I dreaded the time spent in the ICU during my medical training. As a student, the management of respiratory compromised patients perplexed me. The doctors, and by proxy the residents and fellows that worked under them, seemed to protect their knowledge in a metaphysical way.
On rounds they did not teach but pronounced the dictums of acid-base balance, of patients being “wet” or “dry”, of respiratory rates and tidal volumes and of FIO2’s. And this was done while facing a device that looked similar to a MOOG synthesizer with dials and knobs, with flashing lights and toggle switches. I had to repeatedly remind myself that to the right or left of this hissing throbbing device there was a patient struggling for their life.
The compelling thing about medical training is that I knew, eventually, I would be in a position to make decisions regarding the myriad of things I was exposed to in the first four years of training. This did not always hold true but I could not discount the fact that it might be true. Because of this, I strove in the time allotted to each specialty to learn as much as I could to be as prepared as possible.
In this regard, ventilators hold a special place in my memory as an intern. The time came early one morning when the resident running the ICU decided he was desperate to sleep after being awake for several days. I was briefed on the future needs, as best as he could assert them, of the patients inhabiting every bed in the ICU. And then he left.
I stood there as if naked amidst the quiet chaos of the ICU, and thought that after a decade of intense study I was a complete fraud. That I had learned nothing of value in that time to help me help this cadre of patients survive and flourish. Of course, when in a situation such as this it is best to contemplate these thoughts inwardly and not to demonstrably breakdown.
I turned and surveyed the room. I noted the clock on the wall, only 5 hours left before rounds started. I said to myself, with the help of the superb nursing and respiratory tech staff, I could do this. I walked to each room, examined each patient, and studied their chart. If I had questions, I sought out the assigned nurse to discuss their patient’s care.
At first time passed glacially, but then events began to unfold and decisions were made. Before I knew it, I felt the resident rest his hand on my shoulder. When I finished my report, he thanked me. It was the last day I ever had responsibility in an ICU. I moved on to my next rotation, and never looked back except in a nightmare or two over the years.
April 2020
