My last day of palliative care was on Wednesday, and I'm now working at the opposite end of the medical spectrum in the ICU. The change between the two services has been one of the biggest mental shifts I've ever made in my training, and my brain is reeling from all of the details about ventilator settings and sedative infusions and vasopressor dosages that I'm suddenly expected to know. As horrible as it sounds, it was actually a relief today when one of my patients was transitioned to palliative care, as I finally had a clue what I was doing for the first time in two days.
As a medical student who wasn't expected to know anything and who had absolutely zero responsibility, I really enjoyed my ICU experiences. I loved the complexity of the patients, and my anal retentive side was thrilled by the hourly recording of every physiological parameter that is capable of being monitored. As a resident who is now expected to save people's lives, ICU is a terrifyingly awful miserable place. I spend my time willing my patients to not decompensate, as I feel utterly incapable of doing anything for them if they do. My heart races uncontrollably when a "Medical 25" (a prelude to a "Code Blue") is called overhead, as I know it's only a matter of time until the formal code is called and I have to go tearing through the halls towards an unknown crisis. I volunteered to see a consult today, and I was filled with utter panic when I arrived on the ward and it suddenly occurred to me that the poor unstable patient was dependent on me for his survival.
(Lest you think that the survival of all critically ill patients in my hospital is in the hands of one terrified second-year internal medicine resident, I will point out that there are numerous ICU doctors, nurses, respiratory therapists, and other people who are much more competent than me watching everything I do. It just feels like I'm personally responsible for everything that goes wrong with the critically ill patients.)
It's been a long time since I've had this feeling of utter incompetence, and I'd forgotten how horrible it is. I like to think that I'm making progress in my training, but then I'm faced with a new challenge that leaves me feeling like a third-year medical student setting foot on the wards for the first time. I long for a time in my life where I'll feel competent and on top of things, although this may be a pipe dream. Many attendings whom I've spoken with say that they're still plagued by self-doubt and uncertainty after years of practice. Great. Something to look forward to.
Once again, I haven't anything particularly profound with which to end my post. I know that things will get better by the end of my rotation, as they always do, and that I will survive this constant feeling of terror and despair. But I still hate it and find myself wishing away the next twelve days. I'm going to really deserve my vacation by the time it arrives.