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Intensive Care: A Doctor's Journal
Intensive Care is an affecting view from the trenches, a seasoned doctor's minute-by-minute and day-by-day account of life in the Intensive Care Unit (ICU) of a major inner-city hospital, San Francisco General. John F. Murray, for many years Chief of the Pulmonary and Critical Care Division of the hospital and a Professor at the University of California, San Francisco, takes readers on his daily ward rounds, introducing them to the desperately ill patients he treats as well as to the young physicians and medical students who accompany him. Writing with compassion and knowledge accumulated over a long career, Murray presents the true stories of patients who show up with myriad asthma, cardiac failure, gastrointestinal diseases, complications due to AIDS, the effects of drug and alcohol abuse, emphysema. Readers will come away from this book with a comprehensive understanding of what an ICU is, what it does, who gets admitted, and how doctors and nurses make decisions concerning life-threatening medical problems.
Intensive care for critically ill patients is a new but well-established and growing branch of medicine. Estimates suggest that 15 to 20 percent of all hospitalized patients in the United States are treated in an intensive or coronary care unit during each hospital stay, so there is a real possibility that the reader will either be admitted to an ICU himself or herself or knows someone who will be. Murray not only offers a real-time account of the diagnosis, treatment, and progress of his patients over the course of one month but also conveys a wealth of information about various diseases and medical procedures in succinct and easy-to-understand terms. In addition, he elaborates on ethical dilemmas that he confronts on an almost daily the extent of patient autonomy, the denial of ICU care, the withdrawal of life support, and physician-assisted suicide.
Murray concludes that ICUs are doing their job, but they could be even better, cheaper, and--most important--more humane. His chronicle brings substance to a world known to most of us only through the fiction of television.
Intensive care for critically ill patients is a new but well-established and growing branch of medicine. Estimates suggest that 15 to 20 percent of all hospitalized patients in the United States are treated in an intensive or coronary care unit during each hospital stay, so there is a real possibility that the reader will either be admitted to an ICU himself or herself or knows someone who will be. Murray not only offers a real-time account of the diagnosis, treatment, and progress of his patients over the course of one month but also conveys a wealth of information about various diseases and medical procedures in succinct and easy-to-understand terms. In addition, he elaborates on ethical dilemmas that he confronts on an almost daily the extent of patient autonomy, the denial of ICU care, the withdrawal of life support, and physician-assisted suicide.
Murray concludes that ICUs are doing their job, but they could be even better, cheaper, and--most important--more humane. His chronicle brings substance to a world known to most of us only through the fiction of television.
311 pages, Hardcover
First published June 17, 2000
4 people are currently reading
351 people want to read
About the author
John F. Murray
26 booksInternationally renowned medical doctor specializing in pulmonology, chief of pulmonary and critical care at San Francisco General Hospital from 1966 to 1989.
Husband of novelist Diane Johnson.
Husband of novelist Diane Johnson.
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Displaying 1 - 8 of 8 reviews
August 16, 2018
Highly recommend for any Internist, Medical Resident, Intensivist (Critical Care Specialist). Not recommended for anyone who is not a physician.
Rating: 4.5 stars. Rounding up because so perfectly done.
This book is "Four Weeks In The Life Of An ICU", specifically, The ICU at The General sometime in the 1990's. Very well written. Day by day, Dr. Murray describes the patients entering and exiting the ICU at San Francisco General Hospital (now, sadly, renamed Mark Zuckerberg Hospital which is a bloody shame).
"The General" is a legendary hospital and an Intensivist I know personally who worked there described some of the patients he knew in the same terms as Dr. Murray.
I have taken care of many of these patients (or rather, ones just like them) although this population is extremely heavy with heroin/cocaine/alcohol addiction and HIV infection.
I'd like to say I enjoyed this but it was quite Intense (Pun Intended). I am very fond of Dr. Murray--he seems like most Intensivists I know--admirable, efficient, caring, compassionate, highly skilled. I loved his explanations of diseases in lay-person's terms.
Anyone who has done an ICU rotation or will do one in the future can benefit from this incredibly delicately wrought, graceful and gritty account of life-threatening illness.
Rating: 4.5 stars. Rounding up because so perfectly done.
This book is "Four Weeks In The Life Of An ICU", specifically, The ICU at The General sometime in the 1990's. Very well written. Day by day, Dr. Murray describes the patients entering and exiting the ICU at San Francisco General Hospital (now, sadly, renamed Mark Zuckerberg Hospital which is a bloody shame).
"The General" is a legendary hospital and an Intensivist I know personally who worked there described some of the patients he knew in the same terms as Dr. Murray.
I have taken care of many of these patients (or rather, ones just like them) although this population is extremely heavy with heroin/cocaine/alcohol addiction and HIV infection.
