ICU Rules #6 and #7: Your Ego Can Be Dangerous

I had known the patient well. She was just in my ICU a few weeks previous with a perforated bowel and multiple abscesses in her abdomen. She was now in the hospital emergency department several weeks later with severe acidosis (or acid levels in the blood). I was absolutely convinced that she had sepsis, a dangerous body reaction to an infection.

Other colleagues called Poison Control, worried that she maybe ingested a toxic alcohol. I was incensed: “What are you talking about? She has sepsis! Get the antibiotics! Get the fluids!” I was on a tear in the Emergency Department.

I spoke to the Poison Control colleague (likely a physician in training), and he recommended I make sure she didn’t have any toxic alcohol ingestion (like wood alcohol or antifreeze) given how acidic her blood was. I rolled my eyes. “She has sepsis. I am absolutely positive.” He replied politely and said, “That is our recommendation. You can do what you want.”

I ordered a CT scan of her abdomen, fully expecting to see multiple abscesses like they were before. I was shocked: her abdomen was completely clean. I couldn’t believe my eyes. And while I was totally convinced it would be negative, a little voice deep down inside me said, “Maybe just check for an antifreeze level…just in case.” So, I ordered one.

The ethylene glycol (i.e., antifreeze) level came back very high. It turns out that my patient tried to commit suicide by drinking antifreeze, and she had dangerously high acid levels as a result. I, therefore, came back into the hospital from home to put in a special tube so she can get emergency dialysis. She did well after that and was discharged to an inpatient psychiatry facility.

I frequently share this story to highlight my ICU Rule #6: “Your Ego Can Be Dangerous.”

We can never let our ego get in the way of patient care. We need to always keep a sense of humility when dealing with the patients for whom we care. In this case, the Poison Control trainee was absolutely right. My patient did not have sepsis, but indeed had ethylene glycol (antifreeze) toxicity. I was wrong, and he was right.

In other cases, the bedside nurse may make a suggestion that turns out to be right on; or, the medical student may do so. We cannot be full of our own self and ego to not take suggestions from everyone in the care team. Different clinicians bring different perspectives, and as leaders, we need to welcome those perspectives.

We are all on the same team with the same objective: to help heal our patients. If we ignore salient facts or suggestions because a nurse or tech or student or therapist suggested it, we are liable to place the patient in great danger. We have to resist this with every fiber of our being.

I shudder to think about what could have happened if I ignored that little voice inside me which said, “Dumb resident can’t tell me what to do!” and NOT ordered the antifreeze level. I shudder to think about what could have happened if I continued to feed my ego in this case. It is a lesson I have never forgotten, and I pray that I never, ever forget it in the future.

Along the same vein, I can’t tell you how many times I have said, “Call a Code!!!” while working in the ICU. When I say that, it means that a “CODE BLUE” needs to be called overhead in the hospital. When this is called, as many people who can respond come to where I am with my patient. It is a call for help.

Now, I have been practicing in the ICU for more than 16 years. I have been blessed with a lot of clinical experience. I am confident in the clinical abilities with which I have been blessed. But that does not mean that I am “too cool” to call for help, which is my ICU Rule #7: You Are Never “Too Cool” To Ask For Help.

Sometimes, I will call for help before even trying. For example, if I see that a patient needs to be placed on a ventilator and they have a challenging airway, I will call my Anesthesia colleagues from the very beginning. Yes, I have placed hundreds and hundreds of breathing tubes in the throats of patient. That doesn’t mean that I am the world expert at it. I want what’s best for my patient, and if that means have an Anesthesiologist rather than me place the airway, then so be it.

Now, does my ego get bruised a bit if my colleague easily does what I couldn’t do? Maybe. But, who cares about my ego? We are dealing with life and death in the ICU, and I am not going to stick a patient’s vein or artery multiple times – for example – so I can save face. If that was my family member, I would want the same for them.

Our egos can be dangerous. We are never too cool to ask for help. Yes, we have the experience. Yes, we are confident we can do the job right. But asking for help is not a sign of failure. We are all one team, and we have the same goal: healing our patient. And if that requires asking for help, then that is what we should do.