The surgical intensive care unit [SICU]

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination – a small room containing a couple desks and computers dedicated to mid-level providers – but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it is relatively quiet, aside from the occasional blips emitting from the numerous machines all the patients seem to be hooked up to.

As I peer into a patient’s room, I notice infusion pumps, a ventilator and an endless spanse of tubing coming from all directions. A monitor displays various waveforms floats at the head of the bed. The bedding has a wallpaper-quality pattern on it that feels oddly comforting, despite the patient’s weak body sprawled upon it.

I watch the patient’s chest rise and fall in a rhythmic, forceful manner. There is a line straight down the center where the surgeon gained access to the heart. A wave of awe washes over me as I think back to the open-heart surgery I witnessed earlier that morning – it never ceases to amaze me how we can stop the heart completely and miraculously bring it back to full function.

Turning my attention to the bustling healthcare team, I see a group of nurses, physician assistants and physicians discussing patient care. …should this drip be stopped? …my patient is in a-fib, what’s our next course of action? …I think this patient is ready to be transferred up to the floor. Every workstation monitor is filled with the EMR [electronic medical record] software, with its plethora of tabs, buttons and drop down menus.

I walk into my target room and start to read up on the patients we will be rounding on. CABGs [coronary artery bypass grafts], AVRs [aortic valve replacements], MVRs [mitral valve replacements]… these open-heart surgeries have become a part of my knowledge. Although there are non-cardiac patients within the unit, they are outnumbered.

Rounds begin when the cardiac surgeon appears; most of the time it’s at 9AM, but it can vary. He reminds me of the “stereotypical-surgical-type” – confident and assertive. But over the course of my time in the SICU, I grow to appreciate his personality. Most importantly, the teaching is top-notch.

We assemble our team outside of the first patient’s room. One of the physician assistants presents the case and paints a numerical picture of the patient’s status [vitals, ABG, electrolytes]. The surgeon probes for more information – …why was this patient extubated? …what can we do about these pulmonary pressures? – until he is satisfied. Then, the group walks in.

“How are you feeling today?”

“Much better. When am I leaving this place? I want to take a shower!” We chuckle and assure the patient that a shower lies within the immediate future.

Non-invasive reading [i.e. echocardiograms]

Today’s inane image of the day:

The Heart & Vascular Services at Beaumont Royal Oak have been headquarters for my summer cardiology experience [“internship”]. I can actually find my way around at least a small part of the hospital now!

Nine of us elected to do a Cardiology “internship” [I’m hesitant to call it a true internship as most of what we’re doing is like “advanced shadowing” since it’s definitely more hands-on than shadowing prior to medical school and everything makes so much more sense, however, we still aren’t doing as much as if we were doing a clinical clerkship] [more appropriately, it is a summer Cardiology experience] – and I hope I’m speaking for my group when I say that it has been tons of fun. As with most things, there are definitely high points and mundane points, but overall I am extremely happy that I elected to spend six weeks hanging out with the Cardiologists/Cardiac Surgeons.

Our particular program is setup such that our weekly schedule mimics a Cardiology fellow’s monthly schedule – basically, each week we rotate through a different service [e.g. inpatient, SICU, Cath lab, etc]. We are expected to attend noon conferences [and there’s really no reason for us to skip this – they provide lunch everyday] and Cath conferences [early morning on Tuesdays]. Additionally, each of us spends at least one half-day in clinic following our mentor [each of us were assigned an attending]. Finally, we are also assigned a fellow to follow around each week [the only exception is the SICU/surgical week] – from my experience so far, the fellow generally dictates our schedule outside of the “required” activities.

My first week was spent in “non-invasive reading” which basically translates into performing and interpreting echocardiograms. Imaging is definitely one of my interests so I was pretty excited to start off with this service. The fellow I was assigned to had worked with our TBL group during clinical case studies so I was already somewhat acquainted with him.

The schedule for the week was pretty much performing ultrasounds in the morning [both transesophageal and transthoracic], noon conference, then reading/interpreting the images in the afternoon. Although this may seem somewhat slow-paced… I thought it was an extremely appropriate way to start off, plus I was able to get some experience doing the transthoracic ultrasounds [not that we saved any of the images I got, but hey, I could totally do a mean four-chamber apical view!]. Plus, I’m a big fan of dark rooms with images [this is, of course, assuming I have coffee] [this does not mean I’m going to become a radiologist].

I thought that the best part of my first week was probably picking the brains of the fellows – it’s great to hear their experience going through medical school, residency then finally this fellowship [two of them actually took a year to be a hospitalist prior to starting their Cardiology fellowships – I didn’t realize that this was so common]. Their advice was priceless and they were just a lot of fun to hang out with.

Anyway, I have to get up early to make it to Cath conference – I hope you’re enjoying your summer [I know I’m loving the sunny days!].