INTENSIVE CARE - A Doctor’s Journal, John F. Murray, MD, University of California Press, Berkeley, Los Angeles, London, ©2000, xiv & 296 pp, $27.50, £17.50, ISBN: 0-520-22089-7

Review by Del Meyer, MD

The mystery and drama of the Intensive Care Units continue to intrigue Americans, both while observing their own critically ill loved ones or while watching the drama playing on the small screens in their homes. Most of them have not come to grips with the real issues or how they are played out in real life. Such an attempt is made by Dr John Murray as he chronicles his attending rounds at San Francisco General Hospital (SFGH) for a one-month period.

SFGH has a very lively ICU because of the demographics of the city and the unusual mix of inhabitants. It serves the city’s socioeconomically disadvantaged and has a large number of people with HIV infection as well. He believes what he records is ordinary in most respects. He feels his closeup offers a reasonable overview of what intensive care is meant to accomplish, how the system operates, and what obstacles can encumber the rescue of desperately ill people clinging to life or, conversely, what constitutes unreasonable torment for people who are bound to die. He describes situations where patients have given clear directives not to be resuscitated. Yet the families, unable to watch their loved ones die, countermand those wishes by calling 911, which results in patients being intubated against their will.

Murray describes meeting his three third-year medical residents who were all smiles, curious as to how the next four weeks together would aid or be an obstacle in their learning. Meanwhile, he was scrutinizing them as to how comfortable he would be with their carrying out the plans that would be agreed to on rounds and to contact him if something came up that they were uncertain about.

The format of the book is based on Murray recording his notes on the chart during rounds. He then provides a lay interpretation and explanation about the reasons for the treatment that was proposed or that had occurred prior to arrival in the unit. He documents situations such as a patient being intubated who explicitly requested not to be, and the angered response of the private practitioner who spent time getting the DNR order.

He gives due accolades to the nurses who take care of these critically ill patients on a one-to-one, sometimes two-to-one, patient basis. They have the key responsibility for making independent decisions and acting on them when there is a sudden change in a patient’s condition, such as cardiac arrest, shock, seizures and other emergencies.

While a journal such as this is perhaps of interest to any doctor, nurse, or allied health specialist to peruse, it is also written so that lay people with an interest in health care can gain perspective from reading it.

Doctor Murray, Professor Emeritus of Medicine at UCSF where he was Chief of Pulmonary and Critical Care Division from 1966 to 1989, has done the world a favor, at this stage in the eighth decade of his life, by giving us his perspective on such an important issue. He is the author, coauthor, or coeditor of a number of books including the multi-volume textbook in Pulmonary Medicine, Textbook of Respiratory Medicine, third edition.