“I don’t think of all the misery, but all the beauty that remains.” – Anne Frank

As a fellow in the intensive care unit (ICU), sometimes it’s hard to see the beauty through the misery. The misery of my patients, their families, the nurses, fellow trainees and physicians, and my own misery – of not always knowing the answers, sometimes missing the key piece of the puzzle, and not being able to help everyone. But over the last two years, and particularly in the last six months, I’ve been reminding myself more and more to take those deep breaths and ponder all the beauty the ICU has to offer.

 

How do I do that? Well, I always loved critical care medicine – even as a first-year medical student. The unit embodies the purest of medicine and physiology mixed with adrenaline. The days never feel the same, and while the unexpected is scary, it’s also exciting. When I started fellowship, I assumed my ICU months would be as satisfying as they were in residency. An oasis in the midst of endless wards. But while the first months were great, I couldn’t expect my body, brain, and heart to keep up with the grueling hours, exponentially steep learning curve, and emotions related to working with patients who are dying, without using all the resources at my disposal.

 

The first and foremost – my co-fellows. These were (and still are!) the people who knew everything I was going through in gritty detail and normalized all the insecurities and fears I had. My attendings and program leadership were right behind them in emphasizing that becoming an ICU doctor is a shared experience. They reminded me that while some days can be long and lonely, there is always someone to reach out to and chances are that connection will be good for both of you. And perhaps the best resource were the people I saw everyday – the patients, their families, the nurses, and everyone else who filled our ICUs.

 

But I didn’t fully realize their value until I spent a week in the COVID-19 unit and encountered an ICU beyond my worst nightmares. An eerily silent unit with each patient locked away in a negative pressure room, the smiles of nurses hidden behind masks and goggles, the humor of rounds buried under fear of dealing with an unseen enemy, and the bedsides of patients surrounded only by machines. It took that week (and the following several weeks) to be able to put words to the lesson fellowship has been teaching me from day one.

 

Maintaining humanity in the ICU, finding the beauty in a quagmire of misery, is an exercise in remembering the people in the ICU. For me, that means forming a human connection with at least one person every day in the unit – my deep breath. I’m not so idealistic as to believe I will do that with every patient, nurse, and coworker, but if I can manage one, it usually keeps me going and allows me to remember that each body in the unit is a person. Sometimes the connection is easy – a shared meal with a resident; helping a nurse sift through someone’s belongings; sometimes it takes more time – the 30-minute video call allowing a matriarch’s children to say a last prayer with her.

 

Since we all like algorithms, I’ll try to break this down.

 

  1. Find a way to remind yourself that your job is important. It will help remind you that you are taking care of people, not simply getting through the day. For one of my attendings, this was a mindfulness practice of touching the door and saying the patient’s name before entering the room. For me, it’s that daily connection with someone in the hospital.
  2. Give yourself permission to have some days where your job is simply a job. Not every day can be infused with meaning and that’s ok. There will be days when all you want to do is come home to your recliner.
  3. If you have more bad days (days you feel you’ve barely survived) than good days, seek some help. Help comes in many forms – family and friends, program director, a therapist, pets, etc. And there’s an app for that too! Headspace, The Mindfulness App, and MyLife Mediation are just three options. Often, I listen to a body scan activity on YouTube. Music, the outdoors, exercise, or my personal favorite – reading a good mystery, can also add a different energy to your day. Make sure your life doesn’t become a run of only bad days.
  4. Build a culture of humanity and safety – especially among trainees. This means normalize people sharing their bad days (not complaining, but acknowledging that our jobs can be tough), insecurities (we all have them), and fears (of making mistakes, of not knowing enough). In our program, our faculty models this for us. Attendings, including program leadership, will share with the fellows their experiences and invite open, non-judgmental, discussion of the same. It’s not always perfect, but so little in life is.

 

I don’t think this will work for everyone, but I think finding a way to remember that while not every day in the ICU is a beautiful privilege (because, let’s be real, some days are just painful), every day we are humans taking care of humans.

 

Ankita Agarwal, MD is a third-year Pulmonary and Critical Care Fellow at Emory University. Her future plans include a career as a physician-scientist with a research interest in end-of-life care and its delivery in critical care medicine.