Last night I asked my colleague how her patient W was doing, since I'd taken care of her for several weeks in the ICU. W had been extubated (breathing tube removed, was breathing on her own) two weeks ago, and been moved out of the ICU to floor care last week. She was starting to nod yes/no to questions but was not very interactive and hadn't said anything at all. My colleague said W was doing okay, slowly getting better, but somewhat depressed. So I stopped by to see her, tell her who I was, and that she looked a million times better, and was making good progress. She nodded a little while I spoke and seemed aware that I was there. A few hours later, her nurse found me again. "I need you again in W's room, come with me," was all she said. I went and stood near W's bed, and her nurse said, "W, tell Rose what you just said to me." I glanced skeptically at her nurse, but took W's hand and looked at her. "I want to go home," she said simply. "You want to go home?" I replied. She nodded, looking me right in the eye. And while I'm always loath to make promises to patients, I told her, "Of course you do. And of course you're going to go home. Not tomorrow, and probably not as soon as you'd like, but that's the path you're on. Every day you get stronger, and every day we all work really hard to get you ready to go home. And you're working the hardest at it. So I can hear it in your voice now W, that you're getting better and you're going to go home."
Then I went back to my own patient's room [ed: another RN had been watching my patient and my monitors while I was in W's room], to continue titrating his levophed to maintain a blood pressure that actually perfused his organs with blood and adjusting the amount of oxygen the ventilator was giving him. He is really sick, at least as sick if not sicker than W had been. Some of them get better, and some of them don't, I don't know why. Maybe if I knew why then I wouldn't be hopeful when the situation was futile or I wouldn't distance myself when there really was hope.
There was also a code on the unit tonight, not my patient however. I was entering the room just as two young doctors ran onto the unit then stopped short in the doorway. "Shit, I hate it when we're the first doctors at a code. Have you ever run a code before?!" one said to the other.