Beer does this.

Dear patient,

Your husband wanted to take a picture of this room today.

What would that photo have showed? You are lying in a hospital bed, with your wrists tied down. Pillows are stuffed under your back because I turn you side to side all night.

There is a blue tube as thick as my middle finger down your throat. It is connected to a machine, 4 feet tall, that breathes for you. From those tubes are two very fat tubes, a white one and a blue one. For air going in and air coming out. Also, a thin wire attaches to the knot at the end of your endotracheal tube and goes to the monitor, so that I can watch numbers that are relevant to keeping your body's pH balance stable.





You have five electrodes attached to your chest, which is attached then to a tv screen over your bed. It shows me your heart rate and rhythm. Another cord goes to the blood pressure cuff on your arm.

You have a thin tube down your nose. This tube goes into your intestine, and comes up and out and is connected to a small pump, which is connected to large bags that are giving you amino acids and sugars. The box tells me that it has milk proteins, sunflower oil, medium chain triglycerides, cellulose gel (insert 34 other chemical substances), and corn syrup and vanilla flavoring. It smells like soymilk with fake vanilla sweeter. Which, I suppose it almost is.



There is a much larger tube going down your throat and into your stomach (you have two tubes in your mouth, see). This one is suctioning out the acid. Green crap is coming out intermittently.

You have a foley catheter in your bladder.










There are two photographs here of the same thing because you needed all six loaded with different medications, programmed differently by med, by how that med is measured (mcg/kg/min and ml/hr and units/hr, etc).
You have an iv line with what we call a "chicken foot" on it. That means we don't have enough iv ports for all the meds you need. I am pumping phosphate, magnesium, heparin (a blood thinner), and an ungodly amount of sedation and pain medication.

You also have a gigantic 2-tube catheter going into your jugular. EACH of the two is almost the diameter of my pen. One of those tubes is slurping all your blood into it and pulling it into a dialysis machine larger than my dishwasher, but smaller than my fridge. This is scrubbing your blood with acid and base baths, respectively. The waste is going through several pipes thick as my big toe (all of them), and dumping it through that huge port in the wall. God only knows where it goes there.

This dialysis machine requires that I count every milliliter of fluid I am pumping into you (however it gets there), and every milliliter that I take out to try and meet the goal of fluid we're trying to take out. Every hour on the dot I flush this machine with saline so that you don't throw a blood clot and the machine doesn't clot off.

You require constant 1 to 1 care of an ACLS-certified specialty trained registered nurse 24 hours a day. And I do mean every moment of the day. There are exactly three nurses on this floor right now who are able to relieve me when I need to go to the bathroom. I eat here, at my computer on wheels. Lucky for me you have no cooties.


This is the type of clinical needs you have. You may be independently wealthy, I don't know. ICU nurses don't come cheap. Let's not even mention the drugs you're receiving. Drugs, narcotics, sedatives I am dumping into your veins like they're on sale. Or even just having a bed here on the unit. Or the three MD groups following your case. That little foley catheter costs fifty bucks.

Every four hours, I draw blood from you (from one of the several tubes), send it to the lab, and based on the results, adjust your medications. I constantly evaluate your heart rhythm and blood pressure, which has a habit of tanking. I keep your mechanical kidney working properly, and I sit here at your bedside because if those fat tubes disconnect for any reason, you can exsanguinate in a matter of 5 seconds unless someone is here to stop it. But don't worry. I have three huge clamps, several emergency meds, an ambu bag, two additional suction tubes all in neat piles in various places in this room in case you need it.

Tonight, I also plan to give you a bath. Your hair's in a braid (well...dreadlock), and I will try to attend to that, too. I can't lower your head to wash your hair or you'll aspirate the tube feeding and potentially pop a lung. But we'll see how creative I can get with the hairwashing. You outweigh me by 75 lbs. And as you went into respiratory failure, you were fighting the nurses and no less than seven RNs (three of them men) had to hold you down so that we could maintain an airway for you. You kept trying to yank everything out. You would have died without that tube. So I'm sorry about the restraints, but they're stayin.

The irony is that you came in with a bellyache to the ED a week ago. What they found is that you have a disease caused by alcohol. It will take months for you to get over this disease. It will be painful. I have never seen a patient with this disease not leave the hospital setting without an Oxycontin addiction that an MD manages with the patient. Be honest with whoever that MD is, by the way. It'll go better.

Your husband asked me if you'd remember "any of this." I assured him, no that, I'm doing everything I can to keep you out of pain and oblivious to this horror we're doing to you. But then he thought about it, and thought maybe he should take a picture to get you to stop drinkin, or at least 'cut down', cos some alcohol is worse than others, right?

No, sir. Alcoholics cannot 'cut down'. There is stop and there is off the wagon, period. She cannot ever drink anything again. And alcohol is alcohol. "But sometimes she only drinks beer." Beer is alcohol. Beer does this. Many alcoholics eventually maintain their alcoholism with Nyquil, sir. It makes no difference.

Patient, since I can't take an actual picture of you, I painted you a word picture.

So you should know, dear patient. Beer did this to you. Beer killed you, except that some doctors and nurses brought you back. To this snapshot.

Your nurse,
/jo

This photo is obviously not my patient. But I see ventilators, CRRT, monitors, an NG tube and some fluids running. The only thing missing are the two triple channels. So, patient? You looked a lot like this.