Update: Rotating in the MICU

Happy New Year!

Am I the only one who didn’t enter this year with as much umph as 2019? I think it’s because I don’t have much in the way of big life shifts like I did last year. Nevertheless, I’m looking forward to another year of working hard, learning, and becoming a better version of myself. This month, my work is cut out for me in the medical intensive care unit taking care of some of the most acutely ill and medically complicated patients in our hospital.

As with any new rotation, there was a learning curve and a new level of confidence I had to develop in order to do my job well. Despite being “just an intern”, I have the power to make decisions that really affect my patients. My patient’s nurses come to me when they need someone to assess them and decide what to do (unless it’s real bad). Majority of the orders I put in are my own doing without speaking with my attending first (but shoutout to my upper levels and clinical pharmacists though). Especially in the mornings. I pre-round from about 6:30-8am, and may not get to discuss my patients with the attending until 11am. So, I typically formulate my plan and go ahead and put orders in, then talk about them on formal rounds afterwards. It’s a healthy challenge because you’re forced to nail down your decisions, and be confident enough to defend them to your attending and other resident colleagues. Of course it’s all about teaching and overall it is a learning environment. You aren’t expected to get it right all the time, or even most of the time probably. With each patient, there is so much to learn, and with time and experience, you grow as a clinician.

On top of your routine patient care, you get called to CODE BLUEs all over the hospital, which happen when someone is in a percieved life threatening situation. More typically, their heart stopped, they can’t maintain their airway or can’t breathe, and they need CPR/ACLS or an emergent intubation. I’ve gone to others when someone has passed out, had a seizure, or been found down inexplicably and they did not need CPR. For someone like me, codes are the worst place to be. I am terrible under pressure! I usually just do chest compressions and leave it at that. If I ever had to lead a code I think I’d code myself lol. If ever in my career I get to a place where I feel confident taking charge in a code, I honestly wouldn’t recognize myself.

I actually like the ICU more than I thought I would–mostly because of the endless learning. I also really like how there are so many different ways to care for people, and every ICU doc has their own style. Some are pro-fluid, others are pro-diuresis, some are pro-steroids in shock, and others prefer to hold off. The attendings give us room as residents to develop our own style as well. I’ve seen hyperkalemia managed 3 different ways, all successfully. I like the flexibility and being able to apply what I’m reading directly to my patient care. I still couldn’t imagine it as a career though (and too late if I could lol). The patient’s are so sick, so complicated, and many of them don’t return to their usual state of health. You face death on a weekly basis. It’s just not the job for me, I’d burn out like toast. Don’t get me wrong though, the impact ICU docs make in the lives of patients and their patient’s families is unmatched. Holding their hands through the darkest of times. Walking that tight rope of optimism and painful reality. It really is the perfect blend of art and medicine. It takes special kind of person to commit their lives to this patient population. I tip my hat off. It’s not me.

I must say the most shocking thing to me was actually how amazing our attendings are! Despite everything they see day in and day out in the unit, they are still so pleasant. I imagine you develop pretty robust coping skills for separating your work life and your home life which probably helps. Either way, I have been so impressed. I think I’ve actually laughed and enjoyed myself more during this rotation than any other (well, ED might be tied). The credit goes to my attendings and my awesome team that I get to work with.

Overall, it’s been a ton of hard work, long hours + additional reading outside of the hospital, but it has all led to the huge growth I’ve experienced as a resident. One bummer is that I really didn’t get to do as many procedures as I thought I would; my patients just didn’t need them, or would get them done in the ED before coming up. I don’t expect to ever need to place a central line in my future career, so it’s not a big deal. I just like to do procedures, so it would have been fun to get my hands dirty. I have one week left though, we’ll see what it brings.

Thanks for reading! Wishing you all the best! Next rotation after this is back to OBGYN.