Living & Learning in the ICU
by Nitasha Sharma

Today was my first day in a new Intensive Care Unit (ICU). I woke up early, drank my coffee during the rainy day commute to the hospital, and opted to take the stairs to the 5th floor in an attempt to perk myself up enough to meet my resident. I was assigned a patient; she was simple but complex, just the right balance of the known and the unknown. I entered her room and began to take note of all the lines, tubes, monitors, machines – all the things working to keep her alive. Then I looked at her, laying there, waiting peacefully for us to figure out how to bring her back from the depths to which disease dragged her. It occurred to me how privileged our team was to be entrusted with such a critical and important task.

The day melted away quicker than I realized, and I found myself back in my car, commuting home, reflecting on the 12 hours that had slipped by. In those 12 hours, I laughed until my cheeks hurt. I fought back tears and willed away an enormous knot in my stomach. I was absurdly bored. I was incredibly invigorated. I felt helpless. I felt empowered.

The ICU has a way of making you feel comfortable right as it turns you upside down and disproves all you've ever known. It produces every emotion we experience as physicians, sometimes all in one day. It seems to be some sort of magical machine that relentlessly churns out the ups and downs, the highs the lows, the drama, the suspense, the heartbreak, and the success that many of us crave.

As physicians, we empathize and acknowledge emotion regularly. Feelings are an integral part of the disease process and the way in which we relate to and treat our patients. Rarely, however, do we ourselves truly feel emotions in a deep and meaningful way. I've said "that must be so difficult" or "that's great news" at least a hundred times in my very short career. On the contrary, I can count on one hand the amount of encounters I've had during which emotion rushed through me like a river.

The first time I felt overcome by emotion was when a young man tripped and fell into his father's arms moments after being diagnosed with Guillian Barre. His father clutched him ever so tightly and they sobbed, frightened by the disease stealing the boy's ability to walk, hopeful that the treatment would cure him. They held each other for what felt like an eternity as I fought to maintain my composure. The second time was when a man with terminal cancer saw my San Francisco Giants sweater. He smiled as he shared with me the memory of the last Giants game he and his son went to. He wept as he relived his son's final moments before passing away from osteosarcoma – knowing then that he was certainly facing his own imminent mortality. The next time would be the day my senior resident told a mother that her 23 year old son did not survive the gunshot wound he sustained, even after hours in the operating room, our team working relentlessly to save his life.

Not everything is doom and gloom, though. The ICU can be the best place to see what some would call medical miracles. Patients wake up from comas with no lasting effects on the precious brain cells that work together to create their personalities and drive their thoughts. Drug overdoses are treated and long time addicts stalwartly commit to a life of sobriety. Once-estranged families come together to support each other through a loved one's recovery from life-threatening trauma. I've seen all of this and more, each time learning and growing as a future physician.

The truth is, medical school itself doesn't prepare us for the situations we find ourselves in once we begin to work with patients. How could it? Some things just can't be distilled into a lesson plan or a textbook. At 28 years of age, I've spent almost my entire life in pursuit of an education. Some would say I haven't really lived. Many times, I wonder who I will be when I'm no longer a student. Will I lose my sense of identity? Will I know how to be a functioning member of society? Will I wish I could go back? My experiences in ICU push me to live outside of my own set of life experiences. I learn what grief feels like by feeling the grief of my patients. I see how much hard work recovery can be. I understand that time doesn't often pass as quickly as you'd wish. Sometimes, it passes far too quickly. The ICU doesn't allow me to let my guard down, and it doesn't become "routine." Most importantly, it pushes me to not only acknowledge and watch emotion happen, but to experience it as well.