Intensive Care: A Doctor's Journal

""What this book is about,"" explains Murray (professor emeritus at U.C.-San Francisco) in his prologue to this journal, is ""how doctors and nurses make decisions concerning... urgent medical problems."" As an attending physician on the Intensive Care Unit at San Francisco General Hospital--a unit that sees a large number of poor patients--Murray believes the processes guiding those decisions deserve strenuous review. In 28 chapters he does just that: using a daily journal format, he leads readers through 28 typical days on the ICU, describing the patients who come through the unit's doors and reproducing the medical notes he writes in their files. It is not long before his point becomes clear: although he believes that an ICU should give all patients care that will restore them to a good life regardless of why they came to the unit (including alcohol or drug abuse), he is convinced that patients who will die within a period of days or weeks should be denied ICU admission. It's a controversial point, but one that Murray defends with case examples and analysis. According to the author, patients who are unable to make decisions and have not instructed their families about end-of-life care are sometimes kept in the ICU when they are close to death, painfully prolonging their dying. Although the dry presentation of chart notes is occasionally either repetitive or confusing, Murray's narrative indicates that he is a dedicated physician who debates with himself about the patient care decisions he has to make on a daily basis. His book is likely to spark a heated debate. (May)