So this whole blog thing...

I'm ending a month in the MICU (M=medical, instead of surgical or neuro ICU) today. It's been a good one for the most part. The ICU is one of those places that really separates docs and nurses from the rest of the population, in a way that isn't easy to describe to someone not in the field.

Imagine this: Your uncle just got admitted to the hospital with heart failure - he couldn't breathe. He's had several heart attacks, and he takes about 15 medications. He comes up to a regular patient floor, but he just keeps getting worse despite treatment.

Now he comes to us. He'll need to be intubated (have a breathing tube inserted) and put on a ventilator. He'll get an extra IV or two, just in case we need it, and maybe we'll put in a line to access the major veins right next to his heart. To you, it's Uncle Frank. To us, well, he's an 85 yo WM c/o increasing SOB c h/o MIx4 and CHF, EF 20, sedated and intubated on ACMV 400/14/60% c PEEP 5. We get so that the tubes and the lines don't even exist to us, really; we can see the patient beneath all that, and it doesn't always occur to us that those things would bother someone else. After all, they're commonplace to us. In the OR, nearly everybody looks like this.

You, on the other hand, just see Uncle Frank. We can spout numbers all day, about how his chances of leaving the hospital are vanishingly small - his heart just isn't strong enough. But all you remember is that he was fine last week.

I could say it's sad, but that's not entirely true. It's sad when these people are in their 40s and 50s, but for an 85 year old man who's been fighting a losing battle for 20 years , it seems more like a well-deserved rest. I'm not sure what to think; I became pretty inured to misery, pain, and death, but this is one of the situations where you really treat the family much more than the patient. Rewarding, but still depressing - nobody likes being the bearer of bad news.

A weekend off, and Monday I start in the ER, 3-11pm shift. I've apparently taunted the gods too much, as one of my weekends is when I do the 11pm-7am shift (Friday, Saturday, and Sunday), and another is the 7am-3pm shift (Saturday, Sunday, and Monday). It's not as though I don't have time off, but my wife is a medical student too, and right now she gets regular weekends. At least I'm off for Thanksgiving (nearly a full week, actually; fair compensation, I suppose, for losing two weekends completely).