Blog | Wednesday, August 22, 2012

The surgical intensive care unit [SICU]

I open the heavy, wooden door to the unit. On my left are the patient rooms, equipped with minimal privacy; to my right are members of the healthcare team shuffling around. I continue toward my destination, a small room containing a couple desks and computers dedicated to mid-level providers, but cannot help but notice how eerie the unit is. Although there are at least fifty individuals within this space, it is relatively quiet, aside from the occasional blips emitting from the numerous machines all the patients seem to be hooked up to.

As I peer into a patient's room, I notice infusion pumps, a ventilator and an endless expanse of tubing coming from all directions. A monitor displays various waveforms floats at the head of the bed. The bedding has a wallpaper-quality pattern on it that feels oddly comforting, despite the patient's weak body sprawled upon it.

I watch the patient's chest rise and fall in a rhythmic, forceful manner. There is a line straight down the center where the surgeon gained access to the heart. A wave of awe washes over me as I think back to the open-heart surgery I witnessed earlier that morning, it never ceases to amaze me how we can stop the heart completely and miraculously bring it back to full function.

Turning my attention to the bustling healthcare team, I see a group of nurses, physician assistants and physicians discussing patient care. ... should this drip be stopped? ... my patient is in a-fib, what's our next course of action? ... I think this patient is ready to be transferred up to the floor. Every workstation monitor is filled with the EMR [electronic medical record] software, with its plethora of tabs, buttons and drop down menus.

I walk into my target room and start to read up on the patients we will be rounding on. CABGs [coronary artery bypass grafts], AVRs [aortic valve replacements], MVRs [mitral valve replacements] ... these open-heart surgeries have become a part of my knowledge. Although there are non-cardiac patients within the unit, they are outnumbered.

Rounds begin when the cardiac surgeon appears; most of the time it's at 9 a.m., but it can vary. He reminds me of the "stereotypical-surgical-type", confident and assertive. But over the course of my time in the SICU, I grow to appreciate his personality. Most importantly, the teaching is top-notch.

We assemble our team outside of the first patient's room. One of the physician assistants presents the case and paints a numerical picture of the patient's status [vitals, ABG, electrolytes]. The surgeon probes for more information, ... why was this patient extubated? ...what can we do about these pulmonary pressures?, until he is satisfied. Then, the group walks in.

"How are you feeling today?"

"Much better. When am I leaving this place? I want to take a shower!" We chuckle and assure the patient that a shower lies within the immediate future.

Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich. She has a Bachelor of Science in Engineering [Biomedical Engineering] and Master of Science in Engineering [Biomedical Engineering, again] from the University of Michigan. This post originally appeared at her blog, "And Thus, It Begins," which chronicles her journey through medical training from day 1 of medical school.