The Coronary Care Unit

In general, interns do not take patients in the cardiac ICU as they can be quite complicated and sick, but we participate in rounds where they are discussed. Most of the patients have cardiogenic shock, requiring vasopressors to maintain their blood pressures, special lines to measure hemodynamics, and possibly devices such as intraaortic balloon pumps or ventricular assist devices. Although heart attacks are the most common etiology, we also see viral myocarditis, severe valvular disease, and heartstopping arrhythmias. I was really struck by how sick these patients can get. Although on my ICU rotation at the VA, I cared for many patients with multi-organ failure or bypass surgeries or severe infections, the patients at the Stanford CCU have a level of complexity that is currently beyond me. I think these are the patients that benefit most from a team pow-wow where we all analyze the data together to come up with an assessment and plan. Although the attendings direct the discussions and ultimately come up with the day's goals, an interdisciplinary team approach is incredibly robust. I have to say, the attendings I worked with on CCU were the best I had in intern year so far; they were engaging and their love for teaching was evident. Although it is always somewhat intimidating to be called on to read an EKG or CXR in front of the group on rounds, it is incredibly educational. The attendings brought in the most relevant and up-to-date studies and role-modeled the most professional behavior. It was an incredibly wonderful part of this last rotation.