A few weeks ago, I moved into the SICU, a medical gauntlet for which I was unprepared. Ten minutes into my first day, I started CPR on an ailing patient, a procedure, at least, that years on the ambulance and months in the ED have made familiar.
Twenty minutes later, I was introduced to a new world of ventilator settings, vasopressors in sepsis, and open abdomens that, in short, scared me. The fact is, for more than two years now in medical school, I’ve never quite been exposed to anything that was so alien that it was intimidating. The sickest of patients never showed up on my shadowing census or were so far gone they required only continued rounds of ACLS.
I’m enjoying critical care. In fact, I wake up each morning with an excitement to enter the hospital that I haven’t had since leaving my emergency medicine elective a few months ago. Certainly, I look forward to each day nearly as much as I dreaded another hour in the OR watching the intern dissect around the Triangle of Calot.
Here the patients are sick and frequently unstable. Here I study each evening with an extra fervor, alight with the chance that the ailing patient just around the corner from the ICU workroom might benefit from my late night research.
But as much as I take pleasure in each day, as much as I learn from every patient and team member, I find myself faced with no small amount of conflict. So many of our charges have little hope of ever escaping from the prison of mechanical ventilation. Too many require heavy doses of Levophed just to achieve some semblance of a blood pressure. We sustain life with CRRT, ECMO, and ARDSNet, all with end goals that seem paltry at best. I entered medical school with dreams of staving off disease and defeating death, but over the past few weeks I’ve questioned the cost at which we achieve our victories.