ICU

Well I just finished a week on ICU.  Definitely more intense than previous rotations, but getting a lot of experience and trying as hard as possible to be a fast learner.  So many sick patients.  Many vegetable or "anoxic encephalopathic" patients, from quadriplegics with huge ulcers who need to get a trachostomy because of recurrent pneumonia, to people with interstitial lung disease who have been in and out of the hospital for many years and just start taking a turn for the worse.  I've assisted in several intubations and central line placements.  Central line placements feel the most natural - intubations are unpleasant.  My second one was aspirating "coffee ground emesis" the entire time and we are still not sure where her upper GI bleed is.  

This weekend I have one day free, so I'll be hopefully using it to work on my personal statement for residency and setting up my applications online.  Also hopefully spend some time with the fiance.  We get a few hours every evening but now we are both working until essentially 8pm each day.  At least we are both busy.  

I don't know that I could work in a field where most of the people do not get better, or they get slightly better and then you see them a month or two later nearly brain-dead with family refusing to accept that this might be the time they don't come back.  It's hard hearing the explanations for patients who are vegetables, where patients' families will swear that they were looking at them, or had tears coming down their face, or squeezed their hand.  Bad news every day is very depressing.  We actually had a family that was rather quick about it today - Three hours after we intubated an old woman who had severe pneumonia and many other comorbidities, her family arrived to remove it and let her die in peace.  This compared to three others on the ward which will probably not get better.  

Anyway, another three weeks of this.  I have heard that the preceptor next week (they alternate weeks) is easier than my current one, which is fine since it might be nice to have a reprieve.  It's funny, my current preceptor talks about how he doesn't want to be anyone's boss, so he joined a physician group, would never join Kaiser because they own your life, and yet he is constantly taking calls about patients, staying beyond 12 hour days, etc.  I find it hard to believe he has more of a life than a lot of the doctors I talked to at Kaiser, where they can actually leave a lot of their work at work.  We'll see - he's given me more to think about as far as potential work environments.  I will definitely have to thoroughly investigate the different options for practice.  Short of solo practice.