I'd like to say I enjoyed this but it was quite Intense (Pun Intended). I am very fond of Dr. Murray--he seems like most Intensivists I know--admirable, efficient, caring, compassionate, highly skilled. I loved his explanations of diseases in lay-person's terms.
Anyone who has done an ICU rotation or will do one in the future can benefit from this incredibly delicately wrought, graceful and gritty account of life-threatening illness.
September 9, 2012
This was a quick read about our nations' health care in the ICU. He is somewhat biased towards the expense of caring for the poor; who have chronic illnesses, which could have been avoided w/ earlier preventative health care. Our system is so broken, that you cannot receive routine health care. When it is too late, people have developed chronic illness and repeated hospitalizations create a burdensome expense. Socialized medicine is a possible remedy to allow routine health care for everyone. However, until there are regulations imposed on the insurance industry and managed cost for services, this is a losing battle. Money, profit and greed drive the medical/health care industry.
January 14, 2019
This book follows Dr. Murray, an ICU physician for one month as he cares for ICU patients at San Francisco General Hospital. Each patient and their symptoms are described and Dr. Murray explains why he takes the course of treatment he does. I liked that he interspersed bits of his personal life - he worries about patients when he's playing tennis and wonders what happened to those who left against physician advise or were transferred to other facilities.
His patient population largely dealt with breathing issues such as COPD, tuberculosis, and asthma often as the result of HIV/AIDS, drug abuse, and infectious diseases that are common among the homeless population (notably TB). So the patient profile was a bit repetitive after a bit, but it was interesting to see the different presentations and nuances from patient to patient.
A good bit of the book showcases modern medicine's ability to keep very sick people alive, perhaps longer than the patient would want. Very few of Dr. Murray's patients had advance directives or had friends/family who could speak to their wishes regarding end of life care. Dr. Murray is right that medical scenes in movie and TV seems to be miraculous - everyone comes back after their heart is shocked or after being in a deep coma. In real life, though, the odds aren't they great. Research has shown that only 15% of the 26k patients who were resuscitated survived long enough to be discharged from the hospital. Further, follow up research on a 340-person sample of patients from a single hospital indicated that only 5% were alive 1 year after resuscitation. Research on ER, Chicago Hope, and Rescue 911 episodes though had a 75% success rate after resuscitation with a 67% rate of hospital discharge. Murray argues this distorts people's expectations for resuscitation and makes it difficult for family members to make decisions on behalf of loved ones who have not explicitly stated their wishes.
Over the 1 month period, Murray cared for 60 patients who spent a total of 230 days in the unit or an average stay of 3.8 days each. Variation in patient stays was wide and ranged from a few hours to 25 days. This book was written in 2000, so I'm sure the costs have increased significantly, but the average daily rate for physician care/fees at the time was $5k per day. So for the month, his patients incurred charges of roughly $1.15MM or about $19k per patient. SFGH's payor mix at the time was 35% Medicaid, 14% Medicare, 10% self pay, 10% from commercial insurance, 7% from workers' compensation, and 24% from the City and County of San Francisco. He notes, though, that due to the safety net nature of the hospital and high indigent population, most patients don't receive a bill for the charges they incur.
Overall, this book sparks interesting questions about critical and end-of-life care - when does it make sense to stop care? how far should doctors go? how far should families push? As everyone knows, the population of older adults is growing every day. At the time this book was published, adults aged 75+ made up 13% of the population but accounted for 33% of all healthcare spending, much of that incurred in the last year of life. Not that older people are not worth important care, but Murray was deeply uncomfortable that many of his patients on which extreme measures were taken were actually made worse off and that more pain was caused in trying to sustain life. This is a common worry among doctors in this field and most seem to err on the side less care rather than more for their own lives.
An interesting tidbit was around the modern ventilator, a common treatment for Murray's patients. During the polio outbreak, which paralyzed the muscles used to breath, iron lungs were in short supply. To cope with the shortage, a special unit was created in Denmark to work on new breathing assistance techniques. They began with inserting rubber tubes down patients' throats into their lungs, but the oxygen had be pushed in manually, with an oxygen bag. So medical students would work 4 shifts of 6 hours taking turns squeezing oxygen bags. Patients usually need months of breathing assistance! In 1953, a mechanized ventilator was created and quickly became a normal part of the hospital scene.
Overall, 3.5 stars for me.
His patient population largely dealt with breathing issues such as COPD, tuberculosis, and asthma often as the result of HIV/AIDS, drug abuse, and infectious diseases that are common among the homeless population (notably TB). So the patient profile was a bit repetitive after a bit, but it was interesting to see the different presentations and nuances from patient to patient.
