Resident Life in the ICU at St. Joseph Regional Medical Center, South Bend, IN.

Howdy, my name is Bruce and I wanted to spend some time with you sharing my experience in the ICU here at St. Joe. As a third year resident, life as a resident is quite different from other years in that you have more responsibilities and expectations placed on but you also get to do the things that you feel passionate about. I have decided to become a hospitalist so working in the ICU is the place to really grow and be challenged on a daily basis. I have spent three months working with the intensivists and feel comfortable managing ICU patients because of this exposure.

The patient population in this unit ranges from cardiac to stroke to septic to those with severe multiorgan failure for a number of reasons. I will try to share a few of these patients with you to give you an idea of what I have seen. Over the course of three years, I have seen necrotizing fasciitis, with both positive and negative outcomes. Cerebral hemorrhage patients who needed evacuation surgery. Vasculitis patients so critically ill they needed heavy doses of steroids, intubation and dialysis. There are also plenty of cardiac patients who go to surgery and return to the unit for post op care. Patients in DKA who need our constant help during the first 24 hours.

In the ICU, it is a place where advanced medical treatment is given to patients in order to improve their lives, but it can also be a place where a patient does not respond to treatment and then the focus is on the surviving family. Unlike other units or the general medical floor, these patients and their families look to the staff and physicians working in the ICU to perform to the best of their ability. And, in some ways, go beyond. The staff, nurses, clergy, therapists, and physicians all play an important part in caring for the patient and their family members. Keeping the family updated on daily events and sometimes hourly events is key.

As a resident, the amount of work you do is dependent on your personal goals. There is always enough work to do and new things to learn while on rotation. Given my personal goals, I made it my responsibility to manage all the mechanically vented patients within the unit. I also managed every patient admitted to the intensivist’s service. For any patient we were consulted on, either in the unit or general medical floor, I would choose those that I found interesting or that I suspected had a higher risk of deteriorating and being admitted to the unit.

Rounds started at about 8 – 10 am. So, it was important for me to see the 6 – 10 patients I was managing ahead of time. I generally got to the hospital around 4 – 5 am. I would look at the films of the day and note any changes and begin to make my list of changes in care for each patient. I would then begin with the ventilated patients since they often took more of my time. Checking the labs, vent settings, drips and fluids was next. Speaking with the nurses became a welcoming part of rounding because they would often direct me to the areas of treatment that were not working and needed adjustment or that were deficit. They also took this time to get to know me and become comfortable with my abilities and it was an opportunity to gain trust. Looking at the medication list is another important part of the work in the ICU. Thankfully, there is a pharmacist within the unit to help with any needs and to guide you in your treatment options. Making decisions based on the patient’s needs was at the forefront of my mind.

If I were lucky, I would finish my rounds before the formal rounds began. For each ventilated patient, we would begin rounds as a group. The nurse, nursing supervisor, attending, respiratory tech, pharmacy, dietary, myself and a host of students would stand at the entrance of the room and begin our presentations. The attending would listen to each of us and the discussion of treatment options would follow. This interaction was much like a dance, each person careful not to step on the toes of others present. The rest of the rounds occurred on the general medical floor with the attending and myself. Teaching occurred during every step of the way so it was a great way to learn new things regarding treatment options or considerations about what tests to order.

One of my favorite things about being in the unit is the opportunity to perform procedures. Lumbar punctures, central line placements, brochcoscopies, arterial lines, intubations and bedside surgeries are opportunities to get your hands dirty. Being present to do these was always challenging since they occurred without much planning and on an as needed basis. I would spend hours hanging around the unit helping nurses and discussing cases in order to be present for such things. But when they happened, it was great to get involved. Attending the codes and rapid responses were also part of my duties since most of these patients would end up in the unit intubated or on some type of assistance.

My day never really ended while working in the ICU. I had the nurses page me at night with lab results and questions so I could keep informed of what was happening and have a head start for the next day. It is a place where all the action and a great deal of learning has taken place. If you decide to work in the unit, you’ll not be disappointed! Cheers.

Click here for our Resident's Day Archives