Wednesday, February 3, 2010

Culture Clash

The new year has me starting off with back to back rotations in the Intensive Care Units. Last month it was Surgical ICU (SICU). This month it’s the Medical ICU (MICU). Let me tell you – the only thing these units have in common is the name.

Now it is common knowledge that Surgery and Medicine clash in their beliefs about patient care. And I am not one to bash other departments because, well, that’s just neither nice nor productive. But man, my two experiences couldn’t be more different.

The SICU was intense. Patients being rushed to surgery with dead bowel, opening up infected wounds at the bedside, procedures on the great vessels, chest, lungs – it was literally a matter of bringing people back from the brink of death. Take M.W., a 45 year old man with, as they say, really bad protoplasm (read: shitty luck or bad genes, you decide). He had a family history of hypertriglyceridemia (a type of fat in the blood). Although he had been followed by doctors and was compliant with his medication, one day his pancreas just gave up. He developed the worst case of necrotizing (dying), hemorrhagic (bleeding) pancreatitis (angry pancreas) that I’ve seen in my short medical career. In the month I was in the SICU, he was taken to the operating room 5 times, had 3 bedside debridements of dead pancreas, was coded and received full CPR twice. He repeatedly dropped his heart rate to the 40s. He had also been living with an open abdomen for 3 weeks. Every day on the service I thought for certain, “This man is going to die.” Today, longing for the company of my surgical colleagues, I ventured down to the SICU. And guess what? M.W. is breathing on his own, talking, off life-sustaining blood pressure medication and most certainly will walk out of the hospital. Wow.

The MICU is a different story. Now if there is ever a place that will make you depressed about the state of the world today, it’s here. In my 1 week on service, I have seen 3 suicide attempts (one via antifreeze cocktail), 1 drug overdose, 3 end-stage complications of drug and alcohol abuse, and a crapload of patients dying from cancer, heart disease, and stroke. Of course, there were a small handful of patients who actually got better. The frustrating part for me was that all of these patients had issues, psychiatric or medical, that a trip to the operating room couldn’t fix. As MICU residents, our only tools are an arsenal of drugs and the tincture of time. There are wonderful physicians who are smart and patient and love the thinking behind this type of patient care. God bless ‘em because for me, thinking is simply not satisfying without the doing. I guess I’m just built like a surgeon.

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