Let's Play "Spot the Omen"

Week two of this final level of school has come to a close.

I had the first day of my latest clinical rotation today. This time around, I'm at the medical intensive care unit at the teaching hospital associated with the university.  My clinical instructor works in the trauma ICU. There is a clinical group there as well. A third clinical group went to the ER. (I'm happy not to be in the ER.)

We came up to the ICU lobby--the neuroscience, trauma, and medical units share a large, main lobby--and as the instructor was explaining the layout, two men in suits and a nurse in scrubs came out of one of the set of doors, joking and laughing with each other. One of the men was pushing a gurney, on it a corpse covered in a gray blanket. 

We dropped our things in the break room and toured the unit, looking into patient and med rooms, equipment rooms, utility areas, and so on. It's an intense environment, overwhelming. We checked in on a couple of patients. One patient was completely unresponsive, hooked up to almost every kind of machine you can imagine. Five IV pumps controlled the various substances going into his bloodstream. A machine first inhaled and then exhaled for him, endlessly, replacing his whited-out lungs. One tube fed him. Other tubes carried the waste away. It took three people to turn him on his side and prop him up with pillows. (This helps to prevent skin breakdown and pressure ulcers.) They carefully checked over every part of him. Don't ever let anyone tell you that modesty is not a modern construct.

In a room nearby, another patient was alert and responsive. He was hooked up to a machine that runs continuously but instead of breathing for him, every minute four liters of his blood exit his body through one catheter, loop into the machine where it's mixed with oxygen, then it re-enters him through another catheter. On the way back to his body, it takes a detour into another machine that removes the waste that the kidneys normally remove. He came in six weeks ago with the flu--that nasty flu that we heard warning after warning about--then his lungs shut down. It will take a miracle, the nurse said. She said this to us outside the room, of course. (I'm not entirely sure yet, but it seems to me that in the ICU miracles don't function the way they do out of the ICU.) I don't think anyone's broken the news to his family.

Get your flu shot.

While explaining the machine that oxygenates blood, the instructor veered off into a story about a young woman who spent 77 days hooked up to that machine. They ran test after test and no one could figure out what was wrong with her. The CDC came in, then went out again. Day after day, her equally young husband came in and sat by her side. After 77 days, her equally young husband and her family made the decision to remove her from the machine. She died within three minutes. The instructor told us this story and choked back tears at the end.

It was a short day, but the environment is so overwhelming that it felt like a million years. In between looking at room after room of equipment that seems so essential that the patient is almost superfluous, we did bookkeeping things associated with our rotation. We tried and failed to get our user names and passwords for the charting system established. We tried and failed to get badges that open the various doors, including (importantly) the staff bathroom doors.

There are a couple of ridiculously annoying people in my clinical group this time. I've only worked with one of them before, a couple of levels ago. She was bad enough then, loud-mouthed, self-centered. It hasn't gotten better. Last term she did the psych rotation in the same unit I was on but she was there on different days than I was. She was so annoying that one of the staff members confronted her and had her removed from the unit for the duration of the rotation. And here she is again. The other annoying woman is just young and stupid. Those are her main faults. Everyone is so tired that that's enough.

I have a paper due tomorrow at midnight, then three exams and a paper due next week, so my weekend is mapped out for me.  Today though, I came home from the hospital, left my shoes and scrubs outside, got back into my pajamas, and put on an episode of Frasier.

That was nine hours ago.