The problem with the CCU.

They will not let you die.

That, right there, is the whole problem with critical care.

Regular readers here at HN are thinking, "Dude. Death again?" I say, yeah, death again. Because, let's be honest: it's not the people who get better and take two turns around the floor with the help of physical therapy that send you home at the end of the shift to stare at that six-pack in the fridge.

It's the purpose of a hospital to help people heal, and mostly we do pretty well. I'd say 95% of the people I've cared for over the years have gone on to have decent-to-exceptional recoveries, and that's coming from a nurse who works in one of the strangest branches of medicine. When something goes wrong with your brain, a whole lot of other things tend to go off the rails a bit, and when we get those fixed, well, there's still something wrong with your brain. Ninety-five percent is good odds, given those limitations.

And when you're used to seeing most of the people you work with get better, the ones who don't hit you particularly hard. Every death is a failure. Some are more FAIL than others; it's harder, naturally, to lose a patient who's younger than average, or nicer than average, or who just had a run of crappy luck.

Which is where the problem with critical care starts.

Critical care is, by definition, critical. Like, "anything could go wrong, so I'm going to be particularly paranoid" critical. Like, "let's hope this thing in your head doesn't bust loose all of a sudden" critical. Like, "we've tried everything, but the rare and aggressive blood dyscrasia that's killing your 25-year-old wife won't go away, so let's put her on three pressors and pressure-bag some fluids in and put her on a ventilator" critical.

That last is where my own personal sticking-point is. Sometimes, people have to die. I hate it as much as the next nurse, but I come from a background of watching people die on a fairly regular basis and mostly being relieved and happy for them when it finally happens. It's not a big, scary horrible monster for me, and mostly it's not an admission of failure by the time it comes about. Instead, midwifing somebody through the process, letting them take the lead while still responding to their needs, is a tricky, thoughtful business, and one I'm glad and proud that I can do well.

But the folks in critical care (especially the oncology guys, because really, that's a tougher call than seeing a black brain on a CT, right?) don't see it that way. Death is something that *can* be beaten, and *will* be, no matter the cost to the doctor, family, or patient.

So we keep the patients alive, no matter what. A nasty case of sepsis can be fought. A stroke or brain injury can be fought. Multiple broken bones and pneumothorax can be fought. Those things are reasonable and logical--the person with the problem will likely go on to make at least a partial recovery, so you're not wasting your time or torturing them.

But the ones who simply won't get better, who've used up all nine of their lives? Those ones bother me.

Honestly: if we have you on three different drugs to keep your blood pressure up and your systolic won't come up out of the sixties, or if you're so damn sick that you've got three different central lines running six different antifungals and antibiotics, and you're still not improving, it may be time for us to give up. You've probably left the building long ago and are waiting impatiently for the chance to get on with things.

It's hard to make that call, and I respect that doctors don't want to judge too quickly. We've all heard about or seen miraculous recoveries (or at least, unexpected improvements). It's not up to anybody to determine, actively, when another person's life should end.

Still, it leaves me with a nasty, metallic taste in my mouth that has nothing to do with the drugs I've been running into someone.

I wonder what it's like for the person in the bed, the patient. I can begin to appreciate what it's like for the family; I've fielded plenty of tough questions even in this short time. I know what it's like for us: a colleague of mine is getting the hell out of nursing and going back to accounting so she doesn't have to be sad every day.

Maybe we should be more accepting of failure. Maybe we should turn our attention to the whole situation, and realize that sometimes, that small failure in losing a patient can mean a huge comfort for the people who are left behind. They won't have to think about, late at night, whether they caused more misery than they prevented. And it would be better for that person in the bed, sometimes, to just up and say, "Look: we can bring her back, but it would mean that her intestines would be dead, that she'd be comatose, that she'd be dependent and in a nursing home for the rest of her shortened, sickly life. Is that worth it?"

We have amazing technology and incredible understanding of the body and the brain. Sometimes I wonder if our humanity isn't lagging a bit behind our understanding and technology.