A good bit of the book showcases modern medicine's ability to keep very sick people alive, perhaps longer than the patient would want. Very few of Dr. Murray's patients had advance directives or had friends/family who could speak to their wishes regarding end of life care. Dr. Murray is right that medical scenes in movie and TV seems to be miraculous - everyone comes back after their heart is shocked or after being in a deep coma. In real life, though, the odds aren't they great. Research has shown that only 15% of the 26k patients who were resuscitated survived long enough to be discharged from the hospital. Further, follow up research on a 340-person sample of patients from a single hospital indicated that only 5% were alive 1 year after resuscitation. Research on ER, Chicago Hope, and Rescue 911 episodes though had a 75% success rate after resuscitation with a 67% rate of hospital discharge. Murray argues this distorts people's expectations for resuscitation and makes it difficult for family members to make decisions on behalf of loved ones who have not explicitly stated their wishes.
Over the 1 month period, Murray cared for 60 patients who spent a total of 230 days in the unit or an average stay of 3.8 days each. Variation in patient stays was wide and ranged from a few hours to 25 days. This book was written in 2000, so I'm sure the costs have increased significantly, but the average daily rate for physician care/fees at the time was $5k per day. So for the month, his patients incurred charges of roughly $1.15MM or about $19k per patient. SFGH's payor mix at the time was 35% Medicaid, 14% Medicare, 10% self pay, 10% from commercial insurance, 7% from workers' compensation, and 24% from the City and County of San Francisco. He notes, though, that due to the safety net nature of the hospital and high indigent population, most patients don't receive a bill for the charges they incur.
Overall, this book sparks interesting questions about critical and end-of-life care - when does it make sense to stop care? how far should doctors go? how far should families push? As everyone knows, the population of older adults is growing every day. At the time this book was published, adults aged 75+ made up 13% of the population but accounted for 33% of all healthcare spending, much of that incurred in the last year of life. Not that older people are not worth important care, but Murray was deeply uncomfortable that many of his patients on which extreme measures were taken were actually made worse off and that more pain was caused in trying to sustain life. This is a common worry among doctors in this field and most seem to err on the side less care rather than more for their own lives.
An interesting tidbit was around the modern ventilator, a common treatment for Murray's patients. During the polio outbreak, which paralyzed the muscles used to breath, iron lungs were in short supply. To cope with the shortage, a special unit was created in Denmark to work on new breathing assistance techniques. They began with inserting rubber tubes down patients' throats into their lungs, but the oxygen had be pushed in manually, with an oxygen bag. So medical students would work 4 shifts of 6 hours taking turns squeezing oxygen bags. Patients usually need months of breathing assistance! In 1953, a mechanized ventilator was created and quickly became a normal part of the hospital scene.
Overall, 3.5 stars for me.
February 21, 2019
The book started with a 76 year old dementia patient, and I thought that was why I needed to read it. Overall she was the exception, and the majority of the ICU cases involved problems stemming from chronic drug, tobacco, and alcohol use.
I found it interesting and easy to follow. Obviously there are bodily fluids and painful things, and a lot of death, but it is not written in a gory way; should be manageable for all but the most squeamish. It is also interspersed with medical history and the dynamics of the medical team, and even the effects of long hours on his cat.
In the epilogue Murray grapples with some of the tough choices involved in deciding when to use intensive care, one of which is the cost. I am not sure that much has changed since the 2000 publication, but I at least hope that more people are filling out advance directives, especially as they age. Just reading more about intubation should inspire that.
I found it interesting and easy to follow. Obviously there are bodily fluids and painful things, and a lot of death, but it is not written in a gory way; should be manageable for all but the most squeamish. It is also interspersed with medical history and the dynamics of the medical team, and even the effects of long hours on his cat.
In the epilogue Murray grapples with some of the tough choices involved in deciding when to use intensive care, one of which is the cost. I am not sure that much has changed since the 2000 publication, but I at least hope that more people are filling out advance directives, especially as they age. Just reading more about intubation should inspire that.
October 2, 2018
It’s a great way to see his intimate reactions to patients & their care, but the side comments about tennis really point to his obliviousness.
January 20, 2025
kind of a slog. you cant really help anybody you can only give them a chance.
April 21, 2015
What I really liked about this book is the detailed descriptions of the patients and their medical situations. The write up from the dr for the chart and then his thoughts and experiences beyond the chart. It was very familiar after watching both my father and father in law battle their last days in the ICU on opposite sides of the country.
I believe there are many great points made about the struggles still facing society, patients, doctors, governments and insurance companies regarding ICU and end of life care.
Even though the information is 15 years old it is still very relevant and very familiar.
I also enjoyed the historical descriptions of medical care and particular strategies.
A good read. A fast read. An enjoyable and interesting read.
I believe there are many great points made about the struggles still facing society, patients, doctors, governments and insurance companies regarding ICU and end of life care.
Even though the information is 15 years old it is still very relevant and very familiar.
I also enjoyed the historical descriptions of medical care and particular strategies.
A good read. A fast read. An enjoyable and interesting read.
Want to read
February 17, 2015Recommended by Joan Didion in the Year of Magical Thinking.
Displaying 1 - 8 of 8 reviews