I was on service as the attending physician recently, and it struck me how closely our sickest patients in the intensive care setting mirror the political mires of our country.
Usually, when I’m on service, it’s an all-consuming matter, with little time for media and external affairs. However, this time it was different: history in the making with a Supreme Court decision that eviscerated a woman’s right to choose, to care for her own body, and make decisions about her health. This followed on the heels of decisions regarding the right to carry firearms, especially cruel as funerals in Uvalde, Texas, were still ongoing. While I listened to news radio and devoured stories about these as I tried to sleep every night, I also thought about the patients under the care of our team.
This was the same ICU I trained in. The faces of some of the staff are the same, while others have retired or moved on. The main medical problems are the same: shock, cardiac arrest, myocardial infarctions, congestive heart failure. But it is also so different: these patients are just so much sicker now. Every time I’m on service, I seem to sign more notes regarding someone’s passing and have longer and more involved discussions about goals of care and how to administer end-of-life care.
Involving our palliative care team has become commonplace. It’s not that these patients’ hearts are not working well anymore. It’s that neither are their lungs, livers, kidneys and brains. They stay in the hospital much longer. It is getting harder and harder to find an empty bed in the hospital for new patients and transfers. We’re chronically understaffed due to myriad factors — some related to the pandemic and many just related to a system constantly working at more than its capacity.
The larger issue for which the patients were admitted were often relegated to lower on our list as we focused on more acute issues that cropped up. Instead of focusing on the decreased heart function, we’re urgently dealing with a gastrointestinal bleed. Instead of setting up the patient for a life-saving cardiac device, we’re instead focusing on their renal failure.
There are and have always been common complications of being in the ICU setting. But it’s the degree to which they occurred this time — it was one step forward and two steps backward. The frustration on the team was palpable. We had unexpected complications from procedures, decompensation of seemingly stable patients and worsening of conditions resistant to all interventions. Much as we tried to center on the big picture every morning on rounds for each patient. By the time evening rounds rolled around, it felt as if we were focusing on something else for most of them. It was incredibly important to the patient at that moment, but making little progress towards that previously discussed bigger picture.
And this is what it feels like we’re doing on a national level. We lurch from issue to issue–incredibly, incredibly important issues. Inflation, guns, abortion, gerrymandering, regulation of the EPA, the sanctity of elections — these are issues that impact millions of people. They all deserve our attention and the effort of our leaders.
However, much like the gastrointestinal bleed that pops up in a patient who is waiting for a much-needed procedure that will now need to be put on hold, these issues of importance are not moving our government or us forward.
Abortion was decided in 1973. It is taking precedence in our national collective and will for years to come. While we focus on these issues that arise on a regular basis, we are not able to make a single iota of progress on what really threatens all of us: climate change. It will always be on the list of things we need to do, the thing we need to do to discharge the patient and successfully get them home — but the thing we’re not able to do because we need to address the four other issues that arose first, the issues that we need to resolve more urgently before we can get to the main issue.
Never the first story, but thrown into coverage are the stories of decreasing water in the Colorado river, record fires in New Mexico, drought spanning multiple continents, record floods in Europe and China, volcanic eruptions, melting ice caps — just throw it on the to-do list. Still, of course, that item won’t be crossed out today. Let’s save it for the next round while we focus on more urgent issues.
Of course, we have to stem the bleeding so the patient can proceed with their procedure, but what if it’s too late? I worry, just like my week on service, that dealing with these urgent issues will take all our time and effort, with nothing left to show to our children in the fight against climate change.
Initially, as I prepped for signing out to my colleague, I thought we wouldn’t have a lot of progress to show for the week. However, I realized that there was some movement in the right direction — some patients were better and moving towards their planned procedures, and a few had even made it home. I credit this to our daily discussion about each patient, where we address the day-to-day issues. When we see the forest and not just the trees for each patient, we ask, “What is the ultimate goal to get this patient better?”
Nationally, this conversation does not seem to be taking place. Caught up in a bipartisan quagmire, there seems to be little hope of actually moving forward. I hope that our politicians start having a discussion about the larger picture as well: what do we need to do to get this sick planet better? Because otherwise, the path forward may be lost to us.
Rabia Rafi Razi is a cardiologist.
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