czwartek, 31 lipca 2008

Am I Going to Die?

After a bicycle accident landed me in the trauma intensive care unit (ICU) in what would be a three-month hospitalization and three-year recovery, I am compelled to share this story. It begins as I am recovering from one of a series of operating room visits to debride my open wounds. Alarms and the bustle of the ICU were familiar to me, a neonatal intensive care physician. However, this role was new. The haze of intravenous narcotics and sedatives was punctuated with intense pain whenever I attempted to move. With my femur in traction, I lay flat on my back. I could see very little, but I could hear and spent many hours listening.

The trauma team and the ICU staff were kind and caring. The nursing staff was attentive to my needs and to the needs of my husband. With a decade of experience as a hospital attorney, he was also comfortable in the ICU, but not in his current role. My husband fares poorly with sleep deprivation, and the days in the ICU had taken their toll on him.

The frustration of being intubated and unable to effectively communicate had been immense. Just the previous day, my respiratory status had allowed for extubation. With my voice back, I was verbally asserting my opinions. On the previous night, I had been agitated and insisted my husband stay late. Now, after midnight, I demanded the nurses call him back to the hospital. They refused, in an effort to allow him sleep. After bartering, a compromise was struck. They called him and I was handed the receiver. I still remember his voice, gentle, but concerned, questioning my needs. I remember abruptly blurting, Am I going to die?

Although confused by the question, he reassured me that I was improving and much better than expected. This brief conversation calmed me.

I did not speak of this night for some time, but it was etched in my brain. The fear and confusion I gave voice to in that question haunted me as I listened to the voices at the nursing station, questioning why they were pursuing the current level of medical care. Why are we continuing to support her? We should let her go. In my egocentric haze, I was convinced that they were discussing me. These discussions were familiar to me, as I had participated in many before. Although I understood that I had escaped death several times in the preceding days, I was in a panic considering whether it was time to discontinue my support.

Thinking of it still makes me uneasy today. Although I could not see, I could hear and I could listen to those words, spoken by faceless voices. Because the ICU was busy and the beds were full, the discussion concerned another patient. However, said aloud, the words were out there for everyone to hear. Although the ventilator was gone and all was better than anticipated, the drugs clouded my reality and facts were immaterial.

Intellectually, those of us caring for ill patients understand the importance of avoiding participating in sensitive conversations that can be overheard. We all know that patients are listening, even in the middle of the night. But somehow, the background noise, our familiarity with the ICU, and the daily stress of working there must make us amnesic of this fact. Daily, patients or their families must overhear and misinterpret similar discussions. Families out there have most certainly overheard and misinterpreted my conversations. As I continue to recover from my injuries and return to care for patients in our slightly overcrowded and noisy ICU, I remind myself to be careful of what I say, how loud, and where I say it, as someone may be listening.

Author information: Pamela J. Kling, MD is associate professor, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin and Meriter Hospital, Madison, Wisconsin.

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