July is just around the corner. For hospitals it’s a dynamic time. A changing of the guard. Graduating residents moving on and new interns, fresh out of medical school with their clean and crisp long white coats, moving in. Out with the old, in with the new. The ICU rotation for medicine residents and medical students is stressful under the best of circumstances but always an additional challenge early in July. I remember as a resident, trying to glean from my peers who had already completed their ICU rotation, picking their brains for tips and tricks on how to survive and succeed. But often what we are looking for is not what we need the most. Acid base disorders and ventilator management seemed so daunting. But in hindsight, learning how to manage and treat specific diseases and conditions was not the hard part. Learning how to survive, mentally and physically, the rigors of the ICU and growing as a physician were much bigger challenges. Read more
The alarm sounds, a painful reminder that it’s my week to cover the ICU. I take off my favorite sweatshirt, stripping away its warmth and comfort. I quickly jump into and out of the scalding shower, racing to get ready. Making my way toward the kitchen, I roll my eyes at my teenage daughter who is eating ice cream and waffles for breakfast. Her ride waits out front but before she can escape, I get a rare hug, her wet hair cool as it brushes against my cheek. I spy her melting, unfinished breakfast and I shovel what’s left into my mouth. The cold vanilla ice cream and maple syrup drips down my chin. Wiping away the evidence of my indiscretion, I get into my jeep with the top down. The twenty-minute ride is a guilty pleasure, with the spring air cool across my face. The coffee in my hand warms me from the inside out as I make my way to work. Read more
The patient in front of me is trying to die. Elderly and frail, he is lying in the bed. His ribs outlined under skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for each breath, drowning in the air around him. From his cancer or pneumonia or more likely both. It is my first night on call as a senior resident in the ICU.
It’s early in my second year of residency at the University of Chicago, where I am splitting my time between internal medicine and pediatrics. The ICU is outside my comfort zone, with its rapid pace, large volume of data to process, and the complexities of multiple failing organ systems to manage. I am both intimidated and inspired by those who seem to recognize patterns, synthesize information and anticipate problems with ease. I want to be like them. I want to face my fears head on. I have chosen to be here, to prove to myself that I can do this. I am capable of caring for the sickest of the sick. And now, in the middle of the night, without a supporting daytime cast of residents and attendings, I am anxious for my first test. And it happens to be the man in front of me struggling to breathe.
I want to be here. I want to be a critical care physician. I know what to do. Read more
I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you have witnessed a steady stream of nurses, residents, phlebotomists and x-ray techs file in and out of his room. Your dad has withstood a barrage of insults to his body. Radiation to his chest for daily x-rays. Needles piercing skin and veins for IVs and blood draws. Catheters inserted in his neck, his groin and his bladder. Still you hold on to a cautious optimism, clinging to hope. But family meetings usually imply things are not going well, and today is no exception. Taking a deep breath, I open the door and walk inside, leaving for now, the rest of the world behind. Read more