Intensive Care: A Doctor's Journal (review)

Intensive Care: A Doctor's Journal.By John F. Murray. Berkeley: Univ. of California Press, 2000. Pp., xiv + 296. $27.50.

Some who read Intensive Care: A Doctor's Journal, John Murray's excellent portrayal of life (and death) in the intensive care unit (ICU) of San Francisco General Hospital, will no doubt be reminded of other contributions to the confessional literature of medicine written by practicing physicians, such as the work of William Carlos Williams or Richard Selzer. Dr. Murray shares with these authors a style of describing the task of the physician and the impact of the medical care system on patients and families which is deeply personal and which provides a window on the soul of the author that is not open in the usual doctor-patient relationship.

My thoughts while reading this book, however, turned in part to a book not by but rather about a physician: A Fortunate Man:The Story of a Country Doctor, written by John Berger. Berger describes the life and work ofJohn Sassall, a general practitioner for the National Health Service in a remote English village. Over his career Sassall becomes deeply embedded in the life of the village, appreciative of the richness of human transactions but often caught between the roles of healer and counselor on the one hand and social critic unable to alter those forces that overwhelmingly govern the course of disease and human misery on the other. Berger writes:

Sassall is nevertheless a man doing what he wants. Or, to be more accurate, a man pursuing what he wishes to pursue. . . . It is easy to criticize him. One can criticize him for ignoring politics. If he is so concerned with the lives of his patients--in a general as well as a medical sense--why does he not see the necessity for political action to improve or defend their lives? . . . He himself is aware of the implications of such criticism. "I sometimes wonder," he says, "how much of me is the last of the old traditional country doctor and how much of me is a doctor of the future. Can you be both?"

Scroll forward 30 years to Dr. Murray, a most decidedly modern doctor. Murray, Professor of Medicine at the University of California at San Francisco, world authority on the interaction of tuberculosis and HIV infections, and senior co-author of a major textbook of pulmonary medicine, is also an active clinician rounding in the ICU. Intensive Care is an account of 28 consecutive days of his direct supervision of the team delivering care in the ICU, a series of stories based on each admission to the ICU and the subsequent interactions of patients, families, nurses, students, residents, and multiple consultants with Murray and with one another. Murray states his chief purpose is "to inform people about what really goes on in ICUs. . . . Few have this information but it concerns everyone." He is thus writing for the general public, and to inform us all of the nature and implications of ICU care he employs a methodical structure to his tales. Each day of his rotation is a chapter of the book, and each day begins with introduction of an important issue that confronts both patient and doctor in the course of ICU management. Murray then describes the admissions presented to him on morning rounds, one of which is illustrative of the issue or problem previously described. He then returns to fill in the details of the course of patients we have previously met, weaving together their tribulations and outcomes in a fashion reflecting the complex comings and goings of this special care area. Often the day ends with Murray at home, feeding the cat or enjoying a beer, attempting to balance a personal life against the onslaught of experiences in the ICU, reflecting on things that are difficult to capture in real time on rounds.

Many of the important but not widely appreciated problems...