Day in the Life: Intensive Care Unit

Hello and welcome to another Medical Mondays! My first rotation for the new year was in the intensive care unit, which, truth be told, I had been absolutely dreading.

The ICU in the hospital I’m at is a closed unit (only we should be putting in orders) divided into two teams: Scarlet + Silver. I worked with the Silver team and stayed on with them for the full four weeks for continuity’s sake, so ’twas a good thing that they were an awesome group to work with. :]

The other intern I worked with was very laidback and really helpful in terms of answering any questions that I had. Our attending for the first week was super awesome! I really enjoyed working with him–he reminded me of the surgeon I worked with back when I was a med student (they were both super nice, friendly, and passionate about teaching)!

Day in the Life: Intensive Care Unit

7-7:30 a.m.

We receive sign-out from the night team on any overnight events that happened with our patients. The team with more members there at the beginning of sign-out would get sign-out first, so we usually all tried to be on time, although this sometimes wasn’t possible (e.g. patients coding :/ ).

7:30 a.m. – 9 a.m.

We’d use this time to round individually on our patients, follow up on labs and imaging, replete whatever was necessary, check in on consults, talk to families if they were there, etc.

I got to see sunlight approximately twice a week, so I got myself a container of vitamin D supplements. Yay for preventative care, hahaha.

9 a.m. – 12 p.m.

We meet up with our attending and do team rounds on all our patients and come up with a plan for each of them if there isn’t already one in place. Our team eventually amassed to a total of 13 people (1 attending, 1 fellow, 1 senior resident, 1 pharmacist, 1 advanced practice nurse, 2 interns, 1 pharmacy resident, 1 pharmacy student, 4 medical students), so that definitely made for some interesting times. We’d hijack two of the rolling computers with us so we could put in orders and look up whatever we needed while we were rounding (something I wish we could do for our own service, but alas).

12-1 p.m.

We usually grabbed lunch during the first few minutes and went to conference/didactics during this time. Lecture topics included anything from arterial blood gases to the use of pressors to nutrition in the ICU.

One of my co-interns made marshmallows from scratch!

1-6 p.m.

We’d use this time to follow up on anything else pending on our patients, call consults, talk to family members, write notes, update the sign-out sheet, put in morning labs, etc. Somewhere in between, we’d do rapid rounds with our attending to see if there were any other concerns or to follow up on patients who could potentially be downgraded from the unit.

6-7 p.m.

Sign out to the night team and let them know about anything they might need to follow up on or keep a closer eye on overnight!

I’d take off on Wednesday afternoons to see my patients at the office and on Friday afternoons to go to my own conferences/didactics, and I actually managed to go to the gym on a semi-regular basis despite the crazy hours (~72/week), which is a definite plus!

Someone has been low-key trolling on the computers, hahaha. (If you can’t tell what I’m talking about, look for the “pownager” and the “meowdical signout sheet.”)

The downside to the ICU was that so many of our patients were severely ill. Just within even the first couple days, there were several deaths, and I almost teared up while talking to one of my terminally ill patients. (I was asking him how he was doing and he told me he’d lived a good 70 years and had no regrets). I have a hard time with perhaps caring a tad too much, which is why, much as I love working in geriatrics, I don’t think I could sub-specialize in it as I’d likely get too depressed. :[

The intensive care unit is not a setting I will be working in in the future since I’m in a different specialty and also much prefer the outpatient setting, but there was definitely a ton of learning to be had there. Our attendings were awesome with the amount of teaching they did so I managed to learn a lot while I was in the ICU (now if only I could retain everything…).

I was wondering why they were called cows until someone finally told me it stood for “Computer On Wheels.”

• Is there a field you enjoy working in (or a population you enjoy working with) that you don’t see yourself actually going into?
• How are your vitamin D levels doing?
• Do you get seasonal depression?