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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Wednesday, July 18, 2007

Short White Coat: To care intensively

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at

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The intensive care unit is the most aptly named wing of any hospital. Everything about the ICU at Childrenís Hospital Boston is intense: the patients are acutely ill and many require the simultaneous monitoring of each breath and heartbeat. Caring for these patients is intellectually and emotionally demanding for the nurses and doctors.

Many of the patients in the ICU are intubated and sedated and therefore unable to speak. As a student, I visit and examine the patients I am following before rounds every morning. This ritual of pre-rounding is usually my favorite part of the day -ó a chance to chat with the patients in order get to know them better, and also an opportunity to practice my physical exam skills.

Pre-rounding in the ICU, however, is different. One of the patients I am following is recovering from a neurologic injury so severe that she is unable to talk to me or even to open her eyes by herself. In the absence of speech, the many monitors chirp her progress. While in many instances the physical exam during pre-rounding feels perfunctory, in the ICU the physical exam is one of the few windows into a patientís overall condition. I shine a light into my patientís eyes and watch her pupils constrict, a reflex that reveals that the nerves that sense light and cause the pupil to get smaller are intact along their entire tract in the brain. Wielding only a red rubber hammer, I document the reflexes in her arms and legs. I am meticulous, because the smallest change in her physical exam could be the symptom of a larger change in her brain or other vital organ.

In the ICU, lifesaving drugs and advanced technology help keep my patient alive, but as one of her caregivers, all I can do is monitor her progress and wait and hope for her to get better. More than the machines or the array of illnesses, I think it is the collective waiting and hoping of parents and nurses and doctors that makes the intensive care unit so intense.

Posted by Jennifer Srygley at 10:54 AM
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