Heart Health

The Waiting Room

January 4, 2010

The Waiting Room

Earlier this evening I made a trip to the intensive care unit of one of our area hospitals.  As I walked down the hall to the patient’s room I had to pass by several waiting rooms filled with family members.  The units were especially busy and the waiting rooms were filled to capacity.

Years ago, when I was in residency, I used to go to great lengths to avoid the ICU waiting rooms.  My job, when on call with the internal medicine service, was to admit all patients who presented to the hospital over a 24-hour period, launch their evaluation and initiate therapy, and dismiss those patients whose condition became stable for them to leave the hospital.  Going through this process for 10 or 20 patients invariably eats up every one of the 1440 minutes of the day  (most of the routine work didn’t get done until midnight, and the rest of the night was spent solving problems and “putting out fires”).

One sure way to fall hopelessly behind was to get trapped by a family with an endless list of questions and demands for their ill relative, and the best way to become thus ensnared was to casually wander by the waiting room.  One senior resident counseled me to stride past the waiting room at such a fast clip that it always looked like I was rushing off to resuscitate a coding patient.  “Leave the family interactions to the attending physician.  That’s why he gets the big bucks.”

During one particularly sleep-deprived stretch of internship I even envisioned writing a video game based on the experience of a resident on call.  The goal of the game would be to manage the utter chaos of a call night while avoiding pitfalls that suck up your time, such as the interminable attending rounds and dreaded ER call for the impacted nursing home patient.  Getting snagged outside the ICU waiting room would be a penalty akin to having your car towed in Grand Theft Auto.

I hesitate to admit such things since it makes me come across as a callous and uncaring individual, but you have to understand that during internship my goal was much the same as my patients’: survival.

Now that I am the attending physician I see it as my duty to spend whatever time is needed to communicate with the family and friends of my patients.  I no longer speed past the waiting room trying to look too occupied to stop and answer questions, and this evening in particular I paused to take in the scene.

There’s no question that the ICU waiting room can be a sad, dreary place, but what I saw tonight was something quite different.  Families were gathered around talking and laughing, sharing stories, playing games and putting together puzzles.  No one was watching TV, working on their computers or doing homework or chores.

It’s helpful these days that the hospitals accommodate the atmosphere needed in the ICU waiting room.  They offer plenty of chairs and tables, food for late night snacking, and games that foster communication rather than competition—the scrabble boards and jigsaw puzzles were particularly popular tonight.

It made me think back to my own experience when my father was in the hospital for the last few days of his life.  My five siblings and I came in from near and far to gather outside the ICU waiting for the doctors to deliver their final verdicts.  For us it was a terribly difficult time, but it was also a reunion of sorts and allowed us to catch up with one another and share childhood stories about our father.

As I watched the families tonight I was struck with a nostalgic wistfulness. I found that I look back on the events surrounding my father’s passing not so much with sorrow but with fondness.  What else could bring a disparate family of grown, independent siblings together, dropping everything at a moment’s notice, than the critical illness of a family member?  What could better bolster the bonds of family than standing by each other in times of shared grief?  I was fortunate to have brothers and sisters to shoulder the burden of my father’s loss and tonight I found myself missing their company more than ever.

We will all die at some point, and for many of us this will involve a stay in one of our intensive care units.  For all the tragedy that surrounds the family gathering in the ICU waiting room I’m glad to see the good in it.  It is somehow reassuring to me as a doctor—and a future patient—to be able to watch family members revel in the company of the living as they support the suffering of the nearly departed.

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