ICU

I start out at the VA ICU. The details are fundamentally important to me, though I'm not sure how relevant they are to readers. It is a 15 bed unit with both medical and surgical patients. The ICU team is huge, made up of 4 interns, 3 residents, 2 fellows, and 2 medical students along with the attending, pharmacist, and dietician. We're the primary team for all medical patients and we comanage surgical patients. Every day we have about two planned surgical admissions from the operating room, usually cardiac, vascular, or thoracic cases. The medical admissions are pretty diverse, from neurologic catastrophes to heart attacks to COPD exacerbations. About half our patients are intubated and half are on vasopressors. Interns are on call every fourth night; residents every third.

At least I feel comfortable in this setting. Compared to San Francisco General Hospital where I did my ICU rotation as a fourth year medical student, we have fewer patients but more responsibilities. Luckily, that rotation taught me about ventilators, drips, and lines. We have lectures every day, but learning is really experiential. The patients vary in how complex and sick they are, but I have good oversight and supervision. Hopefully I'll also get a few procedures in. It'll really be a trial by fire, and as it's the first of five call months in a row, I hope I don't get worn out too quickly.