ICU Overwhelming
My thoughts about the ICU, starting chronologically from my first day until now, starting my third week:
Pre-ICU:
Boy, I think I’m really starting to get decent at clerkships–I feel like I’ve got a good grasp of management for most diseases, I can present pretty well, I’m keeping up with the interns on my service. I’ll learn a lot in the ICU!
ICU, Days One and Two: (aka Why Being A Med Student Sucks)
I hate this. I hate hate hate this. I am stupid, I don’t know anything. These patients are too complex! They’re overwhelming! It takes me an hour just to collect data on all these patients! What the hell are all these ventilator settings? All these random numbers? And the numbers keep changing! And there’s like 4 ABG’s drawn every day! Ugh, this sucks! I don’t know how to present, I turned bright red trying to present this patient to the 19 person team, full of residents, fellows, and attendings (no interns, just med students), and my attending had to take over and explain everything cause I screw it all up! And I called LeMierre’s Syndrome Meniere’s Disease and ugh, did I mention I HATE THIS?
ICU, The Rest Of Week One
Well it’s a brand new team of residents and first year fellows, most of which haven’t done the ICU in a long time or ever before, so I’m on more equal ground now. Lectures are starting over with “What Is ACLS?” and “How do I manage shock?” and everyone is getting confused on how to present patients in morning and afternoon rounds. This is muuuuch better. I feel much less like a dumbass. (But still a dumbass.)
ICU, Week Two
Okay, I’m getting the hang of this. Stuff’s starting to make sense. I can round on my patients pretty quickly, get all the relevant data and not fall too far behind. Big picture. Remember the big picture–what’s keeping the patient in the ICU? What are we doing for them that can’t be done on the floor? Why are they so sick? Still getting lots of suggestions for management from the rest of the team, but I’m getting a better hang of things–what needs to be presented and what can just be recorded in the note. The patients are really sick, and really interesting, and man, one patient can be a review of every system in the body. Kind of… cool. (For learning, not for the patient.)
Two weeks down, two weeks to go!
Don’t get too confident just yet …
My most embarrassing moment in the ICU came on the next to last day. The team was twice its normal size because the brand-new interns were rounding with us to see how the service worked. The first patient on rounds was mine, and I honestly had no idea what was wrong with him. He had been admitted by my senior a night before, so I barely knew his history. Furthermore, he’d been intubated after admission, so I couldn’t find out more about him.
As I finished up my presentation, the other senior glanced up from the computer and asked: “What do you think about his p-ANCA?”
Blank stare.
“And his floridly positive ANA?”
Deer in headlights.
“And the anti-GBM antibodies?”
Stone cold silence. Conveniently, your color doesn’t change when you simultaneously turn white from fear and red from embarrassment.
But I recovered — sort of. I first came up with Wegner’s – but that’s c-ANCA. Then I came up with the correct diagnosis: Goodpasture’s.
In retrospect, it wasn’t that I was an inept intern on my last week of being an intern — the labs had come back between the time I had pre-rounded and when we rounded as a team.
I did a month in the surgical ICU (SICU) during my fourth year of med school. Baaaad idea. I had already booked passage into pediatrics and since my med school didn’t offer a PICU elective and I like surgery/trauma, I figured I’d do a month in the SICU. It was one of their worst months ever. A patient died almost every day and there were at least three patients who long outlived my time there. It was the antithesis of Disney World.
I do my first month of PICU in October. There’s a patient that’s been there since November – I’m sure she has a thing or two to teach me.
Wow- great post!- very informative and revealing of what rotations are like. Thanks!
If you actually felt *comfortable* that would mean you already knew everything and were wasting your time with that rotation.
At least, this is what I plan to tell myself next year when I start my clinical rotations. Thanks for making me not feel like I’ll be the only one who feels like an idiot.
Hey Graham:
Don’t beat yourself up too much. I’d still want to land in your ER, should I ever need one. As you yourself said, “I’ll learn alot in the ICU!” And, you’re going to keep on learning post-residency, all your life as a physician. You have to, otherwise, I’m out of a job! ;)