Zebra hunting

One of my patients died. I was very... angry about it. Well, not angry. It was just that... we did a ton of workup and treatment on a guy that was toast. Y'know, it's very frustrating to be in a setting where we almost don't know when to stop. To me, my patient died at 6AM. The death certificate I'm sure will read sometime in the evening. The family was all torn up about it, and I guess I can understand. I'm torn up about it too.

Y'know, the one thing that I learned in medicine about life is that I'd like to die with a little dignity. I've seen too many people die too messy a death in the hospital. When I go out, I'd like it to be a little less nuts. Y'know, we spend our entire careers in medicine battling the inevitable.

Still, I went down to the coffee cart to try to get an espresso after work, to take the edge off the horrible taste in my mouth from knowing that my patient was alive yesterday and is dead today. I'm not sure if you've never been in medicine that you can really appreciate what it's like to know that someone in your care has done exceptionally badly, and is now dead. You detach yourself. You harp on little things.

It's impossible for me to concentrate, so I spent tonight playing America's Army. It's better than thinking about the whole situation and my aggravation with it. Y'know, the guy is dead, and we're still hunting zebras on him. And everyone feels comfortable with that, and that's the part that bothers me the most.

Y'know, I've greatly disliked my month in the ICU, because it has single-handedly gone against everything I've ever thought about medicine. We order million dollar workups on everyone that comes through the door. We order so many tests that tracking them all down is next to impossible. We order tests that take days to come back for questions on acute management. Everything in the ICU is a zebra. We spend no time with the patients. I've actually written a note on a patient, and only realized after rounds that I had not done a physical exam. We treat numbers almost exclusively.

I wish I was back on my sub-internship. I liked seeing my patients. I liked taking care of them. My ICU patients, a good number of them got better, but I certainly don't feel any better about it. And maybe that's because I really can't say for sure that we actually did anything to help them. I'm willing to bet that aside from the vent, they did it all themselves.

My resident couldn't believe I wanted to do general medicine, but the thought of doing critical care for a living makes me nauseous. Y'know, people talk about lifestyle and pay and all that stuff, but in the end, you have to do a job that at the end of the day, you can go home and sleep at night. I think about the ICU, and it makes me ill.

I have so many criticisms of my ICU experience that I wouldn't know where to start, but I guess in the end, my biggest problem with it is that you would think that the ICU is where you get the absolute best care in the hospital, and the truth of the matter is that if not for the nurses, I'd never admit anyone to the unit.

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