Intro to the ICU

My first few days at the ICU have started without much angst or drama, as my team was post-call the day I started and we have not taken new patients since. We take call tomorrow. Our call schedule is, in med speak "overnight Qq", which to the rest of the world means that we take call (i.e. admit patients) day and night until the next team takes over(usually from ~6am of day 1 to noon of day 2). That's a 30 hour shift, usually with less than 1 hour of sleep, during which we take care of our patients and admit new complex, sick and often unstable patients from the ER - either until they stop coming from the ER, our shift ends, or the beds fill up.

So far, the ICU has been great. Great teaching, nice people, amazing nurses, interesting medical cases. It is intellectually exciting, but alas, I doubt I will head towards a career in critical care, for several reasons that have already become very clear:

1. In the ICU, many patients die. It is not uncommon to have one person pass away a day and to be preparing to transition others to "comfort care" and "stopping the prolonging of their dying process", as we say in med-speak. Bodies are fragile things, and by the time one's body ends up the ICU, much of it is a wreck. We have these crazy machines that can do a lot, but they never replace what has been lost, and if it starts to look like one's existence is permanently dependent on those poor substitutes for the original, you can be sure that most doctors will be working hard to convince the patient or their family that this cannot be an indefinite process.

2. It's really not a place to connect with your patients. Most patients are intubated/obtunded/unconscious/fading towards brain death. If they are not, they are usually on their way out to the floor. (i.e. being transferred out of the ICU to be cared for by the ward teams.) There is nothing more frustrating than watching a team round on a patient, fully awake, but unable to speak because of one reason or other, and completely ignore the fact that the patient can even hear them. There is nothing personal about ICU care, which is probably a good thing given the mortality numbers, but it is very strange. We doctor bodies, not people, and any connections you hope to make with your patients will be limited at best.

3. It's an awkward, complex place. Most patients come to the ICU for their last chance. Many don't make it, see point 1. But unlike in the movies, it is not a solemn, quiet place. People work here for years and they need to maintain a sense of normalcy. Some attendings joke more than others, but everyone laughs. Happy conversations continue outside the door, even as a patient is pulled of a ventilator and allowed to expire in front of their grieving family. Jokes are frequent on rounds. Rarely if ever, are they at the patient's expense, but almost always, they are at the expense of any romantic thoughts one might still have about life. My unconscious patient's nurse, who was amazing with him every minute of the day, referred to my him as "flipper" because he would occasionally toss one of his legs off the bed. It was funny, not malicious, but worked well as a simple tool to balance the tragedy that was unfolding before us. And while the jokes and joviality is common, these nurses and doctors, are able to be solemn and respectful when needed. Rarely a day goes by when they do not have to meet with a family, show compassion and respect for their loved one, and convince them that it really is time to let them die peacefully.

Anyway, my first call night starts in 7 hours. Time for some sleep.