Joan Is Okay(4)

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A COMMON CONFUSION IS between intensive and emergency care. The latter is chaotic, usually on the first floor near the ambulance drop-off, in a room without dividers or enough beds. Someone might scream, Doctor! and because no one answers, that person screams on. Intensive care is just the opposite. It’s the best care that a hospital can give, and the room is quiet except for machine sounds, alarms that go on and off.

Just as radiologists know their imaging, ICU doctors know machines, ones that push oxygen into you, the all-mighty vent; ones that clean your blood, dialysis; the pumps, aka drips, that deliver medication and sedation through a central line directly to the heart. With many machines come many tubes. The endotracheal tube down the throat and to the vent for air, the nasogastric tube to the stomach for food, rectal tubes for stool, a foley for the bladder, etc. Fluid control was imperative. Too much fluid in and the body would swell. Too much fluid out and it would desiccate.

At my interview three years ago, the director asked why I chose intensive care, and I said I liked the purity of it, the total sense of control. Machines can tell you things that the people attached to them can’t, I said. I liked that the sick didn’t stay with us long, but for the stint that they do, we give it our all.

A sprinter, I described myself. The idea of longitudinal care wasn’t for me.

My director praised my honesty and offered me the attending position right then. More so than any authority figure I’d met before, he seemed to believe in me and agreed with my point about machines. From then on I knew that we were a match.

In any specialty, an attending is expected to lead and guide her interns and residents along in their careers. To become an attending, I had trained for twelve years. The job was to teach machine readings, and a question I liked to ask was how is this patient interacting with her machine, what’s the dance there like? If a patient fought, machine and patient became dyssynchronous. If they danced, the two were synchronous. Usually, the patient fought. Our innate drives to breathe and to dance alone are strong.

I taught on average three to five hours a day; the other hours were spent supervising. Procedures that I did in half the time pre-attending, I watched someone else do in double. If learning required mistakes, then teaching required watching different people make the same mistakes. Teaching was relentless déjà vu but grounding. It cemented the idea that we are all the same—height and weight did not matter, and the possibility of failure (or success) for anyone was never too far off.

To streamline the instruction process, I had a habit of printing double-sided handouts, and during morning rounds, the sound that I waited for and enjoyed most was that of my eight-person team, the pharmacist included, turning their pages in unison and on cue. The sound reminded me of the wind, which reminded me of being outside, which I currently was not.

At my first-year review, the director asked if I liked my new role here.

I said I did.

Did I respect my team?

I said I respected them on more days than not.

He commended my honesty again. Anything else he could help me with? Anything at all?

As part of my hiring package, I’d been given my own private office. But I didn’t like how it echoed, or how far I had to walk from unit to office, cafeteria to office, office to another office, wasting time.

A smaller, more centrally located space comes with people, the director warned. As in you would have to share it with your colleagues, and is that what you want?

I said I would like to try.

Soon I was relocated to a shared office with other attendings. The hospital had hundreds of doctors but only ten or so for three ICUs. To my left and right sat Madeline and Reese. Before I moved in, they had heard things about me, all true.

The private office went to an older cardiologist who also wrote philosophical books about death. I tried to read one but put it down. The books were too thick, with indexes alone of a hundred pages. Death was inevitable, I didn’t know what else there was to say.



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HOW WAS CHINA? REESE asked Monday morning when I had returned. He was heading up to the surgical ICU, as I was going into cardiac. We were passing each other in the corridor meant for equipment.

I relayed my cousin’s message that the country has changed. Buildings were taller and fatter, as well as the people. Obesity would soon be a problem, since food was ubiquitous, along with very high-tech phones. Everyone had a phone, and everyone paid with their phones. The economy was cashless.

But how’s your family, I mean.

I asked why he wanted to know that.

You never talk about them, he said. And then this terrible thing happened. I keep wondering if you and your father were estranged. Was there a small, teensy generational or cultural gap?

To illustrate how teensy, Reese brought his pointer finger a centimeter away from his thumb.

I said my father was entirely supportive of my path.

And who wouldn’t be? said Reese, standing with both hands on his waist, above the belt, in a pose that he called his “power stance.” Great paths, both of us, not many people can do what we do, but put another way, what’s your fondest memory of him? Your father.

I started to say something but then forgot the memory and the rest of my thoughts.

No wonder, Reese said.

No wonder what?

He didn’t tell me and then quickly changed topics.