April 26, 2019

'Exhausted to delirium': How one ICU resident uses poetry to cope with tragedy and loss

Daily Briefing

    Clinicians working in the ICU witness a lot of "pain and suffering," Colleen Farrell, an internal medicine resident physician at NYU Langone Health, writes in a STAT News opinion piece. So Farrell turned to poetry to acknowledge and cope with the tragedy and loss.

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    'Pain and suffering' in the ICU

    The first time Farrell entered the ICU was as a medical student, when her professor brought a group of students there to learn about lung physiology and ventilators. While she was in the ICU, Farrell was emotionally moved by an unconscious patient with "[a] tube secured in his mouth connect[ing] him to a ventilator."  

    She recalls, "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?"

    But Farrell's questions were never answered, instead her professor "jolted [her] from these thoughts" with a question about the ventilator. While Farrell enjoyed such academic discussion, at that point, she "couldn't reconcile this academic discussion with the existence of the man in the bed," she writes.

    Throughout her internship, Farrell spent more time in the ICU. "Most of the patients were like the man I had seen in medical school: so sick I would never get to know them," she writes.

    She recalls one case in which a patient suffering from liver cirrhosis took a turn for the worst and died.  Farrell had to break the news to the patient's wife: "She collapsed to the floor. I got down on the floor next to her and held her arm as she sobbed," Farrell writes.

    During her time in the ICU, Farrell writes that she often "stumbled home from these long shifts, exhausted to delirium," struggling to process the pain and suffering she'd witnessed. "I didn't know how I would ever cope working in an ICU," she writes.

    A way to cope

    But, Farrell "soon found out," she writes.

    One night, Farrell stayed up late reading poetry and discovered "The Rabbit," by Mary Oliver. "In it, a rabbit has died and his body is decaying in the elements," Farrell writes. She continues, "The narrator knows she needs to bring the rabbit to his final resting place, but she can't." Farrell writes that the narrator imagines the rabbit "'leaping in the moonlight … / wanting it miraculously to heal.'" Eventually, the narrator accepts that she has to bury him.

    Farrell writes that "The Rabbit" reminded her of her patients, "bleeding, moaning, gasping," and that reading the poem helped her accept "that death, as painful as it is, has its place in nature," she writes.

    When Farrell returned to the ICU as a resident the next year, she was tasked with teaching the three medical students on the team about critical care. Instead of launching straight into discussion of the ventilator settings, she gave each student a copy of the poem "Intensive Care" by Jane Wayne.

    The poem "describes the ICU from the perspective of a patient's loved one," Farrell writes.

    One student said the poem reminded him of one of their patients who had become paralyzed. While the medical students could never discuss how "heart-wrenching" the situation was when they were on shift or making rounds, "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," Farrell writes.

    "It is difficult to step foot in an ICU without feeling the pain and suffering held within its walls… And yet it's easier to talk about ventilators than these very human response," Farrell writes. "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" (Farrell, STAT News, 4/18).

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