The Code Blue

"Everything was fine until few hours after,
 patient bled inside her head."

I ended up my rotation in the ICU with a Code Blue--a patient arrested.

The night prior, patient A succumbed into a cerebral infarct. As what doctors usually do, they provide antithrombolytics and all. Patient stabilized for a while. Vitals were normal. There were no signs of respiratory distress. Everything was fine until few hours after, patient bled inside her head. From this point forward, everything went in a down slope pattern.

Patient was ordered a stat craniotomy to drain the hemorrhage. In total, patient was under the knife for about 5 hours.

There was a call from the OR that patient A is desaturating and that she'd be transferred to the ICU for stabilization. Patient was brought to the ICU by the surgical team. At first, i thought everything was okay until one of them shouted: "We're on code blue"

"Patient went asystole for 6 minutes"

That was the first time that i'd really felt a patient's soul trying to leap out of its body. Asystole. Everything was being done to her but to no eventful results. Arterial and venous lines were added, blood transfusions were given stat. A central line was placed. Boluses of epinephrine, bicarb, and atropine were given. Cardiac resuscitation was being done simultaneously until a pulse of showed up. Patient went under arrest for over 6 minutes. That, i must say is long. That, according to studies is tantamount to brain damage.

The patient survived; however, stepping back, I would say the life of the patient may have only been prolonged for just days. I hope she lives longer. I hope she can fight-off her illness. I hope that one day, she'd be able to function again. And I hope, that after all these things, I'd never see her again in my entire practice.

Death is just around the corners of the ICU or should I say around us. We can never know when a patient or when we will expire; what we only know is that living is a slow process of meeting our end, inevitable  goal-- death.

The Intensive Care Unit

I'm currently rotating as a junior intern at the ICU. Being a junior intern is no joke. As they say, this year would be the worst year of my medical-student-life and this is just the second week of my rotations. It is difficult, i tell you. Not only does lack of sleep  pushes you to your limits; the agonizing emotional and psychological aspects does, too, contribute to the difficulty of being a junior intern.

Let me tell you what the routine is in the ICU. Everyday (morning and afternoon), we do rounds on all our patients. We have at least 15-20 patients a day. The team of doctors includes two consultants, three fellows, 5-6 residents (neuro, cardio, infectious, et. al.), 1 senior and 4 junior interns. The team discusses the cases one by one- from one room to another. It is like doing window shopping; however, a lot more intimate and requires more of intelligence. We discuss the cases in front of the patient; however, they can'thear us because the person of interest  is separated by the glass panel from us (and yes, i think they are sound protected). Here, we try to predict the future of the patient- will he live or die. Questions are always raised by the consultant. Usually, all these questions are addressed to the junior interns. Which makes the lives of junior interns toxic.

The junior interns are what they call the lowest breed of doctors and as of now, i am part of this. We are the ones who usually get challenged and ridiculed. We are the ones who, literally, do not have anything to offer. We are the "slaves" of the team. This may sound devastating and saddening; however, this has been how the system has been going since time immemorial. I myself, have already been humiliated in front of the team. But oh well. Our curriculum tries to defy this; however, it can only do as much, as of now.

I call their ICU team as the Team of Extraordinary Brain Cells. For heaven's sake, the team consists of intelligent, highly reasonable, objective, and very competent doctors. They can throw multitudes of differential diagnoses and can defend such in just few seconds. I am amazed how these doctors were trained. I was owe-struck on my first day of rotation on how they are able to memorize all lab values of their patients down to the last decimal. Believe me, they are really that good. Here i saw the pseudogods they are telling. Downside, what I personally think is, they purposely detached themselves from the souls of their patients.

Tomorrow would be the last day of my rotation there. I'm not sure if i'm gonna miss the team, the pride, the angst, or not. I'm not sure if i'd like to go back there. I really don't. I'm happy about the rotation; however, i think, i was caught in between intimidation and self-preservation.