Dr. Kalb is blending technology and experience to touch lives, virtually. 1 A young man on a monitor recovers from another seizure—his third this week. It would be troubling news for any patient, but it was especially puzzling given the fact that he was using anti-seizure medication. Another patient exhibits signs of severe acidosis, much worse than I would expect to see in a guy who simply had too much to drink. After many years of working in an intensive care unit, I thought I had seen it all. Now, leading a team of intensivists at Advanced ICU Care, I’ve had my horizons stretched. I’ve had the opportunity to see populations of patients on a national scale, presenting a wide range of conditions far beyond the possibilities of a traditional medical setting. These stories are just a couple examples of what we informally call “fascinomas” – fascinating, challenging cases – which I and other tele-ICU doctors see on a day-to-day basis. These illustrate how we are able to save lives from hundreds of miles away. In the first case, I was able to recognize a rare case of ammonia toxicity caused by anti-seizure medicine exacerbating his condition. In the second, we found that the patient was not simply drunk, but he also had ingested anti-freeze. I credit much of my success in a tele-ICU environment to the ability to apply information that is only discernible after taking in large amounts of patient data. Because I see more patients and they draw from a much wider geography, I can learn from a case in Arizona and recognize a condition in a patient in Kentucky. That view, in particular, let’s me complement the perspective of a bedside doctor or nurse. Working in the tele-ICU environment trained me to take care of the important details first: blood clotting, fluid levels, blood transfusion practices, antibiotic use, avoiding complications of excessive pain medications, etc. When the monitoring of these areas is neglected, that’s when things begin to go wrong. Fortunately, our tele-ICU technology can provide the continuous support and best practices monitoring that helps ensure that a sepsis case is detected early or that the air volume of a ventilator is set at the most effective level. Even though it can be very empowering to have so much information at your fingertips, medicine reminds me that it is among the most humbling of practices. While we help save lives each day, we are also reminded regularly that there are limits to the things we can do. For a patient, just knowing that a doctor is there with them during a scary time is important, too. When complications do occur, patients know that an expert is right there with them, doing everything possible to help them.