what all the fuss is about
Finally, I'm in. The PICU. I've been waiting months to see what all the fuss is about this place. I've listened to other resident's war stories about working in the PICU, like, "oh my god, were you there the night when..." [fill in catastrophe]. I've had patients from the floor and the ER that I had to transport to the PICU emergently because they were septic, or seizing, or decided that breathing was boring that they'd rather not do it anymore. It's the only place left in the hospital that I haven't rotated through yet (well, except for, like, Radiology or places like that), and I was psyched to finally be a part of the action.
But people, our first day on service, morning rounds lasted for nine hours.
Nine. HOURS. On a Monday morning! How are we supposed to get anything done around here?
It was both interesting and disorienting, as first days often are. Every time I switch to a totally new rotation, I feel like a third year medical student all over again. I don't know where anything is, I'm getting in the way of useful people doing their job, and I feel like the most clueless person in the whole unit. Actually, as the most junior resident on-service, that's probably spot-on accurate. Even the Sub-I had started a few weeks before me and knew more about how things ran than I did.
In some ways, I really didn't mind being on call my first night. Kind of a trial by fire. Though it did make me a little nervous that the fellow one-call was a little difficult to locate at times. Not that anything catastrophic happened, mind you, but I felt extremely underqualified to handle some of the things these kids were doing. With the exception of a few, everyone on the unit seemed like they were dying in slow-motion. Though some were slower than others.
We withdrew support from one of our patients last night. I guess this must happen all the time on Medicine, but as a Peds resident, it was the first time I'd ever actually seen it happen. It was a little confusing to me to what exactly was going on, as he had been full-code just a few hours ago, requiring just that--chest compressions, epi, the whole song and dance. But apparently, afterwards, the fellow and attending spoke with the kid's mom and decided that should the situation arise again, it might be better not to put him through it all and instead just let him go.
Around midnight, the nurses were yelling for a doctor in his room, so I ran in there to help. He was bradying down. I thought we were going to start chest compressions again, like we had earlier in the day, but then the fellow came into the room and said, very calmly, "Let's turn it all off." So we did. We turned off his vent. We turned off the alarms. And we watched his heart rate slow from 70s to 50s to 30s, until the all the multi-colored tracing on the monitor went flat. The hospitalist covering the patient overnight looked at a clock and read the time out loud, quietly.
I'd never watched someone die before like that. I suppose in some ways he was dead already by the time I came on service, but I mean I'd never been there at the moment that the acutaly machinery itself stops, and everything grinds to a halt. In some ways it was a lot less dramatic than you would think, though there was a real cognitive dissonance in watching all those numbers on our precious, precious monitors drift downwards, alarms beeping and buzzing until manually inactivated, with us standing there and doing nothing. Not that there was anything to be done. But it just felt strange.
So there was that kid. And the fourteen other kids on the unit next to him. And the fifteen other kids on the other side of the PICU. I feel like by the end of this month, I'm going to forget that there are any normal, healthy kids anywhere in the universe. What, aren't all kids septic, dialysis-dependent, and rejecting their second heart transplant? Sure seems like it.
Currently reading: "Angels and Demons." I'm not really blazing through this book at my customary speed, because I got a ride to work on Monday morning (therefore no subway reading time), and I was so tired post-call that I took a cab home and went straight to bed. But I read five pages before I passed out, so there.
Tomorrow: An update on our "Queer Eye" video interview!