At 2 a.m. in February, I found myself speaking with the family of a dying man. We had never met before, and I had only just learned of the patient. As an ICU doctor, I have been in this situation on many occasions, but there was something new this time. The family was 200 miles away, and we were talking through a video camera. I was staffing the electronic intensive care unit, complete with a headset, adjustable two-way video camera, and six screens of streaming data.
The eICU at Emory University in Atlanta provides care by physicians trained in critical care medicine to a number of hospital locations within the large Emory system. It also provides coverage to some smaller hospitals, away from the large academic medical centers, that are not able to provide continuous on-site ICU physician staffing. The eICU functions 24 hours a day with nurses in the day and physicians and nurses at night and on the weekends. For physicians, interacting with patients and families through the small screen and without the benefit of touch is an unusual and sometimes uncomfortable feeling. As physicians, we are trained to use all of our senses to make sense of a situation, and the eICU does not allow the shared intimacy frequently needed in diagnosis and treatment. It can feel remote, and when wearing my headset, at times I feel more like an air traffic controller than a doctor. Never was that truer than when I was confronted with a dying man and grieving family 200 miles away.