I've just finished a pretty intense 2-week stretch in the ICU, having been on call most of the weekend, and worked both the week before and this week. It sure makes the second week drag a little bit! But it's now over. I was on call again yesterday/last night - more on that later. For now I'm ready to jump into the shower to clean up (I usually do that when I get home and then sleep when I'm post-call, but I was too tired for a shower when I got home this morning, so fell straight into bed), and then study a bit...my exam is on Sunday. Weird time for an exam, I know. I'll be glad when it's done, not so much because I'm nervous about it - more just because then I won't feel obligated to keep on studying. At this point I really don't think more studying is going to help me do any better, but I still kind of feel the need to do it.
I'm really enjoying my ICU block. I was pretty terrified at first, and there was a ton of new stuff to figure out. But now that I've figured some of that out, I'm finding that I'm liking it a lot. I like looking after really sick people, especially when you have to make decisions quickly and think on your feet. I didn't realize I was an adrenaline junkie, but maybe I am a bit. (Actually, I think you have to be a bit of one to be a surgeon) I've found on my other rotations that some of my favourite times have been in the scenarios where there are urgent things that need to be done for someone who otherwise might die or not do very well. Not that I'm happy for them, obviously, but I seem to thrive in those types of circumstances.
Yesterday/last night was one of those days where there was a lot of that. Usually things are relatively quiet early in the day, so that we can go around to each bedside and figure out the plan for the day for each patient. That still happened yesterday, but I wasn't part of it, because a really sick young guy (22 years old!) came in first thing in the morning, and I was looking after him all morning. Our hospital is the regional trauma centre and neurosurgical centre, so all of that stuff comes to us, and often ends up in our ICU. The neurosurgical stuff, especially, can be so devastating, and it's often in young, otherwise healthy people. We have 3 people in the ICU right now in their 20s in really rough shape - 2 because of brain tumors, and 1 because of a huge bleeding aneurysm. It's very sad. The guy with the aneurysm came in yesterday afternoon (fortunately after we'd gotten the 22-year-old in the morning stabilized!), and it doesn't look like he's going to make it, at least not without a huge miracle. He had been fine the day before, and then in the morning he wasn't, and by the evening he'd had a big emergency brain surgery and was on life-support in the ICU. Crazy how things can change so quickly! He's 27 years old. He has a wonderful family, obviously devastated. I can't imagine. Same with the guy who came in earlier in the day. I don't particularly enjoy (I don't know who would) talking with families to tell them the bad news about what is going on with their loved ones. But as hard as that is, it is also a privilege to be part of their lives in these times. I pray that through me, some of God's comfort and hope would come to them.
Yesterday morning we had someone needing to be intubated (breathing tube, ventilator), and I did it, though with my staff doctor (the general surgeon) standing over me and watching me. It was a bit stressful having him watching, but I was glad he was there, too, because I haven't intubated many people, and until then, never when I was the only doctor there. Unlike the situation on Saturday morning, this one wasn't a difficult one, and it wasn't such an emergency that we couldn't take our time. It took a few attempts, and I was getting frustrated and wanted my staff to take over for me, but he wouldn't. At first I was getting mad that he wasn't taking over, but then I got the tube in, and was then ecstatic that I had actually done it. This is so typical, especially in a surgical residency. Your staff is watching you very closely, and they know when it's safe for you to keep doing something, even if you're having a bit of trouble. I often start getting frustrated and want them to take over, but they don't, and then when, in the end, I actually do what needed to be done, I'm quite happy about it. When all was said and done with that one yesterday, he was really nice about it all, and said, "I saw you were about to give up, but I knew you could do it." (I'm SO looking forward to working with him in January!) I was glad that had all happened, because then in the middle of the night, when I was the only one around, someone else needed to be intubated. It again wasn't looking like a difficult one that I needed anaesthesia for, but I was a bit nervous because this time I was the only doctor around in the ICU. But I knew we had time on our side again (and that I had some skilled respiratory therapists with me, who may not be doctors, but who are quite good at what they do, including assisting with intubations, and intubating). So, armed with the confidence that had come from the morning's event and from now having participated in several of these (and with a prayer!), I intubated the guy on my own, without any trouble. At that moment, I was very grateful for a staff who had persisted and pushed me in the morning, because without that I don't think I would have been able to do it, or I would have been a lot more nervous. Nothing like being thrown in and being forced to swim! I'm quite happy about all this, though, because intubating is a pretty important skill in the ICU, and I had been kind of shying away from doing it. I still will be pretty quick to call someone in if I'm not sure about something, but at least the straightforward ones don't scare me anymore.
The nurses and respiratory therapists are, for the most part, really supportive and encouraging, too. I don't think everyone finds them that way, but if you respect the knowledge and experience they have, they respect and support you. There's one nurse in particular - an east Indian guy - who has worked there a long time, and really knows what he's doing. I always like doing procedures when he is around, because he is very encouraging and helpful. And the respiratory therapists who were around for both the intubations I did yesterday were all encouraging, too. It makes for a nice environment and a lot less stress. And all of this reminds me to make sure I encourage and support my medical students and more junior residents as I take on more supervisory/teaching roles over the next few years.
Well, time to get cleaned up and go study.
