If Medicine was a symphony: a day in the ICU
Working in the intensive care unit is very much a team-based approach, and for those familiar with it, a fairly noisy one at that. On any given day, there’s a gamut of activity (and emotions) which the team must take in their stride…
Movement 1: The morning adagio starts routinely, with a gathering of bodies as computers chime open to start rounds, the monotonous sound of people speaking one after the other, handing over cases and making plans for the day.
Movement 2: A difficult conversation today - the harsh red and yellow alerts on the monitor in contrast to the soft slow conversations between family and doctors, interspersed with quiet sobs. Tissues out of the box, crumpled in hands. Why are tissues always white? Stillness and quiet balanced with the heaviness of the emotions in the room. Górecki’s Symphony of Sorrowful Songs** plays in my head- the swells of a mother’s grief and anguish fill the silent room.
Remember to breathe.
Movement 3: A new admission. Everyone hopes it’s not going to be a bad one.
Encephalopathic-
Hello!
Hello?
Hello??
The decision to secure the airway triggers a frantic dance. E-cart rumbles to the bedside. Saturation volume turned up on the monitor- bing bing bing… the tone coincides with the speed of the heartbeat- the lower the tone, the faster your heart rate. Vivacissimo! More and more people gather around the bed- “What size tube do you want? Who is drawing the medications? Is there a lifeline to give drugs? Where’s the family, have we told them what we’re planning to do?” Standing still in the middle of the room where everyone else around you dances to an unspoken tune called “Let’s save this patient”. Hands opening drawers, spoken instructions for 5 different activities happening simultaneously. Managed madness. Organised chaos. Intubation successful and just as quickly, the noise and chaos dissipate. A quiet triumph. Just another extraordinary thing done as a team, without fanfare.
Movement 4: Back to the heavy room. Lento. They’ve made a decision. No more pain. Let’s stop everything. The hardest and most courageous decision to make. Where does my sadness go? Back to the cupboards of my mind, to think about later. Now to be strong for the family, to hold hands, help to draw that weight off their shoulders.
How beautiful he is, without those tubes and lines in his body. How peaceful.
*Oh, sing for him
God's little song-birds
Since his mother
Cannot find him
And you, God's little flowers
May you blossom all around
So that my son
May sleep happily*
**Henryk Górecki: 3rd movement, symphony no. 3 (Folk song in the dialect of the Opole region)
Movement 5: Tranquillo. Home. Open the cupboards to air. To prepare for another day.
Breathe.
Yee Hui is a paediatric intensivist with one too many creative hobbies and a room overflowing with craft supplies to prove it. She believes that stories can be healing, and help to shape the world we live in.