ICU thoughts

I was just reading through ya'lls post, and I have had a similar experience in the Neurosurgical ICU that it seems that Rachael is having in her ICUs (so maybe we should just have a roommate pow wow instead of posting this on the blog...). Most of the patients that I have seen are post CVA or MVC and have fairly poor prognoses, though there are definitely some who are there until they are stabilized and will make a full recovery. I think the Neurosurgical ICU is really hard to be in because many of the patients families do choose to turn to palliative care. The ICU is a place where you can learn a lot about recovery (from a really sick person then getting better and walking out of the hospital) and also a place where you learn to deal with end of life discussion, which are certainly hard as we are all empathetic humans. I do see the ICU as a place where dietitians are really important because of the necessity for TPN/TF and also for the ability to keep the person with adequate nutrition when they are unable to do it on their own so that when they recover they have adequate strength to breathe, do rehab, etc.

I have also been following my case study (I talked about her a while ago- 59 y/o woman who has drug-induced liver failure from herbs/NSAIDs/wt. loss supplements/wine?...they still dont have it pinpointed but probably some combination.) She rapidly declined last week and was emergently intubated due to hepatic encephalopathy. She has been on and off tube feeds, and they have determined that her liver will not recover on its own and she now must have a transplant. However, she has sepsis from a UTI and they have to clear that up before she can go back on the transplant list. It has been really interesting to watch her over the past 4 weeks go from a jaundiced woman with normal function to encephalopathic to more normal function to intubated to extubated (yesterday) and then today I spoke with her during lunch and she told me about her chicken being cold and said if I wanted she would drink Ensure again (so she's doing much better again!). The liver certainly does crazy things (and rapidly), and my fingers are crossed that this infection will clear and she will have a transplant very soon because she could again quickly take a turn for the worse! I would love to see her walk out of the hospital before I am finished with my internship!