As a doctor working in general medicine, the intensive care unit (ICU) seemed to be a mystical place. When our patients became very, very sick, we would ask the ICU doctors for help and then they’d swan down onto the ward and point out all the things we hadn’t done. What usually happened next is that they’d then say that they didn’t want to take the patient onto the unit, offer a little advice and swan off again. However, very occasionally, they’d they WOULD take the patient and within minutes, the patient would be whisked off to the intensive care unit. They’d vanish off behind big, locked doors and we never knew what happened to them there. It was like a big black hole that the patients disappeared into. Sometimes, they re-emerged days later, sometimes they never came out.
The bible for junior doctors across the land is the Oxford Handbook of medicine. If you read the sections on treating critically ill people, regardless of the condition, it’ll say something like “do X then Y then Z and if that still doesn’t work, call ICU.” Rarely, do you get any more details and, as a result, I was always more than a little mystified about what went on behind those locked double doors. It’s been a real revelation working on the intensive care unit and seeing things from the other side.
To be honest with you, I was a little underwhelmed when I found out the truth. Aside from mechanical ventilation, nothing particularly special or profound happens in intensive care. Intensive care is based around meticulous attention to detail. It’s based around being focused on every aspect of your patient’s wellbeing. Closely monitoring ALL of their organ systems and intervening quickly and appropriately to try to correct anything that is drifting awry.
I’d say the single biggest difference between ICU and a normal medical or surgical ward is the nursing staff. I’m not saying that the nurses are better on ICU, it’s just that there are many more of them. We get one nurse for every patient. It’s great. It means you have so much more scope to do things. For example, we can confidently put a patient on an infusion of midazolam with the knowledge that they’ll be someone around to turn it off if the patient stops breathing.
It’s also made me realise that it’s often the simplest of things, done early, that make the biggest difference to critically unwell patients. Things like giving oxygen or fluids or adequate pain relief. I honestly believe that every doctor working in an acute specialty should spend some time working in intensive care at some point. Intensive care is based around simple things done well. Good medical care is based around simple things done well, and this is what I’ve seen again and again over the last few months.