A Form of Love with Peter Barish, MD
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What is the premise of the episode and who is the guest?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
As physicians, we get to know patients in a different way than they know themselves. We become intimately familiar with their diseases, their lab values, and radiology images. But beyond the medical chart, who our patients actually are maybe a mystery. I'm Emily Silverman and this is The Nocturnous, stories from the world of medicine. In this episode, hospitalist Peter Barish recounts an intimate experience he had with a patient he knew next to nothing about. In the conversation that follows, we discuss what it means to know our patients. Here is Peter Berish.
So one of my favorite movies I saw this year was Lady Bird. And it's a small movie in a lot of ways. It is shot as a series of intimate moments. And it's a love story between a mother and a daughter, between friends, between a girl and her hometown. When I was in my last year of residency, I admitted a young girl to the ICU whom I'll call Jesse. She was transferred from a small town hospital a few hours away and uh she was transferred with a terrible infection. By the time she got to us, the infection had spread to her lungs, and so she was intubated, she was on a ventilator. It's one of the challenging aspects of taking care of patients in the ICU, uh that a lot of times they can't speak to you. They can't tell you their stories and you're left figuring out their stories on your own.
The first thing I actually noticed about Jessie was that she and I were the same age and she looked quite young, which as you can see is a curse I also share. And I felt this instant connection to her that you feel sometimes as a young physician taking care of an especially young, sick patient. And even though Jessie couldn't talk to me, I caught glimpses of her past life by paying attention to her disease. How a longstanding addiction to heroin had led to this terrible infection that was now ravaging her lungs. As often happens in the ICUs, things got crazy and we When I'm focused on other things, and I kind of put Jesse out of my mind for the rest of that day. And then at one in the morning I get a page from the nurse asking me to urgently come to the bedside.
Jesse's ventilator was alarming. It was telling us that there was too much pressure in the system, which can happen for a number of different reasons, some of them benign, some of them not so great. And we get a chest x-ray and it shows that Jesse's entire right lung has collapsed. She has a massive pneumothorax. A pneumothorax is something that happens when air gets into the lining of the lung and then can't escape. In Jesse's case, one of the pockets of infection had popped, and so the ventilator was forcing air in, but when it couldn't get out, it crushed her lung. I'm now vividly recalling a conversation I had with my attendee eight hours earlier. When he handed me an almost comically large needle and sterile packaging, and he said verbatim, Peter, you should carry this around with you in case Jesse gets a pneumo in the middle of the night.
What he was really saying was, Peter, you should keep this in your pocket because if at one in the morning Jessie's lung collapses and so much pressure builds up in her chest that blood can no longer flow back to her heart, you should come in here and take this and stab it into the middle of her chest to relieve the pressure. It's kind of like that scene in pulp fiction, but four inches to the right. And I said, excuse me. And he said, Don't worry, you'll be fine. So I'm watching, watching Jesse's blood pressure cycle, thinking, Am I actually gonna have to John Travolta this 30-year-old? When thoracic surgery comes to the bedside, we paged them urgently because they were there to put in what's called a chest tube, which is basically a long hose the diameter of a Sharpie, and it's surgically implanted between the ribs for situations just like this.
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Chapters
4 chapters
1
What is the premise of the episode and who is the guest?
0:00–5:41
2
How does Peter Barish connect the film *Lady Bird* to his ICU story?
5:41–7:25
3
What led to Jesse’s admission to the ICU and what was her initial condition?
7:25–14:20
4
How did the team discover Jesse’s pneumothorax and what emergency steps were taken?
14:20–35:42