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Where Night Is Day: The World of the ICU

Where Night Is Day: The World of the ICU

by James Kelly

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"There is no night in the ICU. There is day, lesser day, then day again. There are rhythms. Every twelve hours: shift change. Report: first all together in the big room, then at the bedside, nurse to nurse. Morning rounds. A group of doctors moves slowly through the unit like a harrow through a field. At each room, like a game, a different one rotates into the


"There is no night in the ICU. There is day, lesser day, then day again. There are rhythms. Every twelve hours: shift change. Report: first all together in the big room, then at the bedside, nurse to nurse. Morning rounds. A group of doctors moves slowly through the unit like a harrow through a field. At each room, like a game, a different one rotates into the center. They leave behind a trail of new orders. Wean, extubate, titrate, start this, stop that, scan, film, scope. The steep hill the patient is asked to climb. Can you breathe on your own? Can you wake up? Can you live?"-from Where Night Is Day

Where Night Is Day is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an ICU in a teaching hospital in the heart of New Mexico. It takes place over a thirteen-week period, the time of the average rotation of residents through the ICU. It begins in September and ends at Christmas. It is the story of patients and families, suddenly faced with critical illness, who find themselves in the ICU. It describes how they navigate through it and find their way. James Kelly is a sensitive witness to the quiet courage and resourcefulness of ordinary people.

Kelly leads the reader into a parallel world: the world of illness. This world, invisible but not hidden, not articulated by but known by the ill, does not readily offer itself to our understanding. In this context, Kelly reflects on the nature of medicine and nursing, on how doctors and nurses see themselves and how they see each other. Drawing on the words of medical historians, doctor-writers, and nursing scholars, as well as the works of James Agee and Michel de Certeau, Kelly examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. As Kelly reflects on the rise of medicine, the theory of nursing, the argument of care versus cure, he offers up an intimate portrait of the ICU and its inhabitants.

Editorial Reviews

From the Publisher

"This book is a must read for all nursing and medical students. Here, critical care nurse Kelly shares his experiences in an ICU in New Mexico over a 13-week period. He also perfectly describes the experiences of the ICU patients and their families—what they see, do, and reflect on during this time. Lastly, he discusses his interactions with physicians, and explains how nurses and doctors collaborate to accomplish the common goals of keeping patients comfortable, sedated, and alive. Kelly successfully depicts 'the good' and 'the bad' of ICUs. He tells the stories of individual patients and families, and describes the ICU subculture in a graphic, realistic manner. He conveys the nurse's perspective on the grueling experience of having to make life-and-death decisions on a daily basis. He clearly shows how emotional, and sometimes unemotional, a nurse must be to survive this type of professional setting. . . . Highly recommended."—Choice (October 2013)

"James Kelly's telling of life in an ICU provides a unique perspective on the daily realities of critical care professionals. . . . He seamlessly integrates the complexities of critical care and of the organizational politics surrounding the ICU. Experienced and novice health care professionals will find this work to be entertaining, humbling, and thought provoking, while lay readers can learn from the complex realities of critical care. Kelly perceptively articulates what it means to experience daily life and death in the critical care environment. His compelling story will capture your attention, cover to cover."—Citation from from the American Journal of Nursing Book of the Year Award Committee (Critical Care-Emergency Nursing Section)

"This revealing personal account blends the day-to-day drama of life in the ICU with a fascinating history of medicine, hospitals, nursing, and intensive care—told through the eyes of Kelly, a critical care nurse at Lovelace Women's Hospital in Albuquerque, New Mexico, over a twelve-week period in the ICU....The evocative language puts the reader in Kelly’s shoes—in the halls and bedsides of the ICU."—Jessica Bylander, Health Affairs (December 2013)

"James Kelly's ICU is a relentless and claustrophobic space where all the stories begin in the middle and only some have endings. His book is an exhilarating and humbling depiction of nursing in the twenty-first century."—Arthur W. Frank, author of The Wounded Storyteller: Body, Illness, and Ethics and Letting Stories Breathe: A Socio-Narratology

"James Kelly provides an exceptionally thoughtful narrative of the modern intensive care unit. He characterizes the rhythms of the ICU and captures odd juxtapositions of the deeply emotional and highly technical, while he explores the complex history and unspoken social hierarchy of American hospitals. Through the experience of caring for critically ill patients and their families, he ultimately delivers a moving meditation on life and death."—Peter Clardy, MD, Director, Medical Intensive Care, Beth Israel Deaconess Medical Center/Harvard Medical School

"Where Night Is Day will be of interest to doctors, nurses, medical and nursing students, patients, and those interested in the organization of health care delivery. This excellent and compelling book marries theory to observation. James Kelly has created an intriguing presentation of social science thought about the health professions and illness, the socialization process of medical and nursing students, a clinical ethnographic study of life in an ICU, and an auto-ethnography."—Brian Hodges, MD, PhD, FRCPC, University of Toronto, coeditor of The Question of Competence: Reconsidering Medical Education in the Twenty-First Century

Library Journal
Kelly (registered nurse, Lovelace Women's Hospital, Albuquerque) draws on his experiences as an intensive-care nurse to put a human face on the decisions made by the practitioners of medicine. He writes about patients not simply as biological problems, but as complex individuals whose health and decisions are deeply shaped by their families, histories, and economic circumstances. Interspersed with these portraits are reflections on the nature of medicine, the development of medical education, and the history of health care. At times the book seems overly critical of physicians; while some may not appreciate nurses, many doctors understand what nurses do and trust their judgments and opinions. VERDICT Some patient portraits are moving, while others seem overly dramatized and filled with clumsy descriptive writing. In addition, general readers may find the unexplained medical terminology a hindrance to fully understanding Kelly's message. Despite the relative scarcity of nurse's memoirs, this is an optional purchase.—Aaron Klink, Duke Univ., Durham, NC

Product Details

Cornell University Press
Publication date:
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Barnes & Noble
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926 KB

Meet the Author

James Kelly works in critical care as an RN in the ICU at Lovelace Women's Hospital in Albuquerque, New Mexico.

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