A Day in the ICU II

Throughout the day, code blues and "e-teams" are called. Code blues, as popularized in the media, signify a medical emergency, usually from someone who has stopped breathing or who has lost their pulse. "E-teams" or rapid response teams are called when a patient seems to be doing a lot worse and requires more help. Although we expect each code to be a life-or-death situation, the truth is, they vary a lot in acuity. No one can ever be faulted for calling for more help, though. As the intern, I grab the transport box - a portable monitor with EKG leads, oxygen saturation, and a blood pressure cuff - as well as the medication suitcase and run to the scene. Our job as interns is to do chest compressions if indicated. It's a little scary and definitely gets the adrenaline going.

Otherwise, the afternoon is set aside for "work" until afternoon rounds where again, the giant team reassembles to discuss all the patients. Instead of formal presentations, afternoon rounds is focused on any events or new information acquired during the day and the problems the call team should focus on overnight. Then the giant team disperses, leaving only the on call intern, resident, and fellow to man the fort.

Evenings tend to be busy on call. With a full house of 14 patients, we can be kept occupied the entire night, especially if anyone is unstable. Sometimes a few more patients come in, either late surgeries, e-teams or codes, or emergency department admits. If there's a medical student around, I'll take time to do some teaching; otherwise, I'm triaging and prioritizing to-dos for all the patients and making sure they make it through the night. If we're lucky, we take a break for dinner; the VA sends us patient food which is not very appetizing - but it means we don't dawdle at dinner.

Evening rounds (yes, the day is pretty much made up of rounding) occurs with the fellow. We usually bring a computer around and go over any pertinent issues and goals overnight. While at first, I balked at the amount of rounding that happened every day, I realized that it's necessary for the ICU. Patients and their disease states change so quickly and dramatically that we have to keep everyone on the same page. After evening rounds, the fellow usually takes home call, and the resident and intern try to wrap things up before going to sleep.

I usually hang out in the unit until early morning. I get notes done, then do some reading and studying, and make myself available as nurses have questions and concerns. If I'm exhausted and think the unit is stable enough for me to get an hour of sleep, I go around from bed to bed asking if the nurses need anything. I bring a portable computer to my call room so I can have labs and vital signs immediately from bed. The sleep is hardly refreshing but its much desired and so if I'm lucky enough to get some, I'm entirely grateful for it.