I’m officially finished with my MD Anderson ICU rotation and looking forward to my next rotation on the cardiac transplant and ventricular assist device ICU service at Texas Heart Institute. Working with critically ill cancer patients showed me the importance of prioritizing problems, many of which aren’t even medical in nature.
Patients can present with sepsis, develop shock requiring vasopressors, multiple electrolyte abnormalities, various infections, mechanical ventilation requirements and/or the need for continuous renal replacement. We often times (and rightfully) become so preoccupied with the imminent, life-threatening issues that we forget to address what actually matters to our patients.
One of the most important lessons I learned as a medical student was talking to patients very openly about their concerns and hospitalization. What do they consider to be their biggest problem? Do they understand what and why we are doing certain tests/procedures? Often times it’s not what we think.
I’ve been routinely asking my patients what they feel is their biggest problem.
“Doc, I just want something to wet my mouth. I know I’m sick. But my mouth is so dry I can’t even talk.”
If the patient is strictly NPO, I’ll explain the rationale behind our concerns and potential consequences we are trying to avoid. Otherwise, I’ll definitely do whatever I can to ease the patient’s suffering… even if it’s providing a slurry of ice.
Over the next month I’ll be learning about extracorporeal membrane oxygen (ECMO), ventricular assist devices (VADs), cardiac transplants, and a whole plethora of other critical care topics. I’m looking forward to it! 🙂