Get started
Work

Are You Okay?

Year: 2025
Type: article
Abstract: “Hey,” she said. Her intonation dropped throughout the greeting. “Are you okay?” The warmth of her expression made it clear she could relate. After a couple days away, I was returning to my next overnight shift as a pediatric critical care physician. Walking into the ICU, I had the typical strut that comes from knowing your team, being way too familiar with your surroundings, and having a certain sharpness of mind—alert but relaxed, ready to deal with whatever comes our way. It’s taken time to refine, but my pre-call rituals include exercise, bringing my children home from school, eating fruit with a protein bar, and partaking in the “perfect” amount of caffeine. The incorporation of a nap would go a long way, but I’m not Lebron James. Her question, initially, stopped me in my tracks. It also triggered a response that helped me acknowledge how messed up I was from the previous night on-call. “No,” I answered. “I’m not okay. But what can you do.” The evening in question began like countless others. I joked with colleagues as I entered the unit. To the layperson, it could appear I was excited to stay awake, like a madman, while most of our continent sleeps. I printed the handoff sheet and went into a room with the daytime attending for our ceremonious “passing of the torch.” While my partner delivered their narrative of the patients, I was glued to the computer screen—simultaneously assimilating vital signs, laboratory results, and imaging studies. For me, the computer investigation feels proactive, efficient, and self-improving. No doubt, it also quells certain anxieties I have in caring for critically ill children. Like so many, I make a distinguishing mark on my sheet, near the patient’s room number, if the child is at high-risk for decompensation or if their story doesn’t add up. Those demarcated patients are the ones I evaluate first. Like any other day, I was given the most information about those who were high-risk, and least about those who were low-risk. The efficiency in communication regarding low-risk patients is bizarrely validating despite its monotonous nature. It represents our collective agreement that “we” know more than enough about a patient’s disease and condition. Sometimes, this conclusion is dead wrong. The patient this night centered around, who I’ll call “Saanvi,” was low-risk and therefore communicated in few words. The daytime attending left, and I “officially” started my shift. I examined the patients who were lucky or unlucky enough to gain distinction on my papers, but not Saanvi. I also spoke to fellows, nurses, and respiratory therapists, reviewed test results, and made changes to ventilators, blood pressure, and sedation medications. Despite the potential for chaos, the unit felt under control. And then it happened. “Can you look at Saanvi?,” a beside nurse requested. I paused to recall the 9-month-old girl I had reviewed earlier in our electronic medical record (EMR). The one whose profile picture showcased her furrowed brow, an uneven smile, and a protruding bottom lip—as if she was making a face at the camera. “Sure, let me check on one other thing and I’ll be right over.” “Actually, can you come over now?,” the nurse reiterated. The look in her eyes was even more explicit. I rushed to the bedside. Labored breathing, low oxygen levels, and pale appearance. Her central pulse, initially thready, quickly vanished beneath my fingertips. I thought, “This isn’t supposed to happen to this patient.” We’re all familiar with the choreography that followed—chest compressions, bag-mask ventilation, defibrillator pads, rhythm and pulse checks, code medications, etc. Unimaginable to the rest of the world, but acquired instinct for us. In Saanvi’s room, I hypothesized, “We should get her back within a couple rounds of CPR,” not truly understanding the cause of her arrest. Two rounds of goal-directed cardiopulmonary resuscitation (CPR), endotracheal intubation, and still no pulse. We activated extracorporeal membrane oxygenation (ECMO) and I briefly left the room, while resuscitation continued, to update Saanvi’s parents. “I am so sorry we’re meeting this way. I’m not sure what caused Saanvi’s heart to stop, but I believe we can stabilize her on ECMO.” For the parents, this unfair introduction included an abbreviated explanation of central, venoarterial ECMO cannulation coupled with inadequate time to process. “Over the next few days, we’ll re-assess her brain and vital organ function to help you understand what this all means over the long-term. I genuinely apologize for being so short…I’ll follow-up with you as soon as I can.” When I returned, the surgeon was at the bedside and the circuit was primed. CPR continued until Saanvi was cannulated onto ECMO. Unfortunately, the next few hours were uncharacteristically filled with aggressive resuscitation—a reminder that “rescue therapies” don’t always live up to their name. Despite our array of subspecialists, medications, and equipment, we were unable to stabilize, much less reverse end-organ damage. Saanvi was dying and we couldn’t stop it. Hopeless. If I was reading this article, I’d have questions. But this isn’t a medical inquiry. In many ways, that would be easier. Eventually, it was time. Eye contact between the physicians in the room confirmed our collective surrender. “This wasn’t supposed to happen,” I again reflected. My discomfort immediately converted to action. “We need to update Saanvi’s parents and ask them how they want to spend their remaining time with her.” During our next conversation, I observed myself. “Despite trying everything,” I said, “your child is dying. There’s nothing more we can do. We’re so devastated by your loss and the loss of Saanvi...,” my voice trailed off as I thought of my own children. The words felt entirely inadequate. Not because they lacked in honesty, compassion, or even regret, but because they were just words—with no potential to fill the inevitable void that would follow. The expressionless stares on the parents’ faces confirmed this. “When will it hit them?,” I wondered, as if foreboding what was to come. …and then it happened. That unmistakable wail that begins with a soft, deep-pitched moan, and progresses, within the course of a breath, to a shrieking and prolonged cry. The entire unit felt their stomachs hit the ground, but it was actually our hearts. To me, this is the sound of the soul crying, and I wanted it to end. Saanvi’s parents ultimately decided to withdraw medical and technological support. Before they entered her room for the last time, there was a heroic scurry. With the efficiency of a Formula 1 pit crew, our team cleaned her body from the blemishes of the day. She was wrapped in a woven and colorful throw blanket to conceal the catheters and destruction that could not be wiped away. These gestures added a brightness to the dark room. Shortly thereafter, Saanvi died in her parents’ arms. Upon leaving the hospital, her father approached me to say, “thank you,” with a kind handshake and sincere eye contact that only made me feel worse. We then debriefed as a larger team to review the unanticipated event—not defined by the outcome, but instead by the effort, and what we could learn for our next patient. …and, with the clockwise rotation of the minute hand on the hospital wall clock, we moved forward. My global awareness of the ICU orchestra intensified. Alarms beeped, cell phones chirped, and the hum of staff chatter and medical equipment filled the air. The room, where the battle took place, was thoroughly cleaned and sanitized. With no gross evidence of its past, it was ready to support the living. But these impressions never leave us. An inadvertent glance at a hospital room, on any given day, conjures up specific names, faces, images, and stories. Nonhealing wounds—in memoriam. Desensitized, yet tormented by cases we never forget, stories like these seem all too ordinary—often feeling undeserving of attention or sharing with others. But that’s a mistake, isn’t it? Maybe, we’re also uncomfortable with acknowledging that the way we move forward, rituals intact with human-centered mission, is nothing short of extraordinary. That EMR, dashboards, billing queries, satisfaction scores, or (dare I say) artificial intelligence will always fail to assimilate these types of human impact. Our marks don’t register there. I’m okay with not being okay. To my colleagues across the world, I hope you’re also okay…
DOI: 10.1097/pcc.0000000000003851
Language: English
Open Access status: hybrid
OpenAlex ID: W4415439348
FWCI:
Cites:
Cited by:
Related to: