Done Like Dinner
Another ICU rotation done and over with, and it’s back to the ER tomorrow, and I’m so glad to be out. The last stretch was six days that were pretty darn painful, both physically and mentally. By the end of it, my legs hurt, my back was sore and my shoulders ached. The unit has 20 beds, which is small by some standards, but there are only a few residents and one attending and no fellow, so when you get all 20 beds full, it’s a LOT. We were cruising along there with only 8 or 9 patients in the middle of the block, then boom, sepsis launched a comback tour and it performed shows in all 20 rooms, or so it felt at least. It’s fine in a way, you are busy and so the day goes by fast. And it was one of my favorite intensivists manning the helm, so we got through it, I learned a lot and lived to tell about it with only a few sore muscles. Reflecting on it though, part of the reason why I don’t really like these ICU months is that I find very little satisfaction in treating these patients. You don’t really get to “fix” anyone. When they leave the unit, they are all pretty much still sick, just not sick enough for the unit. They are certainly rarely well enough to say “Hey doc, I feel great, thanks!”. Which is partly why I love the ED so much, you get that instant satisfaction of fully fixing someone’s problem. In the unit, the only time I really had a sense of a job well done, and this might seem weird to say, was when I allowed one of my patients to die with some modicum of dignity. The thing that I was most pleased about doing this past month, was getting my 101 year old with severe respiratory distress such that he was essentially drowning on his own secretions, from a full code (ie, we’d do everything we could to keep him alive) to put on a morphine drip and allowed to comfortably slip away over the following 36 hours. I couldn’t imagine doing this full time, especially coming from the ED. But many do, and many more will, now that EM trained doctors are going to be allowed to sit for the critical care boards.