Dark Days in a Glass House

I had never been in an ICU wing prior to my surgical rotation. Now, as a newly minted third year medical student, I was entering the surgical ICU for the first time. My first week in this strange new world coincided with the height of the COVID-19 pandemic in Minnesota, and what caught my attention first were those spectacular glass doors.

Up to that point, my medical education had largely been in classrooms, and my imagination had failed to guide me through the glass doors of an ICU room. I still thought of medicine as practiced solely in clinic exam rooms, supported predominantly by otoscopes and ophthalmoscopes. But behind those glass doors beckoned a form of medicine of which I had never dreamt. It was filled with machines that hummed; sedated patients that did not move. Nurses bustled, families huddled, and gravity lingered in the air.

The surgical ICU ward was not operating in a normal state of affairs in November of 2020. In addition to the regular traffic of gunshot wounds and other traumas was an overflow of Covid-19 patients. Even if I wasn’t able to see active cases of Covid-19, taking care of patients that had been impacted by the disease was unavoidable. My first ICU patient was an African refugee in his 40s. He had been suffering from a score of diseases that were rare in the Western world (neurocysticercosis, viral hepatitis, and tuberculosis) in addition to a previous stroke. Covid-19 had brought his fragile state of health tumbling down. Now, a couple months out of the COVID infection, his chest x-rays were still whiteout from a superimposed resistant klebsiella infection, and he was sedated, ventilated, and hanging in the grey zone between life and death. His eldest son, the only English speaking adult of the family, communicated on his behalf.

For a week, I served as the conduit for his son’s concerns to the medical team. Every morning after night sign out, I would pick out my new patients; gunshot wound, surgical abdomen, necrotizing fasciitis. But I continued to see this static man. There was a continuity to his care that I couldn’t bring myself to withdraw from. And each morning, like clockwork, his son would be attentive at the bedside, the sole visitor allowed. The rest of the family, a wife and younger children, were only able to visit their father through Facetime and through descriptions from his eldest son. As I presented the patient each morning to the team of doctors, nurses, pharmacists, and social workers, the son was beside me, taking part in the communication of his father’s needs.

Possibly what compelled me to keep seeing this patient were the qualities of his son. He couldn’t have been older than twenty, but in the brief moments of small talk we engaged in, I had picked up a few remarkable details of his life. He was a first generation college student. He had learned English in primary school, as it wasn’t spoken in his home, and now he was a science major at a nearby college. He worked almost full time, not to help pay for college, but rather to support his family. On top of this, he advocated for his father every day. I felt in awe of this young man for his strength and sense of conviction.

The glass house of the ICU cannot have been easy for him. He was yet another person who had been swept up in the scourge of the pandemic.  I so dearly wished that his father’s story could feature an element of redemption, a sweeping arc of healing and faith, and the power of modern medicine. But I knew that it could not. The human body can only handle so many insults before it gives in to the pressure of disease. The son who spent his days looking after his father communicated an understanding of this as well. It was only in accordance with his father’s wishes that the family kept pushing on. On my sixth and final day in the ICU, he told me that he and his family fought for the small victories, not the larger ones.

Reflecting back, medical school is not what I had once imagined. I can’t quite describe what my younger self had pictured, but I know I was brimming with an optimistic naivete. This naivete persisted through my time in didactic education and only now is beginning to wane as I enter into the clinical realm. As much as I have learned about the skills of patient care, I have also been introduced to the blunt realities of aging, pathology, sickness and dying. This is not to say that I am now filled with a sense of pessimism. Quite the opposite. But as I gain experience in hospital medicine, I am learning the virtues of reimagining the goals of care for each patient. I think the reason that this father and son are burned into memory is because they illustrate a lesson that I am just beginning to understand. Mature beyond years, my patient’s son taught me that being a good doctor is fighting for the small victories, even when the larger one is out of reach. I owe him—and his father—much more than they owe me.