It's hard to believe that my ICU month is over! I spent the last 4 weeks in my hospital's Medical Respiratory Intensive Care Unit, which handles patients with primarily medical or respiratory problems (as opposed to cardiac or neurosurgical problems, we have special ICU's for those people!). I felt feeble in the beginning with so many new things to learn: ventilators, pressors, sedation. And how easy it was during third year to think of vital signs as such a minor thing (a fever might point you in the direction of an infection, or a fast heart right might make you think dehydration). But in an ICU they can not only change rapidly and dramatically, but you also have to look at them in the context of how much fluid and pressors are required to keep the vital signs at an acceptable level. But those things quickly became routine, since so many people in the ICU require these types of life support.
I saw some really crazy things happen too. I saw a guy with a massive upper gastrointestinal bleed go through a massive [blood] transfusion protocol (he got upwards of 30 units of blood in the blink of an eye) and go on to have a Blakemore tube placed. I watched a young guy get placed on ECMO. I helped with countless central lines and even got to try my hand at placing one by the end of the month.
But the things I may never forget are much sadder, maybe too sad for these pages. So many people die in ICU's and to be honest, it's a terrible place to die. I wish more people had this kind of opportunity so that they could better understand what they might want at the end of life. The ICU should be there to resuscitate patients who have a good chance at life after the ICU, not to prolong the lives of those who have no prognosis, who are essentially dead or dying when they get wheeled to our floor. Then it becomes a gut wrenching process of keeping the patient alive long enough to guide the family from shock and denial to acceptance or to convince the family that palliative or hospice care would be in the patient's best interest. I don't think anyone goes into medicine wanting to do this kind of work, but it's the sad reality of our current system.
Anyway, on to brighter and cheerier things. The residency interview invites have flooded my inbox and I can't wait to go on all these adventures! I also started my Emergency Medicine rotation and we're three days in and I have yet to do any work...can't complain about that. My first shift in the ED is tomorrow. Hold onto your hats!
