The Arena

“Hey, my name is Read. I’m the resident in the ICU taking care of you tonight. How are you feeling?”

Tears welled in her eyes. “I’m scared.”

Silence.

“I know.”

Three weeks into my Surgical and Neuroscience Intensive Care Unit (SNICU) rotation, first week of nights. It had been a busy stretch, but things were going well. I was starting to get the hang of life in the SNICU after dark.

It was Friday. I woke that afternoon to news that my sister had gotten engaged. Back home, hours away, my family would be celebrating all weekend. My wife’s birthday was coming up. Sleep-deprived and groggy, eyes burning, I woke a few hours early so we could sneak in a pre-birthday dinner at our favorite Mexican restaurant. Then it was off to work.

The shift was hot from the start — transfers, open beds. Strokes. Seizures. Post-operative respiratory failure. A patient briefly dipped into asystole.

Around 3 a.m., I got paged about another — and hopefully last — admission of the night.

25F. Two weeks of headaches, diplopia, blurry vision. No motor deficits. Hemodynamically stable on room air. No past medical history. Brain mass on imaging. Neurosurgery requesting SNICU admission. OR at 8 a.m.

Thank God.

An otherwise healthy twenty-five-year-old. No clear ICU indication at the moment. In the SNICU, very few patients come sitting upright in wheelchairs. Even fewer walk themselves to the bathroom minutes after admission. This was going to be an easy one.

I walked in to introduce myself once she was settled.

“Hey, my name is Read. I’m the resident in the ICU taking care of you tonight. How are you feeling?”

Tears welled in her eyes. “I’m scared.”

Silence.

“I know.”

My easiest admission of the night was the worst day of her life.

I hadn’t thought about what I would say before walking into her room. What did I expect her to say? Why hadn’t I stopped to consider the reality in front of me before opening the door?

I remembered, suddenly, how scared my own family and I had been years ago when my sister was the one in an ICU bed. Had six months of residency already built that much of a callus?

I’m not used to this kind of medicine — being consistently surrounded by death and uncertainty. I’m an ortho intern. Break bone, fix bone, walk on bone. Back to life. An exaggeration, maybe, but not by much. One of the reasons I chose orthopedics was the promise of good outcomes. Even in ortho, though, we’re not immune — just more insulated.

I took a quick history. Confirmed her reassuring exam. I weakly assured her that neurosurgery was on board, that there was a plan. The note and orders were easy. A simple admission, technically. And at the same time, the furthest thing from simple.

I slept for twenty minutes. No one else dipped into asystole. Morning came. I gave sign-out, logged out of secure chats, and went offline.

It was cold outside — winter here is harsher than at home. My sister had just gotten engaged. It was my wife’s birthday. My dog didn’t understand why I had been gone all night, nonetheless he was giddy when I walked through the door. I caught up with my wife, listened to her stories, nearly falling asleep mid-conversation. Too tired to eat. I slept all day.

I woke up. Made coffee. Packed lunch. Ate with my wife. Pet my dog. Called my sister. Drove to work.

Time to enter the arena once again.

Read Streller is an orthopedic surgery resident at the University of Iowa, husband to Carmen, and dog dad to a 1-year-old golden retriever named Cowboy.

Photo Credit: Rui Alves