Time in the ICU

Hello,

I've been out of the ICU for 4 days now, and not only am I still exhausted, I'm still trying hard to process everything that happened. It's been a really rough 5 weeks, one of the most challenging but amazing experiences I've ever had and I'll try to share only a tid tad bit with you (though that's probably too much anyhow!).

The first week, even though we overlapped with the interns-soon-to-be-seniors, things were so overwhelming. Neither Amanda (the other intern)nor I had been in medical school at all for almost two months by this point; neither or us had had a hard core, internal medicine rotation for almost half a year, and I had been in Nigeria for two months, learning medicine so different from the US. So we felt we knew nothing. Then, we were expected to learn the system; the right way to write orders; how to staff patients with attending physicians; how to talk with consultants; how to print out the proper forms to admit someone; and so on. The paperwork is incredible, annoying, and unfortunately quite mandatory! We wasted so much time just learning the basics.

And of course, the hardest of all, patient care. There's nothing like finally being responsible, making decisions for someone who is so seriously ill, and being the person everyone comes to about a patient's care. Our senior gave us the advice that even when you're terrified, you have to look like you know what you're doing; that even though everyone knows you are new and don't know what you're doing, you have to pretend like you do. Because the nurses, and respiratory therapists and pharmacists are great, but I'm the one who's ultimately in charge. And if they don't feel like I'm confident, they'll get anxious and feel like the burden is on them and will worry about their patient---not to mention, if they don't trust me, that's a bad precedent for my relationship with them in the future. So I grew very good at being very calm, taking the time to think before responding to a very distraught nurse (in the beginning, any little thing the nurses did in a distraught way got me all distraught and panicky and unable to think!), and then being able to fudge it with them; after which I promptly went the back room, panicked, paged my senior resident, or looked up the answer REALLY fast online. But the point is, I learned to panicked where they couldn't see me!

And then there's the nights when you're on call alone. You know you have a senior resident on the floor, but you're the first one everyone goes to in the ICU, and things that aren't as scary at 3PM when everyone's there, are WAY more scary at 3 AM. When your patient has a heart rate of 150, or your patient develops a temperature of 39.5 degrees celcius, or your patient's blood pressure has dropped to 80/40---those moments are so, so, scary at night. Even though you know what do, somehow, it's so hard to think when the nurses are upset, you're by yourself, and that person might die, fast, in front of you. Or, someone's blood pressure is 80/40, a new patient is coming in from the ER who has overdosed on heroin, and you're doing CPR on a person, practically cracking their chest, because they aren't breathing. That's when you want to cry!

But you just do it. And honestly, one of the hardest things, but often most rewarding things, was not the medical therapy part, but communicating with the patients and their families. It was so hard to pick up a patient in the morning, never having seen him before, trying to look at his chart for 5 minutes, before having to tell his family, which often consisted of 30 people, that the patient was probably going to die. Or, having to explain to an angry husband how his wife was having multi-organ failure as a rare complication to a common procedure and everyday, finding something new to tell him was going wrong. Or watching the nicest patient I ever had get sicker and sicker from his cancer and eventually die from it. Not only is it hard emotionally, I often felt like they had all these questions, and I was so inadequate to answer them. I just didn't know, when I knew someone with ten more years of experience would have known. That was really tough.

But then, there were the great things. Watching the cancer patient die, but knowing his family was at peace with it and I had been a part in helping them with it. The day one of my heroin overdosing patients came back to the ICU to thank me for the care I gave to him. This man should have died, he was so sick, and even when he woke up, he was completely out of his mind, not functional, and begging me to kill him. To see him awake, alert, smiling, and talking like a normal person---I almost cried. Just to know that patients and their families depend on you to help them and you actually can help them most of the time, even if sometimes it is just to keep them informed and hug them, that is an amazing thing.

And finally, the sense of comraderie I had with the people I worked with was great. I chose this program for many reasons but one was that everyone seemed to work together so well, and the ICU really solidified that for me. God really blessed me in Amanda especially. She is a Christian as well, perhaps the only one committed Christ follower in the intern class, and just a wonderful person. We literally cried on each other's shoulder; we prayed together, and it was such a privilege to be able to do that. Here in the US, it's not like Nigeria, where you can pray openly for each other and for your patients; here, it's almost illegal! But we had so many people tell us we were doing well, even though we never felt that way, and our seniors never made us feel stupid and always went out of their way to check on us.

So that's way too much for now, but I needed to share! So I hope to hear from you all soon and I'll hopefully be more available now that I've been set free from the ICU!