This was easily my most emotionally challenging month of intern year to date. I watched patients receive life-saving organ transplants. I pronounced patients dead (and when I finally regained myself, I had to do it again… and again). I did bronchoscopies and arterial/central line placements. I worked with well-reputed physicians, residents, nurses, and ancillary staff members. And I remembered why I went into this field in the first place.
My co-residents frequently commented: “Hey, I saw your note on John Doe was started at 3:45 AM. WHAT THE HECK?!” The fact is, even on my inpatient wards month, I cannot separate work from home. It’s one of the reasons I went into anesthesia (LACK of continuity), but it’s something that makes me heavily vested in my patients’ outcomes and daily progress.
Much of the month went into treating the extremes of pathology and consequently learning about life-sustaining measures like mechanical ventilation, continuous renal replacement therapy, and vasopressors (hooray for Levophed and vasopressin). I also picked up some simple pearls like:
- Patients who are intubated because of increased work of breathing should only be extubated 36 hours after being mechanically ventilated to allow enough time for their diaphragm to reaccumulate its glycogen stores. Otherwise you’ll extubate and the patient will tank.
- Hypotension in TRALI (transfusion-related acute lung injury). Hypertension in TACO (transfusion associated circulatory overload).
- Short of the objective extubation criteria, it’s incredibly important that a patient can clear his or her secretions appropriately before pulling the tube.
- The flu is bad. Like bacterial superinfection -> ARDS -> intubation -> ECMO bad. Get your shot!
Having finished six months of my internship, I’m pleased with my progress. I feel like I can triage patients more effectively, understand pathology, and treat them appropriately. Of course, the next six months will be challenging in their own way, but my first six as a physician have been extremely educational… and even more humbling.