Free at Last

I survived my ICU month. Yesterday I stumbled out of the hospital after my last call night EVER. I know that it was a good rotation education-wise, the hours were just so tiring. Last week I spent 85 hours in the hospital, with much of them being without an attending being in house.

My last call night was rough. Most of the day we spent trying to fix this guy that needed surgery. His pH was 6.9 and his potassium was over 7. All day long we poured blood and various medications into this guy, and even dialyzed him, hoping to get him stable enough for surgery. In the end, the surgeon signed off, saying it was just too risky.

Meanwhile, one of my usually more stable patients responded to being ignored all day by going into SVT. I pushed adenosine (medication that temporarily stops the heart) and when that didn't work but slowed him down long enough for us to see that he was in a-flutter, we started him on several other medications. While all of this stuff was going on, we put central lines into two other patients, performed a lumbar puncture, and admitted another patient who was having a heart attack.

So it was a busy four weeks. While there wasn't much time for reading, I did learn a lot on the job. I also suppose my confidence level went up a bit. I am halfway through my residency program now, with the remaining time being pretty much all in the emergency department. There are just a few more rotations left, but none will have the intensity of high-acuity patients or the time demands of the intensive care unit.

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In the last 24 hours it has snowed over 12 inches here, and rather than the usual melt away mess, it really has built up. This morning I wasted by lounging away, but it took me 1.5 hours to clear the driveway and we're supposed to get more tonight.

Urban Hiking

Last night I felt like I was living in the stairwell. All the silly climbing back and forth reminded me of M.C. Escher's drawing, "Relativity". By the time I get to the ICU in the morning, I have climbed 7 flights of stairs. I decided to keep track of just how many flights I would do in the course of a shift on-call. My final number was 54, but that includes both going up as well as going down stairs. I did take the elevators once during the shift, but that was only because my intern was with me at the time. A few weeks ago, she had a bad experience of getting locked in some obscure stairwell, without her cell phone, and had to pound repeatedly on a door until someone happened to walk by. I personally found this hilarious, but took pity on her and got in the elevator. (It is hard to empathize with someone who averages 8-10 hours of sleep on call nights compared to my 1-2 because she only gets paged by me for admissions, and doesn't get woken up every 30 minutes by "updates" or lab results from well-meaning nurses.)

Last night was my 5th call night of the rotation out of a total of 9 scheduled, so as far as I am concerned, it's all downhill now. Things got a little hairy this morning when a patient that we had expected to do well overnight decompensated and now doesn't look like he's going to make it. When I left, the ICU attending thanked me for my hard work, but part of me thinks he was just being nice. As far as keeping up on people's studies and labs, I tend to stay pretty well on top of things, but these people are so sick that I don't think I always understand the whole picture of what is going on.

When I got home this morning, there was over 6 inches of snow on the ground. I couldn't get my car into the driveway, so after a quick nap, I cranked up the snowblower and got to work. The thing works so much better on a level driveway, unlike last year when it was pulling up chunks of asphalt with the snow. Hopefully it doesn't snow so much tonight that I can't get the car back out onto the street, but there's no way I'm getting up early to make sure I have a clear path.

Slow, Deep Breaths

Tomorrow I start my four-week rotation through the ICU. I am somewhat anxious about it, as I am going to be the senior resident on the service (ha!) with some poor medicine intern to help/hinder me. Every 3rd day will be a 27-hour work day, after which I will go home, try to enjoy part of the day, work a normal 8-hour day the day after that, and then show up for another 27 hours. Repeat this about nine times. No actual calendar days where I am not physically in the hospital at least for some part of the day.

The ICU is not my favorite place. It is where we keep all of the actively dying people. Many times, their loved ones are completely unaware of just how sick they are. Sure, there are people that recover, sometimes miraculously, but often it seems to be a slow, steady decline. A decline over days and weeks, in which one gets to know a patient's family. I remember the rotation from medical school as being a month of terminal weans from ventilators.

It is also a good rotation for learning. There are a lot of bedside procedures to be done, and I am definitely going to be challenged to make quick decisions and know my own limits. There will be an attending physician on call at night, but they aren't even in the hospital.

I was talking with one of our chief residents about his experiences the other day and he said, "Well, you are either really going to learn a lot, or there's going to be a lot of people dying and you won't have a clue why." Great, I can't wait to get started.