I’ve just wrapped up a month on the ICU service at the VA hospital in Palo Alto, and it’s been an honor serving our vets and a pleasure getting to know a few of them. As I’ve reflected on the patients I saw in the ICU, there were a few surprises for me.
Entering the ICU clerkship I expected to see the sickest of the sick. Given the fact that up to 1 in 5 Americans pass through the ICU before death, I also was expecting to see death often. The patients were indeed very sick, and a few patients did unfortunately pass away in the ICU, but in this ICU the majority of patients were actually surgical, and most got better.
In the public consciousness, we tend to think of ICU’s as command centers for managing gunshot victims. Places where chest compressions and electric defibrillation are administered around the clock. However, during my month I saw chest compressions administered only three times. Each ICU and hospital is different, and understanding how the patient population and mission of each hospital affects its practice has been enlightening for me.
The tighter link between ICU services and elective surgeries was a phenomenon I wasn’t quite aware of before this clerkship. Almost a third of our patients were patients from elective cardiac surgeries such as bypass or valve replacements. These patients are also getting older and older, as we cared for multiple cardiac bypass patients well into their late 80s.
Overall it was an exciting month and an opportunity to learn how my expectations for a specialty can differ from the reality.