ICU at the Clinic

This week, in addition to working on my research project at the Cleveland Clinic, I will be doing rounds in the ICU with the physician that I work under. It's only been two days and so much has happened so far. Maybe I have so much to reflect on because I've been removed from medical school for a month, or maybe I'm just seeing things that I haven't seen before. Regardless, it's worth quite a bit of reflection!

I go on rounds in the ICU, where my physician is treated like a mafia boss. The rest of us are below him: fellows, residents, interns, PharmDs, and lastly me. Each day, rounds happen in the morning to fill in the big physician with what has happened since he last left (and everyone else stayed up all night handling). On my first day, I was filled with excitement. I was going to be part of a medical team! Finally what I had been dreaming of this whole year: applying my knowledge to real patients! We started with a very ill patient, especially ill even for the ICU. I started to feel really comfortable and dare I say confident in my knowledge as I answered some of the questions that the big physician asked the team. I started thinking, "Hey I can do this! I actually know some of this!" I started answering questions about Fick's law, West zones, oxygen consumption, and hypoxic vasoconstriction; woa look at me was what I was thinking. As the physician started asking more challenging questions (that I felt less confident about answering), the lower levels of the team (interns, me) started to notice that the patients blood pressure (normal 120/80) had precariously dropped to 50/20 and was dropping despite pharmacological intervention. To my surprise, no one in the team was really surprised by this. Someone made a passing comment about how there was nothing else to be done, and ROUNDS CONTINUED AS THIS PATIENT DIED. I didn't know what to do with myself. Should I pretend that it's not a big deal that I was watching this woman pass away? Should I try and fit in with the more experienced team members by continuing to answer questions? Even though there was nothing that could have been done for this woman, I still struggled with how little care there was for this fact. THIS WOMAN IS DYING AND NO ONE IS DOING ANYTHING. No one was even holding her hand as she passed away. She died minutes later, without her family, and without anyone except for the nurse to record her passing. Rounds continued, we joked about the patient who tried to overdose on Viagra, and no one mentioned what had happened. I started thinking, how does one ever get used to this. Even more, how do you ever get to a point, where this patient's death doesn't affect anything? More so, is this something that I WANT to achieve through my training? We also met a patient who was under comfort care life support, there was nothing else to do to help him, because he wanted to wait for his son to fly in from Europe to see him before passing away. This was presented by one of the physicians as a matter of fact: son arriving today at 6pm, per patients wishes. Is it so wrong that I started thinking about this man's life, the son when get got the news that he would have to fly into the US to say goodbye? Am I too sensitive?


I survived the first day of rounds and looked up as much as I could before the next morning for rounds. Overnight four of the patients we had seen passed away. I couldn't even remember what they looked like. No thought was really paid, just a brief mention, and we moved on to the new patients admitted to the ICU. Although I didn't see anyone pass away this morning, two codes were called. These physicians really are "ON" all the time, making diagnoses then rushing off in an attempt to revive a crashing patient. A patient passed away before rounds began. The patient's daughters saw my big physician doing rounds and came up to him. In front of the entire team, these grieving patients attacked him telling him to "get that fat stupid smile off his face" and that "he should be ashamed to call himself a doctor." My physician, my boss, the mentor for the entire team just stood there and took the verbal abuse from these women who had lost their mother. All he said was "please do not raise your voice in the ICU." Even though I recognize that these women were searching for a way to deal with their grief, albeit through placing inappropriate blame, I was really taken back. My boss, one of the most decorated physicians in one of the world's best hospitals was being told off in front of HIS team of students and he didn't do anything. I was so uncomfortable to watch this happen. Once the women were removed from the ICU, rounds continued as usual as if nothing had happened. I couldn't help but wonder, what kind of profession IS THIS? Where the most successful physicians who have dedicated decades of their life to their career still get insulted? It must have taken so much humility and profesisonalism for my boss to handle the situation the way that he did. And yet, I doubt I would be able to do the same, even after all the years of training to come!

Goodness! And I still have the rest of the week to go in the ICU! Keep your fingers crossed!