Goodbye, MICU! Hello, wards!

Oh man, my last overnight call in the MICU was pretty rough. No sleep. All my other nights I slept at least 45 minutes to an hour, but the next morning I took the advice of my attending and just kept moving because if I stopped I would realize how tired I was. It's really my own fault for not getting any sleep. If things aren't too busy, I usually update future discharge summaries and note templates until 1 or 2 am. If all is quiet then, I aim to sleep between 2 and 5 am, but if a patient starts becoming unstable around then, sleep is hard to come by.

After a week on the wards, I surprisingly find myself missing the MICU. There's a wonderful sense of teamwork among your fellow interns and residents as well as with the nursing and support staff. They were all my new best friends because we depended on each other so much, and now if I pass by one of them in the hallway, we chat as if it's been years since we've seen one another.

However, there are things I don't miss about the MICU:
1. Overnight call every fourth night. It wasn't so bad at the beginning, but the sleep deprivation towards the end was making me a grouch.

2. Carrying the code pager and being on the code team. Although I had the code pager, codes were always announced on the overhead paging system first. I still get a catecholamine rush whenever there's an overhead announcement even though nine times out of ten it's something like "there will be a nondenominational mass held in the chapel at 11 am." Going to codes was fine because my role was well-defined (chest compressions, get an ABG, fetch anything that someone yelled out), but the constant state of readiness was exhausting.

3. Calling family members to let them know their loved one has taken a turn for the worse. I don't mind talking to families. I usually enjoy it, but breaking bad news isn't something that I want to do. It comes with the MICU territory because all the patients are so sick.

It's a bit of a shock to be on the wards again. My patients aren't intubated. They can talk to me, walk to the bathroom themselves, reposition for me to examine them, and often complain about the quality of the food. After being in MICU, these patients barely look sick to me, so I'm working on recalibrating my eyes. I can't say that the schedule is loads better than the MICU because some days I went home relatively early from the unit, but I can't emphasize how nice it is to sleep in my own bed more often.

Being "Doctor" Jess

One of my first nights, a patient's family member came up to me and asked if I was one of the doctors, and after a confused paused, I realized that the correct answer was "Yes!"

I haven't yet introduced myself as "Dr. ____" to anyone yet. It's still too strange to me. I usually just state my full name and then say "I'm one of the doctors in the ICU." I've only signed my name with "MD" a few times and only when it seemed necessary to say explicitly that I'm a doctor, such as death paperwork. For my charting, I just stick with "PGY-1".

As hesitant as I am to shout from the rooftops that I'm a doctor. I'm realizing how much I love being one. My worst experiences in medicine have been when I just followed orders instead of questioning the plan set by my residents and attending. In the ICU, I'm on a great team that values my opinion. When I say I'm concerned about my patients, they listen, and we discuss the best course of action. It's hard to believe that I only have two calls left in the ICU, and then I'll likely be on the wards, which will present a new set of challenges.

Outside the hospital, I've been making an effort to see my husband and friends. There have been definitely sacrifices, such as missing a friend's out-of-town wedding and not seeing my husband everyday. However, this week after my usual post call nap, I went to see the new Harry Potter movie and have a delicious meal in Chinatown. Despite the constant exhaustion, I never regret going out. It makes me feel like a normal person for a little while. Even working up to 80 hours a week (and it's pretty close to that), I haven't had to sacrifice all the joys in my life. My Tivo keeps all my favorite reality TV shows, such as So You Think You Can Dance, for me, and I've been rereading my Harry Potter books in my spare time.

It's taken me three times as long to figure out what to say in this post. What am I really trying to say? I'm surviving, and it's not so bad. It's actually pretty darn good.

As the sleep deprivation sets in

I woke up this morning and thought, "I can't believe I'm on call again tomorrow. Wasn't I just on call the other night?" Yes, I was just on call Saturday night and again tomorrow night. That's the beauty of a q4 call (every fourth night). On my noncall days, I used to stay in the MICU an extra hour to do paperwork--update notes, discharge summaries, or the signout, but now when the resident suggests I go home, I say thanks, grab my bag, and run out the door.

I now recall during intern orientation an excellent talk about sleep deprivation. The presenter said that trying to judge how impaired you are when sleep deprived is as accurate as doing so when you're drunk. During one of my first post call days, I woke up from my nap and tried to cook some dinner for me and my husband. I thought I was fine after my nap, but I ended up burning my arm on the oven door! How bad was my reaction time? I have a very nice, painful, second-degree burn to remind myself that I'm a poor judge of how impaired I am post call. We eat out now on post-call days!

I'm going to sleep earlier and earlier every night trying to remedy the sleep debt, but the truth is I'm just plain tired most of the time. I have 3 more calls in the MICU but I honestly don't think being on the wards next is going to be any easier on my sleep schedule or social life. All I'm thinking about now is seeing the new Harry Potter movie on my post call day. Just one more 30-hour shift until the movie and a day off!

And on the seventh day ...

I'm resting. There are so many things I could write about because this week has been full of firsts and emotions. Off the top of my head ...

I did my first procedure this week. I was finishing up my work at the end of the day when my resident text paged me, "Get over here. You're doing a lumbar puncture." I had never done one before, but I had seen a few. To make a long story short, I did it! What I felt when I saw the cerebrospinal fluid coming out from the needle in my patient's back was disbelief. I couldn't believe I had done it. My resident was like a proud father running around the ICU telling anyone that would hear that his brand new intern did her first lumbar puncture on her first try. It was pretty cute. I got a lot of pats on the back, and I'm pretty sure that's the closest I'll ever get to feeling like a rock star.

The down side of my rock star moment was that I was very late for my friend's birthday party. I was also dead tired and barely able to hold conversation with an awful tendency to talk about my lack of sleep and little else. I felt terrible because we had purposely arranged the dinner for the night before I was on call (logically known as the "precall" night). Typically your team tries to get you out early on your precall night so you can get a good night's sleep before your overnight shift. What my friend and I hadn't anticipated was my co-intern being off on my precall day, which meant that I was covering the whole service by myself, and things were pretty busy.

As I enjoy my day off, I know that my co-intern is now feeling what I went through on Thursday and Friday (his post call and off days). While the time off is well deserved, it comes at a price. Someone has to take care of my patients every minute I'm not in the hospital. At night plus my post call and off days, one of my co-interns is taking on my load so that I can enjoy my time out of the ICU. I do the same for them. We are all dependent on each other, and I'm with a great group of interns in the unit. We're still trying to find out the best ways to help each other because we're all new at this, but we are all helping each other. This dependency on my teammates is something new for me. As a medical student, sometimes you're a bit extraneous. You're there to learn, and if you can do some work to help the team, then that's great. However, the team can run well (and likely more efficiently) without you. You're sent home way before the rest of team because you have books to read and tests to study for.

After my call yesterday, I got home and slept until 5 pm. My husband and I went out for a wonderful dinner outside on a restaurant patio. I enjoyed actually being outdoors, and he and I talked for hours with each other. There was so much to catch up on! I have no definite plans for today except to relax and maybe read a little bit about ICU management of patients. I want to cook a meal in my lovely new, under-utilized kitchen, call my mother, and deposit my first paycheck. Otherwise, I'm a little surprised at how ready I feel to dive back into work tomorrow morning.