Heide says I’m happiest working in the MICU, and she’s right. I love the physiology, the drama, the stories, the teaching, and the teamwork. I’m halfway through a 12-day stretch, and today I’m going to share a half dozen semi-random lessons from last week:
- Read the old chart: Patients are admitted repeatedly for the same problem. Clues are buried in notes from past hospitalizations, ER visits, and office notes. Get your shovel and dig them out.
- Round in the room: Patients may not understand the lingo, but they love listening to the conversation. Rounding at the bedside builds trust and shows you care. If the patient is awake, go in, and remember to explain what you said before you leave.
- No mysteries allowed: There has to be a reason your patient needs more oxygen, more norepinephrine, or more propofol, and it’s your job to figure out why. Once you diagnose the problem, the treatment becomes obvious. Don’t walk away without a viable explanation.
- Speak to your consultants: I’m amazed at the time wasted trying to divine why neurology wants higher BPs, ID wants a CT, or GI wants to scope. Ask them. Better yet, invite them to rounds.
- Listen to your nurses: Nurses know when a patient is ready to extubate, sit in a chair, or leave the unit. Nurses are always the first to detect skin breakdown, delirium, and retained urine. Like oracles, they predict problems before they happen. If a nurse is worried, you should worry too.
- Embrace joy: Last week a patient’s wife brought in a platter of pickles. The homemade garlic gherkins made our day.
Residency is the time for each of you to discover where you belong. For me, it’s the MICU. For others, it’s the hospital floor, the procedure suite, or an outpatient office. You’re each destined to find the place that will bring you joy, where you can do the most good, and where you can tell yourself every day that this is the place to be.
And now, I’m off to join Tania, Candice, Ahmed, and Maddy in the unit, but first a quick stop at Whitney Donuts to get some fuel for the team.
Enjoy your Sunday, everyone,
P.S. What I’m reading: What Thoreau Heard in the Song of the Crickets