The difference between the ICU and the medicine wards is sort of like the difference between making a microwave dinner and preparing a five course meal from scratch. What became painfully obvious to me the first day on the ICU is that I’ve gotten really good and pushing the buttons on the microwave, yet I’ve never had a cooking class a day in my life.
I can think of a few days in medical school maybe even intern year that I felt a little overwhelmed, but I knew without hesitation that my first day on the ICU was the most overwhelmed I’ve probably ever felt. The patients are so sick that any one of the 10 problems each of them have would easily qualify for a ward admission. The hardest part however is trying to decipher the maze of wires and tubing running out of every orifice plugged into a variety of machines and pumps that are apparently doing something good for them. There are drugs that I’ve never heard of, or have never used. You don’t exactly treat septic shock with a Z-pack.
Somewhere in the middle of one of my first presentations while stumbling through ventilator settings my attending sensing my stress hormones rising responded “don’t worry you’ll get the hang of it, but you're gonna drink from the fire hose the first week”. Fire hosing was a new term in my lexicon, and I instantly wasn’t very fond of it! The bombardment of foreign drugs, machines and pressure volume curves made me feel like I was working in some kind of bio-physics lab than a hospital, it did however make me question if I actually went to medical school.
At the same time I was eating lunch that first day there was an elderly gentleman that was leaving the allergy clinic, as he got in his car to leave the hospital he started getting short of breath. A passerby noticed this and continued to watch as he stopped breathing and slumped over in his driver seat. As he was rushed back into the hospital by EMS who were pumping away at his chest and intubating his lungs the MICU pager quietly vibrated. My resident who was doing five things at once asked if I would go down to the trauma bay and just write the venitator/sedation orders to get the guy upstairs. As I walked into the trauma bay the ED team looked at me with relief that the MICU team was to the rescue. Needless to say I had no clue what the hell I was doing, the imitator exposed I kept thinking. Thankfully my upper level came down to check on me (aka rescue me) and the crisis was averted. I’m sure that as the month goes on I’ll get better at this, but for now it was a bit much. We got this guy upstairs and it was clear there wasn’t much hope. The family eventually withdrew care and let him pass. The black cloud of the month had begun.