Oscar Night in the ICU

Patient names and identifying details have been changed to protect privacy  

It’s Sunday afternoon in South Los Angeles and I’m midway through a twenty-eight-hour call in our hospital’s fourteen-bed Surgical ICU. Just a few miles north of us, Hollywood’s elite are lining up to walk the red carpet for this year’s Academy Awards. Encircled around the physician’s workstation are L.A.’s poorest and sickest, lying in beds separated (sometimes) by curtains. In ‘the unit,’ life and death is constantly hanging in the air. Sitting at my computer I can hear the ventilator keeping Douglas alive as it sounds its rhythmic hum, signaling the beginning and end of machine-driven breaths. The seventy-something year-old veteran who fell and hit his head a few days prior suffered a massive brain bleed and had a cardiac arrest while in the hospital. His family made him DNR/DNI over the phone, and we’re waiting for them to arrive to remove the tube.  

On TV screens around the unit, the well-quaffed Ryan Seacrest and vibrant Kelly Ripa are interviewing nervous celebrities. With most of our patients on life support, their families do most of the watching on individual screens swiveled out in front of them. They are clearly looking for a distraction. Adam, the teenager who was left paraplegic after a diving accident, is lying in bed next to his cousin who comes to visit him each evening. Tonight, the cousin is drawing a picture of him playing basketball with the LA Lakers. “I want to go home,” he mouths around the tube to me. Instead, he’s next in line for the OR for a tracheostomy. The interviewers meanwhile ask each other how the Oscars will go without a host this year. 

Midway through the show, Tony arrives to the unit. Restraints bind his arms to the bed he’s being wheeled in on. The forty year-old alcoholic is sweating and hallucinating with eyes inextricably darting back and forth,; clearly terrified of unknown apparitions before him. He thrashes against the six of us pinning him down long enough to get an IV in his arm. The sun is setting outside, and Gillian Welch’s soft, melodic voice echoes from TV-to-TV amidst the screams of delirium tremens, singing the words of an Oscar-nominated song, “Let me tell you, buddy and it won't be long, till you find yourself singing your last cowboy song.”

By the end of the show Tony is sedated, Douglas has died, and Adam will be wheeled to the OR for his 20th surgery. The Oscars will come and go year after year; but the most painfully dramatic and honest moments of human existence that require no stage, grandeur, self-importance, or smitten audience will continue to transpire daily in the unit.

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Rob McMickle

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EM Resident. Hobbies: Climbing on rocks aka rock climbing

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