I wasn’t expecting to find my father in the ICU. Especially not out here, 3,000 miles from home. Three weeks in critical care was all it took for me to put him there. Of course he never left, for better or worse.
To be honest, when I started in intensive care, I didn’t think much of our patients. I arrived as a final med would, bushy tailed and ready for action. I felt myself useful, experienced enough to not be shocked, yet young enough to not be cynical. The patients I found resembled what I had seen in surgery before: intubated, unresponsive, eyes empty and glossed over, the ugly stomas and the chest drains leaking fluids – these are things we grow accustomed to in healthcare.
Time dulls our senses to the gruesome in that way; I need only to recall year one in the anatomy lab, how many people fainted that first session that by the end could talk about their weekend plans while holding a dead woman’s brain from the specimen drawer.
A lifetime of seeing humans at their most, well, human, meant I couldn't force a link between the listless and the living
It was on my third week in the unit that I noticed something I didn’t like. I found it hard to see my patients as real people, even when I tried. Real people get up and move, they have emotion in their faces, and agency in their presence. When your level of consciousness is so low, you are stripped of all those things that make you human, reduced entirely to the bulk of your weight.
We make so many men into timeless heroes, rich tapestries of complex emotion that represent such virtue, but in the end we’re all made up of meat and bone. I suppose that’s all our patients were in many ways.
I don’t think this reduction is inherently good or bad, it’s just the truth, and this stipulation makes the strife more palatable – you can’t be productive if you light a candle and pray for every tragedy you see in there. We grow comfortable with the distance, seeing intubated patients less as people and more as cases. Cases we can solve, or at least understand.
There’s an interesting case in bed three. Let me ask you some questions about this case. Have you ever seen a case like this? This becomes our frame of reference, and medicine forces that frame on us so quickly you don’t stop to look around until it’s the only way you see. This bothered me.
I tried to fight against it, to see the humanity in these cases, rattling that frame of reference and collapsing it around me. Standing at the bedside I would stare, straining my mind’s eye to give my patients person vigour, failing every time. I squirmed so hard to give them life that I became frustrated. I tried all sorts of visions, placing different expressions on their faces and voices in their mouths, but nothing helped.
A lifetime of seeing humans at their most, well, human, meant I couldn’t force a link between the listless and the living. I was stuck, unable to see past the meat and bone in front of me. After a week of trying, I found the only thing that worked. I found the way to bridge the gap was to project a different man on them entirely. I put my father’s sleeping face, when he is most at peace, onto the canvass in a bed in front of me, and it broke my heart in two.
I envisioned him at that christening, falling to hit his head on the sheetrock floor, at the dinner table where he had the sudden onset headache, or the persistent cough turned chest infection that’s now spiralled out of control. I envisioned him being found unresponsive, with a fever, last seen well three days ago. I envision him the addict, the never smoked, the first time sick or the frequent flyer.
I see him in the bed looking at me, tube in his throat, in a daze, confused, cogs churning at his bedside, with strange unknown eyes talking at him behind masks. Seamus can you hear me? You’re in hospital. Can you move your arm up please? I’m just going to put in a line now. Sharp scratch.
How long has it been since Fred really was himself? Might he just want to die in peace? What kind of life does he have left? That's the kind of question nobody likes to ask
They know he won’t understand, or respond in any meaningful way, and if we were more honest with ourselves sometimes I think sometimes we wouldn’t say a thing and just get on with it, but that wouldn’t feel right, and so we don’t.
I envision my father finally sitting out of bed, a step towards recovery celebrated by the team that would still make me cry if I saw him not as a doctor, but a son. I hear him calling out for something, his mumbled words incomprehensible, perhaps in another language, and the listener deciding in the end he’s so sedated it hardly matters.
I see a medical student, just like me, thumbing through his chart for his own learning, muttering silent amazement uncovering the details of his case, waiting for any chance to intervene, see some action or show my skills. Behind it all there is a man with so much to say if he was lucid, so many passions to share. So much pain endured and joy lived: the expertise within his field, the nuggets of advice, the incredible memories and experiences of times long gone and people with them.
The entirety of his life remaining tucked behind a veil of silence filled by beeps and breaths. I hoped every morning I’d walk into the unit and he’d be up at full force after a miraculous recovery, ready to fill my ears with great stories and give me life advice. I’d picture that twinkle in his eye that old men and women have when they connect with someone young, the vicarious excitement for a life still unlived.
Of course that never happens, not in front of me anyways, because by the time anyone is well enough to sit up and breathe alone they’re off to the wards, and another patient on death’s door comes in to take their place.
