Long day’s journey into night
For those who work in ICU, every day is a matter of speed, tough decisions, sometimes painful loss. Katie Kennie talks to Wellington Hospital’s Dr Kate Tietjens about what it takes to save lives for a living – whether in the midst of a global pandemic or
ROBERT KITCHIN/STUFF (above) review them in-depth.
‘‘People are often surprised to hear not everyone in ICU is on a ventilator or in a coma,’’ she says. Even when they are in a coma, she talks to them as though they can hear her.
It’s unclear what patients are able to sense or understand while they’re in a medically induced coma, but there are stories of people remembering snippets of conversations, and some later report being aware of their surroundings.
‘‘Before we do anything, we call them by their name, and explain things as though they were conscious.’’
The rest of the day is usually reserved for meetings with families or patients. She might get called to help with a breathing tube or a central line (a type of catheter that is placed in a large vein).
If a patient is really sick, they might require several hours of care, and repeated visits throughout the rest of the day. The team will also receive patients from other wards, the emergency department, or other, smaller hospitals.
‘‘If [a smaller hospital] has a patient who needs high-level ICU care, we’ll provide advice over the phone then make plans to retrieve them via helicopter or plane.’’
While some ICU staff regard the flights as a perk, Tietjens is pleased to have left them behind in her junior doctor days. She’s scared of flying: ‘‘Helicopters aren’t my thing.’’
Most of the time, most of the beds in ICU are full. But with the average stay just one-and-a-half days, there’s a lot of turnover.
‘‘Every day, we’re making decisions about allocating resources and whether, for a given patient, coming to ICU and having all of the invasive therapies we provide would be beneficial for them,’’ Tietjens says. ‘‘Often we’ll decide that wouldn’t be the right thing to do for that person.’’
However, she can’t recall a situation where she’s had to turn away a good candidate for lack of resources.
‘‘If we think someone will benefit from coming to ICU, we can always find a way to make it work.’’
About a quarter of the 1750 ICU patients seen annually are from elective, surgical cases – mainly cardiac surgery. Normally, Tietjens says, they only stay for 24 hours.
Trauma patients, who’ve suffered a severe injury from an accident, tend to stay for longer. So do those who come in with severe medical illnesses such as pneumonia.
From 5pm, just one specialist is on call. If that’s her, she’ll head back to the hospital about 9pm for another ward round and to brief the night team, who’ll call her throughout the night if necessary.
Tietjens will do one or two of these 24-hour shifts per week, as well as non-clinical jobs such as teaching.
Talking to patients’ families is one of her favourite parts of the job.
Before any tough conversations, she reminds herself the family she’s about to speak to will likely remember this day, and possibly some of the words she’s about to say, for the rest of their lives.
‘‘Listen more and talk less.
It’s harder than it sounds. But I try to use silence to allow a family member to talk, and process.’’
Some conversations stay with her, too – good ones and bad ones.
Some grateful patients return to the ward, with chocolates, cake, or a card. An internal staff magazine features an ‘‘ICU survivor of the month’’, complete with an interview and photo.
‘‘It’s really nice to see them in their own clothes, looking like a normal person.’’
The worst conversations involve breaking bad news to parents of young children.
‘‘As a mum of young children myself, I find myself identifying with their grief.’’
The team is able to access counselling services through work, but Tietjens finds comfort in debriefing with her colleagues. ‘‘We’re very close. We often talk these things over ourselves.’’
While decision-making about complex cases gets easier with experience, breaking bad news never does, she says.
For many families, dealing with the uncertainty is just as bad as a bad outcome, she says. Every day, they’re wondering if their loved one is going to get better or worse.
‘‘We’re always reminding people to be kind to themselves, and to prepare themselves for a long journey.’’