Sunday, April 25, 2010


Everything is going to plan and fourth year is grinding along, managing to pass with painful slowness and terrifying speed all at the same time.

I have been on my ICU rotation for a couple of weeks. It is an interesting but difficult rotation. I have always been fine working in ICU as a radiographer. You do a mobile x-ray round, come up a few times during the day and that is it.

However, as a medical student I don't entirely feel comfortable and it has taken me a little while to work out the reason for this. As a person I like to talk to the patients I work with, communicate well with them and hear what they have to say.

A lot of the time in ICU, unless you are in extreme amounts of pain or having great difficulty, the doctor doesn't want to have an in-depth conversation with you because they are too busy and focusing on the machines around you and your body to actually have a chat about the mundane things that you probably focus on just to get by.

Many of the patients have taken neurological damage and they keep asking for the same things again and again, and so the nursing staff don't communicate with them very well, either - particularly the difficult patients.

I'm not saying that they should. If they sat and listened to everything the patient was asking for, nothing would get done and the patient would suffer. I just find it to be a shift in viewpoint to not be listening, and I'm not comfortable with it.

Some of the patients are very difficult to deal with. There are patients with pre-existing personality or mental health issues who are going through a hell of a lot of pain and fear, and regularly act aggressive and abusive to the nursing and medical staff. There are patients who have suffered brain damage and have difficulty communicating, and spend a lot of the day being inappropriate or asking for things that they can't have, or even things that the nurse is in the middle of giving them.

Medically it is fascinating, if a bit scary. I'm learning quite a bit about the extremes of illness.

There are also a lot of family meetings, which must be very difficult for everybody involved.

Mostly I'm tired of this year, of being a student and of not being able to settle and get to be good (or at least competent) at something before having to move on again. Almost there.


Milk and Two Sugars said...

In the last year of uni you seem to put your life on hold. It does suck a bit. Hope you can enjoy it for what it is and look forward to next year :)

As to ICU, I don't like it much either. Now you've made me realise why.

Miss Purple Stethoscope said...

Almost there! No too long to go now :-D

Sara said...

Your ICU patients are awake?

The Girl said...

Sara, in this hospital some of them are. The ones that have tracheostomies inserted because they are having difficult respiratory weans and keep crashing when they are extubated and are going to be ventilated for quite a while. They are often awake, and can be sat out of bed for a while, except they can't breathe for themselves entirely independently yet.

Also, the ICU pod I was in was a bit like a HDU, and patients who were too ill to be on the wards and might need to be re-intubated or resuscitation were there, too, as in the ICU they have one-on-one nursing and ICU doctors readily available. On the wards, the nurses are far more scarce.