ICU
signout | November 14, 2008I've been away from the blog for a while, working on fellowship applications and riding the wave of the ICU. Thank you for your patience, as ever.
As you might remember from my days as an intern, I used to love the ICU. That love is no longer: doing procedures to people whose fate is inevitable isn't as much fun as it used to be, and I feel powerless in the face of a culture that doesn't exactly embrace the avoidance of unnecessary intervention.
This most recent time in the ICU, I worked with an intern who seemed to me less eager than some to take on the burden of her responsibility. About…
signout | August 13, 2008You know how, when you squint at a colorful tree, the borders disappear, and all the leaves merge together into one big mass of green? Turn that inside out, and you have my relationship with The Hospital. At times--especially difficult times--all the departments and interests and people in that place start to merge. Their demands and rules start to become one entity's demands and rules, and their borders disappear. I have to squint hard to separate the strands that come together to form the rope around my neck.
My friend Jack was in a terrible accident last week. I heard about it the evening…
signout | February 7, 2007I'm always a little restless the night before a new rotation. Sunday night was no different, and I laid awake in my bed for longer than I'd hoped to, worrying about leaving behind the intensive care unit (the ICU) and switching to the general medicine floors.
At about six o'clock Monday morning, I walked into the room of a 91-year old guy admitted with antibiotic-related diarrhea. "How're you doing?" I asked. "Anyone I can get my hands on," he said, and cracked a little grin. Instantly, I was back.
What I worry about most prior to starting rotations is whether anything in the new place will…
signout | February 2, 2007A few days ago, I posted here about a recent ICU admission of a patient with pancreatic cancer. Her admitting diagnosis was septic shock, and I'd initially included some detail about septic shock to help illustrate a clinical dilemma in her treatment. Although that portion was ultimately edited out, this is how a snippet of it read:
In septic shock, the blood itself is infected, and byproducts made by the infectious organisms cause the blood vessels to become dilated and leaky. The danger of septic shock is poor perfusion of important organs, like the brain, the heart, the kidneys, and the…
signout | January 31, 2007At about 8 a.m. today, the code bells sounded. ("I love the smell of chaos in the morning," said a nurse nearby.) I ran to the code, but because I had to schlep over from the intensive care unit (the ICU), I was late, and I didn't make it into the room. Scowling, I trundled downstairs to get back to pre-rounding.
Half an hour later, the ICU fellow came and tugged on my sleeve. "The code upstairs? She's here, and she needs lines." I jumped up, gathered supplies, and went into the room.
The patient was lying in bed, her eyelids stained violet as if with makeup. I began to announce myself…
signout | January 28, 2007Back in October, I admitted a patient to the general medicine service with a three-week history of abdominal pain and progressively yellowing eyes. She was a large, pleasant, quiet black woman who was almost always accompanied by her husband, a broad man with laughing eyes and a white beard who wore an old-fashioned train engineer's cap. Her history was suspicious for pancreatic cancer, as was the flurry of radiologic studies and biopsies that followed her admission.
On a Saturday morning shortly before I finished the rotation, I had a long conversation with the patient and her husband.…
signout | July 1, 2006My parents call me every few days and ask to hear stories. Sometimes I'm contrary about it, and just rattle off a list of diagnoses and interventions. But I know that's not what they want. They want a heroic ideal. They want a dramatic arc. They want a story.
To get to the ICU, you have to be unable to either breathe or maintain a blood pressure on your own. Most of our patients are mechanically ventilated and quite heavily sedated, and all require careful attention to the tiniest minutiae of their conditions. We rarely know what our patients were like before getting, as one of my residents…