Critical Care

I enjoyed my critical care rotation. There was a steep learning curve (figuring out the ventilator!) but as I learned how things worked, it got better quickly. The patients were predominantly trauma and neurology patients and for the most part, we knew the diagnosis; the complexity was in the management. To be honest, the disease processes weren't so interesting to me (it's more the fat emboli from the trauma, the cerebral salt wasting in brain patients) but the physiology and pathophysiology of critical illness is very interesting. I liked how the unit was open; the primary team took care of most things while we consulted on sedation, airway, and general management. It requires a lot of communication, but it was fun being in the consult role; we could focus our time on procedures and learning. And indeed, I found the procedures to be fun; I put in nearly a dozen arterial lines and a central line, and over the month, my confidence greatly increased. The hands-on stuff really made me happy. I also grew much more comfortable with assessing who was sick and who was not, dealing with ventilators, and managing anesthetic agents like propofol. I liked the multidisciplinary approach; we had a neurology, anesthesia, and surgery attending, and it was educational hearing their expertise in their fields. Nurses and respiratory therapy were intimately involved in patient care. We had both surgery and anesthesia residents; the ICU is truly a team endeavor.

I only had three calls but on each, I admitted from 3-5 patients; while normally that would intimidate me, I found it to be manageable. It was good to see patients through their entire ICU course and indeed, there were some that I was extraordinarily happy to see walk (or wheelchair) out of the unit. That in itself is a great feeling; starting with someone shot in the head, spending weeks on the ventilator, sedated and unresponsive, who suffers a pulmonary embolism, and watching them be extubated, stand up with physical therapy, and leave the intensive care unit. Even though most of our patients couldn't talk, I still found the relationships to be meaningful, and I was still invested in their care.