Back in the Medical ICU

I'm back in the unit. It's been a little rough because even though things are easier each time around, I feel like I'm shouldering more responsibility. As an anesthesiologist, I'm used to doing everything myself; since we often work alone, we develop a craving and knack for independence. We are also completely and solely responsible for our patients. We become obsessive about details. As a result, the intensive care unit can be tough for us as we navigate team dynamics and relinquish our micromanaging tendencies. The issue I am finding with the team dynamic of the ICU is that residents come with differing levels of experience, knowledge, strengths, motivations, and standards. Certainly, I have gotten much better as a result of my 4 previous months in the intensive care unit (2 as a medicine intern, 2 as an anesthesia resident). But it means that I feel responsible for every detail for every patient on the service, and that becomes completely exhausting. Although it may be good for patients that I catch things other residents overlook, it's unhealthy for me. I obsess over things that seem small but that I find important - nutrition, lines, prophylaxis, antibiotic regimens, frequency of labs, wound care. Most of the others on the team, especially if it is their first month in the unit, forget these things, and I try my best to catch anything that falls through. In the big picture, this extra work probably doesn't translate to huge gains in care, but I feel obligated to do it nevertheless.

So overall, I have mixed feelings back in the unit. I love the medicine, the procedures, the evidence-based decisions, the complexity, the teaching (both as a student and to students). But it will be a tiring and hard month, and I'm bracing myself to learn to delegate more, obsess less, prioritize better, and take care of myself during this rotation.