At my hospital, the ICU is tucked away in a quiet wing on the second floor, far away from the bustle of cafeterias and common rooms. To access it, you have to enter through a set of heavy doors which are impassable without a security code. A small prayer room stands at the end of the hall, and occasionally you will find people inside, chanting the many names of God. Here you will find the hospital’s sickest patients, many of whom are living out the final days of their lives. We all like to think of the hospital as a place of healing, a place where the battle against disease is fought and won. But the outcomes of war are never so predictable, at least not in the ICU. As an ICU nurse once told me, “Sometimes we manage to save lives. But only sometimes.”
“First day in the Intensive Care Unit?” asked Dr. Jones.
“Yes,” I said.
Dr. Jones nodded, “Medical students find the ICU to be a very challenging place. Most of what you will see today probably won’t make any sense to you.”
This statement comforted me; when no one expects much from you, it is a lot easier to learn. “That’s alright,” I said. “This won’t be the first time.”
I was shadowing Dr. Jones in the ICU that morning. He was a calm, quiet man who must have been in his late-forties or early-fifties. Everything about him mirrored the setting in which he worked, as if the years had turned him into a product of his environment. His grey hair and thick glasses gave him the stern, no-nonsense look of an academic. He had the kind of face on which a smile would look out of place. Indeed, he rarely smiled. He moved and worked with great efficiency, as if he understood the value of time and knew just how foolish it was to let it slip away.
I followed Dr. Jones and his residents through the main wing and down a long corridor towards the ICU, glancing around like a tourist who is unsure of what to make of his new surroundings. The attitude in this place was not in keeping with the noise and chaos of a traditional hospital wing. Although there was plenty of activity here, there was no chaos, and very little noise.
It was past eight-thirty when we entered the ICU. Although it was a Saturday morning, the place was already busy. Looking around, it seemed like the ICU was populated entirely by individuals who shared Dr. Jones’s respect for time. Everyone projected a blend of efficiency, impatience, and exhaustion. Conversations were accomplished with an economy of words. I saw the same work ethic in the cleaning staff as I did in the doctors and nurses. Like Dr. Jones, who had become a product of the ICU, they too, had taken on the qualities of their environment.
We walked down to the very end of the corridor, with Dr. Jones leading the way. “Wait outside,” Dr. Jones said to the four of us when we had reached his office.
“So, you’re a first year medical student?” asked Dana, turning towards me. She was an Internal Medicine resident in her third year of training. “That’s cute.”
I had absolutely no idea how to respond to this remark, so I merely smiled. Her comment reinforced my sense of infancy. When you spend hours every day committing pages and pages of knowledge to memory, you begin to think that you know everything. But your ignorance becomes immediately apparent when you leave your textbooks behind and enter the hospital. Confronted with a diversity of new illnesses, you soon realize that you actually know very little. As a first-year medical student, I should have become used to this feeling, but insecurities have a way of feeling perpetually novel. Fear and doubt— often these are not obstacles one learns to overcome, but weights one learns to drag.
Dr. Jones emerged from his office and turned to the residents, “Dana, take patients one through eight. Alex, you take patients nine through sixteen. I’ll take the rest.”
We divided the folders into three piles, and each person took their assigned stack. Dr. Jones looked at me. “You’ll be spending the morning with me. We’ll join Dana and Alex in a couple of hours.”
“Sounds good,” I said.
“Are you ready to begin?”
As I considered his question, I felt a twinge of apprehension. I knew that there was no reason to fear, but novelty always brings with it a little anxiety. Still, I could not help but feel embarrassed for my moment of trepidation. Maybe Dana and the others were right: maybe I really was still a child.
“Yes, I’m ready,” I said.
I wish that I had sounded more certain of myself.