Intensive Care Unit: On Duty 24/7/365
Here’s a look at just one of the areas of Mid Coast Hospital that is on duty around the clock serving our community: our Intensive Care Unit.


From heart attack and stroke, to severe respiratory insufficiency, overwhelming infection, or even car or snowmobile accidents, each patient has unique needs.

Although many of the patients are older, it is not uncommon to have a young adult or even an infant with respiratory needs.

We provide a very high level of care for a community hospital of our size.
“There is so much we do here. Special around-the-clock attention, especially for patients with life-threatening conditions, is often appropriate to a community hospital of our caliber,” says Brian Viele, nurse manager of the ICU.

“Families are very much involved when a family member is in ICU, so the closer to home you can receive this care, the better.”

According to Viele, “We are continually looking for ways to ensure even higher quality.”

Right now, many of those initiatives are apparent.


Paul J. LaPrad, MD, and his partners at Chest Medicine Associates provide exclusive, round-the-clock coverage to Mid Coast Hospital’s intensive care unit.

Each of the doctors—LaPrad, Hal I. Sreden, James P. McCormick, and Patricia A. Lerwick—is board certified in critical care as well as in pulmonology and internal medicine.

(Dr. Sreden is also one of only a handful of doctors nationally to be certified in Sleep Medicine.)

Working at Mid Coast Hospital is exactly the type of practice Dr. LaPrad wants.

“Mid Coast Hospital truly is a state-of-the-art facility, and we as a group are committed to making our intensive care unit the very best. That is a commitment we share with the hospital administration to the envy of many of our colleagues.”

He has high praise for the nurses and their skill level.

“Their focus on patient care prevents errors and decreases costs and length of stay,” LaPrad said. “Together we provide comprehensive care with a multidisciplinary team that includes doctors, critical care nurses, pharmacists, therapists, respiratory therapists, and palliative care counselors.

“Ultimately, the goal of everyone is the best outcome for our
patients,” he said. “Because of the nature of the illness and disease we see (like very serious infections, very low blood pressure, cancer, and respiratory failure), we work together with cardiologists, surgeons, gastroenterologists, and we work together very well.

“We have very close consultations and excellent oversight of our patients’ progress. And we very much appreciate the work of Mark Cushman and the pulmonary rehabilitation program,” he said.

“Having a pharmacist in the unit—in fact, two PharmDs (Doctors of Pharmacy)—is big! They work with us on a daily basis. They know better than anyone the drug interactions and the risks of a particular drug.”

Critical care physicians (who may come from other disciplines as well) regularly participate in lectures, workshops, panel
discussions, and special training focusing this practice and the ever-changing environment of the intensive care unit.


“We have a pharmacist right in the ICU interacting with the doctors and nurses up there. Right now that is primarily Kathy Miller and Shawn Dunehew who have doctorates (PharmD), but also includes Mike VanderWarken,” says Jack Underwood, head of the hospital’s pharmacy.

“We did a survey of the critical care nurses and realized they really value the relationship with the pharmacists because the preparation and administration of medications is so complicated with drug interactions, and pumps, and lines. As we work together with the doctors and nurses, we build our experience level.”

“This is unique for a hospital of our size; usually the pharmacist is in a remote location. It is possible for us to be right there because of the wireless lap top and the Pyxis automated dispensing system” that Mid Coast Hospital has in all its nursing units. These combine to “drastically cut down on our time to first drug,” says Underwood.

“Because there is so much that is important, we may not always know everything immediately, but we know where to find what we need quickly.”
There are other benefits to having a pharmacist in the ICU. “The work is interesting and exciting, which increases job satisfaction,” Underwood said.


Linda Castner, a certified critical care nurse, has been with Mid Coast Hospital since 1986 beginning in Bath. “I have been through all the transitions!” she says.

“The entire nursing staff in the ICU are at the top of our clinical ladder and many have the national CCRN [critical care registered nurse] designation.
“Collaboration and best practice is something we are all committed to—taking care of our patients and taking care of each other.”

She sites three important aspects that makes Mid Coast’s ICU unique for a community hospital — each one of which contributes to better patient care, more focus on patient safety.

