Turns out I’m ending 4th year on a more somber note than I expected. I really didn’t know what to expect from a Medical Intensive Care Unit (MICU) rotation this time last year when I was scheduling it as my last rotation. I’m two of four weeks in and to say it’s been sad would be an understatement. Before this rotation, I had never been faced with so much sickness and death in a short span of time. I’d only had one patient die since starting my clinical rotations. But the patients in the MICU are so sick; many of them require a form of life support or a continuous infusion of medication to keep their bodies going. It’s difficult to see the patients in these conditions and remember that they were once vibrant–walking and talking and living their lives like I am blessed to do today. It’s harder to think of them as people and not patients. That’s where the families play a huge role. I really try to get to know the families of my patients because they are the ones who remind me that this condition isn’t their baseline status. They push me to ask ‘are we doing everything we can for this patient?’
As much as the families can play a positive part in patient care, they also play another role that is much more difficult. Because many times the patients aren’t in the proper mental state to receive updates about their care, we constantly update the families about how their loved ones are doing. When we have patients that aren’t responding to treatment, who have a poor prognosis (etc.), we hold family meetings to discuss end of life care. Family members are asked about the measures their loved one would/would not like to have performed in the event of a cardiac or respiratory arrest. Those conversations are tough to have with families who aren’t prepared to have them, especially when the patient is young or when the treatment course takes a sudden turn for the worse. One of our patients was a woman that I actually met during my third year of medical school. She’s chronically ill, in and out of the hospital. I took care of her while she was still able to crack a few jokes, and I also got to know her husband. She was in the MICU when I started the rotation, sedated and on a ventilator. I didn’t have her as a patient but I still spoke to her husband, who knew her prognosis was poor. After a team discussion with him about his wife’s likely outcome, he made the decision to withdraw care and she passed away a few days into my rotation.
I struggled in that first week to find the balance between caring about my patients but not caring too much, so that I wasn’t carrying that trauma home with me. I wanted to be invested in their care but not too attached. When patients died, I couldn’t figure out how to deal with it. I didn’t want to dwell on it because that wouldn’t be good for my mental health. I didn’t want to brush it off either because I’d feel like a terrible person. Many of the docs/nurses around there had figured it out. I’m not sure if they just eventually became numb to it all, or if they had a strategy for coping with it, but it seemed like they were never phased. I just know I couldn’t imagine being a critical care physician, the work is too intense! I would have to see a therapist weekly.
On top of the emotional demands, this rotation has also been pretty physically demanding. We start at 7am with morning sign out from the night team. Then we have from then until 9am to see out patients and prep for rounds. We usually round on our ~20 patients from 9-12:30p each day. And I’m talking about walking rounds, which means I’m on my feet for 3+ hours straight. It’s so exhausting! Rounds take so long because the patients are so complicated and we discuss all of the details of their care. Also, I was told that the attending physician that we’ve had the last 2 weeks takes more time than usual. After rounds, we run through the list of our to-do’s for the day then get straight to it. You make your own time for lunch, which is much easier to do as a medical student because I don’t actually act on many of the items on our to-do lists. I just finish my notes, pitch in where I can, assist with procedures (central lines, arterial lines, paracenteses, etc.), and check back in on my patients. Eventually we’re allowed to leave anywhere from 4-6p. I typically go to the gym afterwards but my feet are so sore that I just go for seated and supine workouts lol.
The good thing about this rotation is that I’m learning a ton of stuff that’s actually very useful. And it’s great because I don’t have to think about studying outside of what I learn in the hospital. I can just learn directly from my patients and immediately apply my knowledge, which makes things stick so much better. I understand why we choose certain drugs or fluids or ventilator settings–and it actually makes real sense not just pretend sense like during third year. Whether or not I remember all this stuff between now and July is another story.
2 more weeks of this rotation!
1 more week until MATCH week!
4th year is flying by!
Have a wonderful week,