I run the PEA arrest code with a team I've worked with countless times before, everyone efficiently doing their part.
After 4 cycles of CPR, finally, a shock-able rhythm.
48 hours of drips, arrhythmias, shock, complications, desperation, tears, and hope.
Slowly, the young mother starts to respond to her husband keeping vigil at her bedside.
Extubated and with normal vital signs, she transfers out of the ICU on day 5 – only to be replaced 30 minutes later with “56 yo M with cardiogenic shock”.
And the cycle begins again.
I am smack in the middle of the last month of ICU I may ever do in my life. I've worked with fantastic new interns this month, and have truly enjoyed welcoming them and encouraging their curiosity, enthusiasm, and hope. I see a lot of myself in all of them, particularly one as she is pumping for her 6 month old much like I did at the beginning of my intern year.
The new schedule, reflecting the new ACGME work hours, seems to be treating them well and they overall are well-rested and remaining compassionate and enthusiastic despite some brutally busy days.
Meanwhile, back at the ranch, Honey and I have been doing a lot of talking and prioritizing of late as we've entered the final stretch of my training. We've been talking about what we want our lives to look like over the next few/many years, and how to structure my future job to give us what we are looking for. Here’s the short list:
- Time with family, including a day off during the week
- Giving Honey time to follow his path to career happiness
- Finding a job with a consistent schedule
- Finding great people to work with in a supportive and efficient setting
Yup, planning on working less than “full” time – hopefully about .8 time or so.
You may be thinking to yourself that the job qualities I have described above do not fit with that of an intensivist or even a hospitalist…
We recently were asked to write about the most rewarding times as a physician we have had during residency. My writing wasn't about the resuscitations in the ICU, the great saves or even the near misses at death’s door. Nor did I write about the rewarding times spent supporting family members through difficult decision making in the ICU.
I wrote about a clinic patient. And as I wrote about her, I thought about a handful of other clinic patients who touched me in a way an ICU patient never could.
This patient in particular has helped shape me into the doctor I am today and the doctor I’ll be tomorrow. She has shared her journey with me over the last 2 years from diagnosis through treatment and now into the final stage of life. She has entrusted her care to me and we share a close relationship that has many of the qualities of a friendship.
In the end, I need the relationships. I love the relationships. Turns out I may be an outpatient doctor after all.