I was nervous about this month. ICU is one of our "harder" rotations. "NS" stands for NeuroSurgery, so this is primarily stroke patients, brain tumors, head bleeds or other such neural injury. Because it was specialized of a patient list i felt like i had a better handle on what I was doing- generally because neuro tends to be waiting to see if you recover or if you don't. It was also a place where I got lots of practice giving bad news.
In many ways ICU was like the ER but its.... easier. You have so much more time to do everything. When a patient is dying, I have time to think about what to do, what drugs to give and how to tell the family. If you think about it the patient is already intubated and being monitored, you already have labs and images and you already KNOW the diagnosis. Things can change and fast, don't get me wrong, but i felt like i knew a lot of the patients so well after rounding on them everyday that I understood what was going wrong. I also had days to ease the family into the idea that pulling support would be the likely end point, or getting the patient and family to understand that this paralysis was permanent. Plus you spend hours writing a note and asking questions about their childhood and getting to know the family, so you really KNOW the context of this patient, way more than the 15 minutes or less I'm given in the ER.
We also spend so much time wasting time. I mean even though I only got 4 days off, the time I spent at work and doing work was less. Yeah you have to round and yeah it can be long but alot of times my brain doesn't have to be turned on all the time. I don't have to mange 4 people and the nurses and the attending and being yelled at and making sure I don't miss any detail that might kill someone. I get to sit and do a note for an hour. I get to think about my plan and what meds i want to give and why.
I really enjoyed this rotation.
(pt stories to come)
