Medicine is full of superstitions. Anyone reading medical blogs has heard about not saying “quiet night” or “not busy,” for fear that the opposite will immediately happen; or that appys and AAAs and other things come in threes; or that patients who say they’re about to die probably are.
One of the less well-known has to do with specific hospital rooms: When you’ve seen something bad happen in one room, there’s a visceral reluctance to have another of your patients stay in the same room, especially soon afterwards. This is of course irrational, being that we’re in a hospital, and something bad has happened in every single room, more than once.
The floors aren’t too bad. The patient turnover is high, only a couple of days usually per patient per room, so most of the rooms don’t have strong associations with any one person; or if they do, there are several other patients also associated with that room.
But the ICU is different. We had a patient die last week, and a day later another patient, of the same attending, from the same demographic group, was put in the room. The attending frankly begged the charge nurse to change the room, and the chief and I were murmuring agreement. We compromised on transferring the patient out of the ICU within twelve hours.
Our surgical ICU has a little more than two dozen rooms, and as I walk around it in my mind’s eye, I can picture a tragic death in one room after another: the trauma patient from June in that room; the one who died within 24 hours of surgery in that room; another trauma patient here, this one from August; and this last patient in another room. It’s not so much deaths in general that bother me, but the ones that were preventable, the people who weren’t expected or “supposed” to die when they came in; the ones about whom I think that if only I had done something differently, they would have survived. Probably it’s not true, but what wouldn’t I give to be able to rewind the clock and find out.
There’s one room in particular that I don’t really look at at all. Six months later, I still try to ignore its existence; fortunately, I haven’t had a patient in there since it happened. This one wasn’t so much that I thought I could do something differently; but I spent a month fighting for that guy. Literally a month; he’d already been there a while when I came on service, and he died a day or two before the end of the rotation. I spent most of every day in or near his room; I did so many procedures, lines and chest tubes, that I could probably fill out all my procedure requirements just on him, if I’d thought to keep notes. He died anyway; it was pretty hopeless from the beginning, but we kept trying, watching every 5mmHg improvement or decline in his pO2 intensely.
By the end of residency, every room in the unit will have its own ghost. I’ll have to get over it.