My mother, a professor of internal medicine, and the most caring woman I will ever know, told me that she tells her patients’ families to bring photos of them to hang at the bedside. She wants to see them full of life on their best day. I like that idea; it brings more humanity to the bodies we are treating.
I was in <a class="search" href='javascript:window.parent.actionEventData({$contentId:"7.1213540", $action:"view", $target:"work"})' polopoly:contentid="7.1213540" polopoly:searchtag="tag_company">Ikea</a>, waiting in line to pay for miscellaneous kitchen objects that I purchased more for fun than for necessity, and a stark realisation hit me
But I also wonder how that might work against us. How it creates an unhittable target for nurses and doctors worn out enough as it is. The reality is that many of those that come into these beds will never be the same again, and we set ourselves up for failure thinking we can fix things nature never intended to be fixed. In the unit we try to celebrate every victory: Fred can open his eyes today.
Fred is responding to pain. Fred is moving his arms. Fred can cough. Does this man resemble any version of a man he was when he was most himself? We can’t say. Often we don’t know. How long has it been since Fred really was himself? Might he just want to die in peace? What kind of life does he have left? That’s the kind of question nobody likes to ask. It’s not our call to make, maybe it should or maybe it shouldn’t be, I can’t say. We often just hope for best until the smoke clears with no way of knowing the true damage from the blaze.
Doctors refuse life-saving care more than any other profession, and to me it’s clear why. We’ve seen the healthcare machine roll into motion where it becomes unstoppable, investigation after intervention extending lives beyond their expiration point. We’ve seen the lives not so much extended as they are stretched. Stretched in the same way that you can pull a rubber band past its point of elasticity and fool yourself that it’s now longer, when all you’ve done is wear it thin, and try as you might it was destined for the bin as soon as you ran it through your fingers.
There aren’t many things in medicine that we cure anymore barring infection. Diabetes, hypertension, pulmonary disease. Our job is management. We manage diseases and we manage people who manage their diseases. At its most cynical, I suppose sometimes it just feels like we’re bailing water out of sinking ships.
It’s a bizarre experience to watch someone die. A senior doctor told me in the first minutes after I bagged a patient in his third consecutive cardiac arrest, that the best we can do is give our patients a fighting chance. The patient in question had been intubated for two weeks after a head trauma, then came the sepsis, and his already bad heart from a lifetime of living hard was giving in. There’s only so much the body can take before begin things to fail.
Truth is, I'm terrified of dying
When someone dies you get to ask yourself whether you did the best you could, what went well, what could have been better. Some people are just too sick. I knew his whole life story from his chart, but never once heard his voice or knew his temperament. The senior doctor’s words made me feel much better. That night I went home and lit a candle.
Truth is, I’m terrified of dying. It fills me with such a cataclysmic panic that at times it’s crippling. If I’m on the bus, or just lying in bed, and my mind begins to contemplate eternal non-existence, I feel a gripping emptiness so profound and lonely I could call out in despair. The only consolation I can find is one of ignorance.
I tell myself it doesn’t matter, that when death comes I won’t know it. I’ll descend into the big sleep, never to experience anything again, like before I was born. I am used to these waves of despair, and every few months they come and go, sometimes worse than others. I remember once as a kid, I was maybe seven or eight. I just sat in the bathroom and I thought about how my mother would one day die. Like any child would, I didn’t want her to die, and I cried.
I remember my older brother found me there perplexed, asking what was wrong. I understand now that these fears do not grow duller as you age, and in my case at least they’ve only deepened. The Dalai Lama said in an interview once when asked about his “legacy” that it was none of his concern, for death itself is not for contemplating as it detracts from here and now. Feels to me like a cheap way to say that it’s better not to think about it. I had a friend ask me once on a night out, getting a kebab at 1am, if I believed in heaven. I laughed and told him that I wanted to but I didn’t. Heaven sounds nice, I said. That would make things easier wouldn’t it?
That Saturday after the arrest I was in Ikea, waiting in line to pay for miscellaneous kitchen objects that I purchased more for fun than for necessity, and a stark realisation hit me. I thought about how Sunday was my last day off and I'd be back in on Monday. I was living, completely and uncompromisingly, and still in the unit our patients were plugged in, ventilators whirring, clinging to life. Their families still at home pacing anxiously, waiting for that call to tell them good news or bad, and here I was putting my lark onto the counter at the check-out.
I won’t say that I felt bad, because I didn’t, but I did feel privileged. I got the chance to simply clock out for the weekend, turn to other things. Not them though, they were still fighting. The consultants were still on call, the registrars were scurrying, and the healthcare machine was very much engaged. My father was still there too. Of course he never left, for better or worse.
Read: The country that I love doesn’t seem to want me here