Peter Barkin, MD, a pulmonologist and critical care specialist, was the first physician at Emerson to be board-certified in critical care medicine. In serving as director of Emerson’s intensive care unit, Dr. Barkin shares daytime rotation with his three critical care colleagues and oversees the multidisciplinary team that assembles daily for critical care rounds.
What drew you to critical care?
Although my father was a rheumatologist and internist, I came to medicine by majoring in the history of science, followed by a master’s at the Harvard School for Public Health. I took a low-level job at a high-level policy office, Health and Human Services in Washington, where I worked on regulations for people with disabilities and policies related to HMOs. I got satisfaction from working on population issues, but there’s no satisfaction like treating an actual patient.
When I attended medical school at Penn, I found the people I most respected were in the pulmonary/critical care department. I liked physiology, as well as the challenge of taking care of critically ill patients and helping their families.
Intensive care units have evolved a great deal since you were in training.
They developed rapidly during the 1960s with the increasing need to maintain respiratory patients on ventilators, including soldiers who returned from Vietnam with acute respiratory distress syndrome (ARDS), along with patients on dialysis who required support measures. The specialty gelled with the creation of the Society of Critical Care Medicine, which stated that care should be provided by a multidisciplinary team led by a physician certified in critical care medicine. Pulmonologists became the directors of most units.
How did you arrive at Emerson?
First I was offered an academic job by someone who said to me: “But I don’t think you want it.” He was right, because I enjoy practicing too much. That’s the pleasure of being at Emerson. I had a friend at Mass General, where I completed my fellowship, who thought Dr. David Green and I would be a good match. I got here and saw there was an extraordinarily talented, dedicated group of physicians who are committed to practicing in the community. So I proceeded to set up a critical care service based on the multidisciplinary team, which participates in daily rounds. That’s what we’ve done for more than 25 years. A colleague at Boston Medical Center felt that Dr. Julian Lel, who has just joined us, would be a good match for Dave Green and me.
Critical care has been shaped by increasingly sophisticated technology.
Yes, and it has had an impact of our ability to provide outstanding care to our patients, many of whom are fragile. Families are often devastated by having someone in the critical care unit. They see all the monitors and screens, and they hear alarms going off, and assume the patient is going to die. But the reality is that, today, approximately 95 percent of those who receive care in an ICU survive, and the average length of stay is 4.5 days.
At Emerson, we have a great team, including respiratory therapists, social workers, dietitians, pharmacists and all the medical specialties. Our ICU nursing team is superb and is comprised by senior nurses who have the experience, judgment and skills to mentor our younger nurses.
New surgeons have joined the medical staff, which has resulted in the arrival of some highly complex patients.
Yes, this is one of the many dimensions in which Emerson is growing. Our mission in the ICU is: “if you get sick, we can take care of you.” The hospital has often been ahead of the curve, such as when Chuck Keevil used a defibrillator to successfully revive a patient experiencing cardiac arrest in 1962 — the first time this occurred in a community hospital. More recently, we used hypothermic cooling post-cardiac arrest to preserve brain function. When we transferred the patient to Mass General, he was the first one they’d seen who received that protocol.
Other patients come to mind, such as a patient with ARDS; he had bilateral pneumothoraces and chest tubes on both sides and was on 100 percent oxygen. We needed to turn the patient over, so we brought in a prone device to do that — which later proved to be an effective tool for the most severe cases of ARDS.