Where Night Is Day: The World of the ICU

by James Kelly

There is no night in the ICU. There is day, lesser day, then day again. There are rhythms. Every twelve hours: shift change. Report: first all together in the big room, then at the bedside, nurse to nurse. Morning rounds. A group of doctors moves slowly through the unit like a harrow through a field. At each room, like a game, a different one rotates into the center. They leave behind a trail of new orders. Wean, extubate, titrate, start this, stop that, scan, film, scope. The steep hill the patient is asked to climb. Can you breathe on your own? Can you wake up? Can you live? from Where Night Is Day

Where Night Is Day is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an ICU in a teaching hospital in the heart of New Mexico. It takes place over a thirteen-week period, the time of the average rotation of residents through the ICU. It begins in September and ends at Christmas. It is the story of patients and families, suddenly faced with critical illness, who find themselves in the ICU. It describes how they navigate through it and find their way. James Kelly is a sensitive witness to the quiet courage and resourcefulness of ordinary people. Kelly leads the reader into a parallel world: the world of illness. This world, invisible but not hidden, not articulated by but known by the ill, does not readily offer itself to our understanding. In this context, Kelly reflects on the nature of medicine and nursing, on how doctors and nurses see themselves and how they see each other. Drawing on the words of medical historians, doctor-writers, and nursing scholars, Kelly examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. Kelly offers up an intimate portrait of the ICU and its inhabitants.

Genres: Nursing

248 pages, Hardcover

First published March 8, 2013

About the author

James Kelly was born in Norwood, Massachusetts and grew up on Cape Cod. He earned a BA in English from the University of Massachusetts Amherst and an associate degree in nursing from Castleton State College in Castleton, Vermont where he received the Diane McNeil Scholarship for excellence in psychosocial nursing care. He has been an ICU nurse for thirteen years. He moved to Santa Fe, NM in 1998 and works as an RN in the ICU at Lovelace Women’s Hospital in Albuquerque.

Reviews

[Erin · Rating 4 out of 5]

Definitely my job in book form...although Jim hasn't embraced my end-of-life soapbox.

[Tracy · Rating 1 out of 5]

I really enjoy medical books, especially those of stories by "insiders," but I really disliked this. In an effort to convey the same fast pace experienced by ICU nurses, it's written using medical lingo and shortcuts, incomplete sentences, and little explanation. I know at least as much as the average person about medical issues and treatments, and I had trouble just understanding what the author was describing. And the breakneck style of moving from patient to patient with no reminders of who it is and what they're condition was means I was constantly confusing one for another. I also sensed an element of disrespect, if not by the author himself, than by his co-workers. I hesitate to say this, because I think nursing is one of those things that outsiders can never really understand, and just being able to do it for any length of time indicates some characteristic of caring. But referring to patients only by a room number or last name, spending more time analyzing their ethnic background than their medical condition, and referring to them by some disparaging terms that float in the medical community makes me think he's int he wrong profession. If there's compassion, I didn't see it. I also didn't like how he very deliberately separated nursing from medicine, almost offering a defensive point of view of nursing. Don't blame us! Doctors and nurses have different roles, but surely they're all compatible roles int he world of medicine? And he constantly put down the doctors around them. I find it hard to believe so many people in the field are as uncaring as they are depicted. I do recognize that I can't know what it's like to work in health care, and that some degree of separation is necessary to survive,but there were too many generalizations here. BTW, I didn't need all these breaks in the action for stories of his move to New Mexico or history of the Navahos. It's not why I picked up the book.

[Nancy · Rating 3 out of 5]

This is a difficult book to give a star rating. James Kelly has two parallel narratives. I give him (or perhaps his editor) credit for printing the part that is ruminations on the writings of Agee, Foucault, and others in italics so I knew I was coming to it and could skim those parts. I suspect Kelly's true love is conveying his philosophy of life, death and the history of medicine and nursing. Frankly I didn't care for this part of his narrative and would never have read it on its own (one star?)

The part in regular type was very interesting. It described his work as a ICU nurse in Albuquerque. It was a bit bleak in that most of the patients he cared for did not really recover. A lot of them died. His descriptions of how nurses and other medical professionals conveyed to relatives that their loved one was dying and nudged them to acceptance and withdrawing life support had a real ring of truth and got me thinking about end of life issues. Kelly also shared examples of some doctors holding out false hope to relatives which caused unneeded pain to patients in their last days. (5 stars?)

Even though I really liked the ICU descriptions, I found two parts of it irritating. Nearly every page had medical terms that a lay person would not know. The book had no glossary so you had to guess the meaning from context or keep your dictionary close at hand. Also, many of the patients did not speak English. Kelly worked with translators for those who spoke Navajo so I could understand those scenes as well as Kelly could. When the patients or family members only spoke Spanish, he did not translate. This is fine for a common word or two but is pretty frustrating if there is a full paragraph in Spanish where a family is dealing with discussing whether to withdraw life support.(knock off a star and make that part 4 stars?)

The average of 4 and 1 is 2.5. I'm going to round up to three but this is not a simple middle of the road liked it book.

[Vern · Rating 4 out of 5]

I feel Jim's book is an accurate and sound depiction of the activities and operation of the ICU. It would be beneficial reading in critical care courses for those interested in the work. His insights into the nurse/patient and nurse/physician roles are well thought out and quite interesting. I really enjoyed his analogies and descriptions of many of the behaviors and culture that is critical care nursing. His descriptions of the Southwest and our people are touching, insightful and resonates appreciation of those he serves.
The book is an easy read and pulls you into the stories he shares. Obviously a bedside nurse and not an academic separated from his material. Great job Jim.

[Josephine Ensign · Rating 3 out of 5]

I've included this new book in my reading list for a summer narrative medicine course I'm teaching for nursing students. I like the structure of the book with ICU patient vignettes interspersed with more introspective passages exploring a range of related topics ranging from the history of hospitals to nursing theories of caring. I found myself wanting to skip over the patient vignettes though to follow the introspective/reflective portions. I usually love stories involving patients and patient care, but the ones included in this book are too brief and too high tech med-surg'y' to hold my attention. But I think it will appeal to many of my nursing students who are more hospital/ICU focused. A useful addition to the growing nursing narrative nonfiction literature.

[Becca · Rating 3 out of 5]

Fascinating book for even non-medical personnel. It would be fun to have a medical person next to you to explain some of the terms or things going on, but even without, I was able to figure this out.... Eat right, exercise, Dont drink to excess, and dont stay in the ICU more than 3 days. Avoid antibiotics at all costs.

[Rebecca · Rating 5 out of 5]

A lyrical description of what it is like to work in an intensive care unit--the inherent conflicts with medical staff and the unrealistic expectations of families. One of my favorite quotes: "Aspen trees die from their tops down and diabetics from their toes up."

[Gayne · Rating 4 out of 5]

Very interesting read - really gives you an idea of what it must be like to be a nurse in the ICU with very sick and dying patients. Gives a history of hospitals, and the medicine vs. healing approach to illness. Enjoyed it!

[Mills College Library]

616.028 K2972 2013

[Claudia · Rating 5 out of 5]

Really amazing meditation on illness and the nature and philosophy of caring.