Is the intensive care unit bad
From everyday life in an intensive care unit : Between good and bad
A high-pitched, sharp, never-ending alarm tone, like a knitting needle penetrating my brain from one ear to the other, is the earliest impression in my memory of the time in the intensive care unit, I was a medical assistant in a Hamburg hospital. The siren sounds of the fire and ambulance vehicles, the rhythmic sharp sounds of the ECG monitors, the hissing noise of the ventilators and the long drawn out, high-frequency signals of the defibrillator before the triggering of a cardiac electric shock have repeatedly penetrated the inside of my head, often in one like agonizing tinnitus that resounds through my dreams, with which I wake up and fall asleep.
Years later, in the intensive care unit of a Berlin university clinic. An alarm rings out from one of the "boxes". The nurses, the two resident doctors on duty, the senior physician present and myself rush to Mr. D., a 52-year-old patient who had been admitted the day before by the emergency doctor with a severe heart attack. His damaged heart was no longer pumping enough blood into the circulatory system, and he had developed cardiogenic shock, an almost uncontrollable complication of this disease. Cardiac catheter treatment was still in its infancy and was not yet available. For hours, his blood pressure had only been 60 despite high-dose circulatory drugs - and now the heart monitor showed ventricular fibrillation, followed abruptly by a zero line: cardiac arrest.
Everyone stands around the bed with affected faces. Under the disapproving looks of the nurses, one of the two doctors holds the defibrillator's flashing green electrodes over the patient's chest, hoping to shock the heart back to life - he is just waiting for a signal from the senior doctor. He actually seems to be considering a resuscitation attempt for a short moment, then he indicates with a wave of the hand to refrain from any further attempt at treatment. "Cancellation! - We have already sent enough patients into a vegetative state! "
We don't take it very seriously with the peace of the dead
In the hallway, the senior doctor takes me aside. “Come before the dead person disappears into the pathology, practice the intubation quickly. He is still not rigid and the jaws can move freely. I'll show you. Later, when you drive the ambulance, you have to master that, as well as the subclavian catheter, you know, the puncture of the large clavicle vein, I'll show you that right away, okay? What do you look so skeptical about, what is wrong? "
"No, no ... okay, thank you. I just thought ... because of the peace of the dead ... "
"The quiet of the dead? ... Well, you are actually right ... but we don't take that too exactly here ... otherwise you won't learn anything! "
Minutes later we are standing at the head of the corpse, the door of the room is closed. Under the guidance of the senior physician, I stretch the head of the deceased while still warm, guide the tip of the illuminated intubation spatula to the base of the dead man's tongue, lever the epiglottis and now have - sweat is on my forehead - a clear view of the vocal cords, between which I put the ventilation tube advance into the windpipe. "Perfectly done!", Praises the senior physician, "Machense the subclavian catheter on the next corpse is not the last one you will see here."
Defeat is the order of the day in the intensive care unit
Intensive Care Unit - a place the public is deeply mistaken about. She believes that behind the double-leaf frosted glass doors there is a place of heroes and miracles, even if television series have long since ceased to show heroic doctors and high medical technology for the benefit of the sick. She believes it not least because she wants to believe it. Because the horror would be too great if she had to be convinced of the opposite: Defeat is the order of the day, dying and death are at the end of many and protracted attempts to keep life-threatening patients in life. Revival? More than ninety percent of resuscitations fail; only every tenth patient survives, and often only with considerable restrictions: need of extreme care, loss of autonomy, vegetative state.
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