Sitting in the Medical ICU at the VA on a Friday night wouldn’t necessarily be much fun…honestly, i’m not sure it is either. However, there is nothing more enjoyable than eating your dinner, from Jimmy Johns, at midnight no less.
As a fourth year med student, you are a ’sub-i’. Basically, the sub-i is the year before you first year of residency, aslo known as your internship. This is the time you are supposed to assume complete control of patient care all the while being supervised by an upper level resident. Honestly, i’m not sure how well i’m doing at assuming the care completely, but it is definitely nice to have the decision making capacity. After third year, where it is a struggle to just do a simple SOAP note (a daily note in the chart) and find things like the vitals and how to use the various computer systems at the hosptials it is nice to finally have some, albeit just a little, comfort in taking care of your patients.
This is my first experience in the ICU. It hasn’t been too bad at all, but there is definitely a lot to learn! I’m on call this evening; it’s a Q4 system at the VA ICU. So, every fourth day we are on call which means we start at 7am and stay until about 12 or 1pm the next day ~ a 30 hour shift. Really, we are on call whenever our senior resident is on call. It’s amazing how variably busy the nights can be. The first few nights, we had quite a bit of down time, which allowed us to get a few hours of sleep; however, other residents have had no sleep on their call nights. For us, tonight has been a ‘tweener. I’m hoping to go lay down for a few hours after this, but after seeing my dinner time, I’m sure you can assume how busy the night has been. It’s become a bit of a ‘ritual’ – nights i’m on call, I like Jimmy Johns, not just simply because they deliver.
I figure, before I go, that i’ll fill you in on what i’ve been up to in the ICU tonight and these past few weeks. Tonight we had a patient ‘code’ which means his heart went into an abnormal rhythm and he lost his pulse. When this goes out over the hospital intercom, it’s quite a mass of people taking off running to help at the code. As a medical student, we don’t get to do a ton at the code (even though we’ve had the ACLS training) - we need to learn how they run and do whatever is necessary to be helpful. With that being said, I was at a code earlier this week and did get to do chest compressions. We’re hoping the patient from tonight does better, but any time a patient codes, they have a tough road ahead. On top of these two events, i’ve had a variety of other patients including one patient with severe sepsis and another patient with new onset diabetes. He didn’t know he had it until he went into Diabetic ketoacidosis - a decompensated state that can truly be fatal if not caught in time.
Overall, the VA is a fun place to be a student and being in the MICU with the higher acuity of care has definitely been a challenge. But, with that being said, i’ve felt more like a part of the team this month than on any other service. It’s nice to get more control over patient care, all the while, being supervised by an upper level resident and the attending. Overall, though, it’s simply a nice reason to enjoy a Jimmy John’s sandwich “Q4″.