“First, we are on the cutting edge of technology for a hospital of our size.“ Linda notes that besides the equipment in the ICU itself, patients can find a catheterization lab, MRI and PET scans right here when they need them.

Second, “There is in our unit, a spirit of collaboration and teamwork.

“We have four physicians who are board certified in both critical care and their specialties. We deal with them on a daily basis,” she said.
She notes there are four pulmonologists who are certified in critical care as well as pulmonology and internal medicine. “These intensivists are available to us around the clock.”

“We have four board certified cardiologists, three gastroenterologists, and three oncologists, too,” she said.

“Having such a medical staff, working with us as a team, takes a lot of the worry off the nurses and shares the focus and attention we give each patient, “ Linda said. “This optimizes patient care.”

The physician-nurse collaboration is just the start of the team, however. Linda also praises the inclusion of a pharmacist in the intensive care unit.

“They help us decide the best medicine and look at the best of care from a different discipline that specializes in therapeutics,” she said. “They can give advice on the best medication as well as the dosage and frequency.”

Linda also points to the support the team gets from materials management and environmental services and throughout the hospital. “I cannot do my job without them,” she said. “They are well appreciated as part of the medical team.”

Finally, Linda notes “We are small enough that we have engagement with our patients at a level that goes beyond the physical to the emotional and spiritual.”

“My ideology has evolved over the years to a level of confidence that I feel I am able to impact the lives of other people.
“It goes beyond monitors, tubes, IV lines, and pumps” Linda said.

“I truly believe my skill, understanding, and humor may be the primary force sustaining a grip on life, giving hope and a sense of control to the patient.”


The doctors and nurses in the ICU will tell you that their team would not be complete without palliative care for those patients who are nearing the end of life.

“The tremendous attention given to this care at Mid Coast is unique for any hospital,” says social worker Deb Alpern, LCSW. Deb came here after finishing a masters of social work program at the University of New England.

“I knew right away that this type of care is what I wanted to provide. I asked if there was any place with a palliative focus nearer to Portland where I lived and was told that I had better go to the mid coast area.

“The hospital has allowed me to build this role based on what the patients, families, and staff need and want. The hospital has been so supportive since day one, and I am thrilled that the ICU staff allows me to be part of their team,” she says.

Both critical care and palliative care are provided in the ICU by skilled, compassionate physicians and staff. This makes transitioning from one goal of care to another a seamless, professional, and caring process.

“The physician determines where the treatment is going and then I help the family as they work through options.

Daily, Deb’s work might involve clarifying decision-making within the family, advance care planning, providing emotional and spiritual support, helping families sort through treatment options, facilitating family meetings, and discussing hospice.

“In the ICU, I am a consistent advocate working with a patient and family and following the patient through the continuum of care—wherever that may be.” The value of Deb’s discipline is attested to by referrals from the doctors, nurses, family members, and patients. “This hospital is incredibly supportive,” she said.

The critical care team in ICU os a diversified group that worked toward the best outcomes possible for seriously ill patients. At Mid Coast Hospital, are committed to providing the most appropriate care in a community setting in order to ensure patient safety and contain costs.

Terms to know…

An intensivist is any physician providing critical care in an intensive care unit. Intensivists may be specialists in cardiology, pulmonology, oncology, or gastroenterology.

Critical Care
Critical care is treatment for serious illnesses or injuries, many of which may be life-threatening.

Critical Care Nurse (CCRN)
Critical care registered nurses complete additional courses of study and a national standardized exam to earn this designation.

A pulmonoligist is a physician specializing in the lungs and respiratory system.

An oncoligist is a physician specializing in cancers, tumors, and blood diseases.

A cadiologist is a physician
specializing in the heart and circulatory system.

Palliative Care
Palliative care focuses on the total care of patients whose illnesses are no longer responsive to curative treatment. The goal shifts to comfort-oriented care, focusing on quality of life rather than quantity.

Pharm D
The Pharm D is a very competitive, usually six-year course of study (four years after completing general undergraduate studies or two years after an undergraduate pharmacy degree is completed). The curriculum is offered at leading university schools of pharmacy and includes training in advanced pharmacokinetics, pharmacotherapeutics and oncology. Internships, clerkships and/or residencies in healthcare facilities such as hospitals are required.