an already cracked breastbone. In those moments, all that mattered to me was that I push down as hard as I could for as long as I could. A resounding crash outside the patient’s room, accompanied by howls echoing down the hallway, finally severed my focus. I saw a woman banging at the glass door, begging to be let in, as I switched off my compressions with a nurse who had earlier congratulated me on seeing a code so early in my career. The room looked different now. As the woman’s friend pulled her away from the glass door, I noticed all the lines, wires, and tubes running into
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