1st week in CCMU

Posted by Jenna at Tuesday, September 06, 2011

"Bravery is the capacity to perform properly even when scared half to death." ~Omar Bradley

Monday, I met my preceptor, Dr. Alaniz, around 8am. I'm on rotation with one of my classmates, so she and I went up to the cafeteria to talk with him about the rotation. He gave us more detail about the unit and the patients they typically see. Oh yea, and he also started quizzing us right away. I think that made us both scared to death right off the bat. We were able to answer some but most of them left us feeling pretty dumb. After we met with him for about 90 minutes he sent us to start working up 2-4 patients each.

CCMU (critical care medicine unit) is a 20-bed unit with 2 teams. On each team is an attending (the head doctor), a pulmonary fellow (residency graduate undergoing more specialized training), medical residents (3-7 years of training following internship), medical interns (1st year out of medical school), and M3's/M4's (medical students equivalent to P3's/P4's).

We each randomly chose an attending and will be sticking with that team for the entire rotation. Each team is on call every other day (from 6 am to 6 am), meaning that new patients that come in through the ER or are transferred from another floor get picked up (followed by) the team that's on call that day. While it's only a 20-bed unit, Friday we had 28 patients, meaning that some of our patients were in the other ICU's. Monday and Tuesday were so incredibly overwhelming to me. When I was working up my patients, I had to look up what felt like every other word/acronym. I spent so much time trying to figure out what was going on with my patients that literally the only thing I did with their medications was write them down. I hadn't identified why they were taking it, if the dose/timing was appropriate, if there were any drug interactions, etc. Well, crap, that's what I'm supposed to be doing! Add to that the fact that I went on rounds by myself the first 2 days .. I was just a nervous wreck.

The first two nights I barely got 4 hours of sleep/night because my heart was racing, my mind wouldn't turn off, and I was just feeling dumber than ever.

Thursday, I started to feel a bit better. In the afternoon, we had a discussion with our preceptor about sedation, analgesia, & delirium based on an article we had to read. He told us that we both did a great job during the discussion so it was nice to get some positive reinforcement. Also, our PGY-2 Critical Care resident started his CCMU rotation Thursday. It's nice to have a familiar face around!

Wednesday and Friday were also a bit rough on me. Wednesday, I was in the room when a man was told he had a few days to live. He had been hoping that he could die at home but the attending empathetically told him that he would not survive the transport home. It was a very hard conversation to witness and I had to be sure to hold back tears that were building up in my eyes. Sadly, this patient died at the end of the week.. It was unfortunate that he passed before his family from out of town could come say goodbye. He had also requested that his dog be allowed to visit him in the hospital but sadly he passed before the appropriate measures were taken for that to happen (verifying the dog's vaccinations). Friday, I also had to hold back tears. It's hard for me to see people crying/grieving but it's especially hard when I see men crying. A man about my age was visiting his dad with Stage IV cancer that was complicated by an AKI (Acute kidney injury) and from 2 rooms away I could see that he was crying as he held onto his dad's hand. Luckily I didn't lose it but I felt like I was going to. Sadly, that patient also passed.

I know death is a natural part of life but it's also something I don't think I'll ever grow accustomed to. I know medical professionals can't save everyone and don't have super powers .. but I wish they did. I lost two 'young' patients this week and while I never developed a relationship with them, other than following their meds/labs, their deaths have affected me. They were 2 people who still should have had at least 20 more years to spend with their families and friends.

I'm not looking forward to these similar situations over the next 3 weeks but I am looking forward to feeling less lost and confused. There is such a huge learning curve, especially with inpatient rotations. When I was a P1, P2, and P3, I thought P4's knew it all .. but I can tell you from personal experience, that we hardly know a thing. The situations and the complexities of real patients is something we don't learn how to manage in class .. so the learning curve is more of a steep, steep mountain!