It Gets Easier

We have our medical students follow one or two patients in the intensive care unit. I remember being in that boat: arriving early to gather all the data, identifying each medical issue, reading about the disease or injury in a textbook, coming up with a plan, and discussing it with a resident. It was hard work, and I struggled to keep all the information in my head and synthesize it into something that made sense to me.

Then as an intern, I was responsible for up to ten patients, six of whom could be new each call day. At first, the burden of information was overwhelming; I had to be organized and detailed so I wouldn't mix patients up. That transition from just a few patients to a handful was challenging and in the first few months, I remember struggling with the overload of information, the worry I'd miss something, and the difficulty balancing learning about each disease with the limited time I had.

It all gets easier. Now finishing my second year of residency, I find that I can keep up with a dozen critically ill patients and a few new admissions without too much sweat. Part of it is simply experience and learning; I've seen some common problems so much that dealing with them now is straightforward. I recognize things that don't make sense, that feel weird, that need more attention, and I focus my energy on that. Rather than spending my time reading, studying, and investigating every single problem on each patient like I did as a medical student, I now rely on reflex and instinct to attend to those problems that are typical and straightforward and instead concentrate on those patients or problems that are changing, unusual, or concerning. This is not to say that the straightforward stuff isn't dangerous; indeed, septic shock is life-threatening and yet for me it fits a box I understand well and can act on without feeling overwhelmed.

It makes sense; this is what residency is about, developing that sense and ability to handle more and more responsibility. And yet, I don't notice it until I think about it, until I realize I'm in the ICU and managing a dozen patients, a feat I couldn't have imagined doing a couple years ago.