Hi everyone,
Just a quick Note before biking in for my last day in the MICU. It was a rough week in some ways. We may have set a record for CMO orders. At one point, we paused rounds to consider which Ben & Jerry’s flavor we’d risk aspirating if we failed a swallowing evaluation.* More on that in a coming Note.
We also placed lines, heard murmurs, and found spiders (in the skin). We unraveled mixed acid-base disturbances and complex hemodynamics. We calculated lung compliance, airway resistance, dead space, cardiac output, and stroke volume. We diagnosed HLH, hyperammonemia, spurious hypoxemia, and the Warburg effect.
We also learned important lessons like these:
- If you don’t understand a consultant’s note, call them.
- New problems aren’t always new. They inhabit the old chart.
- Ask the nurses what they think.
- And the pharmacists.
- And the respiratory therapists.
- If a patient on propofol is hypotensive, stop the propofol.
- To make a pharmacist smile, narrow the antibiotics.
- For a bigger smile, stop them completely.
- NPO + no free water = hypernatremia.
- NPO + no dextrose = hypoglycemia.
- If a patient doesn’t respond to your voice, shout.
- If a patient doesn’t follow commands, try Portuguese.**
- If a MICU nurse is worried, you should worry too.
- Radiate serenity, no matter how you feel inside; serenity is contagious.
- Consult palliative care.
Thank you Katie, Miriam, Gabriel, Beatriz, and Victor for a great week. Tomorrow morning, Francesca and I are off to Maine for our annual father-daughter vacation.
Yours,
Mark
*Cherry Garcia
**It doesn’t work for everyone
P.S. What I’m reading:
- Thinking Is Becoming a Luxury Good By Mary Harrington
- The 2 Beliefs Driving Conservative Health Care Policy By Sarah Kliff
- Luckiest Man: The Life and Death of Lou Gehrig By Jonathan Eig