I finished my month in the ICU. And, believe it or not, I really, really liked it. I know, I know. My last blog post I said how much I hated the ICU and how I would never want to specialize in Critical Care. I think maybe I was a little delirious with my illness. I actually lost my voice for about a week. Not only did I hate the ICU, but I pretty much hated everything until I finally started feeling better.
And now that I’m doing Family Medicine, I find myself really missing the ICU. And in the past few weeks I’ve been thinking a lot about Pulmonary Critical Care as a potential specialty. It’s way, way too early to even think about Fellowships and specializing. I still know I want to do Internal Medicine, so I have plenty of time to decide about specialties. But here is what I really loved about the ICU.
The ICU is basically Internal Medicine on steroids. All of the physicians I encountered were so, so smart. They knew a ton of pathophysiology – which was necessary because each of the patients we encountered was so complex. I love how few patients we had – the ICU I worked in had only 11 beds. It meant we could spend all day thinking about patients and what is going on with them.
I saw some of the most interesting cases! I had a patient who had to have a brain biopsy because we ran every kind of test we could think of and everything was negative. Believe it or not, the brain biopsy had to get sent to special neuropathologists at Mayo in Rochester, and even they couldn’t find anything!! We also had a lot of HIV patients, which is a population I really enjoy working with. Many of them had a lot of infections, including Disseminated Cocci, also known as “Valley Fever” because it is endemic to Arizona. For as much as I love infections, there were plenty of those in the ICU.
Another thing I loved was how important the physical exam is in the ICU. Most of the patients are sedated and intubated so they can’t give a history, so physical exam is really all you have to go by in addition to labs and things. And a lot of the patients have cool exam findings that you don’t get to see every day.
Finally, I really enjoyed managing mechanical ventilation. I have no idea why, but I think it’s really fun. It’s so complex and so interesting when you start doing it.
So where does that leave me? Basically, it leaves me a little confused. I’ve thought for a long time I just wanted to be a Hospitalist, but now I’m really thinking about something more. Like I said before, I have plenty of time to figure it out. I have another ICU rotation coming up next year, and I will have more time during residency in the ICU. Hopefully I will figure out if it suits me or not!