Sunday, September 21, 2008

The ICU Resident

I am now a real resident. The last several months I was on a research rotation, which kept me very busy ... not as busy as a clinical rotation, but even more so in another sense, in that I spent all my free time (home or at work) thinking about my project.

Regardless, even though I was technically a resident, I didn't have any clinical duties or activities. All that has changed now. I am now on my first clinical rotation, and it is in the ICU no less ... and it is quite a rude awakening.

Not only have I been out of practice for several months, I am now thrown into the ICU, where things change by the hour. No more merely doing what I am told (because I’m the one doing the telling). No more nodding along upon hearing the management plan (because I’m the one doing the planning). And no longer do I have the the luxury of possibly having several hours of sleep while on-call (because I’m the one getting paged down to the ER every few hours for their bogus ICU evaluations)! Like I said, definitely a rude awakening.

Especially scary are the nights on call. Since I admit to both the ICU and CCU, I am the only ICU/CCU doctor in the hospital during the night. My first night of call, when I first realized that, was a momentous occasion. It was extremely scary to think that I alone was responsible for taking care of the sickest patients in the hospital. Someone in the ER getting septic? Someone arriving via ambulance with an acute MI (heart attack)? A patient on the floor going into respiratory distress? It’s all me to take care of!

Granted -- and this is the only thing providing an iota of comfort -- the fellow is always available by phone, and not only that but I have to page him for every admission, but I am still the first line. I can no longer face a group of nurses and say “Let me ask my resident”. These thoughts alone were enough to keep my anxiety levels sky high through the night, and to keep me from relaxing even when I had the chance to sleep.

It has been a few weeks now, and luckily -- thankfully -- I can say it is getting a little easier, and I am getting a little calmer. But it is still frightening.

So … all that bitterness and anger from my internship? Well it is now replaced by terror and anxiety. Not sure if that was a fair trade!


Anonymous said...

I read your post and wish I had magic words to make it all better. I remember being the senior resident, and feeling sick my first night on call. It's pretty darn scary. My suggestion: never hesitate to call for back up. Yes, I know, there is a great deal of hubris in residency, but the bottom line is the patient. It's okay to call your attending or specialists or even call the ED doc back for info and advice. It's also okay to take some time and look something up. Hang in there, learn what you can, and try not to lose focus on why you became a physician.

Job said...

It can't truly work, I believe like this.
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