The heart monitor beeped incessantly, and the pulse oximeter kept dropping to the 80s. I ran to get a nurse. He walked calmly into the room, straightened the patient’s finger and left without a word. The oxygen went back up to 98.
The ICU intimidates me. Patients don’t seem like people in that space. All I see are machines that make scary noises and will definitely break if I get too close. There’s the constant whoosh of air from the BiPaP machine and squeeze … *click* … release … of the SCDs.
Roberto was one of the first people to catch the novel coronavirus back in March, just as cases in the United States started to rise. It was now November, and he’d been in and out of the ICU for the better part of the year. After recovering from COVID, Roberto got an infection from his bed ulcers. Intravenous drip of antibiotics stat. Then he caught hospital-associated pneumonia and was right back on the ventilator. There’s much more to his story, with pages upon pages in his Cerner chart — but that’s all I gathered in my rush to pre-round before the attending arrived.
I entered Roberto’s room to find him in his bed, sedated by some cocktail of propofol, fentanyl and pure exhaustion. I introduced myself, wondering if that was silly. I pulled out my stethoscope and gently listened to his lungs, hoping not to interrupt any of the million plastic tubes tangled across his chest. All I could hear was the sound of the BiPaP forcing air into his tired lungs. I listened to his heart and asked if he could understand or hear me. No response. I pulled up the blanket and checked his legs for any open wounds. Then I stood, dumbfounded.
“What am I even doing here?” I thought to myself.
I had no idea what to do for him. Whether I saw him or not made no difference. I pulled the blanket over his legs, patted them briefly and left.
During rounds, I could barely piece together a presentation. “Roberto is an 83-year-old man in the ICU. He’s been here a few months, first because of COVID Pneumonia and now because of a hospital-acquired pneumonia. Last night he was sedated. Today when I saw him he was still sedated. I’m not sure what else…”
The attending nodded. Then blinked, and promptly turned to the nurse who gave a much more coherent update.
“I’m sorry, the ICU just stresses me out,” I blurted, flustered as we walked away. Dr. Santos smiled. “It’s okay, you’ll get the hang of it. A piece of advice: always ask the nurses,” he said, before hurrying into the next room.
Over the next few days I heeded his advice and learned more and more about how to navigate the ICU each time I rounded on Roberto. As I learned how the ventilators worked, the names of the different lines, how to hang an IV drip, and do an ABG, Roberto seemed to remain totally still. Almost as if he was just another machine in the room.
His stillness, which was essential for his healing, stopped me from being able to appreciate his humanity. I became more interested in the gadgets in the room than the person in the bed.
I realized this when one day Roberto wasn’t in his room. I ran to the nurse: “What happened? Where did he go?” I asked, frantically.
“Oh, bed 8? He was transferred to the floor. Yeah he’s doing great. Room 4037,” he replied.
I went to this new room and discovered Roberto. Over the past few weeks I hadn’t seen him without a machine breathing for him, but now he was sitting up in bed, smiling and talking with an elderly woman at his bedside.
I was amazed at how his image in my mind also changed from a permanently ill patient to one with a full life.
I introduced myself again — this time feeling much less silly.
“Hi, I’m Roshan, I’m a medical student with the hospitalist team. You may not remember me but I’ve been seeing you in the ICU over the past couple of days. I’m so glad to see you’re doing better,” I said excitedly.
“Lo siento,” he laughed. “Español, por favor.”
I was caught off guard, shocked that I had developed a relationship with this patient and wasn’t even speaking the same language! When I’d talked to him in my head, it had always been in English. I laughed and slowed down, and in broken Spanish introduced myself again. I asked if I could complete a physical exam, and he obliged.
This time I could hear his lungs, breathing on their own, without the manufactured whoosh of the BiPaP. His heart beat without the incessant beep of the heart monitor. I could ask him to lift his legs to check for ulcers.
I sat with him for a while and learned that the woman was his wife. They’d been together for more than 50 years. He was originally from Cuba and moved to Miami in his youth. He had a daughter and grandchildren whom he loved. And he couldn’t wait to go home.
Just like that, he transformed from a daunting object to a vibrant, full human being with hopes, dreams and a future. During the next 48 hours, he was finally discharged home.
It’s rare in the course of a single rotation to follow a patient who has been in the hospital for months and then see them go home. I’ll admit, this was a patient I’d looked at with hopelessness. He was healed beyond my wildest expectations — moving from the ICU to the floor and later returning to his own bed.
This experience was eye-opening for me in that it helped me to remember to think of the humanity of ICU patients. Under the machines, wires and eyes forced shut, there’s a person whose body is working desperately to be whole again.