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The daily life of a medical resident..
a.k.a "It's 2 AM and I'm looking at urine outputs."
ICU, ICU I see me... in the ICU? 
Thu, Sep. 2nd 2010
"So are you going to subspecialize?"

At each stage of your medical career, you're asked what your next step is going to be. For all of med school, you're asked to pin down a specialty - and as soon as you make it to said career path, people want to know if you're going to subspecialize, especially in a field as broad as internal medicine.

My answer remained the same for most of intern year "That's an excellent question, ask me again tomorrow."

It's no secret that I love the ICU. I like sedated patients, septic shock, acid-base status, central lines and vasopressors. I love our intensive care nurses, and am in awe of the intensivists we have on staff. To me, there is a certain zen in knowing that you have the sickest patients in the hospital, but it's ok - you have A Plan, and incredible staff to help you carry it out, and what will be - will be.

You save the ones you can, and learn from the ones you can't.

A decade ago, I was convinced I was going to be an ER doc. I wanted the adrenaline rush, the variety - the be a cowgirl and jump into the thick of a trauma and save the day.

And then I learned that the experience described above describes MAYBE 5% of a typical shift in the emergency room. Also that the other 95% was like pulling teeth for me. I hate abdominal pain, have little to no interest in syncope triage and dealing with headaches gives me one.

So I was left with the rest. Peds? No. Surgery? Oh HELL no. Ob-gyn? Maybe... but do I have to do all the gyn stuff too? Yes? No. But then I found medicine and thought "This could work, this is fun."

And then I hit ICU in november of my 4th year - and not just any intensive care unit. This was Henry Ford, birthplace of the Rivers Protocol - my attending was a legend in the field, and my upper level was a 5th year ER/IM resident whose favourite phrase was "C'mon Kat, I have another procedure for you."

So I trekked across the south for interviews, saying "I like medicine, but I really love critical care. Can I see your ICU?" Ultimately I found Memorial's - an enormous, sunlit loop that comprised our 40 bed Neuro/Cardiovascular/Medical/Trauma intensive care unit. It felt like home.

I worried that my expectations were unrealistic, though - after all, medical students were shielded from the worst duty hours, and were rarely given the truly sick patients to manage. But I hit the ICU as an intern with a pair of 6.5 sterile gloves in my pocket and the phrase "I'm here to learn" on my lips. I loved it. I loved the variety of the patients, the in-depth understanding of physiology and the procedures.

But then I found myself at the end of intern year, and the put-up-or-shut-up moment. To get into a critical care fellowship, I was going to have to shine up my CV with some really impressive pulmonary research, start gunning for chief resident and start looking at uprooting from Savannah in two years. Oh, and commit to an additional 3 years of resident pay and lifestyle.

I definitely was not without guidance - I talked to the ICU docs, the female attendings, our critical care-bound chief resident, my Mom. All the factors were brought up, rehashed, reconsidered again and again. I'm young, I've got time. But I want kids, and not when I'm 30. It's only 3 more years, but the closest program is in Augusta. But you're good at it! But do I want it enough? It's harder to go back later! But I have loans NOW.

And so I decided. No. No, I don't want it enough - enough to uproot Nick and myself (again), try and sell the house and match again. Not enough to commit to the lifestyle and missed time with my family.

I realized I'm going to happy "just" being an internal medicine doc. I'm still going to see seriously sick patients, do my own procedures and know that I can call in calvary when they need more acute management than what I can provide.

Besides. I really, really hate sputum.
Wayne State University Class 2009
Comments 
Fri, Sep. 3rd 2010 (UTC)
(smile) Best of luck moving forward. And it's wonderful to hear from you again here. :-)
Fri, Sep. 3rd 2010 (UTC)
Maybe be a hospitalist.
Fri, Sep. 3rd 2010 (UTC)
Oh God, sputum. I made a patient with a tracheostomy laugh yesterday and there was just a nice, juicy mucus plug that quickly found its merry way straight out, hurrrrk. And earlier in the day, we had a patient puking blood. It was a great day.
Fri, Sep. 3rd 2010 (UTC)
This kind of sounds like what I want. Thanks for the story.
Fri, Sep. 3rd 2010 (UTC)
Ahhh, the joys of pulmonary patients. Seriously, it's nice to hear that you've found a niche and are enjoying it. From every nurse in the ICU (and I've never worked with *you*, but I've worked with you - if you cat my drift) thanks for beign good at what you do, and appreciating us. There's more than enough of the other kind.
Fri, Sep. 3rd 2010 (UTC)
We need good and caring internal medicine doctors. The GP I have is wonderful, she gets to know us as people and is really on the ball. She has a network of specialists that she can punt to if needed (e.g. surgery, orthopedics, etc.). Finding a good and caring internal medicine specialist is getting frighteningly difficult (when my current GP retires, any interest in moving to the DC area?).
Sun, Sep. 12th 2010 (UTC)
I hate sputum too!

I understand the dilemma of deciding on whether or not to continue on in the resident pay scale for a few more years...if it is really worth it. I know that you guys have a house there, but I don't know if you were planning on settling there for good. The hospital that I'm at in Dayton, most of the IM docs do all their own stuff. They only use pulm if the pt is really bad off, so if you still like the critical care stuff maybe you could find a hospital like that down there for you so that you can still get your fill of critical care without having to relocate to do the fellowship. Just a thought. Our IM docs are all old school and have been around for years... since back in the day before some of the specialties really started becoming popular.

Hope life is treating you well in the South :)
Sun, Sep. 19th 2010 (UTC)
Anonymous
Hi!!I just wanted to say that I have been following your blog since I was in high school and you were just starting it (I think you mentioned it in one of the communities you were in and allowed random people to read along, and I was hooked). Now, I am in medical school and still find myself fascinated by your posts. Just wanted to say after all this time, thanks for putting this journal together. I always look foward to your postings and am in awe of your experiences and your reflections of them on here. Thank you.

-April
Mon, Feb. 7th 2011 (UTC) - Erotikkontakte aus Saarland
Anonymous

You can never step into the same river twice.
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