In this journal, Murray traces a month-long rotation he spends as attending physician in the ICU (Intensive Care Unit) of San Francisco General Hospital. For each of the 28 days, Murray presents the patients he sees, both new and ongoing, along with commentary on the care of each patient and on broader issues raised by their cases.

In the course of the month, we encounter sixty patients, fifteen of whom die in the ICU. The patients are apparently quite typical for the hospital: cases are dominated by HIV, pneumonia, tuberculosis, and drug abuse, or all four. The ICU is not a very safe place: there are twelve cases of iatrogenic pulmonary edema, and several of hospital-acquired infections.

Murray candidly presents both the triumphs and the limitations of contemporary intensive care while giving us vivid glimpses into the lives of both patients and staff. In his epilogue, Murray asks some tough questions about the value of intensive care units, and discusses palliative care, patients' rights to the withholding and withdrawing of life-sustaining therapy, and even physician-assisted suicide, as "more humane"--and economically responsible--alternatives to intensive care in cases of advanced terminal illness (270).

He describes the ICU as a "battleground" where people who are "clinging to life" can "fight for it" (275). This is its value. But the battles need to be better understood and winning must be carefully evaluated. Murray concludes that the last few decades' medical and technical advances in critical care now need to be matched by ethical ones.


One of the intriguing things about Murray's journal, and something that distinguishes it from most recent collections of "doctor's stories" is the comparative repetitiveness and the narrative frustration that characterize his work. There are a handful of classic IC profiles, and these reoccur, with minor variations, throughout the month he records. What is unique and life-changing for the patient and his or her family is largely routine for the ICU staff.

Even while the care given is evidently humane and emotionally invested, a reader can't miss the difference between these "stories" and the carefully varied accounts one finds in most such books (or TV shows). As Murray puts it, "common diseases are common, and rare diseases are rare" (232).

Equally interesting is the way in which so many of the stories lack resolution: a patient comes in, mysteriously ill and in need of intubation; on the ventilator he begins to recover, is stabilized and extubated, and leaves the ICU. The mystery is never solved, and Murray resists the temptation to satisfy our curiosity, making this book a thought-provoking corrective to the very clean-cut and complete medical stories we are often told.


John Murray is Professor Emeritus at University of California, San Francisco and former chief of the pulmonary and critical care division, San Francisco General Hospital.


Univ. of California Press

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