Trauma, Death, and the Big Picture

In reading this eulogy of Steve Jobs written by his sister, I was tickled to learn that on his ICU bed, Steve was inventing hospital gadgets.
One time when Steve had contracted a tenacious pneumonia his doctor forbid everything — even ice. We were in a standard I.C.U. unit. Steve, who generally disliked cutting in line or dropping his own name, confessed that this once, he’d like to be treated a little specially.

I told him: Steve, this is special treatment.

He leaned over to me, and said: “I want it to be a little more special.”

Intubated, when he couldn’t talk, he asked for a notepad. He sketched devices to hold an iPad in a hospital bed. He designed new fluid monitors and x-ray equipment. He redrew that not-quite-special-enough hospital unit.

For the really big, big things, you have to trust me, he wrote on his sketchpad. He looked up. You have to.

By that, he meant that we should disobey the doctors and give him a piece of ice.

I just came off my first overnight call in the Trauma ICU, after working 31 hours straight. This sketch of Steve is just like the patients I’ve met this week: can’t eat, can’t breathe, can’t move, but would like to go back to skydiving ASAP.

I think there are generally two types of ICU patients. There are the vegetables subsisting on life support, and the rest are feisty. The bull-rider with multiple spine fractures insists on bull-riding again the next day, even as he struggles to sit up. The teenager, whose ATV accident required brain surgery, asks me every hour whether we can take out the tube draining the bleed within his skull: “Will it be later today? Not ’til tomorrow? I can’t sleep with this thing coming out the back of my head.” As I write this, a man whose brain is exposed by gaping holes in his head, is trying to pull out every IV and monitor and walk right out of the hospital.

It seems as though these patients have an entirely different set of priorities than their doctors have for them. We want to manage their fluids and electrolytes. We want to make sure they have an airway. We want to save them from dying of pneumonia, of ischemic bowel, of cardiac arrest. But all they want is to continue whatever they were doing that landed them in the hospital in the first place. Don’t they learn from their mistakes, and don’t they realize that they can’t live without these devices and measures we are taking for them?

But as damaging as it can be to a doctor’s ego, I get it. I don’t believe our work is more important than the lives we save. We bring out the defibrillators and ventilators to make people continue living, but that is not what I consider “saving a life.” People don’t live to have normal potassium levels measured in their blood. People live to bull fight, to dirt bike, to invent computers, to be home with their family.

Obviously the basic needs have to be met in the hospital. It can be a cruel process, and patients may not get that ice cube after they’ve already starved for days, but we take great consideration in the treatment plan and believe that what we’re doing is for the best. But after the healing is done, when bodily functions return to baseline, then what? Our story ends with the hospital discharge.

But the hospital discharge is the beginning of a longer road to recovery and life. Lots of changes and arrangements have to be made at home. The patient may be a burden to their family for a long time yet. That is why, beyond getting to leave the hospital bed, my hope is that these patients can survive to the next time they can do what brings them joy, whether it’s strapping on a parachute or bouncing their child on their knee. To me, that’s when their life has truly been saved, not a moment sooner.