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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."
As always, promises to do better. 
Fri, Jan. 14th 2011
So I'll try and kick-start this thing. Seems I left off as my intern year was winding down, finally making the decision not to go into pulmonary critical care.

Seems right to pick back up with the first day of my second year.

I couldn't have asked for a better Critical Care team. The third years were Joe (a linebacker for the Florida Gators in a previous life and thus is scared of absolutely nothing now) and Jess (our hard-working and utterly brilliant co-chief) and a freshly minted intern who was pretty damn smart and also willing to work. Oh, and one of my very favourite attendings, the one who calls me "Red".

The thing I always sell to interviewees to the program is that you're never alone. (Because I remember being a 4th year med student and thinking "Oh, god, I need to get to the code... just not quick enough to be first.")

Which is true, as an intern, you're never alone. But as of July 1, I was a (supposedly) big, badass upper level. Which meant I did nights in the ICU solo.

Not many stories end well when they start with "It was a dark and stormy night", but I'm happy to say that my first night went well enough. The sepsis, the massive MI's, and the post-code resuscitations rolled through my door and I rolled with them, trying my best to look calm and in-charge while my stomach did somersaults and I second-guessed every decision.

But after awhile my signature on the post-procedure note would be a little less shaky, my stream of verbal orders would be a bit less hesitant and I'd even get a "good call on that patient in MICU8" the next day. Baby steps, each of them.

I can actually pinpoint the moment when I finally feel like I came into my own as an upper level. Residents help run our Medical Emergency Team, (called the "MET team" even though it reminds me of "ATM machine" every time I say it.) which is designed to step in when a patient is crumping, instead of coding.

Room 384 is on our ortho floor, not a place you'd expect to find someone with the unfortunate combo of liver disease and COPD. But when there's only a few rooms left in the hospital, you make do. I get a call from our respiratory therapist, saying "his breathing looks pretty crappy, come take a look."

When Darren wants me physically in the room, I know to get my ass in motion. He once brought me a patient's ABG on top of the intubation kit, and my only response was "So I guess this is your way of telling me the gas doesn't look good?"

But back in 384, it was almost zen. I snap on a pair of gloves, see my patient sitting bolt upright, gulping air and wide eyed. Laying on stethescope yielded the nastiest crackles I've heard to date. A few reassuring words to patient "We're going to put a tube in your mouth to help you breathe. But first, I'm going to give you medicines so you go to sleep. When you wake up, you're going to feel better."

A few healthy doses of fentanyl and versed later, and I pull up my beloved Mac 3 to see a gorgeous pair of vocal chords. One pass, and even though I silently chant "turn yellow" to the end-tidal CO2 monitor, I know I'm there.

Just another day at work as the team tidies up and gets ready to move the poor guy upstairs but the floor nurse's remark pulls me up short. "I'm impressed, you did that like a pro."

"Well, I guess third time is the charm." I reply, trying not to ruin the moment by tripping over the travel vent's O2 tubing.

Which in turn, stops Darren mid-ETT taping. "Whaddya mean, third time?"

"That was my third solo intubation." I admit, blushing now.

"No shit!" I shrug and we all get on with our day, but inside I'm grinning like a fool, for once feeling like the badass I had pretended to be up until that point.

Once again, I cannot understate the importance of "Fake it until you make it".
Wayne State University Class 2009
Comments 
Sat, Jan. 15th 2011 (UTC)
I hope you're able to continue to post. I've been reading you from the start. As someone who has an incredibly different career than you (I'm a communication consultant for an HR consulting firm), I love the glimpse into your life.
Sat, Jan. 15th 2011 (UTC)
(grin) Rock on, Kat. Rock on. :-)
Mon, Jan. 17th 2011 (UTC)
So glad you're back! Been following your posts since med school. Just switched to a non-teaching hospital myself and can personally say I miss residents like you. I do like, however, how it seems as if you don't have to be on death's doorstep to get into your ICU. At my old hospital, it was like pulling teeth (or being blue) to get someone in to more attentive medical and nursing care. Do you notice a different characteristic of doctors or hospitals when it comes to getting someone into the ICU? Also, I find it interesting that you guys do the intubating. Only anesthesiology or CRNA's are allowed to do the intubating at my previous and current hospital. Is that just hospital protocol that varies from location to location?

Keep up the great writing,

L., RN.
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Wed, Jan. 19th 2011 (UTC)
Love your journal. We don't know each other, but I'm a scared little brand new clerk who started ICU Monday and it's great to read about your experiences and passion. Look forward to reading more!
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