It didn’t really hit me how dismal Kara’s prognosis was until I saw her CT scan. Her brain looked like a minefield; there was more space and fluid than there was brain tissue. This little baby had so little substrate to build her life on. But by then it was too late, all the miracles had been done on her; she just wouldn’t die. I eventually got her off the ventilator and off the dialysis. I got her electrolytes corrected, I got her to feed, we stopped the antibiotics, and she became just a baby in a basinette. And one day we needed a bed in the unit and she was the most stable patient, so she was shuffled off to the Infants’ ward.
The third patient was Emilio Diaz, a really adorable three-year-old with AIDS who had done so well for so much of his life. Emilio spent his first year in the hospital because there was no place for him to go. He was finally adopted by one of the nurses who had taken care of him when he was a baby. This woman really loved him. She married Emilio’s father, an IV drug user who had AIDS so that she could legally adopt him and take care of him. She had done a lot to try to give Emilio as full a life as possible. He’d gone to Puerto Rico to visit relatives, he’d gone for trips all over the place, he’d done a lot more than your average Bronx three-year-old. And then he became sick and was admitted to the ICU and rapidly deteriorated. He had terrible pneumonia; he became ventilator-dependent and reached ventilator settings that nobody had ever seen before in the ICU. And he just kept getting worse until finally I had to have that horrible discussion with the parents about DNR on him, too. In Emilio’s case, though, it was his parents who first asked about DNR. I suppose it’s not surprising, since his mother is a nurse and very medically sophisticated. But one day she came to me and said, “He’s suffered enough; we want to make him DNR.”
Emilio died one evening just after I left for home. He was there the longest of all three of these patients; he was my patient for a good three and a half weeks. It was so sad taking care of him. There finally came a point, around the time that he officially was made DNR, when I felt very, very depressed. Every time I had to go over to his bedside, every time I had to write a note in his chart or I had to look at his bedside clipboard or call for his lab results, I became severely depressed. It was really sad. Really sad.
Well, anyway, I learned a lot of medicine from those three patients and from the other patients I took care of in the ICU. I learned how to put in A lines [arterial lines; like IVs, except going into arteries instead of veins], I got good at intubating, and I learned about Dopamine and Dobutamine drips [a class of drugs known as pressors, which raise blood pressure; they’re used in critically ill patients who cannot maintain their own blood pressure]. And I did a lot of thinking about ethics and the fact that, basically, we can keep just about anybody alive for an indefinite period of time but that keeping people alive may not be such a good thing. That’s a hell of a lot to pick up in one month! And I think one of the reasons I was able to do all that was because of the people I worked with.
Diane was a great resident. She’s very, very bright; extremely capable; and very talented. She has a very wry sense of humor. We were on call together five of my nine nights, and we had a lot of fun. I thought she was kind of attractive, too, but of course that was something I couldn’t really tell her. Her body is very similar to Karen’s, and I found that very erotic. I told her that the morning after the last night of the month we were on call together. I was kind of delirious and I don’t know how it came up but I said something like, “You know, you’re very erotic,” and she said, “What’s wrong with you? You must be completely out of it!” And I said, “Yeah, I guess I am,” but in fact I had been thinking about it for a while. But I couldn’t say it until then because we’d been on call and slept in that little on-call room so many nights together. Not that it would have mattered, for God’s sake. Anyway, it would have been an inappropriate thing to have done.
Alex is a great attending, and he really was very supportive. He’d come up, give me these big bear hugs during the day, and ask me how I was doing. He said he was worried about my psyche all the time because I was taking care of all these very sick patients. He was a good teacher, too. And he has a really big heart, he really cared about so many of the patients. He was somehow able to be a very devoted and involved ICU director, there all the time, always available and really involved, and yet he could keep some distance and let the residents try to run the place.
On the last day of the month, Alex took us all to lunch, which no attending has done for me before. He was a role model for me. I felt maybe I could actually do this kind of thing for a living. Even though it was depressing and even though taking care of critically ill children is so far removed from what I originally thought I’d wind up doing, I felt having someone who really cared made a big difference. When you think about it, all you really need in the ICU is a good technician who knows how to run all the machines and monitors. You don’t need an Alex George to run a unit. But I think his heart makes a big difference; Alex is what makes that place seem human and not just a mechanical torture chamber. I’m sure his being there has helped a lot of families. I know it really helped the house staff; his fatherliness, his caring attitude, it really made a difference.