The first time I was in an intensive care unit as a medical student, I wondered if I should pray. The patient was unconscious. A tube secured in his mouth connected him to a ventilator, a machine that breathed for him. He was covered by a smooth, white sheet that had been folded over just below his neck. One of my medical school professors had brought several of us to the ICU to learn about lung physiology and the workings of the ventilator. I had never seen anyone in this condition, suspended in the netherworld between the living and the dead. I had so many questions: Who was he? Who had he been? What had happened to him? I hadn’t been to church since I left for college when I was 17 and yet, in that moment, my agnostic mind grasped for a higher being. My professor’s question about respiratory physiology — How do the pressures recorded on the screen correspond to the narrowness of the bronchi and the elasticity of the lungs? — jolted me from these thoughts. I had enjoyed puzzles like that in the classroom, but I couldn’t reconcile this academic discussion with the existence of the man in the bed. I didn’t know how I would ever cope working in an ICU. I soon found out. I was assigned to the ICU during my internal medicine internship. Every fourth day for a month, I worked a 27-hour shift there. Most of the patients were like the man I had seen in medical school: so sick I would never get to know them. There was the young woman in the final throes of cancer. She could no longer speak, only moan. Her sister asked me through tears, “How will I live without her?” There was the man with liver cirrhosis. His face was gaunt, his belly enormously swollen, his skin bright yellow. As the night progressed, he became more and more confused. At sunrise, his nurse called me urgently to his bedside. I stood over his body, calling his name. No response. His eyes were glassy. I dug my knuckles into his chest, hoping the pain would bring him to consciousness. Still no response. He was barely breathing. I called for the airway team — without a breathing tube and the ventilator, he would die. Though I knew then that even with the tube, he would still die. As a swarm of doctors pushed past us, racing to the bedside, I had to tell his wife what was happening. She collapsed to the floor. I got down on the floor next to her and held her arm as she sobbed. I stumbled home from these long shifts, exhausted to delirium. I would crawl in bed next to my husband, climb under his arm, and sob. “Please don’t die,” I’d say to him as he slowly awoke. After my month in the ICU had ended, I spent my days seeing relatively healthy patients in the clinic. Yet my mind often drifted back to the ICU. Sitting on that floor. That impossible question: How will I live without her? I stayed up late one night reading poetry. I had never been much of a poetry reader, but saw a collection of Mary Oliver’s work in a bookstore and somehow knew I needed it. That night I discovered Oliver’s poem “The Rabbit.” In it, a rabbit has died and his body is decaying in the elements. The narrator knows she needs to bring the rabbit to his final resting place, but she can’t. She imagines him “leaping in the moonlight … / wanting it miraculously to heal.” Finally, she does what she must and shovels earth over his body. The next day, in a nearby field, she finds “a small bird’s nest lined pale / and silvery and the chicks— / are you listening, death?—warm in the rabbit’s fur.” As I read “The Rabbit,” I saw my patients: bleeding, moaning, gasping. I pictured what once was, and what was lost. The poem helped me accept what I didn’t want to be true: that death, as painful as it is, has its place in nature. My first time in the ICU I had wondered if I should pray. With life so precarious, science wasn’t enough for me. But I don’t know how to pray, or for what. Poetry, Mary Oliver showed me, is a kind of prayer. It speaks to the vast mysteries of life and death. It gives voice to feelings I do not know how to put into words. When I returned to the ICU the next year as a resident, three medical students were on our team. I was responsible for teaching them something about critical care. It crossed my mind to take them into a patient’s room and talk about ventilator settings, since over the years I had become interested in the machine. But then I remembered how sad and lost I had felt my first time in the ICU. I decided that the ventilator could wait and I would teach them something else. I gave each student a copy of the poem “Intensive Care” by Jane O. Wayne. It describes the ICU from the perspective of a patient’s loved one. The narrator imagines the sick person as a ship lost at sea and herself as a villager waiting on the shore for a sign of recovery. I asked the students if the poem related at all to their experience in the ICU. One of them, an aspiring surgeon, drew our attention to a particular image: “Day after day, on the same narrow coast, / we stood guard, waiting / for some speck to reappear …” The poem made him think of one of our patients, a man who had become paralyzed and could only blink. Each morning the student went into this patient’s room and spoke with his son, who was standing alert at his father’s side. On rounds, we never acknowledged just how heart-wrenching this man’s condition was. But the poem provided an opening, a permission slip to name the grief we experience vicariously and the helplessness we feel when medicine has reached its limits. It is difficult to step foot in an ICU without feeling the pain and suffering held within its walls. It is hard to suppress existential questions in such proximity to death. And yet it’s easier to talk about ventilators than these very human responses. To care for our patients, we need to acknowledge their humanity, and our own. Bringing poetry to the ICU, I’ve discovered, is one way to the heart of things. Colleen M. Farrell, M.D., is an internal medicine resident physician at NYU Langone Health and the founder and host of the Medical Humanities Chat Source
