It’s 3 in the morning. I’m sitting at the end of the hallway of the boomerang-shaped intensive care unit (ICU) where I work, looking into the darkness beyond the unit’s only window. When I’m on the unit, the world outside the hospital transforms into something entirely remote—intangible, imperceptible, inconsequential. I force myself to imagine the scent of the fresh air I will inhale when I leave. It’s hard to remember that the world is pulsing with life outside these walls. The hospital’s resistance to darkness and quiet permeates the boundaries of reality itself. The fluorescent lights transform me into something other than a person, washing out the details that make me Sophie. In here, I can lose myself. In here, I am lost.
My gaze drifts from the window to the ceiling, settling on the little black hemisphere protruding from the tiles. It is so demure in size and placement that a busy person will quickly forget its presence, should they happen to have noticed it at all. Inside the black shell is a camera—I assume, since I have never seen it fully exposed. I stare at where I think a camera would be. I imagine someone looking back from wherever this probably-camera sends its signal. In my mind, they are surprised, but they look back. We are in a staring contest. I win.
A ceiling-mounted dome surveillance camera, designed for discretion. Photo by author.
I get up and walk to the nurses’ station, stopping in front of the cardiac monitor screens. I watch the hearts flow across the screen. P-QRS-T, P-QRS-T, P-QRS-T. Some of the waves look wrong, stuttering across the screen in fibrillations that might have gone unnoticed for years or lifetimes without us. Now the owners of these disobedient hearts take blood thinners daily, even when they leave us. Their hearts will tell us if they don’t—they’ll be back to file the reports. For now, they’re members of a mandatory club: everyone gets blood thinning shots in the ICU—bruised bellies and thighs and arms the price of medical-grade safety.
Sitting down at the station where I can see all of my patients’ dim rooms, I open my sickest patient’s chart on the computer and click into his labs. I skim through days of fluctuating red and white blood cell counts; potassium, magnesium, and calcium levels; a urinalysis; toxin screens; and x-rays. I read notes from specialists who have been consulted and find out his wife’s name and what he does for work. Did for work. Even if he manages to leave the ICU, he’ll probably never go back to work. His IV pump sounds its alarm: time to bring him a new bag of vasopressin, an IV drug that helps prevent his blood pressure from tanking. I look at his face and find myself unable to imagine what kind of person he might be. I have seen his body by the numbers, but to see is not to know. I can’t remember his name. In a week, I will have forgotten his face as well. These silent patients are a black box: I can describe every system of their bodies, list their histories of illness and pain, and enumerate the ingredients and mechanisms of their medications, but I will never know them as they truly are. These sickest patients are ours to look at but never to see.
When I return to the computer to document the administration of the medicine in my patient’s chart, I am performing a kind of magic trick. Where there was once a man, there is now a collection of numbers, some simple descriptions, and a list of medications. Fourteen respirations per minute. Three bowel movements today. Skin: intact. Pupils: equal, round, reactive to light. Capillary refill: greater than three seconds. Epinephrine drip stopped. The transformation of a patient into a set of data creates an estrangement that distances me from the patient and the patient from his illness. He is not his bowel movements or his capillaries, but all I need to know about him is the sum of these itemized, chart-able characteristics. The sum of my work cannot be translated into the chart, but all the hospital needs to know about me is my capacity to complete and maintain the tasks assigned to me within the electronic medical record’s neat columns and categories.
Alienation and surveillance clatter together to create a sense of biomedical legitimacy in the chart. The patient is alienated from himself in the shadow of a chart that doesn’t care what kind of person he is. The record estranges me from my own work of charting and from my work with the patient. Clinical formality and protocol transform what was once immediate and intimate into a data set that is impersonal and objective. My own hand touching a patient’s fingers, toes, eyelids, lips is removed by official language that only implicates me through my electronic initials, which will eventually be traced by inspectors of the chart and erased if the information within is of enough interest to use as bigger data.
Morning medicine pass comes. In the medicine storage room, I log into the Pyxis,[1] unlocking its many drawers and pulling out pill after pill. Each withdrawal leaves a record of my presence, an account of whom to question if tonight’s counts are off. I need a controlled substance—a coworker enters her number and scans her fingerprint to testify that I am not stealing any extra pills. I need saline flushes, so I enter my number into another machine, the Omnicell.[2] The supply cabinets are locked to prevent waste, or so I am told. I select a patient. I won’t use all of the supplies I pull for him alone, but this is how it’s done. Now we’re both recorded in the machine’s log, implicated in one another’s records. I log into my Zebra[3] scanner and select my first patient, scanning the barcode of each of her medications, entering other data as necessary (blood pressure, infusion rates, level of consciousness). I weave the record of my activity through machine after machine, chart after chart, person after person. I can be found in the frightened intake of a teenager who attempted suicide, in the first moments after a grandmother’s successful heart surgery, in the last moments of a dead man. If everything works properly, the record will be here when the last of us is gone. It doesn’t need us to watch. It watches us anyway.
In the ICU, I watch my patients closely with my eyes, my hands, my machines. The more carefully I monitor them, the more keenly I feel myself being watched by a gaze I ultimately cannot return. And am I not gazing at the patient in the same way? Yes and no. Unlike me, my sickest patient has access to an opacity I cannot achieve. Still and silent, his veins and airway and abdomen opened and commanded by remote technologies, he seems as vulnerable as a body can be. Still and silent, he is open to intervention but not to interpretation. His mind and its workings are unknowable to us onlookers. In this moment, he is both the most and least knowable he will ever be. And in his stillness, his secretness, his opacity, I envy him.
Notes
[1] BD Pyxis™ MedStation™ ES is a mechanized set of drawers and cabinets containing medications. These machines require employee information for access, usually including an ID number and a fingerprint scan.
[2] Much like the Pyxis, the Omnicell is a locked cabinet system that stores supplies such as saline flushes, IV tubing, and urinary catheters.
[3] A barcode scanner made by Zebra technologies, referred to simply as the Zebra in many hospitals. Used primarily for scanning medications, badges, and patient wristbands.
