One nurse's haunting account of working in intensive care where life hangs by a ...

When I get home from work, my husband asks: ‘How was your day?’ Mostly, I smile and simply say: ‘It was good,’ as if I’d been analysing spreadsheets all day.

He doesn’t need to know about the 17-year-old’s brain haemorrhage, or the three dead bodies I had to undress, wash and zip up in a body bag. And I decide not to mention the teacher, just 33, the same age as my husband, whose life-support machine I switched off.

I’d rather not go on about it. No one likes to be reminded of their own mortality.

After ten years as an intensive care unit (ICU) nurse, looking after the hospital’s sickest patients, I’ve almost become desensitised to it.

After ten years as an intensive care unit (ICU) nurse, looking after the hospital¿s sickest patients, I¿ve almost become desensitised to it (file photo)

After ten years as an intensive care unit (ICU) nurse, looking after the hospital’s sickest patients, I’ve almost become desensitised to it (file photo)

Just a tiny minority of those admitted to hospital – one per cent of adults under 75 – are ever admitted to my ward. And only half leave alive.

Most people only face death a couple of times in their life, but for me it happens several times a day, every day.

My prime concern is the well-being of my patients, and helping keep them alive. But it’s important I don’t become too attached, so in many ways it’s just another day at the office.

The first death I witnessed as a newly qualified nurse was of course nerve-racking. I remember my hand shaking as I attempted chest compressions; thinking that my actions in the next two minutes could save this man’s life.

Sadly, they didn’t and I talked about it incessantly afterwards, desperately trying to make sense of what I’d seen, heard, felt. But nowadays it doesn’t faze me. I can separate myself from the dying child, the brain damaged parent and the lifeless body in front of me. They are not my children, my partner or my parent, but just a part of my highly technical job. For the sake of my sanity, I have to think this way.

An Intensive care unit (ICU) is a specialist hospital ward that provides treatment and monitoring for critically ill patients (file image)

An Intensive care unit (ICU) is a specialist hospital ward that provides treatment and monitoring for critically ill patients (file image)

The deaths I still find hard are the ones that could have been avoided – those where, if only a scan picked up a warning sign earlier or a different treatment was chosen, a life could have been saved.

One young guy in his 20s came in last week after suffering a rare type of stroke. He was a keen runner, perfectly healthy with no family history of illness. We had two options for treatment: either we gave him blood-thinning medication to prevent a major blood clot in his brain, or we waited before acting: rarely, blood thinning medication causes excessive bleeding.

Following the neurologist’s advice, I administered the medication. Within an hour, the patient suffered a catastrophic bleed in his brain. It has left him unable to speak, eat normally or walk for the rest of his life. We made the wrong choice.

Then there are the tragic cases – the terrible road traffic accidents or freak falls from five-storey buildings – which are sad, but an unfortunate reality of life. Oddly, these are easier to swallow. If someone doesn’t make it at least we know we did everything we possibly could to save them.

Ambulances can bring people to the intensive care unit. Patients might include victims of serious car accidents, falls or fires, people with severe head injuries

Ambulances can bring people to the intensive care unit. Patients might include victims of serious car accidents, falls or fires, people with severe head injuries

Last week a man was wheeled into my ward: ‘Office worker run over by a bus,’ the hospital porter announced, handing me his charts. ‘Severe internal damage and head injuries.’ His heart had already stopped once and emergency surgery to stem the internal bleeding was only partially successful.

He’d been placed in a medically induced coma and a foot-long gash in his stomach was wide open – red, mangled intestines on display for everyone to see.

It’s standard procedure to leave patients ‘unstitched’ after an operation to reduce the risk of infection.

I thought of his wife and two children. They were at home, expecting him to come back from work at the time of the accident. They didn’t know that morning’s goodbye kisses would be their last.

Intensive care unit: Highly trained heroes who keep us alive 

An Intensive care unit (ICU) is a specialist hospital ward that provides treatment and monitoring for critically ill patients.

Most ICU patients have malfunctioning organs and need specialist equipment to help them to breathe, eat, drink and empty bowels and bladder.

Patients might include victims of serious car accidents, falls or fires, people with severe head injuries, stroke and heart attack patients and those recovering from major surgery.

Often, an ICU admission is only needed for a couple of days and patients are transferred to a less intensive ward to continue their recovery. Others remain in ICU for months, while some deteriorate and eventually die there.

Each ICU nurse is assigned one or two patients. The nurse provides 24-hour care and is expertly trained in painkilling and sedative medication and operating the array of complex machines that keep patients alive.

NHS nurses must complete specific theoretical and practical training before being able to qualify as a specialist ICU nurse. 

For more information about ICUs, visit icusteps.org.

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