(An earlier version of this article was recently printed in our PICU’s newsletter.)

There is a long list of technology, procedures and interventions to learn about in order to care for patients in the PICU. We can’t avoid marrying so much of our care for the patient with our management of all the technology and our monitoring of their effects. In 2023, we are humans living and working in a world of machines, and in so many ways, our patients are better off because of all the interventions we have at our disposal.

As helpful as they are, the machines are oblivious to the patient story, impassive to the parents’ tears, undiscriminating as to the individuality of the patient. The patient almost becomes an extension of the machines, particularly here in the ICU – the recipient of a ventilator breath, the body being dialyzed. How often have our patients’ parents asked, “How is my child doing?” and we immediately go to the numbers. “Well, her vital signs were stable overnight. She didn’t pee as much as we hoped, so we gave some medicine and got some fluid off of her, so that was good.” These pieces of information are important, and don’t get me wrong – sometimes they are all the parents want to know, and they can suffice as our responses. But it can become easy over time for us to interact with the patients and families more from the machine’s perspective than a human one, before we even realize this is happening.

Sometimes, if I’m honest, I find this machine-centered interaction emotionally easier to bear. Some days, I’m so busy managing the technology that I don’t have bandwidth to engage the real story beneath it all, and it can be a kind of relief.

But the danger can be leaving the parents emotionally bewildered and isolated in this world of numbers and machines because we can slowly find ourselves more skilled in operating and communicating at that level than at the human level. When the machines (and we) come up against their limit with how much life they can preserve in the patient at the end of the day, we are forced into uncomfortable moments where we must know how to meet the parents in the most human realm, a space the machines cannot touch. It can be a vulnerable space to try and connect with. It takes practice, courage, as well as good mentoring to navigate those crucial spaces well.

I am so grateful to work in a unit where I see courageous conversations modeled for me all the time. I hope we will always be intentional and increasingly practiced in going beyond clinical and mechanical conversations. I hope we continue to develop the art of asking thoughtful questions. What a privilege to be able to bring a heart to our care that machines never can.