Monthly Archives: October 2013

Lessons from the SICU

UTMC


I know, it’s been over a month since I’ve posted. A quick summary, I finished orthopaedic surgery (and it continued to rock all the way to the end), I worked on the critical care team in the SICU for 3 weeks, and am now in Akron, OH doing a general surgery rotation. 

So everyone who knows me can say “oh not again” but I really do LOVE surgery. I love being in the OR and being able to fix someone hands-on. I can say this because for the past 3 weeks I was in the SICU, medically managing critically ill surgical patients.

What I learned in the SICU…


1.      Appreciate every single day of your life. We had young patients, we had older patients, but when the end of your life nears you aren’t going to care about anything other than whether you were happy and whether you made a difference. So make time for friends and family and for doing what you love.

2.       Make SURE you have end-of-life advance directives and you share those with your family. We had several cases of those wishes not being clear and it not only causes unnecessary prolongation of life for the patient, but gives the family a lot of hard decisions.

3.       I learned how to let people go. This may sound macabre, but there comes a point when a person isn’t going to return, when their pain and suffering is so great or their body has just shut down. While on SICU we had a few patients die – and you take each one personally for a while. But I also learned how to use that to push me to become a better doctor.

SICU
4.       How to see the big picture. It’s easy nowadays in medicine with how specialized it is to get bogged down by the details of what you’re best at. For example, for most of our patients we had to consult nephrology, cardiology, and neurology. Each of them make recommendations based on the problem they see. But at the end of the day someone has to be able to integrate all of the recommendations and do what is best for the patient. It’s not just about one thing – it’s about everything.

5.       And finally, I learned the most important thing is to be yourself. The patient’s (especially in the ICU where there are limited visitor hours) need someone who will just say hi. The residents and attendings have a lot to worry about and do for each patient. You definitely can help, but don’t try to be someone you’re not. I knew I was really good at doing TPN orders – so I did those every day. The fourth years took care of putting the orders in. It’s about knowing your strengths and being part of the team.
   
    I also learned from an attending that I need to tie 1000 knots daily to be a great surgery. I’m actually trying to tie that many! I can now do about 100 two handed square knot ties in a few minutes without even looking. It’s great! 

I’m still trying my hardest to make it to train at least once or twice a week. Some weeks when I’m working 80 (or more) hours, it’s tough. But my Ribeiro family always welcomes me back to train with seriously tough matches, making me better even though I can’t be there often.

An update soon on life in Akron!