Busy

So what is a busy shift like in the ICU? This week, I've been the triage resident for the afternoon and evening. I arrive at 2 and stay until the party quiets down. Tuesday night was a particularly insane day. Over a period of about ten or eleven hours, from the afternoon to midnight, I evaluated seventeen patients and admitted fourteen of them to the intensive care unit. Some were routine, planned admissions such as post-operative admission after neurosurgery for close neurologic monitoring. But most were truly sick patients requiring a lot of intensive interventions. A ninety-year-old gentleman presents with systemic infection from a urinary tract source leading to confusion, kidney injury, and heart strain. He wants everything done even understanding that his likelihood of making it out of the hospital is quite low. A young woman strokes because of intracranial blood vessel stenosis and requires artificial elevation of her blood pressures to perfuse her brain. A man with a near drowning is flown up from Monterey because of severe neurologic injury and intractable seizures. A patient with both heart failure and widespread infection comes to us because the cardiologists feel uncomfortable managing him. A post-operative patient from an orthopedic surgery has a massive heart attack with troponins exceeding our lab's upper limit. A patient on the lung transplant list has deteriorating interstitial lung disease requiring a breathing tube. A patient misses dialysis and comes in with arrhythmias from high potassium. A man who just received a bone marrow transplant has profound diarrhea, a bloodstream infection, and resulting low blood pressure. A crack-cocaine addict comes in with sky-high blood sugars. A woman with schizophrenia who attempted suicide last year unfortunately intentionally ingests an unknown cleaner fluid.

What makes my job especially challenging is that these patients don't arrive neatly in order, pre-packaged by other physicians. Our emergency department is swamped, our operating rooms are full, our consultants are running around the hospital. For most of these patients, I have to dig through records, talk to family, place invasive lines myself, order diagnostics, make therapeutic decisions. The patients and consults come in clumps and I have to multitask yet micromanage. I try to delegate tasks to my residents as I can, but some patients arrive within minutes to hours of potentially dying, and sometimes, it is all I can do to stabilize, triage, and move on. You should see my notes at the end of the night; I've learned to be much more organized because in this business as a critical care fellow in a tertiary center, you feel overwhelmed every day I step into the hospital.