ICU, Where Cure & Care Climax - Acute Physiology: An Anatomical Perspective...!

After spending almost half of my last 34 years of an involuntary & fleeting human existence, in Medicine, now I probably realise the contrasting achievements & limitations of our increasingly evidence based medical science. And, after serving Orthopaedic surgery for about nine years, almost half of my 17 long years with Medicine, and still opting for a tense ICU rotation, was probably one of the most daring surgical incisions, I would ever inflict on my petit medical career. As with every challenging decision, there always are rewards and retributions but ICU was fabulous in that regard, that there was nothing but rewards, too many of them and where even retributions seemed like rewards in that intense, pulsating but selfless zone.

We intend to accept care of patients from physicians in various specialities in the hospital, when they demonstrate even a slightest hint of discomfort in managing or comfortably coping - with fragile & plastic peripheral veins, rapidly transgressing fluids with electrolytes, desaturating blood gases, diving-spiking or rocking pressures/ rates/ rhythms or thermostats, multiple blood/ fluid/electrolyte transfusions, round-the-clock security of restrictive-obstructive, constricting-collapsing airways & vessels or anything that harbours even the slightest of a tiniest of potential to transform over time into a life or limb threatening situation. The ICU specialty, no doubt is excitingly poised for an evolution and expansion of enormous proportions, obviously invading into a physician's scope of practise, more for pre-emptive purposes aimed at patient safety rather than just with a violent intent to colonize general medicine.

Instantly but patiently, our patients are to be diligently and aseptically multi-plugged with leads into appropriate anatomical ports of a fragile and struggling human frame, the opposite ends being obligingly accepted by the intelligent machines surrounding the remote-controlled flexi-bed platforms. Thus, effectively securing a critical control over the vital life channels with close-circuit & night-vision apparatus installed on the machine end of the lines and leads; which now would tirelessly assist us to monitor and assist the fighting human spirit, at times from a distance.

Keeping an eagle eye on the critically and rapidly fluctuating clinical picture and correlating it with changing chemical/ elemental fluid patterns, chasing & interpreting laboratory results minute by minute to eventually adjust micro-grams/litres of elemental infusions/fluids/ medications; and then, most importantly, prescribing empathetic advise to optimise the comfort of a patient and their relations, keeping always in mind their wishes, guided by the prevailing circumstances and situation. This would keep me awake the whole night, without even fluttering an eye lid.

Nothing ever came even remotely close to the satisfaction, the thrill, the passion that a surgical decision making still evokes in me; except the whole transforming and memorable experience of existing in an ICU world. In ICU, the trinity of acute physiology, acute biochemistry and acute pharmacology at times can be as acutely impacting and intimidating, as is the effect of any acute anatomical disturbance being stitched/scoped, grafted/excised, evacuated/resected and transplanted/replaced in an intimidating atmosphere of an awesome OR zone. In OR, the acute trinity is pre-emptively secured and intensively monitored to assist in rapid secondary healing of an acutely distorted anatomy - the naughty pathological twin of normal anatomy. 


Anatomy is like, a forsaken, an un-debatable though routinely incised and dissected art. An amazing evidence of Faith, that we all exist with, receiving our distinct though similar physical identities. Whereas, the superglue, the magical force of Healing, is like a supreme Force that keeps this magical, cellular & suture-less anatomy together, along with its ever flowing sub-atomic & formless Trinity, without which there would be no Anatomy.