They don't call it the Intensive Care Unit for Nothing

Posted by Jenna at Sunday, September 18, 2011

This week was an interesting one for me:

• I played private investigator. A patient came in with SEVERE rhabdomyolysis (muscle breakdown) and for his first 2 days in the ICU nobody could figure it out. Thankfully, his daughter was able to bring in his medications, which gave us some insight & the answers we were looking for.
• I had to identify about 12 pills that were loose in a pill box.
• There were about 6 bottles of medication in a small bag.
• There were about 30 bottles of medication in a huge gift bag.
• I kinda, sorta watched a tracheostomy be placed. I was outside the room but was still kind of observing. Once patients have been vented for ~8-10 days, the team starts considering a trach if the patient isn't able to be weaned off the ventilator.
• I truly felt like part of the team. Starting at the end of my 2nd week, I started to do my work in the ICU, rather than going back to the main pharmacy. Well, the saying 'Out of sight, out of mind' is completely true. When the residents see me on the floor, they actually seek me out to ask questions .. that really makes you feel like part of the team. It's a good feeling!
• I've lost count of how many patients have died in my 3 weeks in the CCMU. It's been about 8. :-(
• I've been having some fleeting thoughts about my interest in psychiatry. I've had 1 & currently have 2 psych patients in the unit. I find this patient population interesting but I also have a lot of empathy for them.
• I saw an autopsy. A young patient who was going to come to the CCMU coded and was unable to be resuscitated so the team wanted to go to the autopsy. The patient didn't have a significant past medical history so no one really knew what happened.
• I have a stronger stomach than I thought. Luckily, it didn't really smell because I think that would've really bothered me.
• The patient was already all cut up when we got there so we were mostly observing the analysis of the organs. 
• Warning - this may be too graphic for some: It's kind of indescribable .. how it feels to be right next to a dead body laying on a table. The head was cut open to remove the brain and the chest was wide open, with pretty much only the ribs and spine remaining. I was able to see the brain, kidneys, liver, & lungs. Sadly, they had already analyzed the heart before we got there so I didn't see that.
• I know what it feels like to truly care about your patients. Now, I've never not cared .. but I just feel so personally invested in my patients' outcomes. On rotations, we're technically not required to follow our patients on the weekends but I haven't been able to stop myself. I feel like I need to know what's going on with my patients.
• For example, the same patient who's medications I went through, is the patient that I've been looking at a lot obsessing over. He had been taking a combination of Simvastatin, Cyclosporine, & Itraconazole .. yikes. His CK (creatinine phosphokinase) levels had been steadily rising to about 120,000 (normal value is <400). We have been waiting for it to start downtrending  (to prove our theory that his rhabdo was drug-induced) and it finally did today! I can't tell you how excited this made me! Dork? Yes of course but I don't care! 

Here's to my last week in the ICU, may it be less eventful than it has been so far!