Today marks the 10th week mark without any weeks spent in the ICU. While my wife says I’m crazy, I still feel somehow absent when I’m gone for too long. I wonder if I’m falling out of practice – if I’ll miss the next fungal pneumonia or esoteric cause of septic shock? It also reminds me of the oddity of what we do. We willingly go to see the sickest people in one of the highest risk settings to do our best, at frequent cost to our family and to our personal lives. Yet, it’s where I feel I’m doing what I was “called to do.”
My mentor sent me a quote that feels timely:
“Intensive care is a symbol, a space, a technology, a clinical concept, an ethical imperative, a last resort. It attracts, it repels. It burdens, it helps, it bankrupts. It enriches. We would not give it up, but at times we wish we could. It is a worthy profession; one that can be a calling with rewards far beyond notoriety or riches!”
At the same time of feeling this absence from the “front lines” of the hospital, I am thankful for being able to spend time with my daughters. I have a 4-year-old girl that I’m wildly in love with, and a newly 1-year-old girl that remains my tiny, sweet baby. I’m curious how much they wonder when I’m on-service in the ICU – Where’s Daddy? Why haven’t I seen him? I hope I am able to make up for it on the weeks I’m home more and less busy. Such is the life of the young physician: I feel the need and have been brought up to be passionate about Everything, with a capital E. Do everything fully; do everything well; do everything with love and passion.
While I can’t imagine doing anything else, when I’m in the ICU I’m curious if the families recognize that I am approaching their care with equal passion. It is at great cost in time and energy (and sometimes, it feels, my youth and personal life) – especially while I have little children I go home to. Do families I lead through difficult conversations about withdrawal of care know that I go home and imagine them and think about whether I “did it right,” whether I guessed incorrectly at their expected survivorship, or whether I could have helped them better if I did this or that better, or sooner, or if I was at the bedside the whole time? Do they know that they receive my full attention, both mental and emotional, even though I’m busy rounding, teaching and learning more, reading and staying up to date myself? I imagine not.
I imagine families see the staff intensivist as the Captain of the Freight Ship that is the Rounding Team. A horde of high computers blocking our faces, strictly formatted systems-based plans, discussion of labs, and so on, all pressed for time due to our clinical responsibilities and while waiting for “the next patient.” I wouldn’t trade my family and home life for anything in this world, but I have a distant appreciation for the simplicity of “old-fashioned” medicine, where you were, simply, a Doctor. You stayed at the Hospital, you Worked and you were There. Families remembered you, you “knew all,” and you were always present. You had few other responsibilities because you had one Calling (and being a Daddy was a side-project, appreciated and approached but not worthy of your time). But still, I consider a quote from the movie “We Were Soldiers,” adapted for me – “What do you think about being a [doctor] and a father?” “I hope that being good at one makes me better at the other.”
Sometimes before rounds I give myself a pep talk – maybe it will help other physicians and decrease the. sense of being pulled by strings in all directions, unable to focus on what’s in front of you. “Today, we are here to help people who may be at the most stressful point of their life. Who may be losing people they love. We need to actively learn in order to help treat them. We need to be complete, and to give them our focus, so we don’t miss anything. And we need to care for them, because we are Physicians, and that means something very important.” We can’t pretend that what we do isn’t without cost – cost for each of the families who are struggling or losing loved ones; and cost for those who miss us at home. But that sacrifice is worth it, every time.