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The last thing I wanted to do that Friday was an LP in the MICU. It had been a long, difficult day in the office, and I was tired from the previous night on call. I had already consulted on the patient and knew that, regardless of how the CSF cell count and chemistry came out, the outcome of her illness was not likely to be good. I wasn’t eager to do the procedure, but my personal rule was to do it whenever I started to argue with myself about why I shouldn’t.
As I walked from my office over to the hospital, the shadows were long in the canyons on the front range of the Santa Catalina Mountains, and a gibbous Moon was well up in the southeast. It was going to be a nice night—for somebody. I wasn’t looking forward to another late evening at work.
I referred to MICU as the place with “so much work and so little hope.” Patients in MICU were not immediately post-operative from lifesaving cardiac, neurologic, or trauma surgery. They hadn’t been saved in the cardiac catheterization laboratory by having stents placed into multiple vessels or by being injected with antithrombolytic drugs.
The nurses in the other intensive care units mirrored their work: SICU nurses were confident, aggressive, with a “let’s do it” attitude. Many were men, and most of the hospital’s basketball team came from SICU staff. CICU nurses, nearly all women, were superb at understanding rhythm strips, conduction physiology, and cardiac drugs.
MICU nurses were different—a tightly knit group, they were quietly competent. Despite their knowledge, however, they never tried to show me up, even when they easily could have. Maybe that is why I liked them so much.
The unit often received end-stage patients from the other two units …
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