Confessions of an intern in the ICU

As this month in ICU draws to a close, I've had a little time to reflect on my experiences. One of the challenges of ICU care, so I've noticed, is the tendency to objectify my patients. Too often, I know them simply as beings on the ventilator with whom I've never had personal contact. Despite the "intimacy" of medical care--attending to every aspect of my patients' physiology--there is no relational intimacy or physican-patient trust. For these reasons, this month I've sensed a pronounced disconnect between being a medical care provider and being a phsyician. I've done far too much of the former (and not very well), and precious little of the latter. And the strange thing is, I'm the one who misses it!

I wonder how my attendings handle doing this for years and years. Part of me assumes that this is something they never wrestle with. Does it simply take a hardened, thick-skinned person to do well in the ICU?

Inadequacy has also been a feeling I've experienced quite a bit of. Every patient has family members who are deeply concerned...when I'm struggling just to get the work done and merely understand the complexities of critical care, I dread questions from family members. Especially if I haven't seen the patient for a day or two (as a result of the "divide and conquer" mentality to rounding), I feel like a deer in the headlights when I'm asked, "How's my father doing?" "Um, let's see, was he the one on the vent with the renal failiure and the fungemia, or is he the one on the vent with pneumonia and post-op heart valve replacement? Maybe I should check with the nurse and get back to you," is what goes through my head.

And the fact that every patient is really sick, every patient has family who needs supported makes me feel stretched thin, or worse, uncompassionate. And so even though I'm drawn to critical care as a possible subspecialty after anesthesia, these are some of my concerns about entering the field. The eternal optimist in the back of my head reminds me that the more competent I become managing ventilators and the more comfortable I feel balancing 10 medical issues at once, the easier it will be to be to step out of the role of medical provider and be the physician I desire to be.