MICU

I am currently rotating through the medical intensive care unit (MICU). My day starts off at 7 am with a morning conference on a topic related to patient care in the intensive care unit. Usually we talk about ventilator management, various treatment strategies in sepsis, or the finer points about hemodynamic management. Yesterday, instead of our usual morning lecture, we had a physician interested in narrative medicine come talk to us about the importance of writing down our thoughts about what we see everyday. Near the end, we were asked to take a few minutes to write about our worst clinical experience. Here is what I wrote:

My worst clinical experience was during my first month of internship and it was in the MICU. There was a patient with lung cancer who had undergone radiation therapy and presented to the hospital coughing up blood (hemoptysis). He underwent a bronchoscopy which did not show any active bleeding. Later that same night -- around 7pm -- one of the nurses came running out of the patient's room yelling "I need a doctor!"

When we ran into the room we saw the patient sitting up on the side of his bed -- leaning on one of the side tables -- with a massive amount of blood pouring out of his mouth. I always think of hemoptysis as coughing up blood, but this was more like a fire hose pouring blood out of his mouth. There was blood all over the floor. While some of us were trying to move the patient so that his left side was down, others were throwing isolation gowns onto the people in the room to protect us from the blood that was spewing everywhere. We could see pallor move down the patient's face. The patient was dead within two to three minutes.

The patient's wife was eating dinner with him when this started. We barely had time to move her outside the room before everything was over. Watching her try to comprehend what had just happened to her loved one was heartbreaking. As I watched his wife cry inconsolably, I felt a tremendous amount of guilt. He had come to the hospital over 24 hours ago. We had done tests and yet the problem had eluded us. Finally, he was in an ICU in one of the biggest medical centers in the country with several nurses and doctors literally sitting outside his room, and we were still too slow to save him.

This is the worst thing I have ever seen and this was the only time I have ever questioned my desire to enter the field of medicine. The feeling of helplessness and the quickness with which it all happened made this a horrible experience.

I would like to think that by working hard in medical school and during training, I would have the knowledge and the ability to at least try to save a patient's life. Even if I was not successful, I could offer the patient a chance. However, all I could do was watch him die.