Special Report: ICU -- A day in the life of the intensive care unit
Published Monday, March 29, 2010 12:26PM EDT
The atmosphere in the Intensive Care Unit of the Montreal General Hospital is filled with calm, which belies the urgency that is often required as doctors and nurses keep a close eye on their patients.
The beds in the glass-walled rooms present a controlled environment for the most critically-ill people in the hospital: people with brain damage from car crashes, the morbidly obese, and those recovering from surgery.
"It really requires a special type of personality," said Dr. Ash Gursahaney. "You have to like the acute care, high adrenaline."
The state-of-the-art ward, only eight years old, allows nurses to constantly monitor the health of the occupants, and there is little room for distraction, with each patient receiving the dedicated attention of one nurse.
"That's kind of your patient for the day, and it's you and them against the world," said Giselle Melanson.
The nurses are one arm of the team led by the ICU's director, Dr. Gursahaney.
"It's a multi-disciplinary team," he said. "It's residents, students, our nurses, respiratory therapists," and others who focus on the physical health of patients.
Spiritual advisors and social workers help families and friends of those in the ICU, and help patients cope with the strain of being cut off from the outside world.
These families are in crisis, it's a tragedy.
-- Dr. Ash Gursahaney
On this day, rounds begin at 8 a.m., with a patient believed to have a tuberculosis infection placed in isolation to prevent the highly contagious disease from spreading.
Changes from the night before are noted, and the data used to decide which tests and further treatment are required.
"We're doing things that if you don't intervene you're going to lose that patient, and life hangs in the balance," said Dr. Gursahaney.
The first new arrival was a man whose immense size poses a severe medical challenge.
He has "fluid in the entire body and not clear why that is," said Dr. Gursahaney. "It can be from the heart, it can be from the kidneys."
Like most patients in the ward, he is placed on a ventilator, but ultimately it does not help.
Within a few days he dies, and doctors are never able to determine exactly what killed him.
Other patients in urgent need of care include a man who swallowed antifreeze, and a man with an aneurysm, before the arrival of a teenager with a severe brain injury caused by a drunk driving collision.
"They were perfectly fine yesterday, these families are in crisis, it's a tragedy," said Dr. Gursahaney.
Dealing with this patient and his family is why social workers like Beverly Coshof are an integral part of the ICU.
Very often she delivers terrible news.
"People may be spending their last days hours and minutes here in the ICU," said Coshof.
But Coshof doesn't just advise family members. She can be a key sounding board for members of the ICU team who have less experience dealing grieving families, such as resident Dr. Debbie Schwarcz.
"It's difficult telling a family member their wife/mother isn't going to make it or has a poor prognosis and to try to help them through that," said Dr. Schwarcz.
I think you can be very touched by what happens here and very grateful for every day that you're well.
-- Nurse Giselle Melanson
Some patients can be in the ICU for months, and may never recover, which can be especially difficult for all involved.
"Every patient has a very particular story," said Colleen Stone, the unit's Nurse Manager. "We meet them at a time of their life in crisis, but we slowly get to know who they are. They could have a whole community behind them or other patients who are very much alone on the world."
Regardless of what happens, the patients who recover, the patients who don't survive, the members of the ICU lean on each other
"We achieve great things," said Dr. Gursahaney. "We have a high mortality rate but we have a much higher survival rate."
"I think you can be very touched by what happens here and very grateful for every day that you're well," said Melanson.
They thank their patients who survive, and the memory of their patients who don't, for that.