After a very relaxing summer, I was catapulted back to reality when I was assigned to the surgical ICU for my critical care rotation. The surgical ICU is a busy place with a census of thirty patients, all of whom are incredibly sick. The hours are long, too. I had gotten pretty spoiled after rotations like psychiatry, emergency medicine, and medicine and literature and had gotten used to sleeping late! For the surgical ICU, just like surgery and obstetrics, I’m up well before sunrise at 5:30 each morning.
The unit takes some getting used to. At first, the nursing flow sheets were like Greek to me. There are so many columns of data, and abbreviations to remember like PAP, CO/CI, PRVC, and PEEP. At first we were each responsible for rounding on one patient, but now we often see three each morning. It’s a lot of data and a lot of trends to keep up with, and sometimes it’s easy to mix patients up. I had a lot of trouble when my two patients were the same gender, roughly the same age, and had undergone the exact same surgical procedure. Also something I had never experienced before that took some getting used to was talking to patients who are on ventilators. It’s difficult since they can’t really talk back to you. I realized that when I asked more than one question at a time, I was never going to get a good answer, since all my patients could do was nod or shake their heads! I had to remember to ask one, clear, simple, yes or no question and give the patient time to think and answer. The pace of a history is different in the surgical ICU.
The aspect of the surgical ICU that I’ve had the most trouble adjusting to is the amount of suffering that happens on a daily basis. No one ends up in the SICU because they’re having a good day. I had the same feeling about the emergency department when I rotated there, but the SICU is even worse because at least in the ER we often can send people home after fixing them up. Surgical ICU stays are typically protracted, and the amount of human suffering is hard to bear. Patients are desperately uncomfortable or in pain, or worse, they’re skeletons of their former selves, unable to think or speak or feel. Patients’ families are suffering in their own way, trying to decide how much to intervene – to go to great lengths for the slim chance of a favorable outcome, or to let their loved one expire with some degree of dignity. And although I am just the medical student rotating on the service, none of this has been easy for me either. I’ve found the experience I’ve had in the SICU to be pretty gut-wrenching. It’s been a challenging month. I’m looking forward to my next rotation: pediatric neurology. Hopefully it will be more cheerful!