Late Night

I know my blog has been dominated by MICU-related events, but when that's where I spend the vast majority of my time, I guess it makes sense. One of our Attendings, the great humanist Critical Care doctor John Hansen-Flaschen a.k.a. "The Flash", this morning likened our MICU rotation to being on a submarine...submerged for a long period of time under intense conditions with a group of people you get to know almost too well.

It's been an interesting call thus far. My intern Ali's first day in the MICU I'll have to characterize as a ringing success by any criteria. He's already faced a number of challenges today--having to present the largest service of any of the other interns (started the day with 5 patients), getting one new patient first thing in the morning, dealing with the Big Move the ICU underwent today, and having to put his first internal jugular central venous catheter ("central line") on an elderly patient who was flailing around in confusion during the procedure, which he carried out with resounding success! (I was actually quite proud of my contribution to the procedure: the idea to use some nursing tape to secure his head in an appropriate position so at least his neck was still while the rest of his body was writhing around).

Today's major issues: a chronic alcoholic going into delerium tremens (basically a bad form of alcohol withdrawal), a patient with severe congestive heart failure who may or may not be getting septic (still trying to get a handle on his fluid status), a man with pancreatic cancer coming in confused because his calcium level is through the roof (hopefully, something which can be easily corrected over the next few days), and a woman with a history of a bilateral lung transplant 10 years ago who's having trouble breathing because she's ever-so-slowly rejecting her lungs. There were two additional admissions slated to come to us from the Emergency Room, but they expired before they could even make it up...

At the moment I'm writing this it's 4:14am and I'm going to try and catch some precious zzz's for a short bit.