Since I started this new blog, I left so many posts that mean a lot to me behind and decided I needed to share them again. So I’ll do some flashback Fridays here and there.. Today I’m sharing a letter I wrote to my ICU patients..

Dear Ma’am / Sir,

When I decided I wanted to work in medicine, I decided to pick a specialty that was “exciting”. One with sick patients that keep me on my toes and constantly make me think. What better place than an intensive care unit? So here I am…. and my goodness there are never dull moments. There are days I’ve spent my shift at the bedside of patients’ whose hearts have lost their fight and continuously stop, requiring round upon round of CPR, often breaking their ribs… and often times all that to no avail. Then there are those times we get multiple overdoses in a day… usually young people…. some who lost their will to live prematurely and took too many pills on purpose, some who accidentally over did it… all of which are suffering to some degree. And those days  patients come in vomiting blood because their liver has failed and no matter how many blood products I dump into them or how many procedures they undergo, we can’t stop their bleeding.

So, I’m sorry we have to meet here and I’m sorry you are sick. This place is like being in heaven and hell on earth… all at the same time. Sometimes we are truly able to fix the problem you came in with… those are good days. Other times we do the best we can but you will return to this place over and over again because your body is too broken to be fixed.

While you are here, there will be times you hear my co-workers and I joking and laughing… I know, I know…. I’m sure the first thing that comes to your head is why are these people so happy when I am dying. Please understand, we mean no harm by this… working in our field, we see sadness daily and need some laughter for our own sanity.

You will hear beeping of alarms, other patients crying out, constant commotion… you will get the worst sleep of your life. You may even develop delirium… and, when that delirium resolves and your family tells you that you were yelling, swearing and name calling, you will have a hard time believing them… don’t worry. You don’t need to apologize to us. We know being confined in these walls can literally change people and we believe you when you say it’s not who you truly are.

I’m sorry if I seemed short when I came to update you and your family. I probably was. I sometimes get that way when I haven’t eaten all day… But that’s not your fault and I realize that. And when your nurse tells you I’ll be in to update you in 5 minutes, I really meant that… I planned on coming in right when I was done finishing whatever I was doing… and then there was an emergency I had to take care of… and I didn’t get to see you until hours later.

I know you are likely in one of the most vulnerable times of your life while you’re in the ICU. You are sicker than sick and I’ve talked to you and your family about goals of care… How far you want us to go if needed. I bring up things like whether you would want us to perform CPR in an attempt to restart your heart should it stop, or whether or not you would want to be connected to a ventilator/life support if you couldn’t breath for yourself… I do this because these are things that are potential realities for you… I know, it’s scary to think about… But I need to know your wishes before an emergency situation. I’m not explaining the alternate options besides “do everything you can” because I don’t WANT to save you. I’m doing this because I’m concerned your quality of life may not be the same should we need to go ahead with these things. I am doing this because I’ve seen what happens when we “do everything” and I often feel like I’m torturing these people. You’ll probably ask me what you should do and I give you the facts and tell you this is not my decision but yours… so annoying, right? But now I’m not working and I’ll tell you what I would want for me or my family members should we be in your position… limitations. I wouldn’t want someone pounding on my chest if my heart stopped or connecting me to machines… but I will do whatever it is you want.

Most of the time, you will not be able to make decisions for yourself while in the ICU because you are so sick or confused… often times you are not even awake enough… so this all falls on your family members. They must think of me as heartless as I stand beside them with a straight face and explain that you’re going to die as they cry more tears than they knew their body could produce. Please understand this… I block my mind from putting myself in their shoes on purpose because I know I will fall apart also… and my job is to stay strong for you and them. But every once in awhile I slip and can feel tears swelling in my eyes… When this happens, I bite my cheeks to make the tears go awake… and sometimes, as I’m driving home, I think about your situation and there is no more laughing or joking… I cry for you and your family when no one can see.

So ma’am, sir… I wish more than anything we did not have to meet in this place while you are so sick. I wish we could have met my accident while in line for a coffee or at the grocery store. But here we are.

I just want you to know that because I’ve had the opportunity to take care of you, you have helped me to appreciate this life and my family so much more… I no longer take things for granted and I hug my loved ones a little tighter. Thank you for that.

Sincerely,

Your PA