OMG, ICU!

Hail,

No over-arching theme, just globules of news here.

I went down to the ICU the other day, to check things out. The reasons were several - I wanted to meet the consultant, I haven't worked in an ICU before and wanted to have a look around, that kind of thing.

It's a fairly small ICU, a combined ICU/HDU (ICU is intensive care, HDU is high dependency) and at the moment there are only about ten patients in there. The small numbers of patients and the longer duration of their stay means you get to know more about their illness - every half a degree rise in temperature, every five percent fall in a white cell count. On the bad side of it the mortality is about twenty percent - one in five of those admitted to the ICU will die there.

This is very different from the ED - death is actually a rarity. For every fatal heart attack or teen car accident or elderly woman in terminal heart failure we would see maybe nineteen people who either get admitted to the hospital or get sent home. The vast majority of ED work is non-life-threatening stuff.

(Another cutting edge paper, by the way, recently published in the Medical Journal of Australia, suggests that the more overcrowded the ED is, the worse it is for patients - they are more likely to be dead in ten days' time if the ED is overcrowded than if it is not).

So I stood in the ICU and stared about at the ten patients and half my mind was wondering which two out of the ten it would be - the middle aged man in kidney failure, the bloated teen who'd taken an overdose, the diabetic woman with the post surgical infection and pneumonia*. In the background the ventilators hissed and the monitors bleeped and the consulting doctors murmured.

Another thing - again, present in the background but not stated - was the events of O-day, and my few days in the ICU at the Royal. Nothing either of us wanted to bring up, but there. I received a package from the College today and a letter from the Medical Board. The package was something on keeping Emergency Doctors alive - I don't know if it was prompted by the recent death of Dr Green or if it just followed on from it. I looked at it - a big workbook, full of exercises on boundary issues, avoiding burnout, that kind of stuff, and thought that this is exactly the kind of thing Dr Green would not have had time for. Too touchy feely. He'd be too busy working to look at burnout, too busy caring for others to worry about self-care, that kind of thing.

The other was a confirmation letter that I was permitted to practice full time again from the start of this month, subject to regular review, but any further events of this kind within the next two years would prompt a review of my registration.

I don't know how to explain how that made me feel. I can see their point. You can't have impaired doctors practicing - the truth of the matter is we do, as I speak the Board is investigating for the squillionth time the activities of one Dr Medellin, who prescribes vast doses of opiates to high risk patients as a matter of course, eight times the maximum safe doses we prescribe.

For the health workers out there, that's one thousand milligrams of methadone a day, plus a handful of benzos, unsupervised dosing. Write that script without your hand shaking.

And simultaneously Dr Norman, who has again - I stress the word again - been called up before the board because he allegedly prescribed methadone in exchange for sexual favours and domestic chores. Happened in Queensland, struck off or something, came over here.

You know that voice in your head that says "Maybe they're right, maybe I don't know best, maybe I'm fucking up here?". Neither of them have it.

Having said that, I think the problem with letters like that is the temptation they create to conceal your illness from your treating doctor. Every time there are penalties attached to admitting a medical condition that medical condition is concealed. Nurses turn up to the opiate unit and lie about their job. Alcoholics threatened with revocation of their licence and who drink a carton of draught a day tell us it's a glass of red wine after a meal with friends. Junkies pockmarked with holes tell us they're not injecting.

And people in my position are tempted to minimize things like disturbed sleep, recurrent morbid thoughts, that kind of thing.

The thing is, the last few months have cost me over ten thousand dollars, when you add up lost earnings plus hospital fees and so on. And that's just monetarily - when you factor in socially, professionally, personally, I found the whole experience profoundly unpleasant. Unpleasant enough to want to do almost anything to avoid a repeat.

But of course, the problems with concealing your illness is you don't get better. Like anything else. Doctors are only as good as the information they are given, and if you want to get really sick really quickly, presumably you can sit there and lie to your physician till your heart's content - or at least until you start swatting the hallucinations out of the sky.

Anyway. One of the reasons I am allowed back to work at all is this whole "insight" thing - when I am unwell I am almost always aware that I am unwell. I know I was sick and I know I am better now, and I know I will get sick again sooner if I don't take the medications. And I know, like most patients know, that it's a bitch taking the things and that the weight gain, the excessive sleep, the other less unmentionable effects aren't worth the consequences - personal, professional, whatever - of not taking them.

And I know that if I was as certain of what I say as I sound, I wouldn't have to be writing it down.

Anyhow. In truth I cannot wait until I start at the ICU. Monday, eight AM, for a twelve and a half hour shift among the intubated, the septic, the jaundiced and the dying. Can't wait.

Thanks for listening

John

*Possibly her, which is very unfortunate.