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.

Surviving to day 2

Well, I'm still alive. I didn't die of fear, which was just one of my many fears. The first day, night, and call couldn't come anywhere near the nightmares I had the night prior.

When I arrived at the MICU the first morning, the intern signing out to me said, "You're on call tonight? Good luck with that! I was scared coming onto this rotation as the last one of my intern year, so I can't imagine how you feel. Since you're the one on call today, you get to read all the chest x-rays during radiology rounds this morning. Oh, here's the code pager." At that point, I wasn't sure if I wanted to cry or vomit. I was wondering if I could do both when my co-interns showed up. There was work to be done, and if we focused on that, I found myself slightly calmer.

Anyway, I won't bore with all the details, but I can say that most of what people told me beforehand was true. The nurses and residents did take care of us, and we were well supervised. They made sure we ate. We didn't receive any pages until later in the day when we were more oriented, and the pages I received overnight were fairly simple. My resident and attending assured me they knew it was my first night and were available for questions. The nurses were fantastic and guided me towards what was best for the patient.

It would have been nice if someone told me that the code pager goes off every 12 hours just to test them, but there were no real codes. I heard there was a code in our other training hospital overnight, and the patient died. I wonder how the intern over there is doing.

I managed to get 2 to 3 hours of sleep here and there. While I probably could have had more, I didn't feel comfortable sleeping until I knew there was nothing else for me to do and was completely exhausted. I signed out after rounds late this morning. We have intern conference on Tuesdays, and while I know no one would have blamed me for going home, I went to conference. Intern conference is a support group for my class, and I wanted some intern support. It was nice to see everyone and hear how the first day went for everyone. While I have very supportive friends and family, no one knows what this week is like except for my intern classmates. We'll all get through this year together.

Trial by fire?

I received my schedule, and I'm on call in the MICU my first night! Yikes! Since I'm familiar with the computer system and the hospital, it does make sense in a way to have me be the one covering the sickest patients in the hospital instead of one of my new co-interns who doesn't know how to put in computer orders. Perhaps it's best for the program, but I'm not sure if it's best for me and the heartburn I've been having all week.

Here's a selection of responses I've received since finding out about the MICU:

That means the program trusts you! The program coordinator swore up and down that I hadn't done anything to offend her. If the program does trust me, that's great and everything, but I'm not sure what I've done to earn that trust. Remember that I'm interested in primary care. I've never done a MICU rotation, so I'm not exactly reading critical care textbooks in my free time.

Isn't it better to start in the unit to get it out of the way? Well, that's one way of thinking about it, but I know they're thinking, "Better her than me!"

Don't worry the unit nurses are so good. They'll tell you what to do! I hope so because I won't know what to do!

Part of me is excited to start. I definitely didn't want to start on something easy because after all this anticipation I'm ready to dive in with both feet. However, now forced to dive in with both feet, the wading pool (i.e. anything but MICU) looks pretty darn good.

I have to say that my program has done a great job with orientation. A lot of the annoying regulatory paperwork was done online, and we spent a good deal of time meeting each other. We had workshops discussing how to cope with the stresses of intern year, and we practiced procedures on models and cadavers.

A few people commented on how much nicer this week was than med school orientation. People are really interested in getting to know each other, and we have a lot in common. Not only are we all new doctors and interested in internal medicine but we were all drawn to this particular program. I dished with some people over dinner about their thoughts on other programs, and I was surprised that we had the same impressions.

I did purchase a critical care textbook this weekend, but I honestly have so many errands to run this weekend before I start living in the hospital that I doubt I'll get much past the first few pages. I'm honestly scared about Monday. The 8-hour or less orientation days have been exhausting me so my first 30-hour shift will be a bit of a shock to the system. *Taking a deep breath* However, I know that I'll have a lot of support. That's what I love about my program--the emphasis on teamwork. So, wish me luck!