Living in the intensive care unit

I finished a 30 hour shift at the hospital earlier today. I started my Shock-Traum Intensive Care Unit (STICU) rotation on Monday, and it has been busy, or at least time-consuming. I have a 30 hour shift every third day, with one day off in seven, averaging about 80 hours per week in the hospital. There are six of us working in the STICU – 3 residents, me as an intern, and two senior medical students. We are each paired and take turns doing call with one other person. My partner is Sarah, an anesthesiology resident. My two overnight shifts so far have not been too busy compared to what I have heard it can be like & has been for others. We admitted two people the first night and just one person last night. Things were kept busy both times, with us constantly having to check in on very sick people and following up on labs and studies being done on them. The STICU is divided into people that are medically very sick, surgically very sick, and then traumas. Many of our patients are in shock when they arrive, either from bleeding, infection, or other problems. Some arrive already intubated; others need interventions soon after arriving. There are a few who end up in the STICU that are not too sick, but the majority of them are quite sick. I have seen people with GI bleeds; intestinal perforations; altered mental status from a number of causes; being found down by family or friends; really bad strokes; really bad infections (bladder/kidney, pneumonia, etc.); and then trauma cases, like people rolling their ATV.

It has been amazing to me to see where medicine has come and some of the things that can be done to bring some of these people back from the brink of death. I am learning some of the techniques that are used to help these people to heal - medicines, ventilators, etc. Yet there are others who we have had who don’t leave the STICU, with some of them not very old. Those have probably been the hardest cases for me to see. There was one this week that was still there mentally but his lungs just were too far damaged to recover, and ultimately care was stopped when it got to the point of futility. That to me is a bit harder than if the person had been older or not still with it mentally. But then there are others who have been in there for a week or more, unresponsive, not showing signs of recovering, continuing on a ventilator, but the family wants to continue care in the hope that the person will improve. It has been an interesting tug of feelings, as I can see from a medical, non-emotional view, that this person really has no chance of surviving, and even if they do, they will never be back to their normal from before. But then I can only imagine how hard it would be if I were in that family’s place to make such a big decision to deescalate care on a loved one, again especially when younger. I’m sure this is going to make for an interesting month.

We knew that this rotation was going to be quite time consuming, so Steph and the boys took a vacation to San Diego to visit with her family for 4 weeks. They left on Tuesday and I am missing them so much already. I am enjoying some time to just relax when I am home, playing video games and reading. But every time I talk with them on the phone I wish I could be there having fun with them too. They are enjoying wonderful weather, swimming in the pool, and being with family. Papa even took Kolby & Elijah on a campout with the teachers quorum this weekend up to Palomar, and they had so much fun – what great memories.

Well, one week down, and only three to go.