Takotsubo in a good way.

After a month spent listening to rattling hearts and lungs, shoving tubes down mouths and noses, coaxing sundowners back into bed, trembling through peripheral line insertions, poking blindly for radial arteries, hiding my afternoon coffee or redbull from infection control, and checking, rechecking, and rerechecking to see that the patient sign-out is updated, my month in the ICU is finally over.

On my way out of the ICU, after an excruciatingly long last day, I stopped by Mr. R's room to say goodbye. I had taken care of this 82 yo man with a dysfunction in almost every major organ system in his body, including his GU system secondary to a traumatic foley insertion which led to almost a liter of bloody urine to erupt out of his meatus after removing the first foley. Thankfully, the urology resident on-call was a close friend, so he graciously accepted the 6pm consult, and even more graciously took care of the bloody mess.

I didn't expect much of a response from Mr. R. Actually, I didn't expect any response at all. See, Mr. R was on a bipap for most of his stay in the ICU. While his initial admission diagnosis was a "left globe rupture secondary to a fall", he was being treated for COPD exacerbation. So with the bipap mask squashing the skin around his nose, his left eye protruded farther out of its socket each day, which caused oozing and pus buildup. He was always in pain, agitated, de-sating secondary to mask removal despite soft restraints. There wasn't much exchange-of-conversation in our relationship. I would trend his numbers each day, making sure he was not trending towards disaster. If he was thirsty, I gave him water. If he was sliding off his bed, I propped him up. If the morphine wore-off and he was due for another dose, I gave it to him.

"Goodbye Mr. R. I know that mask is bothering you, but try to relax. Its helping you breathe."

And as I turned to leave, Mr. R muffled through his bipap mask,

"...Where are you going?"

"My month here in the ICU is over, so I'll be starting a new rotation next week."

"Well I want to thank you for taking care of me. Its been a real honor to have you as my doctor. Best of luck with everything and I know you'll do well."