The VA ICU

The VA ICU is a special place for me for lots of reasons. It is where I started the very beginning of internship year, when my white coat was clean and pressed, when my transfer summaries were gregarious novels, when I was bright-eyed and bushy-tailed. Surprisingly (or perhaps not), it hasn't changed too much. This time returning, I recognized many of the same nurses, argued with the same surgeons, dealt with the same frustrations. But there is a small feeling of recognition, as if returning home.

When I started internship year, I had no sense of perspective, and the VA in Palo Alto felt like a large and intimidating place. As I was sent out to find the spinal cord unit, the preoperative clinic, the emergency department, I marveled at how large the campus was. Now it seems like a tiny microcosm. I used to find the 15 bed ICU intimidating, but now, it's a breeze. I've figured out all the processes, realized how I fit in. And I've seen my peers go through this process too. One of my cointerns is now a medicine attending at the VA and we shared a couple patients together.

With only 15 beds, it is good training grounds for interns. Some days, I am frustrated by how long rounds take, but I remember that I was there once, that this is hard, and that interns have a steep learning curve to surmount. But it also gives me great opportunities for teaching, and it's so refreshing to have time to explain my thought process, discuss our patients, challenge misconceptions. We also have residents and nurse practitioners who help supervise the interns, and they are ever a source of learning, amusement, and assistance. My job was made so much easier by my brilliant residents who kept the interns in line, taught them so much, made sure all the checkboxes in patient care were completed. This structure with interns and mid-levels gave me the opportunity to play junior attending, running rounds, making decisions, and overseeing big picture plans. Having this leadership role was really important for me to gain confidence and nudge me out of my normally introverted personality. After CVICU where I played a resident role, this was refreshing change.