Saving Lives and Saving Deaths

In my office adjacent to the medical intensive care unit, I have a growing file of letters from relatives of patients we have treated, thanking us for our care. But the majority of these letters are not from families of patients who survived. Rather, most come from people who have lost a loved one, from the bereaved survivors of patients who died in our intensive care unit (ICU). Yet they are deeply grateful for what we did. At first, I found these letters ironic and odd. I expected and basked in appreciation for lives saved. But the ones about lives we could not save—those I had trouble understanding. And I felt guilty. I read the letters over and over, wondering what the writers meant and what their writing meant to me. Over time, these letters have helped me to redefine my role as a physician in critical care medicine.

I chose my present career as an intensivist on the basis of my interest in the complex pathophysiology of failing organ systems and my desire to reverse the most serious illnesses. I wanted to save lives; that was what I was taught to do as a medical student and house …