I'll See You at the SICU

Ha ha ha. Oh me.

After four weeks in the surgical intensive care unit (SICU) I can honestly say I have learned one thing -- well two if you count the standard post-operative care for a middle aged man after a coronary artery bypass graft. I have learned that I would have made a terrible anesthesiologist. What was I thinking? Mesmerized by the glamor and allure? Hypnotized by a well put together and adequately managed clinical elective? I would have hated my life. I would have been filthy stinking rich, but, dang, anesthesiology is not my cup of tea. In as much as anesthesia is a cup of tea anyway. Fourth year has also made me very confident that I dislike surgery and radiology as well, and in that sense fourth year has served me well, but those are boring topics for another boring post. In summary, I love infectious disease. Hurray for bacteria and their organelle possessing brethren: fungi and parasites. You all delight me.

My deeply felt romantic feelings for such things aside, it turns out there aren't many interesting stories that result from 28 days of recording patient vitals onto sheets of individual sheets of paper every day. Not much that could or should be shared at least. What was interesting, however, had nothing to do with the SICU, but due to the fact that I was working with the anesthesiology team as at the VA the anesthesiology team is also the Code Blue team.

Code Blue for those of you not familiar with the secret world of hospital codes is basically "Code the Patient is Dead or Dying and You Have About Fifteen Minutes to Revive Him Starting from When I Stop Reading this Message." At the VA it seems most Code Blues, or simply "codes" as they're otherwise called, are run by three teams. The anesthesiology team, who arrive whenever they orient themselves and figure out where the patient is exactly, manages the airway with all their scopes and instruments; the internal medicine team, who usually arrive later because they actually have work to be doing in between codes, manages the code itself; and a team of spectators of unknown composition who generally mill around watching the two or three first responders work before the other two teams arrive. I'm not sure if this last team is composed of nurses or techs or just office workers, but considering we never know where anything is when we arrive and amongst our scrambling and calling for things one of them usually steps in from their gawking to to hand it to us a few seconds later I think it's safe to say they are at least from the area. All the teams aside, though, the general steps of a code are:

1) Find the patient.
2) Make sure the patient is in fact not breathing and pulseless
3) Control the airway, provide rescue breaths, and start chest compressions
4) Inject things
5) Shock 'em!
6) Repeat steps 2 - 5 a few times until someone eventually says enough is enough

How this all actually forms a story is when I step in one day -- or happen to be in the way as the case may be -- and shock the patient with the defibrillator pads. Although I needed a quick instruction on how to use them, I at least remembered to make sure everyone was clear from the body before zapping the guy -- unlike another student who almost got some collateral zapping. For those of you whose entire visual library of a code comes from ER or Gray's Anatomy the patients tend not to jump up that much or really much at all. Mostly just jiggle a bit. What they do tend to do, however, is smell like burnt people. The electricity running from the defibrillators into the body jumps the heart but also burns a little but of subcutaneous fat as well. It's interesting to say the least. And, although the patient died in my case in spite of our efforts, when patients do come back from the brink in real life they're usually pretty friggin' miserable if even responsive at all. Definitely no heart felt thanks or dramatic moments. Oh wells, someday I'll have a code like they do in the movies. And then a helicopter will land on me. What the hell.