SICU

All in all, the surgical ICU was an interesting and educational rotation but not an incredibly pleasant one. It was important for me to see the post-operative management of complex or complicated surgical cases. It felt very much like anesthesia working with these patients the night after surgery, trying to adjust their medications, wean their ventilator, and determine how much fluid or blood was necessary. Other cases were those admitted with severe infections, hypotension, or respiratory issues from the emergency department or the floor; this felt very similar to the medical ICU. Lastly were trauma patients who I was least comfortable with but who I got to understand over the rotation. We even had one patient who was an anesthetic complication: negative pressure pulmonary edema from laryngospasm after extubation. The one cool skill I developed over the rotation was the use of bedside transthoracic echocardiogram to take a quick look at the heart. I became more comfortable with putting in arterial and central lines independently and intubating patients in the unit.

The rotation reminded me how pleasant it is to be an anesthesiologist with one patient to worry about, to have absolute control over each parameter, to make and carry out each intervention. Instead, as a resident in the unit, I ran from room to room, put orders into the computer, tried to take in and understand the complex histories of a dozen patients. I have always been interested in the ICU, and I still am, because I think being an attending will be far easier than being a resident. Although I like the extremes - monitoring a patient one-on-one closely or overseeing a panel of patients - I don't like the in-between, the floor work feeling of having to be in a dozen places at once.