The pulmonary ICU is abuzz; monitors beeping, ventilators pumping, doctors and nurses weaving in and out of rooms. I have tuned all of it out, standing over a patient’s chart, pouring through the surgical reports and nursing notes. As a clinical fellow, I am extra vigilant during my chart reviews. I still have to prove myself.
“Ready?” Lauren is standing next to me, leaning against the nurse’s station. Her expression is one of annoyance mixed with nonchalance. As my fellowship supervisor, she is required to observe me once a month.
I nod, hoping she can’t sense my fear.
“Ok, what have you got?”
“Patient is a 31-year-old female with no past medical history. Collapsed while running a half marathon last week. Found to be in respiratory failure, emergently intubated in ED upon arrival. Intubated for eight days, unable to extubate, leading to tracheotomy placement. She is now day 1 status post tracheotomy and is currently ventilator dependent.”
“What’s the cause of her respiratory failure?” Lauren asks.
I flip through my notes. “They’re not sure, still doing a diagnostic workup.”
Lauren rolls her eyes. “Let’s go.”
We don the bright yellow gowns for contact precautions and slip on gloves before entering the room. The patient is reclined in bed, the large ventilator working loudly next to her, giving her breath.
“Hi Fiona,” I greet her. Her eyes are wide, as if fearful of what’s to come.
31-year-old. Not much older than me.
“We are from speech pathology,” Lauren chimes in. “Can you tell me your name?”
Collapsed during a half marathon. I’ve run plenty of those.
Fiona, she mouths. Then, her eyes grow wide and she attempts to cough, but nothing comes out.
Not sure what caused the respiratory failure. That could easily be me in that bed.
A wave of heat washes over me. I steady myself. Why do these contact gowns make you so hot?
“Jen,” Lauren snaps. “Can you read me her vent settings please?” Judging by her tone, she’s already asked me once.
I make my way over to the vent. This time, a wave of nausea washes over me. I rattle off the settings slowly, paying close attention to my balance. Lauren is inspecting the patient’s trach. I amble towards the door, sure I am going to fall over at any second.
“Lauren, I’m just going to be right outside the room,” I call over my shoulder. I rip the yellow gown and gloves off and feel a rush of cool air. I quickly sink into the closest chair to avoid collapsing. Slowly, my eyes begin to refocus and my heartbeat slows.
“You all right, Jen?” One of the pulmonologists is hovering over me.
“Oh, yeah, I’m ok. Just forgot to eat breakfast,” I lie. He puts a hand on my shoulder.
“Do you want a granola bar or something?”
“Oh no, thank you. I’m ok.” I force a smile.
“So what did you think of our lady?” He asks, nodding towards the patient’s room.
“She wouldn’t know because she didn’t stay long enough to assess her,” Lauren’s voice is sharp and staccato. She turns to the pulmonologist. “Dr. Monzi, we will continue to follow the patient and monitor for readiness to take PO.”
“Great, thank you.” Dr. Monzi smiles and turns.
Lauren turns to me. “What the hell is going on?”
“I’m sorry, I started to feel lightheaded,” I say in a near whisper.
“Are you not capable of seeing this type of patient?” She snaps.
“No, that’s not it. It’s just…she’s so young…and on the vent…” I struggle to piece together a coherent sentence under Lauren’s angry stare.
“You need therapy,” she asserts. “I recommend you find a psychologist and rectify this issue as soon as possible.”
I nod, looking down. Lauren turns, irritated. “I’m going to write up her note. I suggest you see a patient that doesn’t make you sick.”
I nod again, fighting back tears. It isn’t until the end of the day, when I get into my car and close the door, that I allow myself to sob.