in the ICU

My first six week rotation is coming to a close with my final shift tonight.  It seems amazing how quickly the time passed, and I can already see that before i know it I will be out practicing medicine on my own.  I've been slowly, sllloooowwwwllly gaining my footing in the ICU, and even on rare occasions have intelligent thoughts to bring to the table.  Miraculous, eh?  Before I close this chapter and move forward to cardiology, I was thinking about some things I learned in the ICU and I thought I would share them with you:

1.  People are fallible, which means that people who practice medicine are fallible.  Simple concept, right?  Well in principle yes it is, but I haven't actually thought about what that really means until recently.  I hadn't realized how much of a person's care is determined by who is caring for them.  In my head I kind of thought, ok, bedside manner aside, we are all practicing medicine from the same blueprint more or less.  The same general set of guidelines that say give this specific drug to counteract that specific problem, recognize that this particular pattern is pathognomonic of that, the steps for problem A should always follow this certain protocol.  I know I am still in my little student world where I really, really, REALLY want things to be black and white, at least until I can fully grasp their concepts and have a prayer of understanding all the gray, but they never, ever are when it comes to medicine.   But, sometimes I see people doing things that directly contradict what the research says, or I watch someone continue to give a drug that is not working but won't back away from the problem long enough to realize that their original diagnosis might have been wrong.  I don't say that to pass judgement or to make myself look like I know better, those moments have just really made me stop and think about care that I have had in the past, or care that my family and friends have received.  It makes me think that when I am out on my own, even with a supervising physician, it really comes down to what I decide to do for my patients because that's what I think is right, and even if I am wrong, that's what the patient will get.  It's weird to think about, and makes me feel like I will have to study every day for the rest of my life just to keep up.

2.  Holy moly are things sad.  In real life I was thinking about how bizarre some of the behaviors that happen in the ICU would seem out of context or even just to anyone not in the actual experience.  The lead nurse said to me "It might seem strange, but we have to laugh to keep from crying".  I had that realization when I had just completed my second examination of the day to determine if either of my two patients were dead by neurological criteria (which both of them were by the end of the day), and we had just reviewed the most recent head CT and officially declared one of them dead.  At one point right after we realized that this forty year old man was not going to recover, we were all standing in the room and laughing about something trivial, like it was just a jolly ol' day, and at the time it made complete sense.  For me, it was an extremely surreal and disconnected moment to hear myself laughing at a joke, and at the same time looking over into the eyes of my now dead patient, with the ventilator still delivering oxygen into his lungs, maintaining his shell of a body.  And then we went on lunch break.

3.  Holy moly are things miraculous.  At the other side of the spectrum are the incredible, death defying moments where a patient arrives to the unit in a state that just does not seem compatible with living for very much longer, and through the work of the entire team they somehow make it to the operating table, the problem is identified and fixed and they somehow miraculously survive!  It's incredible to see someone who needs 24 back to back blood transfusions to even maintain the slightest glimmer of life, and then five days later talk to them in their hospital bed, off of the ventilator and on the road to living their life again. 

4.  Sometimes in the ICU, if you are me, you will look like a gigantic dumbass.  It is my absolute saving grace that my two best PA student friends share very similar stories to my own at the end of every week, and that we can belly laugh so hard at the incredible things that manage to come spilling out of our mouths at times.  It's really hard to weather those moments all by yourself, but man is it good to know there are 51 other people scattered around New England frantically wishing they could shove those words right back into their own gaped open mouth just like I do at times.  Exercise in humility every day over here!

5.  I've learned that I don't want to be kept alive on a ventilator.  I was thinking about that when I stumbled upon a Radio Lab episode about life saving measures.  They said that when polled, something like 90% of the general public say they would want every measure done to keep them alive (CPR, intubation, ventilator, etc) and something like 90% of medical providers say they wouldn't even want CPR done, that all they would want was pain medicine to keep them comfortable.  It's really interesting how in the ICU I have gained a real insight into the reality of what "do everything possible" actually means, and how tortuous that process can seomtimes be for a body.  You can find the episode here if you're interested. 

5.  Lastly, I have learned that time is short and you never know what is going to happen to you or to the people that you love.  In this entire six weeks of humbling, terrifying,  awe inspiring, and devastatingly sad experiences, I learned and hope that I continue to remember to remind the people in my life how very much I love them. 

So, there are some thoughts, of which there are many many more.  I've got one last shift to learn a few more things and then it's off to the next learning experience.  What a ride!